Chapter Q&As Flashcards
Chapter 1: Anatomy, Neuroanatomy, and Physiology of the Speech Mechanism//Neuroanatomy and Neurophysiology: The Nervous System
Chapter 1
Respiration relies on the muscles of inspiration and expiration. The thick, dome-shaped muscle that separates the abdomen from the thorax is called the:
Diaphragm
Most pharyngeal muscles are innervated by cranial nerves:
X, XI
The neurons that transmit information away from the brain are called:
Efferent neurons
*An important structure adjacent to the brainstem that contains the hypothalamus (which controls emotions) and the thalamus (which relays sensory impulses to various portions of the cerebral cortex) is called the:
Diencephalon
The corpus striatum is composed of three nuclear masses, which are the:
Globus pallidus, caudate nucleus, and putamen
The structure that regulates body posture, equilibrium, and coordinated fine motor movements is the:
Cerebellum
*The anterior cerebral artery supplies blood to the:
Corpus collosum and basal ganglia
The laryngopharynx and the oropharynx add resonance to sounds produced by the larynx. The nasopharynx adds noticeable resonance to which sounds?
m, n, ng
These are composed of a ring of connective tissue and muscle extending from the tips of the arytenoid cartilages to the larynx. They separate the laryngeal vestibule from the pharynx and help preserve the airway.
Aryepiglottic folds
The cranial nerve that innervates the larynx and also innervates the levator veli palatini, palatoglossus, and palatopharyngeus muscles is:
CN X, the vagus nerve
(with XI)
Note: tensor veli palatini (V)
*Muscles that contribute to velopharyngeal closure through tensing or elevating the velum are the:
Palatoglossus, tensor veli palatini, and levator veli palatini
LVP is primary elevator of velum; TVP tenses velum; Palatoglossus evelates and depresses velum; Palatopharyngeus narrows pharyngeal cavity, lowers velum, may assist in elevating larynx
The structure at the inferior portion of the tongue that connects the tongue with the mandible is called the:
Lingual frenum
*When a person is producing voiced and voiceless /th/, the muscle that is most involved is the:
Genioglossus
Protrusion=genioglossus; Retrusion=hyoglossus, styloglossus, genioglossus; Depression=genioglossus, hyoglossus; Elevation=styloglossus; Shortening=longitudinal intrinsic fibers; Narrowing=transverse intrinsic fibers; Flattening=vertical intrinsic fibers
Note: Extrinsics= genioglossus, styloglossus, hyoglossus, palatoglossus; Intrinsics= superior and inferior longitudinal, transverse, vertical
*Which muscles from the list below are the most involved in adducting the vocal folds?
Lateral cricoarytenoid and transverse arytenoid
TA vibrates and produces sound; oblique arytenoid pulls apex of arytenoid medially; CT lengthens and tenses VFs; PCA abducts VFs
The cerebral hemispheres are connected by:
Commissural fibers
The central nervous system’s primary mechanism of attention, alertness, and consciousness, which is also related to sleep-wake cycles, is the:
Reticular activating system
The primary motor cortex in the frontal lobe is located on the:
Precentral gyrus
Which of the following is FALSE?
A. Wernicke’s area in the temporal lobe is critical to the comprehension of spoken language
B. Wernicke’s area is connected to Broca’s area in the frontal lobe through the arcuate fasciculus
C. The occipital lobe contains the primary visual cortex
D. The angular gyrus in the occipital lobe is important for interpretation of somesthetic sensations such as pain, touch, and temperature
E. The pyramidal system consists of the corticospinal and corticobulbar tracts
Answer: D
The angular gyrus is in the parietal lobe
Which of the following is TRUE?
A. The cerebral ventricles are interconnected cavities filled with fluid produced by the dura mater
B. The meninges of the brain consist of the dura mater, pia mater, and arachnoid
C. The basilar artery eventually divides into four posterior cerebral arteries
D. The external carotid artery is the major supplier of blood to the brain
E. The circle of Willis prevents a common blood supply to various cerebral branches
Answer: B
Cerebral ventricles are interconnected cavities filled with CSF produced by the choroid plexus; Basilar artery divides into two posterior cerebral arteries; The internal carotid artery is the major supplier of blood to the brain; Circle of Willis provides a common blood supply to various cerebral branches
Chapter 2: Physiological and Acoustic Phonetics: A Speech Science Foundation
Chapter 2
The term coarticulation refers to:
The influence of one phoneme upon another in production and perception wherein two different articulators move simultaneously to produce two different speech sounds
Broad phonemic transcription involves:
The use of IPA symbols to transcribe phonemes by enclosing them within slash marks (e.g., /f/)
The two properties of a medium that affect sound transmission are:
Mass and elasticity
A sinusoidal wave is a sound wave:
With horizontal and vertical symmetry, with one peak and one valley, with a single frequency, that is the result of simple harmonic motion
A natural frequency is a frequency:
With which a source of sound vibrates naturally and is affected by the mass and stiffness of the vibrating body
An octave is:
An indication of the interval between two frequencies
The back-and-forth movement of air molecules because of a vibrating object is referred to as:
Oscillation
The lowest frequency of a periodic wave is also known as:
The fundamental frequency or first harmonic
When two or more sounds of differing frequencies are added, the result is:
Complex tone; the vibrations that make up this complex tone may be said to be periodic or aperiodic
*When a speaker is producing a vowel and the vowel is being acoustically analyzed, one can state as a general rule that:
F1 varies mostly as a result of tongue height, and F2 varies mostly as a result of tongue advancement (variation in the anterior-to-posterior position of the tongue in the oral cavity)
In a periodic complex sound, tones that occur over the fundamental frequency and can be characterized as whole number multiples of the fundamental frequency are called:
Harmonics
Chapter 3: Language Development in Children
Chapter 3
Who explained language acquisition as the development of verbal behavior?
Skinner (1957)
Behavioral theory: learning, environmental contingencies
Who proposed that children are born with a language acquisition device (LAD) that contains universal rules of language?
Chomsky (1957)
Nativist theory: deep and surface structures, language competence vs performance, “Minimalist Program”
Proponents of which theory state that cognition and intellectual processes make language acquisition possible?
Cognitive theory
Piaget (1954): strong cognition hypothesis states that children pass through 4 overlapping developmental cognitive stages (sensorimotor, preoperational, concrete operations, and formal operations)
Which theory focuses on HOW language is learned and what types of cognitive functioning are necessary for language learning?
Information-processing theory
Emphasis on auditory processing (phonological and temporal), composed of the components of auditory discrimination, attention, memory, rate, and sequencing;
Which theory was influenced by Vygotsky (1962) and emphasized language function over language structure?
Social interactionism theory
Language develops as a function of social interaction between child and environment; motivation is key
“Hi doggy” is an example of:
Notice (hi + noun)
“That chair” is an example of:
Nomination (demonstrative + noun)
“Knife spoon” is an example of:
Conjunction (noun + noun)
A child using “recurrence” would say:
“More cookie”
An example of a sentence using an embedded form would be:
“The boy who got a haircut looks nice”
Embedded forms rearrange or add elements within sentences (e.g., “The man who came to dinner stayed a week”)
Which of the following does not occur between 8 and 10 months of age in the typically developing child?
Using “all gone” to express emerging negation; this usually emerges between 1 and 2 years of age
Does occur: Comprehension of “no,” Uncovering a hidden toy (beginning of object permanence), Variegated babbling, Use of gestural language (e.g., shaking head no, playing peek-a-boo)
You see that Ashton, a 7 y/o girl, has difficulties in conversational exchanges with peers and they frequently ignore her. You notice that when talking with you, Ashton seems uncomfortable and doesn’t say much, even when you use fun games and toys. In therapy, your first priority with Ashton will be to:
Increase her skills in discourse, or skills in the give-and-take of conversation
“In,” “on,” and “under” are examples of:
Locatives
“Him no eat cookies” is an example of:
4 words, 5 morphemes, personal pronoun + negative + verb + plural noun
Which of the following Piagetian stages, which includes object permanence, corresponds with the emergence of a typically developing child’s first word?
Sensorimotor
Sensorimotor (0-2), preoperational (2-7), concrete operations (7-11), formal operations (>11)
Halliday (1975) describes 7 communicative functions that develop between 9 and 18 months of age. “Why doggy bark?” is an example of which one of Halliday’s intents?
Heuristic: want environment/events explained
1) Imaginative
2) Heuristic: want environment/events explained
3) Regulatory: control behaviors of others
4) Personal: express feelings/attitudes; self-awareness
5) Informative
6) Instrumental: want assistance or things from others
7) Interactional: initiate interactions with others
Matthew is 3.5 y/o and he consistently uses -ing, in/on, and regular plural -s. Which morphemes would you begin with when Matthew starts therapy?
Irregular past tense verbs
II: -ing, in/on, reg. plural -s,
III: irreg past tense verbs, possessive -s, uncontr copula
IV: articles, -ed, 3PS -s
V: irreg3PS(does has), uncontr aux, contr cop, contr aux
Mandy has difficulties with rhyming words and sounding words out. She also has a hard time remembering 3-4 step directions. Mandy might have difficulties in which of the following?
Phonological processing and temporal auditory processing
Chapter 4: Language Disorders in Children
Chapter 4
Which technique involves describing and commenting on what a child is doing while playing (e.g., “you are making the car go fast” or “that pig is pink”)?
Parallel talk
You are working with an adolescent, Alyssa, who has receptive and expressive language problems. She is getting Ds in most of her classes at the junior high school and has few friends. In therapy, it would be best to target:
Increasing social use of language and collaborating with the classroom teachers
A child who shows slow, writhing, involuntary movements has which type of cerebral palsy?
Athetoid
A child with TBI would most likely manifest:
Impaired word retrieval and comprehension, and lack of attention and memory problems
Which of the following is false in regards to treatment of children with language disorders
Because many children with language disorders have difficulties with auditory processing, clinicians should conduct therapy primarily though the auditory modality
Best to use a multimodal approach!
You find that an 8-year-old child, Allyson, has a TTR of .31. You conclude that:
Allyson is low in her lexical skills, or the number of words she uses expressively
For children 3-8 y/o, the TTR is typically 1:2, or .5
In order to help a child who uses an AAC device communicate more effectively, the SLP needs to make sure that the symbols on the device are:
Transparent (vs opaque)
Because of Justin’s diagnosis of Asperger’s syndrome, you can assume that Justin will probably have characteristics such as:
Seemingly excellent vocabulary, seemingly normal syntactic skills, and speech which often seems to be a “monologue” where Justin does not allow his conversational partner to take turns
*SCERTS approach refers to:
The SCERTS model emphasizes the importance of targeting goals in Social Communication and Emotional Regulation by implementing Transactional Supports, which include visual supports, environmental arrangements, and communication style adjustments
Chapter 5: Articulatory-Phonological Development and Speech Sound Disorders
Chapter 5
Which speech sound disorder treatment approach is best for children with several discrete sounds in error (e.g., /s/, /r/) with physical difficulty producing those sounds?
Motor approach, which includes:
a) Van Riper’s traditional approach
b) McDonald’s sensory motor approach
Motor approaches focus on remediating motor difficulties and faulty perceptual abilities
Which speech sound disorder treatment approach is best for highly unintelligible children who are assumed to have underlying phonological systems that differ from those of the adult speech community?
Linguistic approach, which includes:
a) Distinctive features approach
b) Contrast approaches
c) Phonological process approach
* Many children benefit from metaphon therapy and phonological awareness therapy
Linguistic approaches attempt to establish phonological rules in children’s repertoires and treat underlying patterns or rules instead of discrete phonemes
A 5 y/o child presents with “th”/s, t/f, w/r, d/”th”, and j/l substitutions. You would begin therapy by addressing which substitution:
t/f substitution (i.e., targeting /f/)
Vowels before consonants; nasals mastered between 3-4 y/o; stops (/p/ first) before fricatives (stops mastered 3-4.5 y/o); glides before fricatives (glides mastered 2-4 y/o); liquids mastered bet 3-7 y/o; fricative /f/ mastered earlier than other fricatives (around 3 y/o) w/ fricatives “th,” “th,” “sh,” “s,” and “z” mastered bet 3-6 y/o; clusters are acquired later than most other sounds
In Oller’s stages of infant phonological development, reduplicated babbling precedes:
Variegated babbling
Stages:
1) Phonation (0-1 mos): most vocalizations are reflexive
2) Cooing/gooing (2-4 mos): /u/, some velar sounds
3) Expansion (4-6 mos): “playing” with speech mechanism; growl, squeal, yell, rasberries, CV-like combos and V-like sounds
4) Canonical/reduplicated babbling (6-8 mos): CV strings
5) Variegated babbling (8 mos-1 yr): CV w/ variety of CVs
The therapy technique of phonetic placement is used to teach or establish:
Production of a phoneme in isolation
technique of phonetic placement is used when a child cannot imitate the modeled production
The articulation therapy approach that emphasizes the syllable as the basic unit of speech production and heavily utilizes the concept of phonetic environment is:
McDonald’s sensory-motor approach
Damien, a 4:3 y/o, uses gliding, consonant cluster reduction, stopping, reduplication, and final-consonant deletion. You would begin treatment by addressing:
Reduplication
- Disappears by 3: reduplication, syllable deletion, assimilation, prevocalic voicing, fronting of velars, final consonant deletion, diminutization
- Persists after 3: final consonant devoicing, consonant cluster reduction, stopping, epenthesis, gliding, depalatalization, vocalization
*Which of the following is FALSE regarding dental deviations?
A. Skeletal malocclusion refers to deviations in the shape and dimensions of the mandible and maxilla
B. Dental malocclusion refers to deviations in the positioning of individual teeth
C. In class I malocclusion, the arches themselves are generally aligned properly; however, some individual teeth are misaligned
D. In class II malocclusion, the maxilla is receded and the mandible is protruded
E. Overjet occurs when a child has a class II malocclusion and the upper teeth from the molars forward are positioned excessively anterior to the lower teeth
Answer: D
Class III: maxilla receded, mandible protruded; “underbite”; Class II: “overbite”
*Which of the following is FALSE re: treatment of children with SSDs?
A. Distinctive features approach is used to find child’s underlying patterns (e.g., probs with feature of nasality) and train sound(s) in that pattern in hopes that generalization to other sounds in that pattern will occur
B. Hodson and Paden’s cycles approach involves treating children with phonological disorders in cycles which the child is trained to a criterion of mastery for error patterns, e.g., FCD and fronting
C. Van Riper’s approach focuses on phonetic placement, auditory discrimination/perceptual training, and drill-like repetition/practice at increasingly complex motor levels until sounds are accurate in spontaneous conversation
D. In minimal pair contrast therapy, the SLP uses pairs of words that differ by only one feature
E. Children whose SSDs are phonological in nature accompanied by difficulties in language are at the greater risk for failing to achieve phonological awareness and eventual literacy skills; thus, it is important to incorporate phonological awareness treatment into therapy sessions with them
Answer: B
In Hodson and Paden’s cycles approach, children are NOT trained to a criterion of mastery for error patterns. Rather, the clinician introduces correct patterns, gives the child limited practice with production of those patterns, and moves on to other error patterns
In the distinctive approach, you would:
Try to find underlying patterns and train sound(s) in those patterns in hopes that generalization t other sounds in that pattern would occur AND… use minimal pairs
An SLP wants to help a 3 y/o who has demonstrated difficulties acquiring the rules of the phonological system, and the SLP decides to help the child pay attention to the phonological structure of language as well as help the child develop awareness that sounds can be classified by characteristics such as place (front-back), duration (long-short), and others. To achieve this goal, the SLP will most likely use:
Metaphon therapy
Used w/ preschoolers; based on metalinguistic awareness; assumes prob with acquisition of rules of the phonological system; SLPs give info to encourage child to make own changes
–E.g., “Here is a picture of a cat. You said ‘ca-.’ I heard the engine and middle train car, but the caboose was left out. Can you say the word again with the caboose, too?”
Chapter 6: Fluency and Its Disorders
Chapter 6
Stuttering may be defined as:
All types of dysfluencies that exceed 5% of words spoken; Production of part-word repetitions and speech-sound prolongations; Movements or events judged to be stutterings; Anticipatory, apprehensive, hypertonic, avoidance reaction
Stuttering is more prevalent in ___ than in ___.
Men, women
Stuttering occurs at such predictable loci as:
Initial sounds and words, consonants, longer and unfamiliar words, content words in older children and adults, and function words in younger children
Stuttering is under strong stimulus control, as evidenced by such phenomena as…
1) Adaptation=decrease w/ repeated oral reading
2) Consistency=persistent stuttering on same loci
3) Adjacency=new stuttering on loci adjacent to old
4) Audience size=increase with increased # of listeners
Neurophysiological hypotheses propose that people who stutter have:
Abnormal laryngeal control, abnormal cerebral language processing, or aberrant neuromotor control of the speech mechanism
Van Riper’s fluent stuttering method aims to:
Reduce the abnormality of stuttering through cancellations, pull-outs, and preparatory sets
Cancellations: pausing after stuttered word and saying word again with easy and more relaxed stuttering
Pull-outs: changing stuttering mid-course
Preparatory sets: changing the manner of stuttering…
The fluency shaping method aims to:
Include airflow management, gentle phonatory onset, rate reduction, and shaping normal prosody
Fluency reinforcement and time-outs involves:
Teaching pausing after every instance of stuttering
Response cost involves:
Losing a tangible reinforcer after every instance of stuttering
What is cluttering?
Includes rapid but disordered articulation, possibly combined with a high rate of dysfluencies and disorganized thought and language. Treatment is similar to that of stuttering.
What is the difference between incidence and prevalence?
Incidence=rate of occurrence in a specified group of people; studied by a longitudinal method; predictive statement; incidence studies are more expensive and time-consuming than prevalence studies
Prevalence=determined by counting the number of individuals who currently have it; “head count” at given point in time; studied by a cross-sectional method; head counting often underestimates the prevalence of a disorder by those who have not received clinical services; most available studies are prevalence studies
What are interjections?
Extraneous elements introduced into the speech sequence. These may include: sound or syllable interjections (e.g., um, shwa), word interjections (e.g., like, okay, well), and phrase interjections (e.g., you know, I mean)
What are direct stuttering reduction methods?
They seek to reduce stuttering directly, w/o teaching specific skills or modifying stuttering into less abnormal forms. To reduce stuttering directly, behavioral methods of TIME-OUT (pause-and-talk) or RESPONSE COST may be used. Response cost is best for younger kids and time-out is best for older kids/adults.
The position that stuttering indicates a social role conflict was taken by:
Sheehan
Research on the prevalence of stuttering has shown that:
A. Familial incidence is higher vs general population
B. Sons of stuttering mothers run a greater risk than sons of stuttering fathers
C. Blood relatives of stuttering women run a greater risk of stuttering than those of stuttering men
Answer: D, all of the above
Stuttering in preschool children is more likely on:
Function words
The facts about stuttering adaptation include:
Most of the reduction in stuttering occurs by the fifth reading
Brutten and Shoemaker proposed that:
A. Stuttering is limited to part-word repetitions and sound prolongations
B. Due to classically conditioned negative emotion
C. Some dysfluencies are operantly conditioned
Answer: D, all of the above
Bloodstein advocated that stuttering may be caused by:
Any belief that speech is a difficult task, resulting in tension and speech fragmentation
The fluent stuttering treatment:
Was developed by Van Riper to reduce the abnormality of stuttering
Cancellations, pull-outs, and preparatory sets are taught in:
The fluent stuttering approach
Such skills as airflow management, gentle phonatory onset, and reduced rate of speech are targets taught in:
The fluency shaping technique
Rachel’s mother describes Rachel’s speech as difficult to understand and “sort of rushed and she kind of stutters sometimes.” The SLP concludes that Rachel clutters. Based upon this diagnosis, one would expect to see that Rachel:
Has a lack of anxiety or concern about her speech, uses spoonerisms, and has rapid, disordered articulation resulting in unintelligible speech
Which techniques would be best to help Rachel become more intelligible?
Reducing Rachel’s rate of speech and increasing her awareness of her speech via audiotapes or videotapes
The theory that stuttering is caused by lack of a unilateral dominant hemisphere is the:
Cerebral dominance theory
To distinguish neurogenic stuttering from that of early onset stuttering, you will assess the effects of:
DAF and adaptation
Positive signs/symptoms that contrast with stuttering of early onset include: repetitions of medial and final syllables in words, dysfluent production of function words, dysfluencies in imitated speech, and rapid speech rate
Negative signs that are absent in neurogenic stuttering but present in stuttering of early childhood onset include: lack of adaptation effect, few associated motor behaviors, minimal or no effects of delayed auditory feedback, masking noise, rhythmic speech, choral reading, shadowing, and singing; no obvious anxiety associated with speech or speaking situations…
Chapter 7: Voice and its Disorders
Chapter 7
The intrinsic laryngeal muscles are the:
Thyroarytenoids, cricothyroids, posterior cricoarytenoids, lateral cricoarytenoids, and interarytenoids
The extrinsic laryngeal muscles are the:
- Infrahyoids/depressors: thyrohyoids, omohyoids, sternothyroids, and sternohyoids
- Suprahyoids/elevators: digastrics, geniohyoids, mylohyoids, stylohyoids, genioglossus, and hyoglossus
You are evaluating a girl who has been referred because of difficulties associated with a partial submucous cleft palate accompanied by a bifid uvula. During your evaluation, you can probably expect to find:
Hypernasality, accompanied by decreased intraoral breath pressure, leading to difficulties with adequate production of fricatives, affricates, and plosives
Specialists can measure ______, or the total volume of air in the lungs; other measurements can include _____, or the amount of air inhaled and exhaled during a normal breathing cycle; and _____, or the volume of air that the patient can exhale after a maximal exhalation
Total lung capacity, tidal volume, vital capacity
Which type of esophageal speech involves keeping the esophagus open and relaxed while inhaling rapidly?
The inhalation method
Which type of esophageal speech involves the patient impounding the air in the oral cavity, pushing it back into the esophagus, and vibrating the cricopharyngeus muscle?
The injection method
A singer comes to you for therapy. She had bypass surgery, and in the process, there was damage to her recurrent laryngeal nerve. In the course of intervention, you will most likely focus on:
Strategies to improve VF adduction
The Blom-Singer prosthetic device is used by laryngectomees to:
Shunt the air from the trachea to the esophagus so that the patient can speak on pulmonary air entering the esophagus
Patients who might be treated with CO2 laser surgery, recurrent laryngeal nerve resection, BOTOX, voice therapy, or a combination would probably have:
Spasmodic dysphonia
Sam is a 25 y/o male-to-female transgender client who has undergone several procedures to become more feminine. He is talking estrogen and wants help speaking in a feminine way. He is also dealing with emotional issues surrounding his gender reassignment. The clinician should:
Advise Sam that a combination of counseling, surgery, and voice therapy to teach more feminine pitch levels and communication patterns would best serve his needs
The cover-body theory of phonation states that:
the epithelium, the superficial later of the lamina propria, and much of the intermediate layer of the lamina propria vibrate as a “cover” on a relatively stationary “body,” which is made up of the remainder of the intermediate layer, the deep layer, and the TA muscle
*In order to see the VFs, you use a procedure that uses a pulsing light to permit the optical illusion of slow-motion viewing of the VFs. This is called:
Stroboscopy
You would expect a very hoarse patient who also presents with diplophonia to demonstrate:
Large amounts of both jitter and shimmer, with more than 1 dB of variation across vibratory cycles when shimmer is measured
Measurements of jitter, or frequency perturbation, indicate that in a normal speaker with no vocal pathology, jitter should be less than 1% as the speaker sustains a vowel. Measurements of shimmer, or amplitude perturbation, evaluate cycle-to-cycle variation of vocal intensity. Some experts believe that more than 1 dB of variation across cycles causes a patient to sound dysphonic
Chapter 8: Neurologically Based Communicative Disorders and Dysphagia
Chapter 8
What’s the difference between aphasia and dementia?
Aphasia: neurologically based language disorder, caused by various types of neuropathologies (usu. stroke)
Dementia: primarily found in people 65+; an acquired neurological syndrome associated with persistent/progressive deterioration in intellectual functions
What’s the difference between fluent and nonfluent aphasias?
Nonfluent: limited, agrammatic, effortful, halting and slow speech with impaired prosody
Fluent: relatively intact fluency but generally less meaningful, or even meaningless, speech; speech is generally flowing, abundant, easily initiated, and well articulated with good prosody and phrase length
Name the causes of flaccid dysarthria
Flaccid: damage to motor units of CNs or spinal nerves that supply speech muscles (LMN involvement); Myasthenia gravis, botulism, vascular diseases, BS strokes, infections (e.g., polio, infections from AIDS), demyelinating diseases (e.g., Guillain-Barre), degenerative diseases (motor neuron diseases, bulbar palsy, ALS), surgical trauma
Name the causes of hypo- and hyperkinetic dysarthrias
Hyperkinetic: BG damage (extrapyramidal); degenerative (e.g., HD), vacular, traumatic, infectious, neoplastic, and metabolic factors
Hypokinetic: BG damage (extrapyramidal); degenerative diseases, e.g., supranuclear palsy, PD, AD, and Pick’s; vascular disorders that cause strokes, head trauma, inflammation, tumor, drugs, hydrocephalus
Name the causes of spastic dysarthria
Spastic: bilateral damage to the UMNs (direct and indirect motor pathways); lesions in multiple areas incl cortical areas, BG, internal capsule, pons, and medulla
Name the causes of spastic-flaccid and ataxic-spastic (mixed) dysarthria
Mixed: spastic-flaccid is associated with ALS; ataxic-spastic is associated with MS
Name the cause of UUMN dysarthria
UUMN: damage to UMNs that supply CNs and spinal nerves involved in speech production; vascular disorders that produce L-hem lesions may coexist with aphasia or apraxia; R-hem lesions may coexist w/ right hemisphere syndrome
Describe the characteristics of ataxic dysarthria
tremors and rocking motion, hypotonia, dysmetria
Describe the characteristics of flaccid dysarthria
diminished reflexes, fasciculations/fibrilations, muscle weakness with use and recovery at rest, respiratory and CN weakness, breathy, short phrases, harsh voice, monopitch/loudness
Describe the characteristics of hyperkinetic dysarthria
abnormal/involuntary movements of orofacial muscles, myoclonus (involuntary jerks), face/shoulder tics, tremor, chorea, writhing involuntary movements (often in hands, athetosis), spasms, dystonia, spasmodic torticollis, blepharospasm (eye closure), voice tremor, intermittent strained voice, voice stoppage, harsh voice, slower rate, respiratory probs
Describe the characteristics of hypokinetic dysarthria
tremors in the resting facial, mouth, and limb muscles that diminish when moved voluntarily, mask-like face, micrographia, decreased swallowing, harsh and continuously breathy voice, irregular breathing and faster rate of respiration
Describe the characteristics of the spastic dysarthria
bilateral facial weakness, jaw strength may be normal, reduced ROM, slowness, loss of fine/skilled movement, increased muscle tone, hyperactive gag, hyperadduction of VFs, slow rate, short phrases, continuous breathy voice, harshness, strained-strangled quality
Describe the characteristics of UUMN dysarthria
unilateral weakness of lower face, tongue, palate; hemiplegia/hemiparesis, reduced loudness, (strained) harshness; dysphagia, aphasia, apraxia, RH syndrome
A 64 y/o patient has been a heavy drinker since 15 y/o, has memory probs, diff. processing abstract info, and visual-spatial deficits. The patient most likely has:
Wernicke-Korsakoff syndrome
Conduction aphasia is caused by lesions:
In the region between Broca’s and Wernicke’s area, esp. in the SG and arcuate fasciculus
Broca; TM (ant-sup FL); MT (arterial border zone); Global (perisylvian region); Wern (post. part of superior temporal gyrus); TS (temproparietal esp. mid. temp gyrus, AG); Anomic (AG, 2nd temp gyrus, juncture of temp-parietal lobes)
Apraxia of speech is often associated with:
Lesions in broca’s area
Of the following symptoms, the one associated with dysarthria is:
A. even and inconsistent breakdowns in articulation
B. impaired syntactic structures
C. forced inspirations and expirations that interrupt speech
D. an invariably slower rate of speech
E. an increased rate of speech under pressure
Answer: C
Dick manifests the following symptoms: a general awareness of his speech probs, sig. articulation probs, probs with volitional speech with relatively intact automatic speech, more difficulty w/ consonants than vowels, intonation and fluency probs, trial-and-error groping and struggling associated with speech attempts. Dick most likely has:
Apraxia of speech
Lucien is a 22 y/o who experienced TBI w/o any injury to the cerebellum, BS, or peripheral nerves. An SLP may expect to find:
Dysarthria, confused language (e.g., confabulation), auditory comprehension probs, confrontation naming probs, perseveration of verbal responses, pragmatic language probs, and reading/writing difficulties
If Mary has dementia of the Altzheimer type, as opposed to aphasia, Mary will show the following symptoms:
Poor judgement; impaired reasoning; disorientation in new places; widespread intellectual deterioration; empty speech; jargon; incoherent, slurred, and rapid speech; problems in comprehending abstract messages
Which one of the following is inaccurate in regards to evaluating swallowing disorders?
A. an ultrasound examination can measure oral tongue movement and hyoid movement
B. a manometric assessment can assess the preparatory phase of the swallow using posterior and lateral plane examinations
C. an electromyographic assessment can be conducted by attaching electrodes on structures of interest
D. a laryngeal examination can be conducted with indirect laryngoscopy and endoscopic examination to inspect the base of tongue, vallecula, epiglottis, pyriform sinuses, VFs, and ventricular VFs
E. a videofluorographic assessment (MBSS) can be conducted to evaluate oropharyngeal swallow involving lateral and anterior-posterior examinations
Answer: B
Conduct a manometric assessment with the help of an esophageal manometer, which measures pressure in the upper esophagus
Chapter 9: Communication Disorders in Multicultural Populations
Chapter 9
Which of the following is not typical of Spanish speakers?
A. t/th substitutins in word-initial position (tin/thin)
B. devoicing of final consonants (beece/bees)
C. v/f substitutions in word-inital and word-final positions (vine/fine, roove/roof)
D. y/dʒ substitutions (yava/java)
E. insertion of schwa before word-initial clusters (esleep/sleep)
Answer: C
Chapter 10: Audiology and Hearing Disorders
Chapter 10
What is the difference between conductive, SNHL, mixed, and central auditory and retrocochlear disorders hearing impairments?
Outer or ear malfunctions may lead to a conductive loss; SNHL result from inner ear malfunction; Mixed loss involves both SN and conductive components; Central auditory and retrocochlear disorders manifest auditory nervous system impairments, which are challenging to assess
Conductive (AC shows HL but BC normal; A-B gap)
SNHL: AC and BC show same loss (+/- 5 dB)
Mixed: AC and BC show loss but AC (10+ dB) worse
Acoustic immitance testing, involving ______ or ______ is used to assess middle ear function.
Tympanometry, acoustic reflex testing
Electrophysiological audiometry (e.g., electrocochleography) and medical imaging are often employed when _____ damage is suspect, since this damage us usually caused by tumors (or acoustic neuromas).
Retrocochlear
Note: retrocochlear disorders may be caused by con Recklinghausen disease
Aural rehabilitation involves two main components:
Amplification (aids/devices), communication training
Hearing severity is as follows:
Normal: 0-15 (25 for adults) Mild: 16-40 (25-40 for adults) Moderate: 41-55 Mod-severe: 56-70 Severe: 71-90 Profound: 91+
Some causes of SNHL include:
Noise, STORCH complex, acoustic neuroma, presbycusis, Meniere’s disease
What is Meniere’s disease?
Condition causing fluctuating SNHL, attributed to excessive endolymphatic fluid pressure in membraneous labyrinth, which causes Reissner’s membrane to become distended
Symptoms: hearing loss, spells of dizziness or vertigo, sense of fullness in ear, tinnitus
People with central auditory disorders generally present the following symptoms:
poor auditory: discrimination, integrity, sequencing skill, closure (recognizing _anta as “Santa”), attention, memory, localization, difficulty following melodic and rhythmic elements of music, reading aloud, and difficulty listening with b/g noise
diff. understanding distorted speech; dichotic listening tasks may be used
A 51 y/o feels like she is losing her hearing in her L ear. She feels generally healthy but notices that she uses her R ear exclusively when talking on the phone. She states, “sometimes the L side of my face tingles” and she also reports dizziness and mild balance problems. Her L ear sometimes rings. Her preliminary audiological results show that she has normal hearing with pure tones, and normal speech recognition in quiet. The most probably diagnosis is:
Acoustic neuroma
A person with otosclerosis often has an audiogram reflecting Carhart’s notch. Carhart’s notch is:
A pattern of bone-conduction thresholds characterized by reduced none-conduction sensitivity predominantly at 2k Hz
- Otosclerosis=new spongy growth starts on footplate of the stapes, causing stapes to become rigid and footplate does not move enough into oval window to create pressure waves in IE fluid
- Otospongiosis=stapes too soft to vibrate
Which one of the following is a homophenous pair?
man-ban
/m/ and /b/ look the same on the lips
The muscle that exerts the pull that allows the eustachian tube to open during yawning and swallowing is the:
Tensor palatini
Speech reception thresholds (SRTs) are:
The lowest level of hearing at which a person can understand 50% of the words presented
Popular forms of amplification today include hearing aids and cochlear implants. Which one of the following is NOT TRUE about these devices?
A. Cochlear implants may be used with children and some adults who have SNHL
B. Digital hearing aids provide a better S/N ratio than analog aids
C. Cochlear implants can help prelingual children make substantial progress through maximizing their potential
D. A consideration in fitting clients with hearing aids is whether the clients are motivated to use and properly care for the aids
E. Hearing aids deliver amplified sound to the ear canal, while cochlear implants deliver electrical impulses (converted from sound) directly to the auditory system
Answer: E
…directly to the auditory NERVE (i.e., CIs replace nonfunctioning inner hair cell transducer system)
Father of profoundly deaf 8 month old wants his daughter to “fit in with children with normal hearing” and he is interested in any amplification that will help his daughter lead a life that is “as normal as possible.” Which training approach would you suggest to fit this father’s wishes?
Aural/oral method
Aural/oral method emphasizes: a) making use of residual hearing through amplification and b) helping people with hearing impairment learn to communicate so that they are comfortable in mainstream settings with hearing people
[Note: Rochester method uses combo of oral speech and fingerspelling; signs are not used]
Chapter 11: Assessment and Treatment
Chapter 11
Standardizes tests include ____ while norm-referenced tests allow _____.
Systematic procedures; comparisons of a normative group
Reliability refers to a test’s _____ while validity refers to a test’s ability to ____
replicability; measure what it purports to measure
In treatment, initial sessions are more _____ than later sessions
Structured
What is the typical follow-up schedule to assess maintenance of clinically established behaviors and the need for additional treatment
3-, 6-, and 12-month follow-up schedule
You are offering treatment to a 7 y/o for his regular plural -s and regular past tense -ed. You need to measure the generalized production of those skills when you withold reinforcement for correct responses. The procedure you would use to achieve this is:
Intermixed and pure probes
Probes are procedures to assess generalized production of responses without reinforcing them. Probes involve a criterion to be met before training advances to a more complex level or to another target behavior
Negative reinforcement:
Increases the frequency of behaviors (because want to avoid aversive event)
A 65 y/o is being treated by a clinician who uses phonological cues (e.g., “starts with D”) to prompt correct naming of objects, then reinforces correct naming. After the trained set, the clinician shows a set of untrained stimuli and asks what the objects are without cues or reinforcement. In the latter procedure, the clinician is:
Measuring generalization with a probe
Josie, a child with behavioral issues, is praised by the SLP for sitting quietly for one minute and naming pictures. SLP also gives stickers for being a “good girl.” SLP does not reinforce bad behaviors, but does not do or say anything when they occur. In gradual steps, the SLP extends the duration between verbal praise and presentation of stickers and eventually praises Josie only occasionally. The SLP used a procedure called:
Indirect method of response reduction
Chapter 12: Research Design and Statistics
Chapter 12
An experiment-first-and-explain-later approach describes:
Inductive reasoning
Deductive reasoning is an explain-first-verify-later approach
In regards to single subject experimental designs (which can have 1-6 subjects): A phase is the _____ and the B phase is the _______
no treatment phase; treatment phase
Types of descriptive research include:
Ex post facto (retrospective or case study), survey, comparative or standard-group comparison, developmental or normative, correlational and ethnographic research
______ validity refers to the degree to which data in a study reflect a true cause-effect relationship
Internal
External validity refers to the generalizability of a study’s results
Threats to external validity include:
Hawthorne effect (subjects’ knowledge that they are being studied), multiple treatment interference, and reactive or interactive effects of pretesting
Threats to internal validity include:
Instrumentation, history, statistical regression(behavior goes from extreme to average level), maturation, attrition(losing participants), testing, and subject selection bias
Describe the 4 types of measurement scales
- Nominal (e.g., “never, sometimes, always,” “hypernasal, normal nasality”)
- Ordinal (numeral rank without mathematical meaning, e.g., “1=strongly agree, 2=agree, 3=neutral”; “1=little hoarseness, 2=moderate hoarseness, etc”)
- Interval (numerical scale)
- Ratio (like interval, expect there is an absolute 0, suggesting absence of something)
An experimental design involving one or a few subjects and focusing on individual performance would be called a:
Single-subject design
A difficulty with cross-sectional studies is that:
Observations are made of differences BETWEEN subjects of different ages to generalize about developmental changes that would occur WITHIN subjects as they mature
What is a multiple-baseline design?
It is a single-subject design in which effects of treatment are demonstrated by showing that untreated skills did not change and only treated skills have; 3 types: across subjects, settings, and behaviors
ABA vs ABAB?
A(base rating)
B(skills are taught)
A(treatment withdrawn)
B(same treatment reinstated)
Chapter 13: Special Topics in Speech-Langauge Pathology
Chapter 13
A normal ratio of 1.00 suggests adequate VP closure. Ratios less than ___ are especially indicative of VPI, reduced intelligibility, and hypernasality
0.89
Decisions for cleft surgery have involved the “rule of 10.” This means:
Waiting until the child is 10 weeks old, weighs 10 pounds, and has a hemoglobin of 10
What is the difference between primary and secondary surgeries for clefts?
- Primary surgery for clefts = initial surgery; clefts closed
- Secondary surgeries for clefts = improve appearance and functioning)
Lip surgery is typically performed when the baby is ____months or ____ pounds.
Palatal surgery, to close clefts, is typically performed when the baby is __-__ months
Lip surgery: 3 mos or 10 lbs
Palatal surgery: 9-24 mos
Describe the following 4 procedures: V-Y retroposition, von Langenbeck, pharyngeal flap, and pharyngoplasty
- V-Y retroposition or Veau-Wardill Kilner surgical method (single-based flaps of palate are raised on either side of cleft, brought together, and pushed back to close cleft– lengthens palate and improves VP approximation)
- von Langenbeck surgical method (raises 2 bipedicled flaps, brings them together, and attaches them to close cleft–leaves denuded bone on either side and does not lengthen palate)
- Pharyngeal flap procedure (muscular flap cut from post. pharyngeal wall, raised, and attached to velum–openings on either side allow for nasal: breathing, drainage, and speech sounds; flap helps close VP port and reduces hypernasality)
- Pharyngoplasty (Teflon, silicon, cartilage, etc may be implanted or injected into post. wall to make bulge and help close VP port)
Describe Angelman syndrome
- Chromosome 15 is duplicated or deleted
- Symptoms: seizures, stiff/jerky gait, laughter and happy demeanor, easily excitable, hand-flapping
- Few/no words
Describe Apert syndrome
- FGR2 at 10q25-26
- Syndactyly of hands, craniosynostosis (skull fusion; smaller skull diameter), flat frontal and occipital bones, high forehead; midfacial hypoplasia (underdevelopment)
Describe Cri du Chat syndrome
- Absent short arm of 5th chromosome (5p)
* High pitched cry of long duration (resembles cat cry)
Describe Crouzon syndrome
*Parrot-like nose, protruding eyeballs, craniosynostosis, hypertelorism (eyes far apart), brachycephaly (short head)
Describe Fragile X syndrome
- Expanded number of CGG nucleic acid repeats…
- Large, long and poorly formed pinna, big jaw, enlarged testes, high forehead
- Most males have intellectual disability
- Comm. probs: jargon, perseveration, echolalia, inappropriate lang, talking to self, lack of nonverbal comm., intelligibility may be compromised
- Austistic-like social deficits
Describe Hurler’s syndrome
- Deficiency of X-L iduronidase; Usu die in early teens
- Dwarfism, hunchback, ID, short/thick bones, “gargoyle-like” face, SNHL, noisy respiration, vocal fatigue/hoarseness, short/wide/thick hands
- Everted lips, small malformed teeth
Describe Landau-Kleffner syndrome
- Unknown cause; form of aphasia where kids between 3-7 lose ability to comprehend language and then to speak it
- Epilepsy in 70%
Describe Moebius syndrome
- Bilabial paresis and weak tongue control
- Bilateral paralysis of eye abductors, mask-like face
- Limited strength, range and speed of movement of articulators, feeding probs
Describe Pierre-Robin syndrome
- Glossoptosis (tongue positioned posteriorly and often causes blockage of airway and pharynx)
- Deformed pinna, low set ears
Describe Prader-Willi syndrome
- Deletion of long arm of chromosome 15 (some cases)
* Excessive eating
Describe Russell-Silver syndrome
- Babies have low birthweight, dwarfism
* Asymmetry of arms/legs, large head, craniofacial disproportion, microdontia
Describe Treacher Collins syndrome
- Underdeveloped facial bones, downwardly slanted palpebral fissues
- Malformations of pinna, ME, and IE
Describe Trisomy 13
*Extra copy of chromosome 13; many babies die before 1st bday, usu. from cardiac or CNS event
Describe Turner syndrome
*Females only; missing/deformed X chromosome
(Noonan occurs in males and females)
*Ovarian abnormalities, webbing of neck (excess skin over neck), low posterior hairline, micrognathia (small lower jaw), abnormalities of auricle
*visual, spatial, attentional problems
Describe Usher syndrome
- Affects 50% of people who are deaf and blind
* Vision probs and eventual blindness
Describe Velocardiofacial syndrome (aka Shpintzen syndrome, DiGeorge sequence)
- Portion of chromosome 22 is missing
* Syndrome most commonly associated w/ cleft palate, usu soft palate (associated with 180 other anomalies)
Describe Williams syndrome (aka Elfin-face syndrome)
- Abnormality on chromosome 7, incl. a gene that makes the protein elastin
- Small boned, short, long upper lip, wide mouth, full lips, small chin, upturned nose, puffiness around eyes
- IQ between 50 and 70
The hard palate fuses between the developmental age of:
8-9 weeks
A medical imaging technique that uses emission-computed tomography that allows imaging of metabolic activity through measurements of radioactivity in the section of the body being viewed is called:
[Tomography/laminography: takes pics of different planes of body structures]
PET scan
- CAT: X-ray beams circle through brain segments, pass through tissue, and takes pictures; often uses in diagnosis of neuropathology associated with strokes
- EEG: electrical impulses of brain through surface electrodes attached to scalp, shows brain waves; often good for detecting seizures
- MRI: pt completely still in cylinder container; provides fine detail in brain and spinal cord structure; may show soft tissue, large blood vessels and heart
- SPECT: evals amount of blood flowing through structure, assesses cerebral metabolism
- Videofluoroscopy: examines movements of internal structures and records movement patterns; assess function of VP, VFs, swallowing,etc
The surgical method of cleft palate repair that involves raising two bipedicled flaps, bringing them together, and attaching them to close the cleft is called the:
von Langenbeck surgical method
Hurler’s syndrome is caused by:
Autosomal recessive deficiency of X-L iduronidase
Nasopharyngoscopy allows the examiner to observe:
The posterior and lateral pharyngeal walls, as well as the nasal aspect of the velum and the adenoid pad as the client produces sentences
Videofluoroscopic examination of the VP mechanism allows clinicians to observe:
The movements of the soft palate, lateral pharyngeal wall, posterior pharyngeal wall, and the tongue as the client produces CV combinations, voice and voiceless fricatives, and selected phrases
Chapter 14: Professional Issues
Chapter 14
In most states, to work in the public schools, SLPs and audiologists are required to possess:
A state-issued credential (from an agency such as the department of education)
Liscensure and certification are required by many other settings such as hospitals and clinics
Which statement is true about ASHA’s special interest divisions?
Clinical specialty recognition is available only in a few specialty areas
Public Law 94-142 (later called IDEA) mandates:
(1975) Free and appropriate education (in the least restrictive environment) for disabled students ages 3 to 21
Public Law 99-457 is concerned with:
(1986) Early intervention to reduce # of children requiring special education services in later years
- -Increased federal monetary support for states to provide services to children 3-6 y/o and toddlers (up to 2 yrs) with disabilities
- -IFSPs
Public Law 101-476 (IDEA):
105-17 (1997)
108-446 (2004)
- Enacted in 1990; Reauthorized P.L. 94-142
- Replaced “disability” with handicap
- Expanded # of disability categories (11 to 13, ASD + TBI)
- Special edu expanded to include all settings
- Reauthorized in 1997 (P.L. 105-17)- included CSHA; and 2004 (108-446)- reducing over-referrals to special edu
Public Law 101-336 (ADA):
- (1990) Provides civil rights protection relative to employment, state and local government services, telecommunications, etc
- Bars employment discrimination against qualified people with disabilities; requires employers to make reasonable accommodations (w/o “undue hardship”)
