CSD Exam 1 Flashcards

1
Q

what is impairment

A

Loss or abnormality of function

E.g. A hearing impairment

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2
Q

what is disability

A

Reduced competence in meeting needs in daily living

E.g. Person with hearing impairment has trouble with a telephone

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3
Q

what is handicap

A

Social, Educational or Occupational disadvantage from the impairment/disability
E.g. Hearing impaired person has trouble in a noisy classroom

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4
Q

what is speech difference

A
Differences 
typically associated 
with a dialect or a 
second language. 
Not a disorder.
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5
Q

what is speech disorder

A
“When a person is unable 
to produce speech sounds 
correctly or fluently, or has 
problems with his or her 
voice, then he or she has a 
speech disorder
.” - ASHA
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6
Q

what is communication?

A

The process by which two or more people share
information, including facts, thoughts, ideas and
feelings

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7
Q

what is formulation?

A

is the process of pulling together one’s thoughts or ideas before sharing them with another. What is the thought or feeling you want to share

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8
Q

what is transmission?

A

is the process of conveying those ideas to another person, often by speaking but also by signing, gesturing, or writing.

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9
Q

what is reception?

A

is the process of receiving information from another person

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10
Q

what is comprehension?

A

is the process of making sense of information presented to you

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11
Q

what are communication modalities?

A

describes the manner in which information is transmitted and received.

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12
Q

what are the three components of communication?

A

Language, Speech, Hearing

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13
Q

what is language?

A

The cognitive process of forming thoughts and ideas

A symbol system for communication

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14
Q

what is speech?

A

Neuromuscular process of turning language into a

sound signal for communication

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15
Q

what is hearing?

A

The perception of sound

Or, in communication, the perception of speech

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16
Q

what are the three domains of language?

A

Content, Form, Use

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17
Q

what is content?(semantics)

A

refers to the meaning of language-the words we use and the meaning behind them.

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18
Q

what is form?(syntax, morphology, phonology)

A

is how words, sentences, and sounds are organized and arranged to convey content.

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19
Q

what is use?(pragmatics)

A

is how language is used functionally to meet personal and social needs

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20
Q

what is semantics?

A

refers to the rules of language governing the meaning of individual words and word combinations.

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21
Q

what is syntax?

A

refers to the rules of language governing the internal organization of sentences.

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22
Q

what is pragmatics?

A

refers to the rules of language governing how language is used for social purposes. Governs three important aspects of social use of language. (communication functions, Conversation, social conventions)

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23
Q

what are the three systems involved in speech?

A

Respiration, Phonation, Articulation

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24
Q

what is respiration?

A

breath of air that begins in lungs and travels up through the trachea(windpipe) over the vocal cords.

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25
Q

what is phonation?

A

air into oral or nasal cavities

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26
Q

what is articulation?

A

air manipulated by the oral articulators-tongue, teeth, jaw

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27
Q

what are the four components to normal speech?

A

breath support, voice, articulation, fluency

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28
Q

what is breath support?

A

Passive expiration is not enough to support
speech

Active contraction of inspiratory and expiratory
muscles creates
a consistent airflow

10% inspiration, 90% expiration

Use several muscles and structures – diaphragm,
abdominal muscles, ribs, muscles in between ribs
etc
.

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29
Q

what is voice?

A
Voice
 quality, volume, and pitch can affect 
speech

Quality: how breathy, hoarse, broken, or nasal a 
voice sounds

Volume: how loud or soft the voice sounds

Pitch: how high or low the voice sounds
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30
Q

what is normal speech articulation?

A
Sounds must be 
produced accurately 
and consistently for 
effective 
speech

Try /s/
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31
Q

what is fluency?

A

Fluent speech is produced easily and
smoothly, without hesitations, interjections,
repetitions, or circumlocutions

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32
Q

Fields of CSD

A

SLP, Audiologist, Speech Language Hearing Science, 3 principles of evidence based practice.

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33
Q

Roles of SLP

A

They prevent and screen for communication
disorders
They assess for and diagnose communication
disorders
They treat and manage communication
disorders
They also advocate on behalf of people with
communication disorders

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34
Q

Roles of Audiologist

A

Audiologists prevent, identify, and
manage hearing and balance system
dysfunction

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35
Q

Roles of Speech, language, and hearing

scientists

A
Speech, language, and 
hearing scientists do 
research related to 
speech, language, 
hearing, and 
communication
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36
Q

Three communication disorders

A

language, speech, hearing

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37
Q

what arelanguage disorders

A
Language disorders can affect any domain 
(content, form, use)

Children or adults can have language 
disorders

Examples:

Children : SLI

Children: Intellectual disability with language 
disorders

Adults: Aphasia

Adults: TBI with resulting language disorders
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38
Q

what are speech disorders

A
Speech disorders can include difficulties with 
any of the components of normal speech 
production:

1. Articulation 
and phonological disorders

Distortions, substitutions, and omissions of 
speech sounds because of structural, articulatory, 
or perceptual problems
.

2. Fluency 
disorders

 Repetitions, prolongations, and blocks during 
speech
3. Voice 
disorders

Difficulties with voice 
production

4. Motor 
speech disorders

Distortions, substitutions, and omissions of 
speech sounds because of neurological problems
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39
Q

what are hearing disorders?

A
Hearing disorders affect auditory pathways 
from the ear to the brain

1. Conductive hearing 
loss:

Affects the outer or middle ear

2. Sensorineural 
hearing loss:

Affects the inner ear or the auditory nerve that 
connects the inner ear to the brain.

3. Auditory Processing disorders
\:

Affects the processing of speech sounds in the 
auditory center in the brain
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40
Q

what are feeding and swallowing disorders?

A
Pediatric Feeding and swallowing disorders

Can be related to some developmental disorders

Cerebral palsy, cleft palate

Can be acquired through a TBI, etc.

Adult dysphagia

Can be because of a stroke
,
 other neurological 
diseases, Alzheimer’s disease, head and neck 
cancer, etc.
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41
Q

what are the categories of communication disorders?

A
Age of onset

Etiology

Progression

Severity
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42
Q

what is age of onset?

A
 When the disorder starts

Congenital or developmental

Before, during, or shortly after birth

Cerebral palsy, childhood apraxia of speech, autism

Acquired

Occurs after a period of normal development

Traumatic brain injury, Aphasia, Amyotrophic Lateral 
Sclerosis (ALS)
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43
Q

what is etiology?

A
The cause of a disorder

Organic 
disorders
 have neurological or 
physiological causes

Aphasia is caused by brain injury

Aphonia is caused by 
laryngectomies

Functional disorders
have no known cause

Childhood language disorders

Autism
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44
Q

what is progression?

A
How a disorder 
changes over time

Progressive or 
degenerative 
disorders

Deteriorate over time

ALS, MS, Muscular 
dystrophy, 
Alzheimer’s disease

Non-progressive

Maintain over time

TBI, Down syndrome
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45
Q

severity category

A
Mild

Moderate

Severe

Profound
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46
Q

Communication Disorders vs.

Communication Differences

A

Disorder:

Significantly lower skills than others of the
same
cultural background, language community,
and dialect community

A communication difference is a variation
between linguistic communities.

In Pittsburgh, speakers often omit linking verbs in
sentences like, “The laundry needs washed.”

In African American English (AAE), speakers
often omit verbs in sentences like “he tired” or
substitute /f/ for “th” in words like “bath” and
“birthday”

A communication disorder is a variation within
a linguistic community.

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47
Q

what are assessments?

A

Often Multidisciplinary

It may involve many professionals who bring
diverse knowledge, skills, and experiences.

School example: special educator, classroom teacher,
reading specialist, SLP

Rehab example: Physical therapy, Occupational
Therapy, Nursing, SLP

Systematic

It follows certain procedures so that its outcome
will be comprehensive, nonbiased, and valid.

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48
Q

goals of assessments

A
Verify and characterize the communication 
disorder

Identify causes (etiology) 

Propose plans to “treat” 

Qualify the client/patient for services

Attempt to provide a prognosis 
Achieved through various means
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49
Q

what are the five stages of the assessment process?

A
I. Screening & referral

II. Designing & administering the assessment 
protocol

III. Interpreting assessment findings

IV. Developing an intervention plan

V. Monitoring progress and outcomes
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50
Q

Screening and referral

A
S
creening is the use of a test or task to 
conduct a quick check of performance in 
one area.

A hearing screening 
provides a quick and 
relatively 
inexpensive probe of 
a person’s hearing 
at key levels.

Passing

Failing

Referral is the process of requesting
speech, language, and hearing
services.

Referrals are made by parents or other
caregivers, or by educational and health-care
professionals.

These people may have completed an official
screening, or may have just noticed a problem
and then refer to the SLP or audiologist

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51
Q

II Designing and administering the

assessment protocol.

A
Record review (Collect a case history)

Interview

Systematic observation

Questionnaire/survey

Formal tests

Instrumentation
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52
Q

Record review

A
Looking at any relevant records that will help 
professional in understanding the problem

Medical records

Educational records

Developmental information

Any previous therapy records
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53
Q

Interview

A

Collecting information from the family,
caregivers, client, or other professionals

See example interview questions for a client on pg.
176

In our clinic, the interview is the first part of the
face to face assessment process

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54
Q

Systematic observations

A
Observing how a 
person uses 
communication for 
functional purposes in 
activities in home, 
work, and school 
environments.

Examples:

Observing a student 
within his/her 
classroom

Observing a 
preschooler interact 
with parents

Observing an adult 
communicating with
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55
Q

Questionnaire/survey

A
Questionnaires and surveys are formal 
mechanisms for gathering information from 
clients, their family members, and relevant 
professionals.

Self-rating scales

Parent/caregiver rating scales
56
Q

Formal testing

A
Formal, commercial 
tests evaluate a 
person’s 
communicative skills 
in a standardized 
manner.

Questions are asked 
in a specific, uniform 
way each time the 
test is given to 
someone
57
Q

Norm referenced

tests

A
Norm referenced 
tests are used to 
compare an 
individual’s 
performance in a 
specific area with 
that of his or her 
same-age peers
Standardization

The test is given in the same uniform and scripted 
manner to everyone who takes 
it

Normative Sample

There is a group of individuals who were given the 
test, to see what the typical or average scores should 
be for that age. 

Standard scores

This is an index that compares a person’s test 
performance with his or her normative peers

Can get percentile ranks, standard deviations, etc.
.
58
Q

Criterion referenced tests

A
Criterion referenced 
tests are used to 
determine an 
individual’s level of 
achievement or skill 
in a particular area
.

Individuals are not 
compared to others; 
they just have to 
meet the criterion.
59
Q

Properties of assessment tests -

Validity

A

Validity – The extent to which we are measuring what we
hope to measure
1.
Face validity – whether on the face of it, it measures
the concept it is supposed to measure. This is the
most basic.
2.
Content validity – whether measure represents all
facets of a concept
3.
Construct validity – the extent to which what it
measures is related to other measures specified by
theory or previous research
4.
Predictive/Criterion related – This applies to
instruments that we have been developed to predict
performance

60
Q

Properties of assessment tests -

Reliability

A

Reliability – Refers to ability of a test to yield
consistent scores over repeated measures
1.
Test-Retest – When the same test is
administered in the same manner multiple
times, do they obtain the same results
2.
Inter item – multiple items used to measure
a single concept should be associated with
each other
3.
Inter rater – different people get the same
results while using the same test

61
Q

Interpreting assessment

findings

A

Diagnosis

Clinician asks him/herself: Is there a communication problem?

Disorders are diagnosed when an area of communication is
markedly different from what is observed in the typical population
or from what is expected in the individual being assessed.

Differential diagnosis

Clinician asks him/herself: What exactly is the problem?

The process of systematically differentiating a disorder from other
possible disorders.

Example: Is this problem difficulty in “finding words” (aphasia), or
is it difficulty with the motor production of those words
(dysarthria)

Severity

Clinician determines how severe the problem is (mild, moderate,
severe, profound [very severe])

62
Q

Developing an intervention

plan

A

Identify treatment goals

Describe the length and frequency of treatment

Describe treatment contexts and activities

Goals depend on the disorder

Professionals plan intervention based on what the
assessment tells them about a person’s strengths
and needs

63
Q

Effective Intervention

A

is one that has been shown by scientists to have value for a certain population. an effective intervention is one that works.

64
Q

efficient intervention

A

is one that effects change relatively quickly compared to other treatment options.

65
Q

feasible intervention

A

is one that can be implemented with adherence. adherence is the implementation of an intervention by an individual in accordance with a professionals prescription; adherence is highly influential in treatment outcomes.

66
Q

three primary purposes of intervention

A

prevention, remediation and compensation

67
Q

Prevention

A

Prevents problems that might arise in the future

E.g. Construction company requires employees to wear ear
protection

68
Q

remediation

A

Slows progress or repairs the communication disorder

E.g. child with difficulty pronouncing sounds attends
therapy to correct sound productions

69
Q

compensation

A

Helps persons cope with a disorder that is not likely to
improve

E.g. person with dysphagia eats a modified diet using safe
strategies

70
Q

intervention goal

A

is the targeted communication achievement,

71
Q

three goals of intervention

A

functional, measurable, attainable

72
Q

functional goal

A

goals should directly improve clients life in some way

73
Q

measurable goal

A

goals should link directly to some aspect of measurement so that progress toward goals can be documented

74
Q

attainable goal

A

should be realistic and achievable for the client so that progress, however incremental, is possible

75
Q

Monitoring progress and

outcomes

A
Assessment is an ongoing process

Why is this important?

Monitor progress to track client progress

Monitor progress to see if client activities/goals 
should be modified

Determine when a client is ready for discharge

Track outcomes

Demonstrate the value of our services

And more
76
Q

definition of anatomy

A

the structures of the body

77
Q

definition of physiology

A

the study of the functions of the bodily structures

78
Q

Anterior v Posterior

A

front/back

79
Q

ventral v dorsal

A

toward abdomen/ toward back

80
Q

superior v inferior

A

toward top/ toward bottom

81
Q

proximal v distal

A

toward the body/ away from the body

82
Q

medial v lateral

A

toward the midline/ toward the side

83
Q

The nervous system

A

The nervous system includes the central and peripheral

nervous systems

84
Q

CNS

A

Brain

Brainstem

Cerebellum

Cerebrum

Spinal cord
85
Q

PNS

A

Cranial nerves

Spinal nerves

The Brain and Language
86
Q

brain stem

A

sits directly on top of the spinal cord and serves as a conduit between the rest of the brain and spinal cord. Consists primarily of nerve tracts that carry sensory info to the brain and motor information away from the brain. Controls visual auditory reflexes.

87
Q

cerebellum

A

is an oval shaped little brain that sits posterior to the brain stem. Its primarily responsible for regulating motor and muscular activity.

88
Q

cerebrum(cerebral cortex)

A

is the part of the brain that governs the unique human qualities of thinking, problem solving, planning, creating and rationalizing. the cerebrum is the largest

89
Q

four lobes

A

frontal, parietal, occipital, temporal

90
Q

frontal lobe

A

is the largest lobe. it sits in the most anterior part of the brain behind the forehead. key functions are activating and controlling both fine and complex motor activities, including the control of speech output and controlling human executive functions.

91
Q

parietal lobe

A
Post central gyrus

Somatosensory Area: 
perceiving and integrating sensory and 
perceptual information 

Comprehending oral and written language 
and 
mathematical calculations
92
Q

temporal lobe

A
Processing auditory information 

Auditory cortex in L and R Heschl’s gyrus

L and R have different specializations

Language comprehension 

L hemisphere – Wernicke’s area
93
Q

occipital

A

Processing visual

information

94
Q

Gyri

A

an auditory cortex aka heschl’s gyrus. primary center for auditory perception and sensation. located in the superior portion of the left temporal lobe. responsible for interpretation of all types of sounds, not just speech and language

95
Q

spinal cord

A
Extends from brainstem

Located within the spinal column

Nerves of spinal cord synapse with 
the peripheral nervous system
96
Q

Neuron

A

“Nerve
cells”

Brain contains 10 billion+ neurons

highly specialized cells that make up the nervous system and carry its sensory and motor information.

97
Q

Efferent

A

away from the CNS Motor. Conveys impulses from higher to lower

98
Q

afferent

A

toward the CNS. Sensory. Brings information to a higher structure

99
Q

Cranial Nerves

A
S
sensory information and motor movement in head and neck

Important for vision, hearing, smell, and 
taste

Emerge from brainstem

12 pairs
100
Q

Spinal Nerves

A

S
sensory information and motor movement for our bodies

Mediate reflexes and volitional sensory and motor activity

Emerge from spinal cord

Run to peripheral areas of the body, including arms and legs

31 pairs

101
Q

3 things that protect the nervous system

A

bone, membranes, and cerebrospinal fluid

102
Q

what is respiration

A

system of the human body that controls breathing

103
Q

Upper Respiratory

A
Trachea

Aka windpipe

Cartilaginous tube

E
xtends 
downward from 
larynx to lungs

Divides into 2 
bronchi

Principal function to 
transport air between 
environment and lungs
Oral and nasal cavities

Larynx

trachea
104
Q

Lower respiratory

A
Lungs

Bronchi

alveoli

Also 
functions 
as 
p
ower source for speech!

Though more air is exchanged for speech than respiration

More voluntary control

Greater ratio of expiration to inspiration
Exchange of carbon 
dioxide for oxygen 
occurs in the 
lungs
105
Q

Muscles of inspiration

A
Primary
 muscles 
involved 
in quiet, restful 
inhalation

Diaphragm

External 
Intercostals

Secondary (accessory)
 muscles involved in 
more active, forced breathing tasks 

lifting, yelling, singing, talking for a long time on a 
single breath
Diaphragm

Muscle shaped like a dome 

Sits at floor of the rib cage (thorax)

Separates the stomach (abdominal cavity) 
from the thorax (thoracic cavity)

During inspiration: 

Contraction of diaphragm causes the thoracic 
cavity to expand 

 lungs fill with air
106
Q

muscles of expiration

A
Passive 
Exhalation:

External 
intercostals and diaphragm recoil passively into 
their relaxed state

Primary muscles are involved during quiet, restful 
exhalation

Forced Exhalation (using secondary 
muscles
):

Secondary 
muscles are involved in active, forced 
breathing

These 
muscles are located in neck area, 
back, and 
abdomen
107
Q

Phonation

A

takes
the energy sent from the lungs and
modulates the airflow to convert the energy
into sound

108
Q

Pharynx

A
M
ucosa-lined 
muscular 
tube

R
uns 
from the nasal cavity, through the back of 
the oral cavity, to the entrance of the larynx and 
esophagus

Includes

Nasopharynx

Oropharynx 

Laryngopharynx
109
Q

Larynx

A
C
artilaginous 
box that sits at the front of the 
neck on top of the trachea

P
rimary 
function 
is protecting the airway

S
econdary 
function 
is producing voice
110
Q

Laryngeal structures

A
Hyoid bone

H
orseshoe 
shaped bone that suspends the larynx

Thyroid cartilage

Forms the front and side walls of the larynx

Cricoid cartilage

R
ing 
that forms the base of the larynx

Epiglottis

L
eaf 
shaped cartilage that runs from the hyoid 
to 
the 
back of the 
tongue

Arytenoid cartilages

Pyramid shaped structures that form anchors for the vocal 
folds
111
Q

M
ovement of
larynx and vocal folds
involves two sets of muscles

A
Extrinsic laryngeal muscles

Extend externally from 
larynx 
to 
hyoid bone/other 
nearby structures

Keep larynx 
at midline and control vertical 
movement during speech 
& 
swallowing

H
elp 
elevate and depress the larynx

Intrinsic laryngeal muscles

Within the larynx

C
ontrol movement 
of the vocal folds (e.g., 
lengthen
, shorten, open, 
close
)
112
Q

vocal folds

A

or vocal cords are two thin sheets of tissue connected on their outer edge to the inside of the thyroid cartilage

113
Q

glottis

A

the space between the vocal folds

114
Q

extrinsic laryngeal muscles

A

(all external to larynx) extend externally from the larynx to the hyoid bone or other nearby structures. they keep the larynx in its midline position while also controlling vertical movements during speaking or swallowing. These muscles help elevate the larynx (necessary for producing speech) and then depress it.

115
Q

intrinsic laryngeal muscles

A

situated within the larynx itself, control the movements of the vocal folds. these help lengthen the vocal folds and open and close the vocal folds, all necessary for producing speech

116
Q

abduction of VF

A

separates VF’s

117
Q

adduction of VF

A

brings them together

118
Q

nasopharynx

A

is the posterior continuation of the nasal cavity

119
Q

oropharynx

A

or throat, is the length of the pharynx that connects with the oral cavity

120
Q

laryngopharynx

A

is the most inferior portion of the pharynx, a small portion of tube that opens in the anterior to the larynx and in the posterior to the esophagus

121
Q

Speech Production Process

A
Phonation

Sound produced by VF vibration

Vocal 
folds come together (adduct)

Air pressure builds up below folds (due to air 
pressure generated 
by 
exhalation)

When air pressure builds up below folds 
(“subglottal pressure”), vocal 
folds are “blown” 
open in wave-like manner
Decrease of air pressure 
then causes 
vocal 
folds to come back together

Movement of the articulators (jaw, tongue, 
teeth, lips, palate) shapes the air into particular 
speech 
sounds
122
Q

Articulatory System

A
Manipulates airflow and voice that was channeled through 
phonatory system

Creates specific speech sounds

Example

Change “ahh” to “eeh” to “see”
123
Q

Jaw

A
Mandible

Houses the lower teeth

Forms the floor of the mouth

Maxilla

Houses the upper teeth

Forms the alveolar ridge and 
palatine process
124
Q

Teeth

A
Major function is 
mastication (chewing)

Involved in the production 
of 
dental
 speech sounds
125
Q

Hard Palate

A

Roof of the mouth and floor

of the nose

126
Q

Soft Palate

A
Also known as velum 

Movable part of palate that 
opens and closes the nasal 
cavity from the oral cavity

The tip of the soft palate is 
called the uvula
127
Q

Tongue

A
Other major 
functions

Taste

moving food for 
chewing 
&swallowing
128
Q

Lips

A

just help shape words

129
Q

Outer ear

A
Auricle

Aka pinna

Visible part of outer 
ear

Includes earlobe, tragus, helix

External auditory canal (EAC
)

Conducts sound waves inward

Produces cerumen to protect inner 
ear

Tympanic 
membrane

Aka eardrum
130
Q

Middle Ear

A
Tympanic membrane

Aka eardrum

B
oundary 
between the outer and middle ear

E
ustachian tube

R
uns 
from the middle ear to the pharynx 

Serves as a pressure equalizing tube for the middle ear

E.g
. 
ears popping

Ossicles

T
he 
three smallest bones in the 
body

Together form the ossicular 
chain

Malleus

Incus

Stapes
131
Q

Inner Ear

A
F
luid 
filled cavity inside the temporal bone (behind the eye 
socket)

C
omplex 
system of canals and 
cavities

Sometimes called a 
labyrinth

Three major cavities

Vestibule

Semicircular canals

Organs of balance

Cochlea

Organ of hearing
132
Q

Cochlea

A
Cochlea

Snail-shaped

Filled with fluid

Primary hearing structure within the inner 
ear

Contains sensory hair cells for the auditory 
system

Converts 
energy into a code that can be interpreted by the 
brain

Mechanical
 energy (from the middle ear) into 
neural
energy

Connects 
to auditory nerve

Auditory nerve carries information to temporal lobe of brain
133
Q

Swallowing

A
Aka deglutition

“bolus”

3 phases

Oral phase

Oral preparatory stage

Oral transport stage

Pharyngeal phase

Esophageal 
phase

Many of the same structures involved as in 
respiration & speech

Jaw, lips, teeth, palates, tongue, 
pharynx, larynx

But some differ

Esophagus, UES/LES, stomach, etc
134
Q

Oral Phase about 1 second

A
Oral preparatory stage

Anticipating eating

Food is brought to mouth

Liquids are sipped/sucked & food is chewed/mixed with saliva

P
reparing a cohesive bolus for swallow

Oral transport stage

Propelling bolus anteriorly to posteriorly through mouth to pharynx

Tongue propels bolus by squeezing against hard palate
135
Q

Pharyngeal Phase about 1 second

A

Start the swallow reflex (i.e. initiate swallow)

Velum raises to seal off nasal cavity

Base of tongue moves back to pharyngeal wall

Hyolaryngeal elevation: Epiglottis inverts over airway,
VFs
adduct, UES begins to open

Pharyngeal constriction: squeezing food down the throat

136
Q

Esophageal Phase about 8-20 seconds

A

Upper Esophageal Sphincter (UES) relaxes to allow food to
enter esophagus

Food moves down esophagus through peristalsis (constriction
and relaxation of muscles) and gravity!

Lower Esophageal Sphincter (LES) relaxes to allow food to
enter stomach from esophagus

Swallowing is complete, and digestion begins

137
Q

Dysphagia

A
Dysphagia

Refers to disordered chewing and/or swallowing

Can have various etiologies

Head and neck cancer, stroke, Alzheimer’s disease, Parkinson’s disease, 
etc
.

Can result from impairment at any stage of swallowing (or multiple)

Penetration

Entry of a foreign substance into the larynx

Aspiration

Entry of a foreign substance past the level of the VFs

Into the trachea!