Lecture 1 - Overview Flashcards
Dementia Definition
A gradual deterioration of previously intact cognitive functions secondary to diffuse brain diseases.
An acquired persistent impairment of intellectual functions with compromise in at least 3 of the following areas of mental activity: memory, language, visuospatial functioning, emotion or personality, and cognition.
Aphasia Definition
An acquired disorder of language processing secondary to brain damage
Common clinical characteristics of aphasia are:
reduced comprehension, limited auditory span, impaired word finding, impaired language formulation, speech problems, and disorders of reading and writing.
Not included:
developmental/cognitive disorders and thought/mental illness problems
Motor Planning
Mapping of linguistic units into phonology incorporating strength, speed, range, direction, and muscular.
Apraxia
A disorder in the voluntary execution of learned movements not caused by paralysis, incoordination, sensory deficits, or a lack of understanding of the desired movement
An inability to carry out skilled motor acts on command, when it can be demonstrated that they person understands the command and can perform the same motor act in a different context
Volitional action
No SM involvement
Apraxia of Speech
Impair articulatory capacity
AoS distinguishes from the movement disorders represented by the dysarthria as well as speech disorders associated with aphasia. The clinical manifestation of AoS are believed to reflect a disturbance in the planning and programming of movements of speech.
Motor Externalization - Execution of communicative content
Respiration Phonation Articulation Prosody Resonance
Dysarthria - Definition
A collective name for a group of neurogenic speech disorders resulting from abnormalities in strength, speed, range, steadiness, tone or accuracy of movements required for breathing, phonatory respiratory, articulatory or prosodic aspects of speech production.
The responsible pathophysiology disturbances are due to the CNS/PNS abnormalities…
Dysarthria - Implications
Dysarthria is:
-Neurogenic
-Movement control
-Auditory perceptual characteristics
- Different underlying pathophysiologies
- Dysarthria types differ with lesion localization
- Exclusion of normal speech variations
age
gender
style specificDysarthria - Characteristics
Age of Onset
- Congenital
- Acquired
Natural Course
- Developmental to stable
- Recovering
- Stable
- Degenerative
- Exacerbating-remitting
Etiologies
- TBI
- CVA
- Infectious
- Neoplastic (tumor)
- Metabolic
- Neurological conditions
- CP
- Parkinson’s
- MS
- ALS
- Communicative Disturbances
Dysarthria - Perceptual Characteristics
Pitch characteristics Loudness Voice Quality Respiration Prosody Articulation Overall Intelligibility
Exclusion from Dysarthria
Developmental Speech Disorders - Dyslalia (articulator abnormality) - Palilalia (rapid word and phrase repetitions) Musculoskeletal defects (clefts) Stuttering Voice change at puberty Psychogenic aphonia Malocclusion Foreign and regional accents
Dyslalia
Articulator abnormality
Palilalia
Rapid word and phrase repetitions
Motor Speech Processes
Respiration Phonation Articulation Resonance Prosody Motor Symptoms - Weakness - Imprecise action - Slowness - Incoordination
Musculoskeletal Valves
Abdominal, diaphragm, & chest muscles Laryngeal structures Pharynx & posterior tongue Lower Palato-pharynx Muscles of tongue Mandible muscles Facial muscles
Articulatory Complexity
There are: 100 controlled muscles 100 motor units 14 phonemes a second 100x100x14 = 140,000 neuromotor events
Dysarthria - Medical View
Medical View
- disease model
- disruption of normal processes
- signs and symptoms
- severity comparable to
disease stages
- diagnosis
- history, neuro exam, imaging,
lab testsDysarthria - SLP View
SLP View
- Functional impairment
- Differential diagnosis
- For understanding syndromes
- Consistency with proposed syndrome
- Monitoring the disease process
- Life quality
Methods of Studying MotorSpeechDisorders
Perceptual Methods
- Auditory attributes
- Gold standard (for clinical differential diagnosis)
Instrumental - Acoustic Methods
- confirmation of observed perception
Physiological Methods
- Movements and articulation
- Relationship of pathophysiology with acoustic and perceptual aspects
International Classification of Impairments, Disabilities, and Handicaps (WHO, 1980)
A standard terminology for describing human functioning and disability
Limitation:
Medical consequences - consequences of diseases were predictable and unidirectional, using a medical vs. social orientation toward disability “handicap”
International Classification of Impairments, Disabilities, and Handicaps - Impairment
Impairment:
Structural/functional abnormality
Dysarthria - dysfunctional speech
- deviance of speech motor
processes due to altered
strength motion rate,
precision, and incoordination
International Classification of Impairments, Disabilities, and Handicaps - Disability
- Effect on skills/abilities
- Any lack of ability to perform an activity in the manner considered normal for a human being
Dysarthria - reduced speech intelligibility and abnormal prosodic patterns
International Classification of Impairments, Disabilities, and Handicaps - Handicap
Effect on the functional performance or activity that involves the whole person.
Dysarthria - a disadvantage for a given to fulfill the role that is normal for that individual
Cultural factors, society attitudes, and the environments
- what may be a disability in one person may be a handicap in others
International Classification of Impairments, Disabilities, and Health (WHO, 2001)
Provide a standard language and framework for the description of functioning and health
Shift from the disease model
Goal is the enhancement of person’s functional capacity through the modification of the environments and structural behaviors
International Classification of Impairments, Disabilities, and Health (WHO, 2001) - Two Components
Health Conditions
- Body Functions and Structures
- Anatomy and physiology of
the human body. Ex.
craniofacial anomaly and
language impairments
- Activity and Participation
- Activity refers to the
execution of a task or action.
Participation is the involvment
in a life situation. Ex.
difficulties with swallowing
safely for independent
feeding and accessing the
general education and social
curriculum.
Contextual Factors
- Environmental Factors
- make up the physical, social,
and attitudinal environments.
Ex. the impact of
environments on individuals'
ability to safely maintain
nutrition and communication.
- Personal Factors
- Internal influences on an individual's functioning and disability and are not part of the health condition:
- Age, gender, ethnicity,
educational level, social
background, and
profession
- PF not coded in the ICF
because of a variability
among cultures, but
included because of
likelihood of impact on
functioning.
- Ex. a person's
background or culture
that influences the
reaction to a
communication disorder.
Coding
The qualifiers - restriction level
0: within normal limits
1: mild deficit
2: moderate deficit
3: severe
4: complete loss
ICF - Prevention
Primary prevention
- preventing the onset of impairments
Secondary Prevention
- Preventing impairment from negative physical, psychological and social consequences
ICF - Rehabilitation
Teaching goal - oriented skills to reach an optimum functioning level
Providing with tools to change the life by compensating for a loss of function
Counseling to facilitate social adjustment.
Oriented skills to reach an optimum mental, physical, and/or level of functioning.
ICF - Equalization of Opportunity
Accessibility of Social Opportunities:
- Cultural environment
- Housing
- Transportation
- Social and health services
- Educational and word opportunities
- Social activities
- Recreational facilities
Functional Communication
Standardized test batteries:
- info. about impairments
- no info about active restriction or participation limitation
The ICF
- Assessment of functional communication
- Functional Assessment of Communication Skills for Adults
Mayo Study of Speech Deviance
Neurological approach Perceptual Approach - auditory attributes of speech - gold standard for clinical identification - subjectivity of judgment
Tremor
4-6 Hz vocal fluctuation
Flutter
10-12 Hz vocal fluctuation
Wow
1-3 Hz vocal fluctuation
Falsetto
Higher than normal pitch range
Vocal Fry
Lower than normal pitch range
