CSD Exam 1 Flashcards
what is impairment
Loss or abnormality of function
E.g. A hearing impairment
what is disability
Reduced competence in meeting needs in daily living
E.g. Person with hearing impairment has trouble with a telephone
what is handicap
Social, Educational or Occupational disadvantage from the impairment/disability
E.g. Hearing impaired person has trouble in a noisy classroom
what is speech difference
Differences typically associated with a dialect or a second language. Not a disorder.
what is speech disorder
“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
what is communication?
The process by which two or more people share
information, including facts, thoughts, ideas and
feelings
what is formulation?
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
what is transmission?
is the process of conveying those ideas to another person, often by speaking but also by signing, gesturing, or writing.
what is reception?
is the process of receiving information from another person
what is comprehension?
is the process of making sense of information presented to you
what are communication modalities?
describes the manner in which information is transmitted and received.
what are the three components of communication?
Language, Speech, Hearing
what is language?
The cognitive process of forming thoughts and ideas
A symbol system for communication
what is speech?
Neuromuscular process of turning language into a
sound signal for communication
what is hearing?
The perception of sound
Or, in communication, the perception of speech
what are the three domains of language?
Content, Form, Use
what is content?(semantics)
refers to the meaning of language-the words we use and the meaning behind them.
what is form?(syntax, morphology, phonology)
is how words, sentences, and sounds are organized and arranged to convey content.
what is use?(pragmatics)
is how language is used functionally to meet personal and social needs
what is semantics?
refers to the rules of language governing the meaning of individual words and word combinations.
what is syntax?
refers to the rules of language governing the internal organization of sentences.
what is pragmatics?
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)
what are the three systems involved in speech?
Respiration, Phonation, Articulation
what is respiration?
breath of air that begins in lungs and travels up through the trachea(windpipe) over the vocal cords.
what is phonation?
air into oral or nasal cavities
what is articulation?
air manipulated by the oral articulators-tongue, teeth, jaw
what are the four components to normal speech?
breath support, voice, articulation, fluency
what is breath support?
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
.
what is voice?
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
what is normal speech articulation?
Sounds must be produced accurately and consistently for effective speech Try /s/
what is fluency?
Fluent speech is produced easily and
smoothly, without hesitations, interjections,
repetitions, or circumlocutions
Fields of CSD
SLP, Audiologist, Speech Language Hearing Science, 3 principles of evidence based practice.
Roles of SLP
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
Roles of Audiologist
Audiologists prevent, identify, and
manage hearing and balance system
dysfunction
Roles of Speech, language, and hearing
scientists
Speech, language, and hearing scientists do research related to speech, language, hearing, and communication
Three communication disorders
language, speech, hearing
what arelanguage disorders
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
what are speech disorders
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
what are hearing disorders?
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
what are feeding and swallowing disorders?
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.
what are the categories of communication disorders?
Age of onset Etiology Progression Severity
what is age of onset?
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)
what is etiology?
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
what is progression?
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
severity category
Mild Moderate Severe Profound
Communication Disorders vs.
Communication Differences
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.
what are assessments?
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.
goals of assessments
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
what are the five stages of the assessment process?
I. Screening & referral II. Designing & administering the assessment protocol III. Interpreting assessment findings IV. Developing an intervention plan V. Monitoring progress and outcomes
Screening and referral
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
II Designing and administering the
assessment protocol.
Record review (Collect a case history) Interview Systematic observation Questionnaire/survey Formal tests Instrumentation
Record review
Looking at any relevant records that will help professional in understanding the problem Medical records Educational records Developmental information Any previous therapy records
Interview
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
Systematic observations
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
Questionnaire/survey
Questionnaires and surveys are formal mechanisms for gathering information from clients, their family members, and relevant professionals. Self-rating scales Parent/caregiver rating scales
Formal testing
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
Norm referenced
tests
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. .
Criterion referenced tests
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.
Properties of assessment tests -
Validity
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
Properties of assessment tests -
Reliability
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
Interpreting assessment
findings
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])
Developing an intervention
plan
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
Effective Intervention
is one that has been shown by scientists to have value for a certain population. an effective intervention is one that works.
efficient intervention
is one that effects change relatively quickly compared to other treatment options.
feasible intervention
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.
three primary purposes of intervention
prevention, remediation and compensation
Prevention
Prevents problems that might arise in the future
E.g. Construction company requires employees to wear ear
protection
remediation
Slows progress or repairs the communication disorder
E.g. child with difficulty pronouncing sounds attends
therapy to correct sound productions
compensation
Helps persons cope with a disorder that is not likely to
improve
E.g. person with dysphagia eats a modified diet using safe
strategies
intervention goal
is the targeted communication achievement,
three goals of intervention
functional, measurable, attainable
functional goal
goals should directly improve clients life in some way
measurable goal
goals should link directly to some aspect of measurement so that progress toward goals can be documented
attainable goal
should be realistic and achievable for the client so that progress, however incremental, is possible
Monitoring progress and
outcomes
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
definition of anatomy
the structures of the body
definition of physiology
the study of the functions of the bodily structures
Anterior v Posterior
front/back
ventral v dorsal
toward abdomen/ toward back
superior v inferior
toward top/ toward bottom
proximal v distal
toward the body/ away from the body
medial v lateral
toward the midline/ toward the side
The nervous system
The nervous system includes the central and peripheral
nervous systems
CNS
Brain Brainstem Cerebellum Cerebrum Spinal cord
PNS
Cranial nerves Spinal nerves The Brain and Language
brain stem
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.
cerebellum
is an oval shaped little brain that sits posterior to the brain stem. Its primarily responsible for regulating motor and muscular activity.
cerebrum(cerebral cortex)
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
four lobes
frontal, parietal, occipital, temporal
frontal lobe
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.
parietal lobe
Post central gyrus Somatosensory Area: perceiving and integrating sensory and perceptual information Comprehending oral and written language and mathematical calculations
temporal lobe
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
occipital
Processing visual
information
Gyri
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
spinal cord
Extends from brainstem Located within the spinal column Nerves of spinal cord synapse with the peripheral nervous system
Neuron
“Nerve
cells”
Brain contains 10 billion+ neurons
highly specialized cells that make up the nervous system and carry its sensory and motor information.
Efferent
away from the CNS Motor. Conveys impulses from higher to lower
afferent
toward the CNS. Sensory. Brings information to a higher structure
Cranial Nerves
S sensory information and motor movement in head and neck Important for vision, hearing, smell, and taste Emerge from brainstem 12 pairs
Spinal Nerves
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
3 things that protect the nervous system
bone, membranes, and cerebrospinal fluid
what is respiration
system of the human body that controls breathing
Upper Respiratory
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
Lower respiratory
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
Muscles of inspiration
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
muscles of expiration
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
Phonation
takes
the energy sent from the lungs and
modulates the airflow to convert the energy
into sound
Pharynx
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
Larynx
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
Laryngeal structures
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
M
ovement of
larynx and vocal folds
involves two sets of muscles
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 )
vocal folds
or vocal cords are two thin sheets of tissue connected on their outer edge to the inside of the thyroid cartilage
glottis
the space between the vocal folds
extrinsic laryngeal muscles
(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.
intrinsic laryngeal muscles
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
abduction of VF
separates VF’s
adduction of VF
brings them together
nasopharynx
is the posterior continuation of the nasal cavity
oropharynx
or throat, is the length of the pharynx that connects with the oral cavity
laryngopharynx
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
Speech Production Process
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
Articulatory System
Manipulates airflow and voice that was channeled through phonatory system Creates specific speech sounds Example Change “ahh” to “eeh” to “see”
Jaw
Mandible Houses the lower teeth Forms the floor of the mouth Maxilla Houses the upper teeth Forms the alveolar ridge and palatine process
Teeth
Major function is mastication (chewing) Involved in the production of dental speech sounds
Hard Palate
Roof of the mouth and floor
of the nose
Soft Palate
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
Tongue
Other major functions Taste moving food for chewing &swallowing
Lips
just help shape words
Outer ear
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
Middle Ear
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
Inner Ear
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
Cochlea
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
Swallowing
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
Oral Phase about 1 second
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
Pharyngeal Phase about 1 second
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
Esophageal Phase about 8-20 seconds
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
Dysphagia
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!
