Ch. 13: Special Topics in Speech-Language Pathology

Question 1

Psychodynamic Theory

Answer 1

Approach to counseling that views behavior as the product of conflictual interaction between 3 systems: the id, ego, and superego. Anxiety is created when emotions arising from the conflicts among these three system are repressed. Requires resolution of the five psychosexual stages to achieve proper development. Purpose is to make clients conscious of repressed problems and help them to resolve these problems so that the personality can be healthy and whole. (Freud)

Question 2

Client-Centered Theory/Person-Centered Theory

Answer 2

Approach to counseling that states that clients need acceptance and positive unconditional regard in order to develop congruence between their self-concept and their behavior. Foundation of therapy is an empathetic relationship between client and therapist that allows the client to freely experience and express all of his or her emotions in a completely accepting climate. (Rogers)

Question 3

Behavioral Therapy

Answer 3

Approach to counseling that focuses one what is observable, with an emphasis on environmental and external influences. All behavior is caused by current environmental stimuli (including states of motivation), past learning, and the genetic/neurophysiological variables. Behavior is shaped and maintained by immediate response. Reinforcement must be given immediately after a particular behavior has occurred. Positive reinforcement increases the chance that a behavior will reoccur. Negative reinforcement can also cause a behavior to reoccur. Behaviors that occur in the absence of reinforcement will be extinguished. Focuses specifically on areas that affect the client’s communication abilities. Permits the creation of specific goals whose attainment can be objectively measured with data. Allows clinicians to measure the success of the counseling relationship. Allows for documentation of behavioral outcomes.

Question 4

Cognitive-Behavioral Theory

Answer 4

Approach to counseling that suggests that the client’s thoughts are key to his or her feelings and actions. They key variable is the meaning a person attributes to an event. The clinician helps the client focus on the problem, specifically identify the distorted thoughts or cognitions accompanying the problem, and replace them with newer, more rational thoughts that lead to behavior change. Change the client’s thinking → Change the belief system → Change the behavior.

Question 5

Personalization

Answer 5

The inappropriate assumption of responsibility for an event that the client did not cause.

Question 6

Rationalization

Answer 6

In this form of resistance, the client provides a logical but untrue explanation of why something has occurred. E.g., a client who stutters may explain away his lack of a social life by saying, “No one will talk to me because I stutter.”

Question 7

Reaction Formation

Answer 7

Clients who experience this have thoughts or emotions that are shocking and unacceptable to them. Thus, they react with opposite emotions. E.g., the husband of an elderly Alzheimer’s patient secretly wishes his wife would die. In this form of resistance, he sacrifices all his own needs and wants to care for his wife, telling the clinician he loves his wife dearly and could not live without her.

Question 8

Displacement

Answer 8

The client takes his or her feelings of hostility or anger about a situation and transfers them to a safe object or person. E.g., parents becoming angry with you for writing a (correct) diagnosis on a diagnostic report.

Question 9

Projection

Answer 9

Clients attribute their own emotions, thoughts, or actions to someone else. E.g., mother says that school administrators never communicate with one another. School administrators said that the mother never communicated with them.

Question 10

Repression

Answer 10

Clients keep their thoughts and feelings under very strict control, out of view of others. Clients themselves are not aware of these thoughts and feelings, which are below the conscious level.

Question 11

Suppression

Answer 11

Clients keep their feelings and thoughts highly controlled, but they are consciously aware of those feelings. This form of resistance is the norm in some cultures. It should be viewed as a difference, not a defense mechanism, in those situations.

Question 12

Tomography/

Laminography

Answer 12

A computerized radiographic method of take pictures of different planes of body structures. Used to scan brain structures and is frequently used as a neurodiagnostic method for people with communication disorders such as aphasia secondary to stroke.

Question 13

Computerized Axial Tomography (CAT) Scan

Answer 13

X-ray beams circle through segments of the brain and pass through tissue. A camera takes pictures of sections of the structure being scanned. The scanner detects density differences, and a computer analyzes the images generated by the scanning machine and produces pictures of the scanned structures. Can detect hemorrhages, lesions, tumors, and other pathologies. Often used in the diagnosis of neuropathology associated with strokes.

Question 14

Electroencephalography (EEG)

Answer 14

Neurodiagnostic method that records and measures electrical impulses of the brain through small surface electrodes attached to the scalp. Can show different kinds of brain waves associated with different kinds of activity (e.g., talking, listening, thinking). Indicates cerebral pathology by abnormal electrical activity and is often used to detect seizures.

Question 15

Magnetic Resonance Imaging (MRI)

Answer 15

Neurodiagnostic imaging technique where the patient lies completely still in a cylinder container. Used to show fine detail in brain and spinal cord structure. Can also be used to provide images of the soft tissues, large blood vessels, and heart. Based on alignment and realignment of nuclei of atoms in the cell when a structure is placed in a strong magnetic field. Variations introduced in the amount of magnetic radiation will cause alignment and realignment. Such changes produce electromagnetic signals, which a computer analyzes to produce images of the structure. Sometimes detects lesions missed by CT scans. Expensive. Patients may have difficulty tolerating it.

Question 16

Positron Emission Tomography (PET)

Answer 16

Neuodiagnostic procedure that is a type of emission computed tomography that allows imaging of metabolic activity through measurements of radioactivity in the section of the body being viewed (e.g., the brain). The patient is injected with a radioactive substance that spreads throughout the brain. The amount of radioactivity is then scanned and observed differences in the amount of radioactivity suggest different rates of cerebral metabolism. Lower than normal metabolic rate suggests neuropathology. If the patient is suspected of having cerebral dysfunction secondary to a stroke, for example, these scans can be helpful by evaluating the function of blood flow and brain metabolism (whereas MRI and CAT scans only evaluate structure).

Question 17

Single-Photon Emission Computed Tomography (SPECT)

Answer 17

Neurodiagnostic procedure that evaluates the amount of blood flowing through a structure. Also known as regional cerebral blood flow (rCBF). Spreads throughout the cerebral hemispheres and enters the bloodstream. A scanner detects radiation uptake in cerebral blood, and a computer calculates the amount of blood flow in given regions and displays variations in blood flow with different flow colors. Helpful in diagnosing cerebral lesions associated with various Neuropathologies causing communication disorders.

Question 18

Videofluroscopy

Answer 18

A radiologic method of examining movement of internal structures and recording the movement patterns for assessment and diagnosis. It is useful in assessing the functions of the velopharyngeal mechanism, VF, swallowing, and respiratory movement. X-rays are transmitted through the tissue under observation. The soft tissue is coated with barium with the help of a nasal spray and observers can have multiple views of the structures (e.g., frontal, lateral, base, and oblique views of the velopharyngeal mechanism) and their movements. The images are shown on a phosphorescent screen and recorded on a videotape for later examination and diagnosis. Often used to assess swallowing function in patients with confirmed or suspected dysphagia.

Question 19

Craniofacial Anomalies

Answer 19

Abnormalities of the structures of the head and face. Congenital and typically due to genetic factors.

Question 20

Cleft

Answer 20

An opening in a normally closed structure.

Question 21

Palatal Clefts

Answer 21

Various congenital malformations resulting in an opening in the hard palate, the soft palate, or both. Due to disruptions of the embryonic growth processes resulting in a failure to fuse structures that are normally fused.

Question 22

Microforms

Answer 22

Minimal expressions of clefts, including a hairline indentation of the lip or just a notch on the limb.

Question 23

Submucous Cleft/Occult Cleft Palate

Answer 23

Microform where the surface tissues of the soft or hard palate fuse but the underlying muscle or bone tissue do not. There is a midline deficiency or lack of muscular tissue as well as incorrect positioning of the muscles. Children typically present with hypernasal speech and ear infections. Only detectable by X-ray examination and nasopharyngoscopy. Treatment may consist of surgery, placement of a prosthetic device to compensate for the velopharyngeal incompetence, therapy to reduce hypernasality, or a combination of these.

Question 24

Congenital Palatopharyngeal Incompetence (CPI)

Answer 24

Impaired velopharyngeal closing-valve functioning. Not a form of clefting, but is a disorder. Characterized by significant impairment in velopharyngeal functions as revealed by videofluoroscopy or endoscopy, although the structures appear normal. May be caused by a short palate, an occult submucous cleft palate, reduced muscular mass of the soft palate, a deep or enlarged larynx, incorrect insertion of levator muscles, or a combination of these factors. Patients typically have hyper nasal speech (between mild and severe). Can benefit from speech therapy, surgery, prostheses, or a combination of these.

Question 25

V-Y Retroposition/Veau-Wardill-Kilner Method

Answer 25

Method of surgery performed to repair the cleft of the palate. Single-based flaps of palatal mucoperiosteum are raised on either side of the cleft and brought together and pushed back to close the cleft. This push-back (repositioning of the flaps) lengthens the palate and improves chances of velopharyngeal approximation.

Question 26

Von Langenbeck Method

Answer 26

Surgical method performed to repair the cleft of the palate by raising two bipedicled (attached on both ends) flaps of mucoperiosteum, bringing them together and attaching them to close the cleft. This leaves denuded bone on either side and does not lengthen the palate.

Question 27

Pharyngeal Flap

Answer 27

A secondary palatal surgical procedure in which a muscular flap is cut from the posterior pharyngeal wall, raised, and attached to the velum. The openings on either side of the flap allow for nasal breathing, nasal drainage, and production of nasal speech sounds. The flap helps close the velopharyngeal port and thus reduce hypernasality.

Question 28

Pharyngoplasty

Answer 28

Surgical procedure in which substances such as Teflon, silicone, dacron wool/silicone gel bag, and cartilage may be implanted or injected into the posterior pharyngeal wall to make it bulge and thus help close the velopharyngeal port.

Question 29

Syndrome

Answer 29

A constellation of signs and symptoms that are associated with a morbid process. A genetic syndrome is such a constellation with a known genetic basis.

Question 30

Angelman Syndrome

Answer 30

Occurs when chromosome 15 is duplicated from the father or deleted from the mother. Diagnosed between ages 3 – 7, although developmental delay may be apparent 6 – 12 months of age. Children do not show regression. Symptoms include seizures, a stiff and jerky gait, laughter and a happy demeanor, an easily excitable personality, hypermotoric behavior, hand-flapping behaviors, and a short attention span. Though most children have few or no words, nonverbal communication and verbal receptive skills are higher than verbal expressive skills.

Question 31

Apert Syndrome

Answer 31

Rare. Physical characteristics include syndactyly (digital fusion), craniosyntosis resulting in smaller anterior-posterior skull diameter, flat frontal and occipital bones and high forehead, increased intracranial pressure and compensatory growth in cranial structures, midfacial hypoplasia (underdevelopment), an arched and grooved hard palate, conductive hearing loss in some, class III malocclusion, irregularly placed teeth, thickened alveolar process, long or thickened soft palate, and cleft of the hard palate in 25 – 30% of cases. Communication problems include a tendency toward hyponasality, forward carriage of the tongue, and articulation disorders involving mostly alveolar consonants and labiodental sounds. Some persons have normal intelligence, while others exhibit mild to moderate intellectual disability.

Question 32

Cri du Chat Syndrome

Answer 32

Caused by an absence of the short arm of the fifth chromosome. Physical characteristics include a high-pitched cry of long duration (resembling that of a cat), low-set ears, narrow oral cavity, laryngeal hypoplasia, microcephaly, hypertelorism, micrognathia, and oral clefts. Communication problems include articulation and language disorders typically associated with intellectual disability.

Question 33

Crouzon Syndrome

Answer 33

Caused by autosomal dominant inheritance, with varied expression in individuals. Physical characteristics include craniosyntosis (fusion of the cranial suture, especially that of the coronal) and hypoplasia of the midface, maxilla, or both, small maxillary structure, sphenoethmoidal synchrodoses, ocular hypertelorism (eyes that are far apart), protrusion of the eyeballs, strabismus, a parrotlike nose, facial asymmetry, tall forehead, malocclusion class III in some cases, a highly arched palate, shallow oropharynx, a long and thick soft palate, and brachycephaly (short head). Communication problems include conductive HL in some, articulation disorders associated with HL and abnormalities of palatal oal cavity structures, hyponasality, and language disorders.

Question 34

Craniosyntosis

Answer 34

Fusion of the cranial suture, especially that of the coronal.

Question 35

Hypertelorism

Answer 35

Eyes that are far apart.

Question 36

Brachycephaly

Answer 36

Short head.

Question 37

Down Syndrome

Answer 37

Caused by an extra whole chromosome 21, resulting in 47 instead of 46 chromosomes. Physical characteristics include generalized hypotonia, a flat facial profile, small ears, nose, and chin, and brachycephaly, midface dysplasia, shortened oral and pharyngeal structures, a narrow and high arched palate, a relatively large and fissured tongue that tends to protrude, a short neck with excess skin on the back of it, hyperflexible joints, cardiac malformations in 40%, and short fingers. Communication problems include conductive loss in many cases and sensorineural loss in some. There may be language delays and disorders, especially deficient syntactic and morphologic features, accompanied by relatively better vocabulary skills. Hypernasality and nasal emission breathier voice, and articulation disorders may also be present.

Question 38

Fragile X Syndrome

Answer 38

Leading inherited cause of intellectual disability in males. Caused by an expanded number of CCG nucleic acid repeating on a specific gene on one of the distal ends of the X chromosome. Physical characteristics include a large, long, and poorly formed pinna, a big jaw, enlarged testes, and a high forehead. Intellectual disability is mild-moderate, becoming more severe in adulthood. Communication problems include jargon, perseveration, echolalia, inappropriate language or talking to oneself, lack of gestures and other nonverbal means of communication that normally accompany speech, voice problems, and articulation disorders. May avoid eye contact, withdraw socially, have limited attention spans, be hyperactive, and have autistic-like social deficiencies. Early intervention is crucial. Typically delayed in all areas of language.

Question 39

Hurler’s Syndrome

Answer 39

A rare, congenital metabolic disease caused by autosomal recessive deficiency of X-L iduronidase. Typically die in teens or even before age 10. Physical characteristics include dwarfism, hunchback, intellectual disability, short and thick bones, a “gargoyle-like” face, SN deafness, and noisy respiration. There is vocal fatigue and hoarseness because of the deposition of metabolites in the larynx. Also have protuberant abdomen, angina pectoris, frequent chest infections, decreased joint mobility, and thickening of the coronary arteries. Hands may be short, wide, and thick. Thick, everted lips, a large tongue, and small, malformed teeth. Compromised intelligibility.

Question 40

Landau-Kleffner Syndrome

Answer 40

Cause is unknown. Form of aphasia whereby formerly healthy children between ages 3 – 7 years lose their ability to comprehend language and then to speak it. This change can occur suddenly or gradually. Some children are left with severe, permanent language disorders. Others regain many of their language abilities over a span of months or years. For some, relapses and remissions occur. Abnormal brainwave patterns have been detected through EEG. 70% develop epilepsy.

Question 41

Moebuis Syndrome

Answer 41

Causation includes agenesis or aplasia of the motor nuclei of the cranial nerves. There is sporadic, unpredictable occurrence in most cases and autosomal dominant inheritance in some cases. Physical characteristics include involvement of facial and hypoglossal nerves in most cases and of the trigeminal nerve in some places. Bilabial paresis and weak tongue control for lateralization, elevation, depression, and protrusion, unilateral an bilateral paralysis of the abductors of the eye, limited strength, range, and speed of movement of articulators, feeding problems in infancy, and a masklike face. Communication problems include conductive HL in few cases and language delay in some. May also be articulation disorders.

Question 42

Pierre-Robin Syndrome

Answer 42

Caused by autosomal recessive inheritance in most cases. May be part of Stickler syndrome. Physical characteristics include mandibular hypoplasia, cleft of the soft palate, velopharyngeal incompetence, a deformed pinna, low-set ears, and temporal bone and ossicular chain deformities. Born with glossoptosis, affecting breathing and feeding. Difficulty coordinating breathe-suck-swallow. NG and G tubes are common. Communication problems include unilateral or bilateral conductive HL associated with otitis media and cleft palate, delayed language, language disorders, hypernasality and nasal emission, articulation disorders, and hypercompensatory articulation.

Question 43

Glossoptosis

Answer 43

A condition where the tongue is positioned posteriorly and often causes blockage of the airway and pharynx.

Question 44

Prader-Willi Syndrome

Answer 44

Autosomal inheritance. Physical characteristics include low muscle tone, early feeding difficulties, failure to thrive initially, obesity after the first year excessive eating, and underdeveloped genitals. Imprecise articulation, oral-motor difficulties that contribute to poor articulation, hypernasality. Flat intonation patterns, slow speaking rate, harsh or hoarse vocal quality, abnormal vocal pitch. Typically have developmental delays and intellectual disability. Impaired expressive (moreso) and receptive language skills. Continuum of abilities. Characteristics that contribute to speech and language problems include hypotonia, altered growth of larynx, micrognathia, narrow palatal arch, tooth decay, sequencing problems, stubbornness, temper tantrums, emotional lability, compulsive behavior, argumentativeness, poor social relationships, and difficulty detecting social cues. Growth hormones and surgical treatments (to reduce hypernasality) are common treatments.

Question 45

Russell-Silver Syndrome

Answer 45

Suspected to be caused by genetic factors. Babies have low birthweight, small for age, and are considered to have dwarfism. Physical characteristics include asymmetry of the arms and legs, very large head, craniofacial disproportion, mandibular hypoplasia, high and narrow malate, and microdontia. Communication problems often include hypernasality, feeding problems in infancy, articulation disorders, expressive and receptive language disorders, and an abnormally high-pitched voice.

Question 46

Tourette Syndrome

Answer 46

A neurological, inherited disorder. Characterized by uncontrollable vocal sounds (tics) and repeated involuntary movements. Symptoms appear before age 18. May utter unacceptable sounds, words, or phrases. Commonly, they clear their throats, grunt, sniff, cough, shout, yelp, or bark. Some may demonstrate echolalia and may repeat actions unnecessarily and obsessively.

Question 47

Treacher Collins Syndrome

Answer 47

Caused by autosomal dominant inheritance in most cases and spontaneous mutation in some. Physical characteristics include underdeveloped facial bones, mandibular hypoplasia, malar hypoplasia, dental malocculasion and hypoplasia, downwardly slanted palpebral fissure, coloboma of the lower eyelid, stenosis of the EAC, malformations of the pinna, middle and inner ear malformations, high hard palate, cleft palate in 30%, submucous cleft in some, short immobile soft palate, and sucking and swallowing impairments in infancy. Communication problems include hypernasality and nasal emission in cases with clefts and velopharyngeal incompetence, as well as articulation disorders consistent with hearing loss and oral structural deviations.

Question 48

Trisomy 13

Answer 48

In this disorder, the baby has an extra copy of chromosome 13 and is thus born with 47 instead of 46 chromosomes. Associated with many life-endangering, severe birth defects including congenital heart defects, severe brain anomalies, spina bifida, severe eye defects, cleft lip and palate, polydactyly, midline facial deformities and clefts, and holoprosencephaly. Many babies die before their first birthday. If they live, they have profound intellectual disability and feeding difficulties.

Question 49

Holyprosencephaly

Answer 49

Failure of the brain to divide into two separate hemispheres.

Question 50

Turner Syndrome

Answer 50

Occurs only in females and is caused by a missing or deformed X chromosome. Similar to Noonan syndrome, which occurs is males and females. Physical characteristics include ovarian abnormality, infertility, congenital swelling of the feet, neck, and hands, cardiac defects, webbing of the neck, low posterior hairline, broad chest, widely spaced nipples, cubitus valgus, pigmented skin lesions, narrow maxilla and palate, micrognathia, low-set elongated cup-shaped ears, thick earlobes, high arched palate, cleft palate in some cases and evidence of right hemisphere dysfunction. Communication problems include SNHL in most cases, middle ear infections, conductive HL in some cases, language and articulation disorders consistent with hearing impairment, visual, spatial, and attentional problems.

Question 51

Micrognathia

Answer 51

Abnormally slow lower jaw.

Question 52

Cubitus Valgus

Answer 52

Elbows bent outward or away from the midline.

Question 53

Usher Syndrome

Answer 53

Caused by autosomal recessive inheritance in most cases and is X-linked in rare cases. May affect 50% of individuals who are deaf and blind. Physical characteristics include night blindness, limited peripheral vision, eventual blindness, and cochlear abnormalities. Communication problems include SNHL, language and articulation disorders consistent with hearing impairment, and hypernasality and nasal emission.

Question 54

Velocardiofacial Syndrome

Answer 54

Syndrome most consistently associated with a cleft palate (usually of the soft palate). Also called Shprintzen syndrome and DiGeorge sequence. Known to be genetic in nature. Over 180 other anomalies are associated and not all children have the same anomalies. Major anomalies include middle ear infections, learning problems, speech and feeding problems, unique facial characteristics, cleft palate, velopharyngeal insufficiency, wide nose, small ears, almond-shaped eyes, micrognathia, microcephaly, and an elongated face. Feeding problems and failure to thrive are common, associated with pharyngeal hypotonia, oral apraxia, laryngeal and vascular anomalies, and nasal regurgitation. May have significant language difficulties and articulation disorders. Intelligence is generally in the low-normal range.

Question 55

Williams Syndrome

Answer 55

Rare genetic disorder caused by an abnormality on chromosome 7. Many people have IQs between 50 and 70. Some can show high intelligence in areas of music, language, and interpersonal skills. Often have charming personalities. Many medical and developmental problems.

Question 56

NDS

Answer 56

Neonatal development specialist. Advanced practice role of an SLP.

Question 57

Role of an NDS

Answer 57

1) Feeding and oral-motor development
2) Hearing conservation and aural habilitation
3) Infant development and behavior
4) Caregiver-child communication