Diagnostics Flashcards
including speech and language, articulation and phonology, language and cognition, fluency and stuttering, voice and resonance, motor speech, neurogenic disorders, dysphagia and swallowing, etiologies, and functional vs. organic
types of diagnostics
- articulation and phonology
- language and cognition
- fluency and stuttering
- voice and resonance
- motor speech
- neurogenic disorders
- dysphagia and swallowing disorders
case history
medical and personal background history used to analyze and diagnose diseases, disorders, etc.
case history: what do we want to know?
- onset and development
- medical history
- family history
- speech-language disorders and concerns
- educational and social history
- prior level of function
- signs and symptoms
case history: onset and development
- age of onset
- other conditions during onset
- length since onset
- variations since onset
- awareness and reactions of onset
case history: medical history
- history of hospitalizations
- history of surgeries
- medication list
- vision, hearing, and motor abilities
case history: family history
blood relatives history of any related SLP conditions
case history: speech-language disorders and concerns
- previous speech/language therapy and outcomes
- reason for SLP referral
case history: educational and social history
- highest level of education
- job and/or hobbies
- primary, secondary languages spoken
case history: prior level of function
- if new (e.g., acute CVA) or not new onset
- changes in function from baseline
- who patient lives with ADLs, daily communication needs, etc.
case history: identify signs and symptoms such as…
- difficulty chewing and/or swallowing
- difficulty expressing self and/or understanding language
- problems with memory and/or problem solving/reasoning
- problems with attention and/or concentration
- problems with reading and/or writing
- difficulty with word retrieval and word finding
- difficulty with topic maintenance and following directions
articulation and phonology
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
articulation and phonology: formal assessments
- standardized
- Goldman-Fristoe Test of Articulation (GFTA-3)
- Khan-Lewis Phonological Analysis (KLPA)
articulation and phonology: informal assessments
- identify strengths and weaknesses
- speech-language sample
- evaluate etiology of articulation and phonological disorders
articulation and phonology: speech-language sample
- phonetic inventory
- speech intelligibility
- rate and prosody
- number, type, and consistency of errors (classify based on most appropriate system)
phonetic inventory
- explain which position/s sound was seen during testing
- assess and identify stimulable sounds
speech intelligibility
24 months: 50%
36 months: 75%
48 months: 100%
articulation and phonology: number, type, and consistency of errors
- traditional SODA errors
- features
- phonological processes
speech-language sample: traditional SODA errors
- substitutions
- omissions
- distortions
- additions
speech-language sample: features
- voice
- place
- manner
speech-language sample: phonological processes
- typical vs. atypical
- typical vs. typical but no longer age-appropriate
evaluate etiology of articulation and phonological disorders
- organic/known physical cause: cleft lip/palate, cerebral palsy
- functional/no known physical cause
- unknown etiology
language and cognition
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
language and cognition: formal assessment
expressive and receptive formal assessments
language and cognition: informal cognitive assessment
- Piaget’s stages of cognitive development
- effective communicator profiles
language and cognition: informal language assessment
will depend based on communication level
prelingual/nonverbal communication level: expressive language
- communication attempts
- frequency and type of gestures
- phonetic inventory
- stimulability
prelingual/nonverbal communication level: receptive language
- nonverbal responses to verbal stim
- attention to speech/orientation
- early pragmatic development
- pointing to objects when asked
single-word user communication level: expressive language
- grammatical morphemes and MLU
- naming of familiar objects
- use of syntactic devices
- simple pragmatics
single-word user communication level: receptive language
- comprehension of words
- simple phrases
- 1 vs. 2-step commands
multi-word user communication level: expressive language
- advanced grammatical morphemes
- semantic relations
- syntactic structures
- advanced pragmatics
multi-word user communication level: receptive language
- response to 1, 2, or multi-step commands and/or directions
- comprehension and understanding of conversational speech
language and cognition: speech and language sampling
- analyze sample
- calculate mean length of utterance (MLU)
- calculate rate of speech (count number of words per minute)
speech and language sampling: analyze sample
- number, types, and consistency or errors
- correct sound production
- intelligibility
- speech rate
- prosody
- language errors
- atypical patterns
speech and language sampling: calculate mean length of utterance (MLU)
- number of morphemes/number of utterances = MLU
- Brown’s morphological markers
speech and language sampling: calculate rate of speech
- count number of words per minute
- average adult: ~270 WPM
- average 1st grader: ~125 WPM
speech and language sampling
provides and diagnostic information and guides treatment plan
articulation and phonology: analyze the sample
- articulation errors and distortions
- rate of speech
language and cognition: analyze the sample
- language errors and patterns of errors
- speech intelligibility
expressive language: elicit morphology, semantics, and syntax by asking the child to…
- point to more than 1 of an objects (plurals)
- follow oral directions (varying number of steps)
- verbalize/gesture serial tasks (e.g., counting)
- name objects, pictures, etc.
expressive language: elicit semantics/syntax by asking the child to…
identify spatial concepts (e.g., over/under)
receptive language: elicit morphology, semantics, and syntax by asking the child to…
- describe pictures
- describe and tell stories
- describe objects by features or relationships
- explain sequence of events for daily tasks
- role play scenarios
- describe solutions to problems or situations
kindergarten-1st grade: elicit language sample in conversational language user…
delve deeper into language pyramid
- phonology, morphology, semantics, syntax in expressive and receptive language
- analysis used for younger children still applies except for MLU (not valid after age 5)
- C-unit analysis
- T-unit analysis
C-unit analysis
conversational analysis for school aged
T-unit analysis
monologue analysis for school aged
older children: elicit language sample in conversational language user…
analyze more global measures
- receptive/general comprehension (listening and reading), expressive (pragmatics)
- evaluation of pragmatics
- evaluation of narratives
evaluation of pragmatics
- appropriate attention and prosody
- topic initiation and maintenance
- conversational repairs and turn taking
evaluation of narratives
personal narratives, retelling stories, appropriate sequencing and details, etc.
fluency and stuttering
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
fluency: formal assessment
- severity scale: assess degree of impairment
- covert scale: assess degree of emotional component
- the Overall Assessment of the Speaker’s Experience of Stuttering (OASES)
informal assessment for fluency
assessment of typical disfluencies vs. fluency disorder
2 main types of fluency disorders
- stuttering
- cluttering
stuttering
- irregular repetitions, prolongations, blocks, secondary behaviors
- individual is usually aware
cluttering
- rapid/regular rate of speech, abnormal disfluencies, reduced intelligibility
- individual is usually unaware
assessment of young child (2-6 years old): purpose
to determine if the child will need speech-language treatment
- identify normal vs. abnormal fluencies
- identify likelihood of recovery without therapy
assessment of young child (2-6 years old): comprehensive assessment
case history, speech sample, observation, and other speech-language comorbidities
assessment of young child (2-6 years old): speech and language sample
- type/frequency of disfluencies
- duration of disfluencies
- rhythm and rate of speech
- secondary behaviors
- parent interactions and reactions
- awareness to stuttering/disfluencies
older child/adult (7+ years old): purpose
to gather comprehensive information (i.e., nature/impact) of the disorder
- identify readiness
- identify desire for therapy
older child/adult (7+ years old): comprehensive assessment
case history, speech sample, observation, and other speech-language comorbidities
older child/adult (7+ years old): speech and language sample
- type/frequency of disfluencies
- duration of disfluencies
- rhythm and rate of speech
- overt features (core vs. secondary)
- core behaviors (involuntary)
- secondary behaviors (voluntary)
voice and resonance
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
voice and resonance: informal assessment
- determine etiology
- analyze conversation
voice and resonance: determine etiology
team approach (refer to ENT for structure and SLP treats function)
- organic: problem with structure (e.g., cancer)
- neurogenic: innervation to structure impaired/damaged (e.g., vf paralysis)
- functional: non biological, behavioral/psychogenic (e.g., muscle tension)
voice and resonance: analyze conversation
- characteristics based on acoustic and perceptual factors
- pitch, loudness, quality
acoustic evaluation: pitch
- determine pitch
- fundamental frequency
perceptual evaluation: pitch
- mono pitch, restricted range
- excessive pitch variability
- diplophonia, pitch breaks
acoustic evaluation: loudness
measure intensity level
perceptual evaluation: loudness
- lack of voice, range of loudness
- inappropriate (soft/loud/monotone)
- phonation breaks
acoustic evaluation: quality
- jitter (frequency)
- shimmer (amplitude)
- s/z ratio
perceptual evaluation: quality
- breathy
- harsh
- hoarse
acoustic and perceptual evaluation: resonance
- hypernasal
- nasal emission
- hyponasal
hypernasal
too much air going through nasal cavity
nasal emission
look for pressure consonants
hyponasal
not enough air going through (i.e., sounds like a cold)
acoustic and perceptual evaluation: respiration
- type of breathing patterns
- stridor
- number of words per minute (6 or less may indicate a problem)
- maximum phonation time
- rate
respiration: type of breathing patterns
diaphragmatic, clavicular
respiration: stridor
vf paralysis may be present
respiration: maximum phonation time
sustained vowel
respiration: rate
words per minute, perceptual judgement of rate
motor speech
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
motor speech: OFSME
- movement and strength: cranial nerve (CN) function
- diadochokinesis
motor speech OFSME: movement and strength
distinguish between different dysarthria types
motor speech OFSME: diadochokinesis
- distinguish between different dysarthria types
- differential diagnosis of dysarthria vs. apraxia of speech
motor speech: informal assessment
- motor speech assessment
- reading passage and speech sample (assess articulation error types)
- informal assessments of voice and resonance
- repetition tasks
- cognition
- motor
2 types of motor speech disorders
- dysarthria
- apraxia of speech (AOS)
informal assessments of voice and resonance
perceptual judgement
motor speech: repetition tasks
- dysarthria: will always struggle with repetition tasks
- apraxia: will struggle with repetition as complexity increases
motor speech: cognition
- orientation
- planning and problem solving
- memory
motor speech: motor
- repetition: simple vs. complex, mono- vs. poly-syllabic
- reading
- conversational level
dysarthria: articulation error types
- distortions
- consistent errors
apraxia of speech: articulation error types
- substitutions, omissions, additions
- inconsistent errors
neurogenic disorders
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
neurogenic disorders: OFSME
especially important for differential diagnosis of neurogenic disorders
neurogenic disorders: informal assessments
- language sample
- cognition
- receptive language
- expressive language
neurogenic disorders: language sample
- analyze for contextual accuracy
- topic maintenance
- length of utterance
- syntactic variety
- word finding
- fluency
neurogenic disorders: cognition
- orientation
- memory
- reasoning
- story telling
- verbal explanations
- perception
neurogenic disorders: receptive language
comprehension and reading
neurogenic disorders: expressive language
verbal output and writing
aphasia
- language disorder
- deficits in expressive and receptive language
dysarthria
- speech execution disorder
- muscle weakness, slowness, and/or reduced coordination
apraxia
- motor planning and programming disorder
- inconsistent speech errors, normal speech musculature
cognitive communication
- disorder of cognitive systems, impacts communication
- cognitive deficits (e.g., attention) impacts communication
dysphagia and swallowing disorders
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
dysphagia and swallowing disorders: OFSME
imperative information
- lips, tongue, mandible, velopharyngeal movement
- ROM, strength, sensation of tongue/lips, oral cavity
dysphagia and swallowing disorders: formal assessment
- Modified Barium Swallow Study (MBSS)
- Flexible Endoscopic Evaluation of Swallowing (FEES)
dysphagia and swallowing disorders: informal assessment
bedside examination
dysphagia and swallowing disorders: bedside examination
- patient complaints
- evaluate cognitive status
- evaluate respiratory status
- evaluate dry swallow
- food and/or liquid trials
bedside examination: patient complaints
difficulty/pain when swallowing, difficulty chewing, etc.
bedside examination: evaluate cognitive status
alertness, orientation, ability to follow directions
bedside examination: evaluate respiratory status
- if present tracheostomy and/or respiratory distress
- shallow, gurgly, and/or wet quality breathing
- rapid breathing
- ability to hold breath
- oxygen saturation level (ask nursing/MD for patient specific norms)
bedside examination: evaluate dry swallow
hyoloaryngeal elevation (HLE)
bedside examination: food and/or liquid trials
- reposition to 90 degrees or as upright as patient can tolerate
- know current diet orders (textures/consistency) and feeding method
- identify signs/symptoms of aspiration and/or penetration (overt): coughing, wet vocal quality, poor HLE, frequent throat clearing, shortness of breath, expelling food, pocketing/food remaining on tongue after swallow, etc.)
- identify need for instrumental assessment (i.e., MBSS, FEES)
potential etiologies for speech, language, and swallowing disorders
- prenatal and neonatal
- hearing loss
- developmental disorder or disability
- psychiatric disorders
- genetic disorders
- physical impairment
- vocal abuse and misuse
prenatal and neonatal
- before or during birth
- e.g., premature
hearing loss
- may contribute to speech and/or language deficits
- e.g., chronic ear infections
developmental disorder or disability
- chronic long-term disabilities
- e.g., Autism Spectrum Disorder
psychiatric disorders
- related to psychosis or some psych event
- e.g., Schizophrenia
genetic disorders
- occurs as a result of a DNA abnormality
- e.g., Fragile X Syndrome
neurological disease
- disease of central and peripheral nervous system
- e.g., Alzheimer’s disease, Traumatic Brain Injury
physical impairment
- physical impairments related to speech
- e.g., cleft lip/palate
vocal abuse and misuse
- prolonged abuse/misuse of voice
- e.g., rough, breathy, etc.
functional
unknown cause
organic
known underlying cause
types of functional etiologies
- mislearning
- articulation
- phonology
types of organic etiologies
- structural
- sensory
- motor
functional: mislearning
- mislearning of specific sounds
- mislearning of whole class of sounds
functional: articulation
- motor aspects
- errors in production of specific speech sounds (e.g., distortions, omissions, etc.)
functional: phonology
- linguistic aspects
- consistent, rule-based errors in place of multiple speech sounds (e.g., stopping, final consonant deletion, etc.)
organic: structural
- structural etiology (e.g., cleft palate)
- obligatory errors: correct placement, abnormal structures
- compensatory errors: incorrect placement compensates for structure
organic: sensory
- traditional errors: typically distortions and omissions
- may use amplification for speech therapy
- phonemic and phonetic treatments may be used
organic: motor
apraxia of speech:
- deficit in motor planning/programming
- hallmark signs: inconsistent and prosody errors, groping
dysarthria:
- deficit in motor execution, may impact all speech systems
- respiration, phonation, resonation, articulation
