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exam #3 Flashcards

1
Q
  • a group of neurologic speech disorders characterized by abnormalities in the strength, speed, range, steadiness, tone, or accuracy of the movements required for speech production
  • adversely affects speech intelligibility and communication effectiveness
A

dysarthria

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2
Q
  • two primary disorders: dysarthria and apraxia of speech
  • common etiologies include cerebral palsy, stroke, ALS, Huntington’s disease, Parkinson’s disease
  • these speech deficits can be caused by damage to the CNS or PNS
A

motor speech disorders

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3
Q
  • masked facial expression
  • resting tumors
  • reduced range of motion
  • rigidity
A

physical characteristics of hypokinetic dysarthria

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4
Q
  • increased or hyperactive muscle tone
  • often resulting from damage to the cerebral cortex (pyramidal system, CNS)
  • common causes:
    ALS, stroke, cerebral palsy or other conditions where brain damage occurs
A

spastic dysarthria

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5
Q
  • damage to the cerebellum (coordination issues)
  • common causes:
    lesions to the cerebellum (stroke, tumor), can also be seen in cerebral palsy
A

ataxic dysarthria

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6
Q
  • excessive loudness
  • transient vocal strain and/or breathiness
  • inappropriate vocal noises
  • fast speaking rate
  • sudden changes to pitch
  • irregular AMRs/SMRs
A

perceptual characteristics of hyperkinetic dysarthria

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7
Q

indirect activation pathway from brainstem to spinal cord
- responsible for maintaining overall posture, reflexes, and muscle tone
- involuntary muscle control

A

extrapyramidal tract

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8
Q

rate, rhythm, and stress patterns of speech

A

prosody subsystem

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9
Q

nasality of speech sounds

A

resonance subsystem

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10
Q
  • damage to the basal ganglia, which controls movement and the extrapyramidal tract
  • common causes:
    Parkinson’s disease
A

hypokinetic dysarthria

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11
Q

voice regulation

A

phonatory subsystem

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12
Q
  • symptoms most often begin in 30s or 40s
  • symptoms: muscle contractures, trouble walking and with posture, speech and swallowing difficulties
  • also common to have cognitive and mental health impairments
A

Huntington’s disease

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13
Q

swallowing disorders increase the risk of choking and may lead to ___,
one of the leading causes of death among the elderly

A

aspiration pneumonia

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14
Q
  • velum raises to prevent the bolus from entering the nasal cavity
  • base of the tongue touches the pharyngeal wall to create pressure and drive the bolus into the pharynx
  • pharyngeal muscles contract and squeeze the bolus down
  • hyoid bone rises, moving the larynx up and forward (epiglottis covers the airway and vocal folds close)
  • upper esophageal segment opens to allow the bolus to pass through
  • approx. 1 second
A

pharyngeal phase of swallowing

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15
Q

combined: pataka-pataka-pataka

A

sequential motion rate (SMRs)

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16
Q
  • tongue performs a cupping motion to hold fluid against the front portion of the hard palate
  • tongue lateralizes food to the teeth for chewing and mixes with saliva to form a solid bolus
A

oral prep phase of swallowing

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17
Q

breath support and control

A

respiratory subsystem

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18
Q
  • nasal-sounding speech
  • rapid deterioration of performance
  • short phrases
  • breathy voice
  • imprecise AMRs/SMRs
A

perceptual characteristics of flaccid dysarthria

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19
Q

damage to the cranial or spinal nerves in PNS

A

flaccid dysarthria

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20
Q
  • bolus enters the esophagus, just below the pharynx
  • peristalsis moves the bolus from the esophagus into the stomach (rhythmic, wavelike contractions)
  • 8-20 seconds
A

esophageal phase

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21
Q
  • rare, inherited condition passed down from a parent (50% chance)
  • characterized primarily by movements that can’t be controlled, called chorea - increase in dopamine
    involuntary movements affecting all muscles of the body, notably the arms, legs, tongue, and face
A

Huntington’s disease

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22
Q
  • cannot inhibit unwanted movements
  • motor tics
  • sudden, involuntary jerking
A

physical characteristics of hyperkinetic dysarthria

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23
Q
  • slow speaking rate
  • strained or harsh vocal quality
  • slow but regular AMRs/SMRs
A

perceptual characteristics of spastic dysarthria

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24
Q
  • tremors
  • poor coordination in jaw, face, tongue
A

physical characteristics of ataxic dysarthria

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25
Q
  • damage to the basal ganglia and extrapyramidal tract
  • common causes:
    Huntington’s disease
A

hyperkinetic dysarthria

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26
Q
  • monopitch
  • monoloudness
  • short rushes of speech
  • reduced loudness
  • rapid, “blurred” AMRs/SMRs
A

perceptual characteristics of hypokinetic dysarthria

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27
Q

two motor pathways of the central nervous system

A
  • pyramidal tract
  • extrapyramidal tract
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28
Q

symptoms include:
- trouble initiating speech
- distorting sounds
- groping for sounds
- inconsistent speech sound substitutions
(dog = mog, fog, dod, dock)
- errors in prosody and tone

A

apraxia of speech

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29
Q
  • impaired ability to plan or program the motor commands needed for speech production and motor movement
  • not related to muscle weakness
  • related to a deficiency in motor control
  • can exist on its own but often present with severe cases of non-fluent aphasia
  • can be present in childhood or acquired in adulthood from neurological damage
A

apraxia of speech

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30
Q

pa-pa-pa-pa-pa
ta-ta-ta-ta-ta
ka-ka-ka-ka-ka

A

alternating motion rate (AMRs)

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31
Q

a mass of food shaped into a form to be swallowed in one collective piece

A

bolus

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32
Q
  • ## flaccid-
    -
    -
    -
A

major types of dysarthria

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33
Q
  • chronic, progressive neurological condition that causes problems with voluntary movements
  • decreased dopamine production in the basal ganglia
  • second most common degenerative brain condition
A

Parkinson’s disease

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34
Q

five speech subsystems - one or more is affected in dysarthria

A
  • articulatory
  • respiratory
  • phonatory
  • prosody
  • resonance
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35
Q

common causes:
- cerebral palsy
- autism
- cleft lip/palate
- spinal cord injuries
- head & neck cancer
- neurological disorders: stroke, dementia,. ALS, Parkinson’s

A

dysphagia

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36
Q
  • weakness or muscle atrophy
  • flaccidity (hypotonia)
  • fasciculations
  • hypoactive gag reflex
A

physical characteristics of flaccid dysarthria

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37
Q
  • excess and equal stress
  • excessive loudness
  • “drunk” speech
  • irregular AMRs/SMRs
A

perceptual characteristics of ataxic dysarthria

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38
Q

production of speech sounds

A

articulatory subsystem

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39
Q
  • oral prep
  • oral transport
  • pharyngeal
  • esophageal
A

four phases of swallowing

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40
Q

one of the most common tasks a therapist will ask their patient to do

A

diadochokinetic rate

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41
Q

diagnosing type of dysarthria is based on a __ method of classification
relies on the auditorily __ attributes of speech that point to the underlying pathophysiology

A

perceptual

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42
Q
  • begins once the bolus is formed
  • bolus moves from the front to the back of the mouth (anterior-posterior propulsion)
  • pharyngeal swallow is automatically triggered when the bolus reaches the faucial pillars
  • 1-1.5 seconds
A

oral transport phase of swallowing

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43
Q
  • early signs: tremor, stiffness, slow movements
  • later signs: poor balance, speech, and swallowing difficulties, slow movements, poor gait, possible dementia
A

Parkinson’s disease

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44
Q

direct activation pathway from cerebral cortex to brainstem (pyramids of the medulla)
- responsible for rapid, discreet, intentional movements of the articulators
- voluntary muscle control

A

pyramidal tract

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45
Q
  • increased muscle tone (hypertonia)
  • hyperactive gag reflex
A

physical characteristics of spastic dysarthria

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46
Q
  • characterized by difficulty moving the muscles needed for speech production due to weakness or reduced coordination
  • brain or nerve damage changes the way muscles work
A

motor speech disorders

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47
Q
  • reduced lip seal (drooling: spillage/reduced oral containment)
  • reduced chewing (“mastication”)
    (poor bolus formation, piecemeal swallow)
  • reduced tongue strength or range of motion (poor bolus formation, poor anterior-posterior propulsion, pocketing - food remains in cheek)
  • sensory aversions
    (structures and capabilities may be relatively intact but sensitivity to textures limits number of food children eat)
A

disordered swallowing - oral phase

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48
Q
  • delayed swallow trigger (penetration, aspiration)
  • poor velopharyngeal port closure (food/liquid escapes through the nose)
  • reduced base of tongue to pharyngeal wall approximation (residue in the pharynx)
  • reduced hyolaryngeal elevation (epiglottis doesn’t protect airway opening)
  • reduced pharyngeal muscle strength (residue in the pharynx)
A

disordered swallowing - pharyngeal phase

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49
Q
  • reduced opening of the esophagus (residue in the pharynx; food/liquid may come back up - reflux)
  • slow peristalsis (slowing of movement of food from esophagus to stomach)
A

disordered swallowing - esophageal phase

50
Q
  • first evaluation typically occurs at bedside in the hospital
  • major components:
    1) case history & symptoms/patient complaints
    2) examination of the oral musculature
    3) trials of food/liquid
    for example, 3oz water test
  • water - puree food - soft food - hard food
  • water by spoon - by cup - by consecutive cup - by straw - by consecutive straw sip
A

evaluation of swallowing

51
Q
  • watery eyes
  • coughing
  • throat clearing
  • burping
  • wet vocal quality
  • fevers
  • changes in breathing
  • food “stuck in throat” feeling
A

signs of aspiration

52
Q

food/liquid enters the airway above the vocal folds

A

penetration

53
Q

food/liquid enters the airway below the vocal folds

A

aspiration

54
Q
  • patient can’t stay awake, coughs on every consistency
  • nothing by mouth
A

NPO patients

55
Q
  • used with pediatric and adult patients who are too ill to go to radiology for VFSS
  • SLP inserts a flexible fiberoptic laryngoscope through a patient’s nose and into the pharynx
  • patient swallows foods that have been dyed blue
  • can provide information about desirable posture, preferred food types, and aspiration
A

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

56
Q

two options for dysphagia management

A
  • rehabilitative therapy
  • compensatory techniques
57
Q

swallowing exercises
- lingual strengthening exercises
- effortful swallow = pharyngeal strength
- masako maneuver

A

rehabilitative therapy for dysphagia

58
Q
  • postures (chin tuck, head turn)
  • diet texture modifications (can select foods that are naturally in that “altered” state or can modify foods to mimic the desired state)
  • thickening liquids
A

compensatory techniques

59
Q
  • x-ray procedure
  • barium is coated onto or mixed into food and beverage
  • SLP determines the size, texture, consistency of food or beverage and head and body position
  • radiologist or x-ray technician uses equipment to observe the movement of barium during the swallow
  • determines whether the client should be fed orally or nonorally, what textures are safest, and the appropriate treatments
A

Videofluoroscopic Swallowing Study (VFSS)

60
Q
  • common to people of all ages and can impact quality of life
  • can negatively affect speech and language development, reading, educational achievement, job performance, social interactions, and psychological well-being
    can have a significant negative impact on family and friends
A

hearing loss

61
Q

__% (48 million) of Americans report some degree of hearing loss

A

20%

62
Q
  • profound hearing loss results in no access to speech sounds without amplification
  • all degrees of hearing loss interfere with ability to do well in school, academically, and socially
  • children with mild hearing loss have more difficulty in challenging listening environments
  • have to rely more on memory and attention abilities
  • greater risk for delays in phonological development
  • unilateral hearing loss results in difficulty localizing and hearing sound in noise
  • children with profound hearing loss do better when the loss is diagnosed and amplified early
A

hearing loss in children

63
Q

untreated hearing loss can result in:
- increased irritability and fatigue
- increased stress
- greater likelihood of becoming isolated
- increased risk of injury
- reduced earning power and less confidence in ability to perform job duties
- reduced self-esteem
- overall reduced psychological health

A

hearing loss in adults

64
Q

when a person’s hearing loss reaches __dB or greater, they are considered deaf
deaf individuals make up the __ community
- American Sign Language (ASL)
- positive identity
- view deafness with a sense of pride
- deaf culture has rich traditions, folklore, and contributions to the arts

A

90, Deaf

65
Q

the discipline involved in the prevention and assessment of auditory, vestibular, and related impairments

A

audiology

66
Q
  • counseling and educating
  • prescribing
  • fitting amplification devices
  • training (speech reading)
A

habilitation vs rehabilitation

67
Q

1) energy source
- air that has been exhaled from the lungs
2) vibrating object
- larynx; vocal folds
3) medium to conduct vibrations
- air to conduct
4) receptor to receive information
- ear & brain

A

fundamentals of sound - 4 major components

68
Q

the distance the vibrating object travels in either direction
- determines intensity/loudness (measured in dBs)

A

amplitude

69
Q

the number of cycles of vibration per second
- determines pitch (measured in Hz)

A

frequency

70
Q

consists of the:
- outer ear
- middle ear
- inner ear
- vestibulocochlear nerve
- auditory brain stem
- auditory cortex of the brain

A

auditory system

71
Q

outer ear, middle ear, inner ear, vestibulocochlear nerve

A

peripheral auditory system

72
Q

auditory brain stem, auditory cortex of the brain

A

central auditory system

73
Q

enhances sound and facilitates localization

A

pinna (outer ear)

74
Q
  • consists of the pinna and ear canal (external auditory meatus)
  • pinna enhances sound and facilitates localization
  • ear canal is an elliptical tube lined with skin that extends from the concha to the eardrum (tympanic membrane)
  • outer ear canal has hair follicles and glands that produce earwax (cerumen)
  • ear canal can enhance high frequency sounds
A

outer ear

75
Q
  • eardrum vibrates in response to sound waves
  • middle ear space is air-filled, lined with mucous membranes, and includes the opening to the Eustachian tube
  • the tube connects the middle ear with the nasopharynx
  • it is normally closed but opens to provide ventilation and equalize pressure
  • the malleus, incus, and stapes are the bones (ossicles) of the ossicular chain
A

middle ear

76
Q

two primary components of the inner ear

A
  • cochlea
  • vestibular system
77
Q
  • provides auditory input to central auditory system in brainstem and, eventually, the brain
  • contains nerve cells that respond to auditory stimuli
    two networks or labyrinths containing perilymph and endolymph
  • contains the organ of Corti, which produces nerve impulses
  • basilar membrane is the floor of the organ of Corti
    contains thousands of hair cells that connect to auditory nerve endings
  • hair cells convert sound waves into electrical signals
    related to the frequency of sounds
  • neuroelectrical energy is generated and transmitted to the acoustic branch of the vestibulocochlear nerve
A

cochlea

78
Q

outer, bony labyrinth

A

perilymph

79
Q

inner, membranous labyrinth
- regulate electrochemical impulses of hair cells

A

endolymph

80
Q

controls balance through the vestibular branch of the vestibulocochlear nerve (cranial nerve that leads to brainstem)

A

vestibular system

81
Q

1) sound wave travels through the air and down the ear canal
2) sound wave vibrates the eardrum
3) vibrations are carried across the ossicular chain to the stapes, at the entrance to the inner ear
4) fluid in the inner ear is displaced
5) chemical transmitters are released by the hair cells
6) neuroelectric energy is generated and transmitted to the vestibulocochlear nerve

A

how we hear - start to finish

82
Q

three types of hearing loss

A
  • conductive
  • sensorineural
  • mixed
83
Q

hearing loss in the outer and middle ear

A

conductive hearing loss

84
Q

inner ear (cochlea/auditory nerve)

A

sensorineural hearing loss

85
Q

both conductive & sensioneural hearing loss

A

mixed hearing loss

86
Q
  • normal hearing = 0-25 dB
  • mild impairment = 26-40 dB
  • moderate impairment = 41-55 dB
  • moderately severe = 56-70 dB
  • severe = 71-90dB
  • profound = ＞ 90dB
A

hearing thresholds

87
Q
  • results from deformation, malfunction, or obstruction of the outer or middle ear
  • usually prevents low to moderate intensity sounds from being heard at all and higher intensity sounds being perceived as softer
  • impacts audibility
  • can be temporary
A

conductive hearing loss

88
Q
  • anotia
  • microtia
  • atresia
A

disorders of the outer ear

89
Q

absence of the pinna on one or both sides

A

anotia

90
Q

small, malformed pinna that does not result in loss of hearing sensitivity by itself

A

microtia

91
Q

closure of the auditory canal

A

artresia

92
Q
  • otosclerosis
  • otitis media (most common)
A

disorders of the middle ear

93
Q
  • replacement of healthy bone with spongy bone in the area of the stapes footplate
  • results in reduced mobility of the stapes and hearing loss
A

otosclerosis

94
Q
  • inflammation of the mucous membrane lining the middle ear
  • generally results from Eustachian tube dysfunction
A

otitis media

95
Q
  • absence, malformation, or damage to structures of the inner ear
  • may be present at birth or develop over time
  • usually permanent
  • hearing loss is predominantly in the higher frequency range
  • audible sounds are perceived as being distorted
  • age of onset is congenital or acquired, or pre-language (before age 2) or post-language (after age 5)
A

sensorineural hearing loss

96
Q
  • degree of the loss
  • age of onset
  • age of the person when the loss was identified
  • age of the person when intervention was done
A

factors that influence the effects of the loss on speech, language, and cognition

97
Q
  • meningitis
  • ototoxic antibiotics
  • presbycusis
  • acoustic neuroma
  • noise-induced hearing loss
A

possible causes of sensorineural hearing loss

98
Q

loss of hair cells as a result of aging

A

presbycusis

99
Q

growth over cells near the auditory nerve

A

acoustic neuroma

100
Q

leading cause of loss among young and middle-aged adults

A

noise-induced hearing loss

101
Q
  • pure tones are sounds that contain energy at a single frequency
  • test a range of frequencies from 250-8000 Hz
  • determine a person’s threshold at each frequency in each ear
  • tone is presented for 1-2 seconds, and client is observed for a response (hand raise)
A

pure tone audiometry

102
Q

lowest intensity at which a person can detect a stimulus 50% of the time

A

threshold

103
Q
  • expressed in decibels (dB)
  • the greater the dB value required to reach a person’s threshold, the greater the hearing loss
  • range of normal is different for children and adults
A

degree of hearing loss

104
Q

hearing loss falls in the slight/mild-severe range

A

hard of hearing/hearing impaired

105
Q

auditory thresholds fall in the profound range

A

deaf

106
Q

administered while the client wears headphones

A

air conduction testing

107
Q

administered with a bone oscillator directly stimulating the cochlea

A

bone conduction testing

108
Q
  • every hearing aid contains a microphone, amplifier receiver, and some type of computer processor
  • signal can be manipulated to improve audibility while maintaining comfort, reducing unwanted background noise and eliminating feedback
  • primary goal is to make speech audible to improve intelligibility
  • will not return hearing to normal
A

amplification via hearing aids (conduction loss)

109
Q
  • a prosthesis designed to bypass the damaged hair cells of the cochlea and directly stimulate the auditory nerve fibers with electrical energy
  • contains externally worn and internally implanted components
A

treatment using cochlear implants (sensorineural loss)

110
Q
  • includes all forms of communication other than oral speech
  • includes both low-tech (picture boards, yes/no cards) and high-tech (speech-generating devices) options
  • often involves gestures, facial expressions, symbols, and pictures
  • may enhance speech or be the primary form of communication
A

augmentative & alternative communication (AAC)

111
Q
  • ALS
  • ASD
  • aphasia
  • cerebral palsy
  • severe developmental and/or intellectual disabilities
A

examples of diagnoses of individuals who use AAC

112
Q
  • an umbrella term for any technology, device, or equipment designed to enhance the functional capabilities of individuals with disabilities
  • broad in scope, __ supports various areas of life, including mobility, education, hearing, vision, daily living, and communication
A

assistive technology (AT)

113
Q
  • does not use external equipment
  • use of gestures, body movements, or observable signals with a partner (ex: sign language)
  • not appropriate for all users
A

unaided AAC

114
Q
  • includes some type of equipment or device
  • wide range of sophistication (no tech, low tech, mid tech, high tech)
A

aided AAC

115
Q
  • does not involve technology
  • use readily available materials
  • paper & pencil for writing
  • alphabet board
  • Picture Exchange Communication System (PECS)
A

no-tech AAC

116
Q
  • simple to use technology
  • limited number of pragmatic functions
  • few moving parts or electrical components (BIGmack, Quicktalker 1)
A

low-tech AAC

117
Q
  • have some amount of electrical power
  • have speech generation capabilities but limited programming or customization options (Go Talk 20+)
A

mid-tech AAC

118
Q
  • most complex and sophisticated electronic devices
  • requires training to operate programmatic features
  • often uses word prediction software to improve communication efficiency (iPads, Tobii Dynavox)
  • systems will only continue to advance
A

high-tech AAC

119
Q

characteristics/abilities a therapist would need to consider before selecting an AAC method

A
  • age
  • cognitive abilities
  • physical mobility
  • literacy skills
  • cost
  • career/personal life circumstances
120
Q

T/F: not all patients need to be cognitively intact to use AAC

A

true

121
Q

keep in mind when assessing AAC

A
  • establish a positive AAC culture
  • use everyday experiences as teaching context
  • individualize the content
  • teach partners to modify their interaction style
  • consider positioning for those with motor impairments
  • use meaningful interactions

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