Lecture 7-10 Flashcards
What is aphasia?
a language disability which occurs some time after an individual has completely developed competent language skills
How does aphasia present itself?
from neurological damage to the language-dominant hemisphere (major hemisphere), usually the left
What includes disturbances of receptive and/or expressive skills, verbally or in written language (and in sign language)
aphasia
What are the three causes of aphasia?
degenerative diseases, TBI (traumatic brain injury(, and
CVAs (cerebrovascular accidents)
What are the two types of ischemic strokes in cerebrovascular accidents/heart attacks?
thrombosis and embolism
What are blood vessel ruptures and blood pools in the cranial cavity referred to as?
hemorrhagic strokes (usually of the middle cerebral artery)
What are dementias such as Alzheimer’s, MIDs, and PIck’s disease examles of?
degenerative diseases
What are MVAs and tumors examples of?
traumatic brain injury
Language disability is often accompanied by other cognitive challenges e.g., judgment issues, more generalized memory difficulties, in
traumatic brain injuries
What is a missing uncontrollable factor for CVAs?
- age (most strokes occur after age 65)
- gender
- ethnic group
- family history
- prior stroke
What is a missing controllable factor for CVAs?
- hypertension
- high cholesterol/heart disease
- diabetes
- smoking
- alcohol use
- oral contraceptives
- lack of exercise
- obesity
What is the missing syndrome for fluent aphasias?
- transcortical sensory aphasia
- conduction aphasia
Wernicke’s aphasia
What is the missing syndrome for non-fluent aphasias?
- transcortical motor aphasia
- global aphasia
Broca’s aphasia
What is the missing syndrome for anomic aphasia?
- all other syndromes tend to resolve to anomic aphasia
primary feature is dysnomia
Where are non-fluent aphasias associated with?
areas in the frontal cortex, Broca’s area
Where are fluent aphasias associated with?
areas in the posterior cortices, closer to Wernicke’s area
Where is Transcortical Sensory Aphasia affected?
parietal lobe and occipital lobe
Where is Anomic Aphasia impacted?
parietal lobe
Where is Conduction Aphasia immpacted?
temporal lobe
Where is Global Aphasia impacted?
anterior temporal lobe (close to Broca’s area)
Where is Broca’s aphasia impacted?
frontal lobe (Broca’s area)
Where is Transcortical motor aphasia impacted?
frontal lobe
Where is Wernicke’s aphasia impacted?
temporal lobe (posterior portion of left hemisphere)
What is Wernicke’s aphasia associated with?
fluent, meaningless speech and jargon; dysnomia
What is Transcortical sensory aphasia associated with?
fluent, meaningless speech and jargon, pharaphasias, and dysnomia with GOOD repetition
What is conduction aphasia associated with?
fluent, dysnomia, and POOR repetition and reading
Is comprehension good with Wernicke’s aphasia?
no
Is transcortical sensory aphasia associated with good comprehension?
no
Is good comprehension associated with conduction aphasia?
fairly; more able to correct errors than Wernicke’s
What is nonfluent, telegrammatic speech, imp;aired prosody and verbal dyspraxia associated with?
Broca’s aphasia
What is nonfluent, difficulty initiating speech, paraphasias, short utterances, and good repetition associated with?
Transcortical motor aphasia
What is nonfluent, delayed/no speech initation, naming and word finding problems associated with?
global aphasia
Is Broca’s aphasia associated with good comprehension?
yes, fairly
Is transcortical motor aphasia associated with good comprehension?
yes
Is global aphasia associated with good comprehension?
nope
What is the most common feature associated with all kinds of aphasia?
anomia
What is the most pronounced symptom of aphasia?
anomic aphasia
What are isolated lesions in the posterior temporal region of the brain (but also associated with other sites)?
anomic aphasia
Many of the other syndromes evolve through recovery into what?
anomic aphasia
What are the missing common language symptoms in nonfluent aphasias? dysnomia telegrammatic speech difficulty with repetition perseveration dyspraxia dysarthrias
syntactic problems/agrammatism and initiation problems
What are the missing comon language symptoms in fluent aphasias? difficulty with comprehension paraphasia (phonemic or semantic) jargon dysnomia difficulty with repetition perseveration
neologisms
dysarthrias
What is the missing speech production difficulty?
dysarthrias
verbal dyspraxia, and?
stuttering
What are apraxia of speech/verbal dyspraxia and acquired dysarthria associated with?
oral-motor speech disabilities
Impairement in motor programming and planning speech movements such as struggle behaviours and speech sound sequencing challenges are associated with
apraxia of speech/verbal dyspraxia
What is a.k.a apraxia of speech?
verbal dyspraxia
What is the other oral-motor speech disability for apraxia of speech, other than motor and planning issues?
there aren’t…there are little to no feeding difficulties
What oral-motor speech disability is associated with feeding difficulties?
acquired dysarthria
What is disturbed in some form of neurological insult (damage in motor neurons, subcortical regions or into the muscle) e.g., CVA, trauma?
disturbance in neuromuscular control of speech production
What is thought to be caused by lesion in cortical or highest cerebral regions?
verbal dyspraxia/apraxia of speech
What is Broca’s aphasia/primary motor projection fibres associated with?
lesion in cortical or highest cerebral regions, lower third frontal convolution
What may be accompanied by dyspraxia in other parts of the body, such as limb apraxia?
verbal apraxia
What may be the most frustrating of all speech disabiltiies?
verbal dyspraxia, because person knows the errors he or she is making, but can’t seem to help it
What are the primary symptoms of apraxia of speech?
struggle behaviours and sequencing errors
What is more severe of the dyspraxias?
oral dyspraxia - patient cannot produce voluntary movements of the articulators, although they may occur reflexively or when not focusing on producing that motor response
the presense of ___ dyspraxia means ___ dyspraxia will be present
oral
verbal
Patient can produce normal, voluntary movements of the articulators during non-speech tasks e.g., blowing, sticking out tongue, eating drinking in what syndrome?
VERBAL dyspraxia
What is associated with acquired dsysarthrias?
- muscle (flaccid dysarthria)
- extrapyramidal system/basal ganglia (athetosis chorea, dystonia, and tremor)
- cerebellar (ataxic dysarthria)
- lower motor neurone (bulbar palsy)
- upper motor neurone (spastic dysarthria)
Incidence and prevalence difficult to determine, with half of all strokes having ___ ____ ___, of which half have communication challenges
right hemisphere damage
Right hemisphere damage affects:
- attentional skills
- spatial/organinzational skills
- holistic/gestalt undersstanding of verbal/written language
- prosody
- abstract/idiomatic language
What other dementias are there?
- Alzheimer’s
- Parkinson’s
- Huntington’s
- MIDs (Multi-infarct dementias)
- Pick’s Disease
Incidence with dementias increases with what?
age
Dementias often only confirmed diagnosis after what?
autopsy
Additional features of dementias are associated with what?
aphasia
Additional features of dementias like aphasia are associated with:
- judgment problems
- cognitive impairment
- personality changes
- paranoia
What are othehr symptoms of brain damage:
- hemiparesis
- neglect of part of the body
- hemianopsia
- initiation problems
- perseveration
- …?
- attentional difficulties
What are other sypmtoms of brain damage?
- fatigue
- denial
- mobility challenges
- fine motor challenges
- depression
Assessment for brain damage occur :
bedside evaluation
more comprehensive assessment (deferred several days to a week)
swallowing/dysphaga. and?
addressing all communication domains
What are the concerns in assessing for brain damage related to addressing all communication domains?
- auditory/verbal
prosody
nonverbal communication
reading/writing
What are the stages of remediation?
Bedside work
Acute care intervention
Longterm care
Community support
Family involvement in remediation is important why?
communication is at least a two-way process
What else is associated with remediation?
verbal/written/aac
Who wrote Communication and communicagtion disabilities: a clinical introduction?
Plante and Beeson
What did tartter write?
Language processing in atypical populations
What is a good Canadian resource for stroke research?
Heart and Stroke Foundation
What is aphasia not associated with?
speech issues
What is aphasia likely due to?
stroke, concussion, Lou Gehrig’s Parkinson’s
what aphasia is associated with language issues?
neurological damage to the left-side of the brain
What are ischemic strokes associated with?
blockages
what could be a worse stroke of the ischemic?
embolism, since it is a blockage in the main carotid, whereas thrombosis refers to a blockage breaking off and then getting stuck higher up in the artery to the brain
What are hemorrhagic strokes?
blood ruptures
What are CVAs an issue for language loss?
L-CVA left hemispheric stroke, associated with right-side paralysis or weakness
what side is associated with right-side paralysis in a stroke?
the left-side
If language is damaged, then what else is an issue?
symbols, which means that sign language is too
What area does a stroke influence aphasia?
the perisylvian area
what artery ruptures and blood pools in the cranial cavity, causing aphasia?
the middle cerebral artery
what are other drawbacks of hemorrhagic strokes?
blood pools under the skull, causing pressure that needs release, let alone areas lose out on blood exchange
Is cognition always influenced by aphasia?
not always; it depends on the area/s
What are MIDs and why are they influential?
multi-infarct dementia caused by TIAs (transient ischemic attacks), with swelling that may damage the perisylvian area, but is more likely for the patient to have personality and executive functions issues
What are TIAs and why are they influential?
(transient ischemic attacks), with swelling that may damage the perisylvian area, but is more likely for the patient to have personality and executive functions issues
Why is gender not as much of a factor for CVAs now?
more women who are smoking
What about ethnicity is associated with CVAs?
non-Caucasians are less likely to have CVAs
What is hypertension?
high blood pressure
What type of Diabetes is worse for CVAs?
Type II, since it is more associated with with poor lifestyle choices
What area separates the aphasias in the brain?
the Rolandic fissure
What area of the brain is associated with non-fluent aphasia?
anterior of the Rolandic fissure
what area of the brain is associated with fluent aphasia?
posterior of the Rolandic fissure
Aphasia refers to disturbance of the:
a) ability to organize and voluntrily control the mottor commands of speech
b) muscular control of the speech mechanism that impairs speech
c0 ability to understand, retrieve, formulate, and use the poken and written language codes
d) ability to assign significance to spoken sounds and words
c) ability to understand, retrieve, formulate and use the spoken and written language codes
Nonfluent, telegrammatical speech with difficulties formulating grammatical sentences is associated with:
a) receptive aphasia
b) sensory aphasia
c) Wernicke’s aphasia
d) Broca’s aphasia
e) fluent aphasia
d) Broca’s aphasia
others were FLUENT aphasias
Thrombotic storkes are cause by
a) ruptures to blood vessels with bleeding
b) a build-up of plaque that blocks a blood vessels
c) arteriovenous malformations
d) aneurysms
b) a build-up of plaque that blocks a blood vessel
NOT ISCHEMIC STROKE
Symptoms that may co-occur in autism spectrum disabiltiies include:
a) anxiety
b) ADHD or ADD
c) depression
d) sensory difficulties
e) all of the above
e) all of the above
repetitive behaviour communication
The minor hemisphere is superior to the dominant hemisphere in managing a- melodic information b- spatial relationships c- holistic or gestalt inforamtion d - all of the above
d- all of the above
melodic info - music
spatial relationships - space
holistic or gestalt info - idiomatic; the gist of something
Nonfluent, telegrammatical speech with difficulties formulating grammatical sentences is associated with a-receptive aphasia b-sensory aphasia c- wernicke's aphasia d- Broca's aphasia e - fluent aphasia
Broca’s aphasia
Impairment of the ability to select, sequence, and carry out the voluntary movements for speech is called a- anomia b- flaccid dysarthria c- echolalia d- verbal dyspraxia
d - verbal dyspraxia
sequencing speech struggles assoc with dyspraxia
Agrammatism is a condition which is most often associated with a- Broca's aphasia b- conduction aphasia c- Wernicke's aphasia d- all of the above
a- Broca’s aphasia
fluent ones are conduction and Wernicke’s, whereas Broca’s is afluent
Neurological differences which have been implicated in autism spectrum disabilities include
a- excess dopamine
b- early overgrown of neurones followed by abnormally slowed growth
c- atypical associative connections between different areas of the brain
d- cerebellar deficits
e- all of the above
e all of the above
The “hidden curriculum” can be defined as
a- difficulty understanding the perspective of another person
b - a set of social rules which nobody teaches you but if you break them, you are not easily forgiven
c- the underlying meaning of any sentence
d - none of the above
b- a set of social rules which nobody teaches you but if you break them, you are not easily forgiven
The nonfluent aphasias are the result of lesions: a - in the temporal lobe b - in the parietal lobe c - in the occipital lobe d - in the frontal lobe
d - in the frontal lobe (Broca’s)
A problem in recalling names, places, or things is often called a- dyslexia b - dyspraxia c- dysnomia d- dysphasia
c - dysnomia (names)
Conduction aphasia is associated with damage to a- broca's area b- the arcuate fasciculus c- the thalamus d- the cerebellum
b - arcuate fasciculus
Difficulties with initiation of speech is most characteristic of a- Wernicke's aphasia b- conduction aphasia c- transcortical sensory aphasia d- transcortical motor aphasia
d- transcortical motor aphasia
The core characteristics of autism spectrum disabilities according to the DSM-5 are
a difficulties with social interaction
b - difficulties with restricted, repetitive behaviours
c - difficulties with anxiety
d - a and b
e - b and c
d - a and b
autism is associated with difficulties with social interactions, and restricted, repetitive behaviours
Depression associated with aphasia is more prevalent in patients with nonfluent aphasia
a - true
b - false
a - true
Broca’s/depression/frontal lobe/nonfluent aphasia
Wernicke’s aphasic patients have comprehension deficits and fluent output
true
nonverbal learning disability is asociated with an individual’s performance iq being significantly better than the verbal iq
false - it’s the opposite!
nonverbal learning disability is associated with an individual’s verbal iq being significantly better than the performance iq
Hyperlexia is associated with difficuties in comp;rehension of the written word even when the child is very young in acquiring the ability to decode text
true - can’t read, but doesn’t understand
Mindblindness is often seen in autism and is when the individual with asd cannot recognize the thoughts of his own mind and that of others
true
Hemianopsia is when one eye becomes blind
false - one visual field is affected
Individuals with autism frequently have difficulties with nonverbal communication skills such as personal space and eye contact
true
After a stroke, hemiparalysis occurs ont he opposite side of the body to the lesion in the brain
true - hemiparessi is a weakness in the OPPOSITE side
Children with asd always exhibit hyperlexia in their reading development
false - there are always exceptions
Chilldren diagnosed with asd typically exhibit difficulties with turn-taking and social/pragmatics aspects of language development
true
cva stands for cerebrovascular accident
true - a stroke
conduction aphasia is associated with difficultis in repetition of speech
true - can’t do feedback - broca’s and w don’t connect
broca’s aphasia is caused by a lesion in the frontal lobe of the minor hemisphere, specifically the third frontal convolution
false - broca’s is caused by a lesion in the frontal lobe of the MAJOR hemisphere, specifically the third frontal convolution
difficulty in learning pronouns is commonly associated with language difficulties in asd
true, particularly 1st and 2nd (I and you)
Only adults experience strokes
false
Name two professionals who may support clients following a stroke:
slp, physician, ot, pt, sw, c
_ aphasia occurs as a result of large lesions involving both the receptive and expressive language areas (both the motor and sensory cortex)
global aphasia - expressive (motor cortex_ and receptive (sensory)
Sensory differnces in individuals with ASD may include the tactile, _ or _ senses
visual, hearing
Following brain damage, continuing to do a particular behaviour (including verbal behaviour) when it is no longer appropriate is terms _
perseveration
e.g., mr tono - repeating word when trying to speak
When a blood vessel bursts and bleeds into the brain, this is termed a _ kind of stroke
hemorrhagic
Verbal dyspraxia is common in _ aphasia
broca’s - associated with verbal difficulties
Receptive language difficulties common in individuals with asd include attentional challenges, capacity limitations in auditory working memory and _ (just name one other possibility)
difficulties with “theory of mind”/mindblindness
In both motor and sensory transcortical aphasia, the defining symptom is preserved or good ability to _ words, phrases, or sentences
repeat - associated with difficulties with the arcuate fasciculus
A made-up word which bears NO semantic or phonemic relation to the target word and may be observed in fluent aphasias is called a
neologism (more assoc with Wernicke’s aphasia)
Speech production skills in individuals with asd may be normal but if there is an underlying oral-motor problem, it is most likely to be
developmental verbal dyspraxia
What type of language is associated with fluent aphasias?
receptive language
What type of language is associated with non fluent aphasias/
expressive language
What typically is last dealt with when aphasias are mostly resolved?
word retrieval, associated with anomic aphasia
What do most aphasias resolve to
anomic aphasia, with a primary feature as dysnomia
What isn't a fluent aphasia? Wernicke's aphasia transcortical motor aphasia transcortical sensory aphasia conduction aphasia
transcortical motor aphasia
What are the three fluent aphasias?
Wernicke’s, conduct, and transcortical SENSORY aphasia (receptive language)
What are the three non fluent aphasias?
Broca’s, transcortical MOTOR, and Global (expressive language)
What aphasia typically is closes to the Sylvian fissure?
Broca’s aphasia int he frontal lobe
What lobe is Wernicke’s aphasia in?
the temporal lobe
The further away the damage from Broca is, the more likely one is to be
a fluent speaker
The further away the damage from Wernicke’s area is, the greater likeliness for
language comprehension
Conduction aphasia si specific to the area of the
arcuate fasciculus
Transcortical sensory aphasia is found often in the occipital lobe and the
parietal lobe
Transcortical motor aphasia are generally found in the
frontal lobe
Global aphasias are typically found
everywhere, although more associated with nonfluent aphasias for some rason
When aphasia syndromes are considered nonfluent, what does that mean?
the individual may have effective comprehension, but is likely to not have effective speech fluency
When aphasia syndromes are considered fluent, what does that mean
the individual may be able to speak fluently, but likely doesn’t have effective comprehension
What areas are associted with issues with expression?
the frontal lobes
More motor-associated issues associated with fibres and prefrontal cortex in
nonfluent aphasias
Where does dysnomia found?
difficult to determine (anomic aphasia)
What are the types of pharaphasias?
- phonemic - sounds similar to a target word (e.g., church is spoken as g-ur-g)
- semantic - meaning is similar, but no phonemic similarity e.g., saying table but meaning chair
What syndrome is associated with paraphasias?
transcortical SENSORY aphasia
What lesion site is transcortical sensory aphasia associated with?
parieto-occipital region
What type of comprehension is associated with the syndrome, Wernicke’s?
very poor
What type of comprehension is associated with the syndrome, transcortical sensory?
poor
What type of comprehension is associated with the syndrome, conduction?
fair to good; more able to correct errors than Wernicke’s
What syndrome is associated with poor repetition and reading skills?
conduction (arcuate fasciculus)
What areas are associated with neologisms?
Wernicke’s and transcortical sensory aphasias (fluent)
What are defined as new, made up worlds that are less understandable generally, and refer more to the language’s phonology than semantics?
neologisms
e.g.,
What syndrome does this describe?
- very poor comprehension
- high fluency incl. grammatical function words (“where would I be”?)
- neologisms (“twangland”)
Wernicke’s (fluent) aphasia
What syndrome does this describe?
- decent repetition skills
- semantic paraphasia (“pen” is “a lined”; “matches” are “cigarette box”)
- anomic paraphasia (“fork” is “fillt”)
Wernicke’s (fluent) aphasia
What is defined as continuing something even when no longer appropriate, likely due to brain damage?
perseveration
What can one perseverate in?
speech and action
What syndrome does this describe?
- repeating “tono” when speaking
perseveration - Broca’s aphasia (likely)
What syndrome does Mr. Tono likely have?
understanding prosody, intonation, using gestures, counting to 10 when specifically counting fingers?
likely Broca’s
What syndrome is associated with:
- fluency, unless perseverating
jargon emerging similar to phonology
transcortical sensory aphasia (fluent)
What is associated with telegrammatic speech, nonfluency, impaired prosody, and verbal dyspraxia?
some Broca’s aphasia (understanding prosody makes it less extreme)
What is telegrammatic speech associated with?
grammatical function
What is associated with intonation?
transortical motor aphasia
What type of comprehension is associated with Broca’s area?
pretty good
What type of comprehension is associated with transcortical motor aphasia?
pretty good
What is the site of lesion for Broca’s aphasia?
frontal lobe (posterior inferior region of left hemisphere)
What nonfluent aphasia is associated with poor coprehension?
global
What is associated with widespread damage involving all of the perisylvian region?
global aphasia
What is associated with nonfluent, delayed/no speech, naming, and word finding problems?
Global aphasia
What type of syndrome was the patient requiring a communication board?
global aphasic
What is hemianopsia?
not being able to see in the right(or left) visual field of the eye
What syndrome is hemianopsia associated with?
Broca’s aphasia
What syndrome is associated with:
expressive language issues
not fluent; can read, repeat (no sequencing)
hemianopsia
weak right side
dysarthric, likely with feeding problems
doesn’t use grammatical words, only content words
Broca’s aphasia
What is hypernasal speech associated with?
glossopharyngeal nerve damage
What type of speech is the phrase, “He is, mmm, I coffee”?
telegrammatic speech/agrammatism
What syndrome is associated with agrammatism?
Broca’s aphasia
What type of syndrome is associated with:
disruption to expression, none to comprehension; speaking 3 or 4 woords, filler words, and many pauses
Broca’s aphasia
What does the phrase “mother and bai and b-ay and baby” suggest?
dysnomia
What does the phrase “para-pamedics” suggest?
dyspraxia
What is the most common feature associated with aphasias?
anomia/dysnomia
What is dysnomia also referred to as?
anomia
Isolated lesions in the _ _ region of the brain (but also associated with other sites) is associated with
anomia
Many of the other syndromes evolve through recovery into _ aphasia
anomia
What aphasia are patients more likely to have depression, and why?
nonfluent aphasic patients because they are likely aware of their speech errors, but yet are unable to fix them
What else does frontal lobe damage affect?
social, emotional regulation, etc
What syndrome is associated with: automatic words (Mon Tues Wed) and no speech issues (not dysarthria), but not able to find the right words in ordinary speech (not fluent)?
dysnomic/anomic aphasia
What is likely to occur in a patient with Broca’s aphasia after a year?
dysnomic/anomic aphasia
What type of stuttering is resistant to intervention?
neurogenic
What are the type types of oral-motor speech disabilities?
apraxia of speech/verbal dyspraxia
acquried dysathria
What type of oral-motor speech disability is likely to occur in the SLP clinic?
acquired dysarthria
What type of oral-motor speech disabilty is associated with impairment in motor programming and planning speech movements, as well as struggle behaviours and speech sound sequencing challenges?
apraxia of speech/verbal dyspraxia
What type of oral-motor speech disabilty is associated with disturbance in neuromuscular control of speech production acquried in some form of neurological insult/trauma?
acquired dysarthria
What is an example of a neurological insult?
a cerebrovascular accident, that creates damage in motor neurons, and subcortical regions or into the muscle
What may be accompanied by issues in other parts of the body (limbs particularly)?
dyspraxia, predicting limb apraxia
What is apraxia of speech a.k.a.?
verbal dyspraxia
What is thought to be caused by lesion in cortical or highest cerebral regions?
verbal dyspraxia/apraxia of speech
What is found in the lower third frontal convolution/primary motor projection fibres?
Broca’s area
What is likely the most frustrating of all speech disabilities?
verbal dyspraxia/apraxia of speech
What is associated with struggle behaviours, sequencing errors, and NO feeding difficulties?
verbal dyspraxia/apraxia of speech
What is more severe: verbal or oral dyspraxia?
oral - assoc with feeding problems
What is associated with a patient not being able to produce voluntary movements of the articulators, although they may occur reflexively or when not focusing on producing motor response
oral dyspraxia
What is associated with the presence of oral dyspraxia?
verbal dyspraxia
What is associated with verbal dyspraxia? DYSPRAXIA AT ALL
producing normal, voluntary movements of the articulators during NON-spech tasks e.g., eating; NOT ASSOCIATED WITH ORAL
What is associated with acquired dysarthria, according to the site of lesion?
muscle
flaccid dysarthria
What is associated with acquired dysarthria, according to the site of lesion?bulbar palsy
bulbar palsy
What is associated with acquired dysarthria, according to the site of lesion?upper motor neurone
spastic dysarthria
What is associated with acquired dysarthria, according to the site of lesion?extrapyramidal system/basal ganglia
athetosis, chorea, dystonia, tremor, and hyporeflexia
What is associated with acquired dysarthria, according to the site of lesion?cerebellar (intonation, patterning)
ataxic dysarthria
what syndrome is associated with a man with a weakened right-side of body, and struggling oral-motor issues
spastic dysarthria
What is associated with minimal muscle tone in jaw?
flaccid dysarthria
Incidence andprevalence difficult to determine (symptoms may be subtle - half of all strokes occur _, 1/2 of these have communication challenges
right hemisphere damage
What is associated with affecting suprasegmental aspects of language?
right hemisphere damage
What is a.k.a. suprasegmental aspects of language?
gestalt aspects of language
What is a missing suprasegmental aspect of language?
- attentional skills
- prosody
- spatial/organizational
- holistic/gestalt understand of verbal/written language
- music
- abstract/idiomatic language
What is the phrase “busy as a bee” an example of, and what is the likely site of lesion?
idiom, suprasegmental aspect of language, right hemisphere damage
What side is a CVA less likely to occur?
right side
What are MIDs?
multi-infarct dementias causes by multiple cvas
What is a missing type of dementia? Alzheimer's MIDs Pick's Disease Parkinson's
Huntington’s
What types of incidence increase with age?
dementia
What diagnosis often only occurs after autopsy?
dementias
What are additional features of dementia compared to aphasia?
judgment problems
cognitive impairment
paranoia
personality changes
What is neglect of part of the body?
losing awareness of one side of the body
What isi hemiparesis?
weakness on one side of the body (opposite of lesion)
what are initiation problems associated with?
nonfluent aphasias
What is hemiparalysis?
one side of body is immobilized
What area is associated with perseveration?
Wernicke’s
What are fine motor skills damage associated with?
swallowing issues, dysphagia and dyspraxia
What is key to assessing neurogenic difficulties?
monitoring progress
What types of evaluations occur with neurogenic difficulties assessments?
bedside evaluation
comprehensive assessment - deferred to likely a week after incident
assessing swallowing//dysphagia
addressing communication domains
What are the communication domains assessed with neurogenic difficulties?
auditory/verbal
reading/writing
prosody
nonverbal communication
What is associated with dysphagia?
larynx beingn able to move to avoid aspirative pneumonia
What x-ray machine do SLPs use in a gastrics lab?
video fluoroscopy (video fluoroscopic swallowing exam)
What is the advantage of a video fluoroscopic swallow exam?
uses a form of real-time x-ray to evaluate a patient’s ability to swallow safely and effectively
What is known as difficulty swallowing?
dysphagia
What are the stages of remediation?
bedside work
acute car intervention
longterm care
community support
What is associated with longterm care?
aphasia - a chronic condition
Why is family involvement essential for remediation?
communication is a two-way process and using strategies such as forced decisions helps therapeutic approaches
What type of communication is good for remediation?
verbal, written and/or aac (augmentative and alternative communication)
what is aac?
augmentative and alternative communication
What % of pop has fluency disabilities?
less than 1%
About % of children will experience a period of stuttering lasting up to 6 months
5%
_% of children recover from stuttering
75%
More _ than _ (4 to 1 ratio) stutter, where 7 to 1 do in adolescence
more boys than girls
Stuttering has a _ component
familial
_% of children who stutter have at least one blood relative who has stuttered
60%
Which individuals are more likely to stutter (not gender)
left-handed, likely udue to brain differences
How do most kids recover from stuttering?
preventing reinforcement of behaviour
Stuttering therapies focus on the stuttering and by
addressing how to avoid it
What are difficulties with fluency?
dysfluency
What is stuttering known as in the UK?
stammering
Do preschoolers stutter?
no, because they don’t have struggle behaviours
Why do preschoolers sound like they’re stuttering?
they think out loud (mommy, i..i…I)
What is also associted with normal nonfluency?
word,phrase, sentence repetitions
interjections
no struggle behaviours
hesitations
What are primary dysfluencies for stuttering?
repetitions, prolongations and
blocks (silence)
What are repetitions in stuttering?
words, sounds, and syllable repetitions
e.g., a-a-a-a-animal
What are prolongations?
repetitions that are more stress
e.g., a-aa-a-a-aa-a-a-animal
What are the secondary behaviours of stuttering?
facial tension or contortions and
extraneous movements
What are associated feelings of stuttering?
avoidance
shame
denial
What helps stutterers?
being self-aware as they get older
Is cluttering associated with word and phrase reptitions?
yes
Is cluttering associated with struggle behaviours?
yes
Is cluttering associated with a slow rate of speech production?
no, the opposite
Is cluttering associated with disorganized verbal formulation/narrative structuring?
definitely
Is cluttering associated with no other motor difficulty?
no, they are more likely to have an underlying language disorder, as well as general motor difficulties
Is cluttering associated with self-awareness?
hell no
What is specific to acquired neurogenic stuttering?
no struggle behaviours
neurogenic in origin
neurological insults (e.g., brain disease, or Traumatic brain injury)
As one becomes more aware of the (likeliness to) stutter, one’s
stress rises
As one becomes more aware of the (likeliness to) stutter, one’s stress rises, and
one is more likely to present all three primary behaviours:
repetitions, prolongations and blocks
As one becomes more aware of the (likeliness to) stutter, one’s stress rises, and one is more likely to present all three primary behaviours:
repetitions, prolongations and blocks and
develop secondary feelings of shame, guilt and avoidance
What syndrome is associateed with saying “metpoltan” instead of metropolitan?
cluttering
What syndrome is associateed with saying “metpoltan” instead of metropolitan in stuttering?
polysyllabic words are reduced
Do patients with acquired neurogenic stuttering have awareness of their condition?
not usually
What is cancelling?
not allowing oneself to talk , then relaxing in order to then speak again
When does cancelling occur?
at the beginning of a stutter to predict eventual continuing of discussion
In stuttering neuroanatomic differences in brain size tend to show
less asymmetry/more consistent sizes between brains
what does less asymmetry in neuroanatomy suggest?
less discussion between hemispheres, and a greater likelihood of stuttering
What area is especially associated with less asymmetry in language processing areas?
the Planar Temporale
What are the neuroanatomica differences of those with speech dysfluency when looking at gyri?
speech dysfluency is associated with mroe gyri and greater variability in gyri patterns
What is associated with more gyri and greater variability in gyri patterns?
speech dysfluency (stuttering, cluttering, neurogenic stuttering)
Why is there gyri differences in speech dysfluency patients?
perhaps a congenital condition or due to changes in brain during pruning stages in preschool years
What hemisphere is typically larger in stuttering?
right side, although typically the left side is larger
What affects communication/information flow between various speech-language areas of the brain?
brain symmetry
What is brain symmetry referring to?
a lack of hemisphere dominance or a lack of brain lateralization
What areas are associated with communication/information flow between speech-language areas of brain?
Broca’s and Wernicke’s, and basal ganglia, the networks for fluent speech
Is brain symmetry a consequence of stuttering, or is it the other way around?
who the hell knows
When is stuttering unlikely in kids?
after 6 years old
When do kids typically need to seek treatment for stuttering?
3 years for boys, 2.5 for girls
When should kids see a neurologist if they appear to stutter?
before doing any treatment with SLP
Why would kids need to see a neurologist before an SLP if they appear to stutter?
it may be assoc with a tumour
What developmental stressors are associated with stuttering?
psychological stressors
rapid speech, more complex syntax
parental speech models - closely matched to child’s stage of development or not
What is associated with parental speech models - closely matched to child’s stage of development or not ?
a child’s likelihood to stutter, particularly for youngest child since they have a more difficult time getting a word in, since parents commun at a higher level for elder sibling/s
Why do preschoolers not show stuttering issues?
rapid speech, more complex syntax not evident until 2.5 years
Are kids generally self-aware if a stutterer?
not usually, however being very sensitive or observant may play a part
What is more effective in preventing stuttering: distractioni or reducing stress?
reducing stress
What is Wendell Johnson associated with?
experimenting on kids by labelling them as a stutterer or not and seeing who became one - more kids called stutterers became stutterers!
What is Wendell Johnson’s (label disable ) theory of stuttering a.k.a.?
diagnosogenic theory of stuttering
What did Orton suggest about stutterers?
they are due to neurological deficits, and or they are associated with left-handedness
What did Van Riper suggest about stuttering?
operant behaviour using rewards for reducing stress more effective than distracting behaviour
What did Perkins and team suggest about stuttering?
neural dysynchrony
What language-coplexity issues are associated with stuttering?
age of onsent
language characteristics of stutterers
Who used EEGs during fluency shaping to reduce the amount of activity in the right hemisphere, and more in the left hemisphere demonstrated dominant hemisphere use?
Perkins and team
What is associated with language characteristics of stutterers?
dealing with childrens’ issues with larger and more complex sentences and improving language skills
What is the Lidcombe approach?
acknowledging stutter and incorporating parental operant conditioning to listen to fluency and reinforce stress reduction with stuttering
What is reducing linguistic stress?
promoting rapid language development is associated with a motor system that hasn’t caught up with language development, therefore being patient with child
What are indirect treatments implemented by for speech dysfluency?
implemented by parents
How do parents modify the environment to treat stuttering?
have more one-on-one discussions with child, incorporate singing (not asociated with stuttering), and limit talking to a stressed child
What is focusing on the moment of stuttering considered?
stuttering modification/Van Riper approach
What are soft contacts with articulators in little phrases while using a full breath in-between (“robot”) known as?
Boberg/Webster approach, i.e., fluency shaping approach
What are other types of intervention for stuttering?
AAF devices (like everyday exercises) and anti-anxiety medications
What is AAF?
altered auditory feedback - patient can’t hear own voice, disrupting the forward/backward feedback loop
What are the two stages of the Lidcombe approach to early stuttering?
structured verbal tasks and conversation
Do you acknowledge stuttering in the Lidcombe approach?
yes
What operant consequences/verbal contingences are used in the Lidcombe approach?
praising child
requesst self-evaluation
acknowledgement of stuttering
request self-correction
What approach is a parent training program for child’s early stuttering?
Lidcombe approach
What stuttering approach involves identification of dysfluencies/level of dysfluency?
Lidcombe approach
What is associated with cancellation of speech during hard blocks?
modifying dysfluencies by applying contingencies/consequences
What is the direct approach for stuttering?
Van Riper
What does “stutter in a better way” refer to?
the direct intervention of modifying it by reducicng pressure at the moment of stuttering
What is another way that stuttering can be modified?
using counselling and practice of techniques
What direct intervention is highly structured with intensive practice as available?
fluency shaping (Van Riper)
What is an example of a highly structured fluencing shaping direct intervention?
only saying 5 - 6 words at a time
What type of approach is associated with application of strategies such as reduced rate, gentle onset, soft contacts, adequate breath support, continuous voicing/prolongation, and phrasing?
direct internventions of fluency shaping
What is continuous voicing/prolongation? in fluency shaping?
continual vocal cord vibration, like chanting
What is this an example of: baby is “_aby”?
direct intervention approach of fluency shaping by application of the gentle onset strategy
What does adequate breath support in direct interventions of fluency shaping?
taking a breath!
When treating associated feelings of speech dysfluency, what feelings are common?
anxiety, avoidance
When treating associated feelings of speech dysfluency, what is helpful in identifying aoidant behaviours?
validating their experience
When treating associated feelings of speech dysfluency, what are hierarchies referring to?
differentiating the degree of discomfort associated with various scenarios: e.g., telephone, public speaking, etc.
When treating associated feelings of speech dysfluency, what is affirmation training?
the recognizing and repeating the idea that he/she can overcome issues
When treating associated feelings of speech dysfluency, what are self-talk strategies referring to?
a need for specific action when speaking to base success on successful implementation
What approach was used in “The King’s Speech” during the Shakespeare reciting scene recording?
altered auditory feedback (AAF)
Stages of intervention:
identification of stuttering, modification/intervention, and
transfer
What is identification of stuttering usually associated with?
stuttering modification (direct intervention approaches
What is modification/intervention associated with in stages ofspeech dysfluency intervention?
focus on stuttered speech or fluent speech
What is “transfer” in the stages of speech dysfluency intervention?
refers to implementation in various areas, whether home, school/work, or social network, etc
What are these core signs of:
excessive number of whole-word or phrase repetitions
fast rushes of speech
poorly organized thinking (speaks before clarifying thoughts)
short attention span and poor concentration
complete lack of awareness of the problem
cluttering
Does increased awareness of cluttering or stuttering help treatment?
yes
What is treated with modifying speech rate and regularity?
cluttering
What is helped by promoting relaxation and mental omagery, improving attention span, strengthening underlying language weaknesses, and working on narrative structuring and organizational skills?
treatment of cluttering
Do stutterers and clutterers often overlap?
yes 40% of time
what % are pure stutterers?
55%
what % are pure clutterers?
5%
when dealing with associated communication challenges, always evalute the whole individual, and his/her communication skills associated with language and
speech production
What is also referred to as speech motor planning?
praxis
What is another type of speech production communication skill other than praxis?
sequencing difficulties
What are the types of language skills that ned to be evaluated for associated communication challenges?
word retrieval, vocab, and verbal formulation skills
Stuttering or cluttering: what is associated with language delays being uncommon?
stuttering
Stuttering or cluttering: what is associated with language delays?
cluttering
Stuttering or cluttering: what is associated with repeating sounds and syllables?
stuttering
Stuttering or cluttering: what is associated with repeating words and sentences
cluttering
Stuttering or cluttering: what is associated with prolongations and silent blocks
stuttering
Stuttering or cluttering: what is associated with omitting sounds/syyllables
cluttering
Stuttering or cluttering: what is made worse with rising stress?
stuttering
Stuttering or cluttering: what is associated with speaking better under pressure
cluttering
Stuttering or cluttering: what is associated with reading and writing typically WNL?
stuttering
Stuttering or cluttering: what is associated with being reading and writing challenged
cluttering
Stuttering or cluttering: what is associated with usually nnormal motor skills
stuttering
Stuttering or cluttering: what is associated with often experiencing a lack of coordination/motor planning/praxis
cluttering
Stuttering or cluttering: what is associated with recognizing condition
stuttering
Stuttering or cluttering: what is associated with being unaware of a problem
cluttering
Word retrieval, stuttering or cluttering: what is associated with experiencing fear and avoidance
stuttering
Stuttering or cluttering: what is associated with not being fearful about speaking situations
cluttering
Word retrieval, stuttering or cluttering: what is associated with language-based difficulties
word retrieval
Word retrieval, stuttering or cluttering: what is associated with a general struggle
stuttering
Word retrieval, stuttering or cluttering: what is associated with mroe generalized disorganization in discourse
cluttering
Word retrieval, stuttering or cluttering: what is associated with lkely other language skills being impacted
word retrieval
Word retrieval, stuttering or cluttering: what is associated with tension
stuttering
Word retrieval, stuttering or cluttering: what is associated with general disorganization in personal life skills
cluttering
Word retrieval, stuttering or cluttering: what is associated with interjections
word retrieval
Word retrieval, stuttering or cluttering: what is associated with the sense of “knowing the target word”
stuttering
Word retrieval, stuttering or cluttering: what is associated with being typically unaware of a problem
cluttering
Word retrieval, stuttering or cluttering: what is associated with circumlocutions
word retrieval
Word retrieval, stuttering or cluttering: what is associated with being aware of the problem
stuttering or cluttering
1 in _ out of 1000 children experience a hearing loss which impairs the ability to communicate
6
Children: Hearing loss impacts communication, socialization and
education
Child _ hearing loss is most common
conductive
Children: When a severe _ loss exists, it may be a lifeong condition which has a significant impact on lifestyle
sensorineural
Adult: _ of Canadians report having a hearing loss; _ % over the age of 65, ,and _ % over the age of 75
10 of all
20 of 65
40% of over 75
Adult: most losses are _ but _ losses may occur
sensorineural
conductive
Conductive hearing loss is associated with _, whereas sensorineural hearing loss is associated with
children = conductive adults = sensorineural
What are peripheral hearing losses?
conductive, sensorineural and
mixed
Conductive hearing loss is associated with _ ear dysfunction
middle or outer (middle more common)
Closed ear canals are associated with
child conductive hearing loss with outer ear dysfunction
Sensorineural hearing loss is associated with damage to the
cochlea
Sensorineural hearing loss is associated with _ nerve up to the brain stem level
audtory nerve
vague nerve #8
Mixed hearing loss is associated with damage in _
middle and outer ear dysfunction, as well as cochlea and auditory nerve
The outer ear leads tothe
external auditory canal
The external auditory canal leads to the
tympanic membrane
The tympanic membrane leads to the
tympanic cavity or the malleus
The malleus leads to the
incus
tHE incus leads to the
stapes
The stapes leads to the
oval window
The oval window leads to the
semicircular canals
The semicircular canals lead to the
vestibular nerve or the round window
The round window leads to the
leads to the cochlea
The semicircular canals leads to the
cochlear nerve
The tympanic cavity leads to the
Eustachian tube
Otitis-media and Eustachian tube dysfunction are associated with
middle ear infection with liquid building up with bacteria
Adenoids/tonsils are associated with
infections of the throat
Why are hearing disabilities associated with infections of the throat?
adenoids and tonsils are further down the Eustachian tube, and can close it off, creating hearing difficulties
Which hearing loss is not usually permanent, and also inconsistent?
conductive hearing loss
Which hearing loss is more common?
conductive hearing loss
What type of hearing loss responds well to medical or surgical intervention?
conductive hearing loss
Why is oconductive hearing loss inconsistent?
Eustachian tube opens when yawning, swallowing, and even chewing
Sensorineural hearing loss occurs when damage exists anywhere from the _ and along the _
cochlea
8th cranial nerve (auditory)
Which hearing loss are people typically born with (genetic)?
sensorineural hearing loss
What are loud sounds to someone with sensorineural hearing loss in chidren?
ototoxic
What hearing disability is associated with infections of the throat, and what can be a consequence of it?
conductive hearing loss
meningitis
What can ear wax build up and infections be associated with?
mixed hearing loss
What are central auditory processing disabilities associated with?
auditory discrimination problems
auditory sequencing problems
and central deafness
Primary auditory cortex processing issues can discern
volume
What is another name for ear wax, and what hearing loss is it associated with?
cerumen
adult conductive hearing loss
What is otosclerosis and what hearing loss is it associated with?
stapes bone (ossicle) bone deterioration; can’t move and set-up wave of fluid changing in hair cells, in mid ear for conductive hearing loss
otitis media is association with
infections in the throat with conductive hearing loss
What is presbycusis?
“old age” sensorineural hearing loss
What is noise-induced hearing loss?
an adult sensorineural hearing loss asociated with repeated exposure to loud noise, or sometimes traumatic noise events
Meniere’s Disease is associated with
increased pressure in endolymph, causing vertigo, usually unilateral
Meniere’s Disease is found in _ loss
sensorineural hearing loss
Ototoxicity is
chemical or drug-related damage to the inner ear, associated with sensorineural hearing loss in adults
Acoustic neuroma is
a benign tumour on the cochlear and auditory nerves, causing hearing loss and/or balancing issues
What adult hearing loss is associated with:
presbycusis and cerumen, and noise-induced hearing loss and otitis-media?
mixed hearing loss
What adult hearing loss is associated with: discrimination difficulties and figure-ground difficulties, etc. (inability to talk to someone in a busy room)?
central auditory processing disabilities
When testing hearing, what is required?
presenting a sound before measuring response/ability
What two things are required with a pre tone audiometer?
a sound proof chamber and ear phones
What type of earphones are used for hearing tests?
air conduction and/or bone conduction (vibration)
Why are bone conduction earphones used?
to discern whether hearing is an outer ear problem or middle or inner ear problem
What are Hz?
frequencies, or cycles per second (pitch!)
What are dB?
hearing intensity or volume
Other than a sound proof chamber, a pure tone audiometer, and presenting a sound, what else is required for testing hearing?
masking/”white noise”
Why is masking/”white noise” used when assessing hearing loss?
discerns whether hearing is in both ears, or one or the other
What Hz are hearing tests based upon?
pitch levels of speech and comprehension
What do pure tone audiometers test in hearing?
threshold of detection - lowest to highest
When testing hearing, the pure tone audiogram is measured using single frequencies individually
yes
What does air conduction or bone conduction determine?
the kind of hearing loss (air - outer, bone - inner or middle)
What does masking determine in testing?
the particular ear’s level of hearing
What can be predicted by how learning impacts speech, at particular frequencies?
pure tone average (pta)
How is pure tone average (pta) calculated?
mean of decibel/volume at tone of preferred pitch (Hz)
What shape is the speech sound threshold of comfort?
a smiley face
What is a.k.a. the speech sound threshold of comfort?
speech banana
When mapping speech sounds on the audiogram, what is on the vertical side and what is on the horizontal side of the spectrum?
vertical - dB - volume
horizontal - Hz - pitch
What hearing loss can find an air-bone gap
conductive hearing loss (air conduction and bone conduction thresholds are different)
Can the air-bone gap be reversible?
yes
What can the air-bone gap be caused by?
middle ear fluid/infection
otosclerosis
ear wax/cerumen, etc.
malformation/damage to middle/outer ear e.g., otosclerosis
Are dB levels different through air than bone?
yes
When does spongey bone occur?
in otosclerosis; injury can interfere with ossicles
What are children often treated with for conductive hearing loss?
tympanic tubes
On a speech banana chart/audiogram, what does an X refer to?
air-conducted signal
On a speech banana chart/audiogram, what does an ] refer to?
a bone conducted signal
When both signals are quite similar in a speech sound test, what do we conclude?
there isn’t an airborne gap, therefore, it is not likely to be treatable
What type of loss is associated with treatable/reversible hearing loss?
air conduction
What is found mor ein females that is associated with middle ear conductive hearing loss?
otosclerosis
What is a Carhart notch?
a drop then improvement dip in an audiogram chart, associated with otosclerosis
What type of conduction loss is found in a Carhart’s notch?
air conduction
Air conduction thresholds are elevated (severity from mild to profound) in _ hearing loss
sensorineural
An air-bone gape doesn’t exist in sensorineural hearing loss
true
Configuration of hearing pattern across frequencies is diagnosistic in conduction hearing loss
false in sensorineural hearing loss
e.g., noise-induced lsos can drop at 4000 Hz with a recovery at 6000 and 8000 Hz
Conductive hearing loss is permanent, and cannot be reversed by surgery
false, sensorineural hearing loss is permanent and cannot be reversesd by surgery
What is recruitment in sensorineural hearing loss?
distortion or reduced range in hearing
What is this an example of: older person too high or too low - smaller range?
sensorineural hearing loss
What is a typical shape for sensorineural hearing loss?
a v
Is sensorineural hearing loss congenital or genetic?
congenital, specific to the cochlea and/or auditory nerve (cranial nerve 8)
What is associated with noise-induced hearing loss?
sensorineural hearing loss
What is associated with Meniere’s Disease?
sensorineural hearing loss
What is associated with Presbycusis?
sensorineural hearing loss
What is associated with aacoustic neuroma?
sensorineural hearing loss
What is associated with ototoxicity?
sensorineural hearing loss
What preferred dB is associated with 20 year olds?
20 dBat 8000 Hz
What preferred dB is associated with 40 year olds?
40 dBat 8000Hz
What preferred dB is associated with 60 year olds?
80 dB at 8000Hz
What preferred dB is associated with 90 year olds?
100 dB at 7000 Hz
Is there an air-borne gap in noise-induced hearing loss?
nope
Is there an air-borne gap in proound sensorineural hearing loss?
nope
What Hz is associated with noise-induced hearing loss?
4000 Hz (i.e., that pitch needs to be at a higher volume to discern, yet higher and lower pitch can be understood at a lower volume)
What does unilateral refer to in hearing loss?
one ear whereas bilateral is both ears
What is associated with a bulged endollymphic sac, distended endolymph, and swelling distorting sound information?
Meniere’s disease
Is Meniere’s disease typically unilateral or bilateral?
unilateral
What is vertigo head-spinning and a ringing in the ear, and low frequency hearing loss, all in one ear, associated with?
Meniere’s disease
What are common combinations in mixed hearing loss?
cerumen (ear wax) and _
presbycusis (old age)
What are common combinations in mixed hearing loss? child with congenital sensorineural loss with
an ear infection
What are common combinations in mixed hearing loss? otosclerosis and
presbycusis
What levels are normal ptas? (pure tonal average)??
up to 25 dB
What PTA level is associated with mild hearing loss
25 to 40 dB
What PTA level is associated with moderate hearing loss
40 to 70 dB
What PTA level is associated with severe hearing loss
70 to 90 dB
What PTA level is associated with profound hearing loss
more than 90 dB
What can acoustics be measured in?
Hz or cps
What is considred a single frequency in acoustic measurement?
a pure tone
What is Db in a lorithmic scale an acoustic measure of?
intensity
What acoustic measurements are often compared?
hearing level (HL) vs sound pressure level (SPL)
What are the average thresholds of PT at?
500, 1000 and 2000
What audiological exam tests air pressure against drum-fluid behind ear?
tympanometry
What audiological exam tests seeing when hearing stops and figure out threshold maximum
stapedial reflex testing
What are tympanometry and stapedial reflexing testing examples of?
immitence audiometry (i.e., stop-and-start)
What audiological exam tests measure conduction of electrical signals along brainstem, and are good for autistic kids?
auditory brain stem response (specialized EEG in response to auditory input)
What are the benefits to immitence audiometry and auditory brain stem response?
they don’t require patient cooperation
What do speech measures of reception thresholds (spondees) and speech discrimination require?
a microphone
What audiological exam tests feedback for sound that is made and then emitted out, using a small microphone in the ear canal, and does not require a voluntary response?
otoacoustic emissions
What audiological exam tests by giving a story and asking the patient to describe it, and their performance is based on the ear tested?
central auditory testing
What audiological exam is helpful for infants and young children, such as playing sounds while he or she is playing?
behavioural methods (i.e., ABA - applied behavioural analysis training)
What is ABA training?
applied behavioural analysis, often used for testing speech, hearing for younger children by assessing their responses while they are at play
What does a decibel express?
ratio betwen 2 sound pressures, reported on a logarithmic scale (e.g., 10 dB and 20 dB is 10 x 20)
Levels of intensity in work environments are reported in _ levels
sound pressure levels (SPL)
Levels of intensity on an audiogram are reported in _ levels
hearing levels (HL)
Every increase of _ dB SPL is perceived as a doubling of intensity
6
_ and otosclerosis are two well-known hearing disabilities
Meniere’s disease
_, aural habilitation, and _ help maximize hearing potential
Hearing aids
rehabilitation
Hearing loss can result in loss of sound discrimination ability as well as
recruitment
What is hearing loss in recruitment?
a rapid growth of perceived loudness in a pitch region containing hearing impairment
e.g., very particular range that some older people can hear vs perceive sound as being too loud
Normal person would hear dB levels from 0 to
70 through 100
Person with a sensorineural hearing loss could hear wit a threshold of comfort at 30 dB to
50 - 60 dB (“with recruitment”)
What does hearing with recruitment suggest?
increasing volume doesn’t always work for understanding (greater likelihood of distortion for people with a SENSORINEURAL hearing loss, as opposed to a conductive hearing loss - more discriminative in the types of sounds)
The frequencies most commonly used on a hearing test are 250, Hz, 500, 1000, and
2000, 4000, and 8000
Intensities tests for a young adult using an audiometer range from 0 to
120 Db HL
Can people vary in the HL vs SPL?
absolutely
Pure tone average (PTA) includes the following frequencies:
500, 1000, and 2000 HZ (or 500 Hz, 1KHz, and 2KHz)
What does masking prevent?
crossover effect for hearing tests
What hearing test requires masking?
bone conduction, unless there is a huge hearing difference between ears in air conduction levels
What is Landau_Kleffner syndrome?
appreciateing sound volumes, but an inability to interpret sounds, often perceiving a hissing-type sound
oto- refers to
ear
The bones in the middle ear convert _ energy into _ energy
acoustic into fluid
_ is the most common conductive hearing loss
middle ear infection / otitis media
The _ helps balance the air pressure in the middle ear with the outside pressure
Eustachian tube
the epiglottis is above the
hyoid bone
The hyoid bone is above the
thyroid cartilage
The thyroid cartilage is above the
cricoid cartilage
The cricoid cartilage is above the
tracheal rings
When vocal cords overlap, they indicate one has
worked them too hard
What is a potential consequence of vocal cords overlapping?
dysphonia
What does the thyroid cartilage, arytenoids, and cricoid cartilage look like when looking at an anterior view of the vocal cords?
lips
What are the three laryngeal functions?
protection of the airway
voice production
stabilize the chest cavity - integral for eliminate waste (pushing hard…)
What are protective reactions to helping the airway?
coughing
yawning
swallowing
sighing - unconscious use of vocal chords
What is the benefit of yawning in the vocal chords?
stretching them
What is dysphonia?
voice disorders
what % of children have voice disorders?
6 - 23%
What % of men have voice disorders?
7.2%
Which % is assocated with which group of voice disorders sufferers?
6 - 23.4%
7.2%
5%
6 - 23.4% chidlren
7.2% men
5% women
In children, increases from _ in preschoolers to _ in school-age children with a prevalence of dysphonia
3.9% in preschoolers
6 - 9% in school-age children
Which group of kids has the highest incidence of dysphonia?
school-age kids who can develop screamers’ nodules from play
Which adult groups tend to have a higher incidence of dysphonia?
teachers
singers
salespeople
What can help someone prevent dysphonia?
keeping the throat well-hydrated, as well as have training
What else is associated with dysphonia, other than overuse?
stress
More tension predicts _ reverberation in vocal cords
less reverberation, therefore lower pitch
Greater mass suggests lower reverberation which suggests a _ pitch of vocal chords
lower
Dysphonia relates to
pitch
loudness
quality
resonance
Kids can have a pitch that ranges from
250 - 260 Hz
Women can have a pitch of _ Hz
200 Hz +- 1/3
Men can have a pitch of
125 Hz, +- 1/3
What is the most common type of dysphonia?
misuse/abuse e.g., nodules/ulcers on vocal chords, bowed vocal chords
What are nodules on vocal cords?
like calluses or blisters
What is a risk of chronic vocal cord abuse, and their disalignment?
a risk for aspiration (ineffective swallowing)
What type of cause is associated with laryngeal cancer?
misuse/abuse, likely from excessive drinking or smoking
Is misuse/abuse of vocal cords reversible?
yes, but not laryngeal cancer
What are these symptoms associated wtih? paralysis fo the vocal cords spasmodic dysphonia vocal tremor vocal tics (Tourette's Syndrome)
neurogenic dysphonia/aphonia
What are these symptoms associated with (re vocal cords)?
stress
psychological trauma
psychogenic dysphonia/aphonia
e.g., woman who experienced a robbery
adductor is associated with strained or strangled vocie, whereas abductor vocal cord issues are associated with
inconsistent, breathy vocal episodes
What is spasmodic dysphonnia associated with?
basal ganglia or vagus nerve damage
What can provide some relief to spasmodic dysphonia?
Botox
What is spasmodic dysphonia a type of?
dystonia
Paralysis of the vocal cords is associated with _ damage to _ cords, which would prevent them being able to open, requiring immediate medical attention in order to breathe
vagus nerve damage
adduction cords
What did Katherine Hepburn have that is associated with abduction of vocal cords cords that wouldn’t close properly?
vocal tremor
What is a concern with vocal tremors?
an inability to close the vocal cords, with a potential for chokng
What syndrome are vocal tics associated with?
tourette’s syndrome
What damage is associated with tourette’s syndrome / vocal tics?
vague nerve damage
How can spasmodic dysphonia be controlled?
using a controlled temperature, throat clearing, coughing, or even “barking”
What is an effective treatment for stress-induced psychogenic dysphonia?
yawning or
Augmented alternative feedback; condition is physiologically not an issue, but a psychological one
What is psychogenic dysphonia not and why?
selective mutism, which suggests not speaking during specific circumstances rather than altogether
why is pneumonia such a problem with dysphonia?
vocal nodules, ulcers and/or polyps can develop on inflamed vocal cords due to excessive coughing
Why does having a cold lower one’s pitch?
it creates strain, and swelling reducing the reverberatio
What is a negative outcome of vocal fry?
constant strain on vocal cords can injure them
What is a missing vocal habit associated with dysphonia?
throat clearing, habitual coughing (colds, pneumonia)
speaking without adequate breath support
overuse of the voice
speaking at an inappropriate pitch
smoking, drinking
What is a missing effective treatment of dysphonia (mild injured vocal cords)?
hydrate
prevent coughing
throat-clearing
don’t speak, hum, whistle, etc. after excessive use
remember to breathe
use “natural” pitch
What community does an inability to effectively change vocal cord pitch associated with?
transgender
How is traumatic laryngitis resolved?
with vocal rest due to acute swelling and irritation
How are vocal nodules resolved?
fibrous tissue may need surgery, as well as SLP treatment
What is required when a patient shows vocal nodules?
a visit withthe ENT to rule out cancer before SLP treatment
Can vocal nodules be unilater and/or bilateral?
uni or bilateral
What do sessile vocal polyps look like?
if you are looking at your legs splayed open, like look like a fluid-filled sac on your inside-thigh
What do pedunculated vocal polyps look like?
They look like Ashley’s growth a on her leg it protrudes much further inbetween the vocal cords
What does diplophonia remind me of and why?
throat singing - vibrating cords with separate pitches due to polyps
What type of dysphonia with a structural change in the vocal apparatus is associated with pitch and quality changes with warts on vocal cords, and can be treated with antibiotics or removal?
laryngeal papilloma
What virus is associated with laryngeal papilloma?
HPV - human papilloma virus
Larygectomy survivors often can use a _ to speak
electrolarynx/vibrator- used to articulate and make speech
What do papilloma look like?
bloodied vessels along the vocal cords that may protrude
_ is a high-pitched, wheezing sound caused by disrupted airflow. _ may also be called musical breathing or extrathoracic airway obstruction (adduction). Airflow is usually disrupted by a blockage in the larynx (voice box) or trachea (windpipe).
stridor
What is pain in the laryngeal region associated with?
thyrohyoid strain
What is breathiness a symptom of?
dysphonia
What is a common symptom of dysphonia?
lower pitch often due to accruing a mass on teh v.c.
What are polyps associated with?
diplophonia
Laryngectomy involves
complete removal of the larynx due to untreatable cancer
What is attached to the o/esophagus after a laryngectomy?
a lower pharyngeal constrictor
What is known as the trachea attached to a permanent opening in the neck?
a tracheostoma/stoma
What is another option for producing voice, other than an electrolarynx/vibrator, and a tracheo-oesophageal puncture (surgically created)?
oesophageal speech i.e. burping
What is a.k.a. as oesophageal speech?
belching speech
What creates potential issues with moisture, air temperature, the risk of bacteria and bug intrusion, as well as constipation?
tracheo-oesophageal punctures/stoma
Why do women have a harder time communicating after a laryngectomy?
the methods available tpically make the voice much lower than their original pitch
Vocal fold paralysis is associated with no movement with the recurrent _ nerve, a branch of the _ CN nerve)
laryngeal nerve, a branch of the vagus/ CN #10
What is an option in vocal fold paralysis?
stabilizing one vocal cord and enabling only the other one to work
What may result from damage to the vocal cords during surgery, tumours, infection, and CVAs?
vocal fold paralysis
What can improve the outcome of a unilateral vocal cord?
pushing and pulling exercises of the vocal cord
Spasmodic dysphonia is a type of neurological dysphonia which is a kind of _, which is associated with damage to the _
dystonia
basal ganglia
What subtypes are in spasmodic dysphonia?
abductor subtype and adductor subtypes
What can be used with vocal fold paralysis in order to cover the larynx to protect it
a chin tuck
What does a chin tuck use to protect the larynx?
it covers the larynx with the epiglottis
Without full protection of airway, a patient with vocal fold paralysis is at risk of
choking
If _ persists longer than 6 months, surgical interventions are likely required
vocal fold paralysis
What type of voice is associated with vocal fold paralysis?
breathy, weaky voice
What can be used for patients with vocal fold paralysis to each?
nasal gastric tube
What is the worst thing patients with vocal fold paralysis can consume, and why ?
thin liquid
likely to aspirate
what is a potential option with vocal fold paralysis?
immobilize one cord in the ADDUCTED position (medial position)
What type of vocal fold paralysis is much more serious, because it is likely neurologically-based,a nd often requires immediate attention to create an airway if both cords paralyzed in adducted position)?
bilateral vocal fold paralysis
What type of voice is associated with the abductor type of spasmodic dysphonia?
more open, with a more steady sound
What type of voice is associated with the adductor type of spasmodic dysphonia?
closed, therefore mro eforced
What are treatment option for spasmodic dysphonia (breathy, strained-strangled voice)?
SLP
botox therapy
surgery - weakneing muscles to limit spasms
What type of spasmodic dysphonia is associated with better treatment outcomes with Botox therapy?
adductor type (prevents cords from remaining strained shut)
What are psychogenic dysphonias associated with?
personality
stress - “voice is the window to the soul”
a combo of these, and
acute events
Who is typically in the professional team for dysphonic patients?
SLP
family physician
psychologists/psychiagists
otolaryngolotists (ear-nose-thraot physicians) - assess throat condition for cancer, etc.
Why are psychologists and psychiatrists helpful for dysphonic patients?
they help deal with IDENTITY concerns with vocal formation and potentially stress-induced disorder
What aspect of dysphonic patient’s history is involved in assessments?
onset of conditions
daily vocal habits
personal habits, stress load, hydration
how voice changes in different situations (duration, consistency)
What is integral for dysphonic patients?
a visit with the otolaryngologists
Why would a ful oral, facial, and neck examination help assessing dysphonic patients (SLP work)?
could determine therapy, particularly if esophagus is hard - adducted vocal cords?
Methods in assessment of dysphonic patients may produce what?
a clear voice
the ideal vocal efficiency flow mechanism suggess that the maximum effect with the least or minimum effort is required for
the efficient use of subglottic air pressure without wastage
What program for adults and children is a direct individual intervention treatment approach for dysphonia?
Boone Voice program
What is the nasometer test for dysphonia?
like the fogged mirror test, it sees how much air flow goes through vocal cords
What other technology can be used for treating dysphonia?
nasometers
voice recordings
artifical larynx
visipitch
What are the surgical options for dysphonia?
laryngectomy and
removal of growths, stabilization of cords, etc using lasers
