Remaining Lectures Flashcards
The Swallowing Phases
Oral - Food/liquid is contained and broken down
Pharyngeal - Bolus moves through the pharynx to the esophagus
Esophageal - Bolus moves from esophagus to stomach
Airway Protection
-The epiglottis is inverted to cover the larynx
-Vocal folds close
-Larynx elevates and moves forwards
Dysphagia
Any issue with chewing or the passage of food through the mouth or throat that makes oral intake difficult or unsafe
(includes swallowing disorders)
Oral Dysphagia
-Difficulty or prolonged chewing
-Accumulation of food residue in the oral cavity
-Drooling or dry mouth
-Reduced sensation
-Anterior labial spillage of food/liquid
Pharyngeal Dysphagia
Delayed initiation of the swallow, results in accumulation of bolus in the pharynx and a decreased/delayed airway closure reducing sensation
Esophageal Dysphagia
-Reflux
-Regurgitation
-Anatomical issues (i.e. esophageal stricture/narrowing)
Anatomical Causes of Dysphagia
-Cervical osteophytes (Bony spurs/ growths from cervical spine)
-Congenital Abnormalities (i.e. cleft lip/palate)
-Head and/or neck cancer
Physiological Causes of Dysphagia
-Neurodegenerative conditions (i.e. Parkinson’s, Dementias)
-Acquired brain injury (i.e. stroke)
-Respiratory conditions
-Autoimmune disease
-Laryngeal pathology
Implications of Dysphagia
-Malnutrition and/or dehydration
-Respiratory complications (choking, aspiration, pneumonia)
-Social isolation/depression
Assessing Dysphagia
-Screening (identify patients at risk)
-Clinical assessment (provides limited diagnostic information as to reasons for Dysphagia [hypothesis])
-Diagnostic assessment (Provides physiological explanation for dysphagia and informs effective treatment
Treatment Strategies for Dysphagia
Behavioural - Tongue strengthening, biofeedback
Alternative feeding - i.e. a feeding tube
Surgical - Reconstructive post-head neck cancer
Pharmacological - For an underlying cause (medical condition)
Health Literacy
Degree to which people have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Landmark Supreme Court Case (Eldridge vs British Columbia)
-Case where it was determined hospitals were required to provide interpreters for deaf patients
-Demonstrates how effective communication is integral to healthcare and not doing so violates the charter
Providing Equitable Access in Healthcare
Must acknowledge that the population is culturally and linguistically diverse where language proficiency is a determent of health and varies
Impact of Language Barriers: Health Incomes
-Less likely to receive effective, evidence-based, and timely care
-More visits and longer stays at hospitals
-Poorer management of acute and chronic conditions (lack of access)
-Reduced mental health and counselling
-Misunderstanding of medication and condition
-Increased chance of adverse outcomes/wrongful consent
-More likely it have inappropriate diagnostic testing
Impact of Language Barriers: Patient and Staff Experience
Patients
Lower healthcare satisfaction, lower compliance/adherence, problems with access and coordination of care an follow ups
Staff
Frequent difficulties communicating, relying more on ad hoc interpreters, increased chance of confidentiality breaches, increased risk of invalid consent
Indirect
Minorities underrepresented in clinical research, results aren’t generalizable, know less about risk factors, prevalence, and treatment
Benefits of Professional Interpretation
Lower rate of ED use, less inappropriate testing, improved clinical outcomes and understanding care/treatment, high level of satisfaction, more efficient use of time, cost effective
Approaches to improving access of healthcare through language
Increase the number of same language encounters
-Increase number of bilinguals or multilingual health care professionals (instead of i.e. pulling a nurse away to fill in)
-Increase the number of minority language speakers who speak official languages
Provide professional interpretation services
-Enable communication between individuals who do not speak each other’s languages
Interpretation vs Translation
Interpretation is focused on accurately re-expressing speech between two languages while translation is focused on text
Simultaneous Interpretation
Interpreted message is delivered nearly instantaneously while the speaker or signer continues to speak/sign
Consecutive interpretation
When interpretation occurs after a section of the source language is produced, during a pause
Limited English Proficiency (LEP)
Legal concept referring to an insufficient proficiency in English to ensure equal access to public services without an interpreter
Ad Hoc Interpreter
Person who is asked to interpret but does not have professional interpretation training
Cultural Broker
Person knowledgeable about the culture and/or speech-language community and passes that information between client and clinician in addition to language interpretation
When to use an Interpreter
-If the health care provider and patient don’t speak the same language or the patient has a limited english proficiency
-A good measure is if the patient is only answering with yes and no
Linguistic Broker
Person knowledgeable about speech community/communication environment and can provide information about language and sociolinguistic norms (i.e. pragmatics, patters, etc.)
Modalities of Interpretation
Telephone, Video Call, In-Person
Issues with Family and Ad Hoc Interpreters
Family
-Cannot remain unbiased, uncomfortable, hard conversations (especially with providing diagnosis)
-Very dangerous when involving minors
Ad Hoc Interpreters
-Often bilingual staff, might know the patient, lack of context or insufficient vocab, pulling staff away from their job, high error
Aphasia
-Acquired communication disorder caused by brain damage
-Characterized by an impairment of language modalities
Causes of Aphasia
-Stroke (most common, about ~30% of stroke survivors experience aphasia)
-Neurodegeneration
-Head Trauma
-Tumour
-Infection
Types of Aphasia
Broca’s Aphasia (Most Common)
Nonfluent, impairment of expressive ability and repetition but comprehension stays relatively intact
Wernicke’s Aphasia
Impaired repetition, auditory and reading comprehension
Neurodegenerative language disorders
Deterioration of speech and language, associated with Alzheimer’s
Phonological Component Analysis
-Targeting verbal expressions and naming
-Prompts person to analyze sound components of a target word to facilitate verbal expression
Better Conversations with Aphasia
(AKA Conversation Therapy)
Weekly communication training program for people with aphasia, uses video recorded conversations
Augmentative and Alternative Communication (AAC)
Refers to any techniques or tools used to compensate for and/or supplement spoken communication
Listener Bias
Studies show that perceived intelligibility of a speaker drops when seeing a minority in comparison to a white person
Motor Speech Neuroanatomy
Speech disorders that come from neurologic impairments
Motor Speech Neuroanatomy: Etiologies
Cerebral vascular accidents, tumours, traumatic brain injuries, neurodegenerative diseases, inflammatory, toxic-metabolic
Apraxia of Speech
-Motor planning/programming issue
-Can co-occur with aphasia and/or dysarthria
-The localization is controversial (has been associated with Broca’s area but a range of other places have been proposed)
Dysarthria
Motor control and/or execution issue
motor control
-Ataxia: Poor coordination/timing
-Hypokinesia: Too little movement
Hyperkinesia: Too much movement
Execution
-Spasicity: Problems with discrete, voluntary movement and supporting movements
-Flaccidity: Problems with stimulating muscle contraction
Assessing Motor Speech Disorders
Chart review, case history and collateral, oral mechanism exam, speech tasks, patient perspective, compare to baseline, intelligibility
What can’t be measured using a standardized test
-Limited for testing languages other than English
-Reliance on informal tools
-consider the patient/client/resident/family values and goals
-Consider dialectal differences
Fluency
-Refers to the continuity, smoothness, rate, and effort in speech production
-Also about the temporal sequencing
Fluency Disorder
Interruption to the typical flow of speech (i.e. atypical rate or rhythm, or disfluencies accompanied by secondary behaviours)
Disfluencies
-Fillers (i.e. um, uh)
-Repetition of sounds or syllables (like stuttering)
-Prolongations (i.e. eat the sssssandwich)
-Blocks (The inability to initiate a sound)
*All speakers/signers are disfluent sometimes
Stuttering and Statistics
-The most common fluency disorder
-Incidence: about 5-8% of the population is diagnosed every year
-Prevalence: 1% or less of the total population stutter at a particular point in time
Note: Prevalence is lower than incidence because 80% of children diagnosed as toddlers recover without therapy
Stages of Stuttering
(AKA “Natural History”)
-Stage 1: Typical Disfluencies
-Stage 2: Borderline Stuttering
-Stage 3: Beginning Stuttering
-Stage 4: Intermediate Stuttering
-Stage 5: Advanced Stuttering
Causes of Stuttering: Biological
-Genetic evidence: does not guarantee stuttering but people who stutter are likely to have a first degree relative who also stutters
-if an identical twin stutters the other is 70% likely to as well, where 25% if not identical twin
Causes of Stuttering: Speech Motor Control
-Hypothesized that stuttering may be a failure to form stable underlying motor programs for speech
-Would explain differences in articulatory movement
-Quality of any motor control task suffers in the face of stress and anxiety
Neurogenic Stuttering
Can be the result of neurological damage after a brain injury or stroke
Treatment: Stuttering
Behaviour treatment is generally considered effective at reducing stuttering
