Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Physio Exam 3 > Speech > Flashcards

Speech Flashcards

1
Q

Speech Production

Highly complex motor task that involves approximately

A

100 orofacial, laryngeal, pharyngeal, and respiratory muscles.
• High speed
• High precision
• Complex coordination and timing of muscle movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Intelligiblity

A
  • Degree of “understandability” of speech

* Depends on the listener (familiar vs unfamiliar) and context

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Fluency

A

• Rate, rhythm, “smoothness” or flow of speech production (how sounds, syllables, words, and phrases are joined together).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Respiration
Speech production requires airflow from the lungs (respiration) to be ——— through the vocal folds of the larynx and ——– in the vocal cavities shaped by the jaw, soft palate, lips, tongue and other ———, in a ———- (fluency/prosody)

A

phonated

resonated

articulators

timely and coordinated fashi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

• Phonation =

A

sound waves are created by vibration of the vocal folds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Airflow from the lungs, as well as laryngeal muscle contraction, causes movement of the

A

vocal folds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pediatric Voice disorders

A

dysphonias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common pediatric vocal pathologies

A 
Infectious, anatomic, congenital, inflammatory, neoplastic, neurologic, and iatrogenic causes (McMurray, 2003).
• Vocal nodules
• Vocal cord cysts
• Vocal cord paralysis
• Laryngeal webs
• Paradoxical vocal fold dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Vocal nodules

of the most common causes of

A

pediatric dysphonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Vocal nodules

Symptoms

A
  • Hoarseness
  • Breathiness
  • “rough” voice
  • “scratchy” voice
  • Harshness
  • Decreased pitch range
  • Throat/ear/neck pain
  • Complaint of “losing voice”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Vocal nodules —>

A

Behavioral voice treatment (voice therapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Vocalfoldcysts—->often entails

A

surgical removal AND possible voice therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Laryngeal web—>

A

surgical resection(may require multiple surgeries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

• Types of articulation errors:

A

Substitutions
• Omissions
• Distortions
• Obligatory vs active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Phonemes

A 
speech sounds)
• Place, manner, voicing
• Bilabials, Lingual-alveolars, Velars
• Stops, Fricatives, Sibilants, Affricates • Oral vs nasal consonants
• Liquids and Glides
• Voiced vs voiceless sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of SSD:

SLPs provide treatment to improve

A

articulation of individual sounds or reduce errors in production of sound patterns.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of SSD

• Articulation treatment may involve demonstrating how to

A

produce the sound correctly, learning to recognize which
sounds are correct and incorrect, and practicing sounds in
different words.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment of SSD

• Phonological process treatment may involve

A

teaching the
rules of speech to individuals to help them say words
correctly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment of SSD

• More emphasis on

A

auditory discrimination training (e.g.,

minimal pairs intervention)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Oral-motor therapy is

A

NOT evidence-based practice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Motor speech disorders (MSD)

A

Dysarthria (DYS)

• Childhood apraxia of speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Dysarthria

A

Collective name for a group of neurologic speech disorders resulting from abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for control of the respiratory, phonatory, resonatory, articulatory, and prosodic aspects of speech production. (Duffy, 2005)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Dysarthria in Children

Congenital:

A

present from birth (infancy) or prior to the acquisition of speech/language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Dysarthria

• Acquired:

A

significant variations in presentation depending on age of onset, after the acquisition of at least some speech-language skills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dysarthria

• Pediatric dysarthria is complex to

A

diagnose and classify due to the effect of the motor speech disorder on the emerging language and speech processing/production systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Typical characteristics of dysarthria

A

Marked difficulties with speech and accuracy of articulatory movements (generalized imprecision)
• Reduced loudness
• Dysphonia
• Hypernasality
• Abnormal speaking rate
• Abnormal breath groups/rate
• Oftenhaveahistoryoffeeding/swallowing problems, drooling, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Dysarthria in Children with Cerebral Palsy

Athetoid (dyskinetic) CP:

A

slow rate, dysrhythmia, inappropriate voice stoppages & reduced stress, more artic errors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Dysarthria in Children with Cerebral Palsy

• Spastic CP:

A

breathy voice, monopitch, monoloudness, hypernasality, voice quality changes throughout utterance, better speech intelligibility with fewer artic errors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Dysarthria in Children with Cerebral Palsy

• Speech deficits appear to

A

involve all speech subsystems (respiration, phonation, VP function, artic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Dysarthria in Children with Cerebral Palsy

• Decreased

A

vowel space and reduced word intelligibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Most children do not present with a

A

“pure” type of dysarthria
• Mixed dysarthrias
• Dysarthria plus “developmental” phonological disorder/articulation disorder
• Dysarthria plus language disorder
• Dysarthria overlayed on structural anomalies
resulting in a complex mixed speech disorder
! syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Dysarthria and Other MSDs in Down syndrome

A 
• Down syndrome (Trisomy 21)
• Childhood apraxia of speech
• Dysarthria: reduced speed and
ROM, hypotonia, imprecision
• Impact of macroglossia vs
malocclusion
• Speech sound disorders
• Voice and resonance disorders;
secondary characteristics of VPD
• Most often fit a profile of MSD- NOS (Rupela et al., 2016)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Childhood apraxia of speech (CAS) is a

A

neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

CAS may occur as a result of

A

known neurological impairment, in association with complex neurobehavioral disorders of known and unknown origin, or as an idiopathic neurogenic speech sound disorder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in

A

errors in speech sound production and prosody (ASHA, 2007).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Treatment approaches for motor speech disorders

A

Articulation therapy when indicated
• PalatalliftorVPDsurgeryifsignificantly
hypernasal
• Improving “breath support “ and/or loudness (e.g.,
LSVT)
• Augmentative and Alternative Communication (AAC) (e.g., simple gestures, alphabet boards, or electronic or computer-based equipment
• Teaching caregivers, family members, and teachers strategies to better communicate with the person with dysarthria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Resonance:

The perceived
• Velopharyngeal closure

A

quality of sound, generated from the vocal folds, as it vibrates through the pharyngeal, oral, and nasal cavities.

38
Q

Resonance

• Balance of oral and nasal sound energy =

A

Degree of perceived nasality in speech

39
Q

Resonance

• Influenced by the

A

size/shape of oral cavity, nasal cavity, pharynx, and surrounding structures (e.g., tonsils/adenoids)

40
Q

Hypernasality !—>

A

usually associated with VPI
• PERCEPTION of excessive nasality (too much nasal
resonance) during production of vowels, glides (w, y), and liquids (l, r)

41
Q

Hyponasality —>

A

nasal obstruction, midface hypoplasia, septal deviation, choanal atresia, adenoid hypertrophy
• PERCEPTION of denasality/too little nasal resonance during production of vowels and nasal consonants

42
Q

Submucous cleft palate

A
  1. Bifid uvula
  2. Midline division or diastasis of
    musculature of soft palate (zona pellucida)
  3. Notch in the posterior hard palate
43
Q

Function of the Velopharyngeal (VP) Mechanism

A
  • Alters the general shape and resonant characteristics of the vocal tract
  • Connects/disconnects the oral and nasal cavities
    * Speech
    * Nonspeech
44
Q

Velopharyngeal Physiology:

•In most normal speakers,

A

the velum moves up and back, and

the lateral pharyngeal walls move medially

45
Q

Velopharyngeal Physiology

•VP closure occurs for

A

swallowing & speech
variation in the degree of closure based on specific demands of speech sounds and coarticulation
• Oral consonants vs nasal consonants

46
Q

Velopharyngeal Closure

The soft palate stretches

A

12-25% of it’s length during VP closure

47
Q

Levator Veli Palatini:

• Originates from

A

petrous portion of temporal bone and eustacian tube

48
Q

Levator Veli Palatini

• Descends to insert into

A

palatal aponeurosis and blends with its paired muscle fibers from the opposite side to form a muscular sling

49
Q

Levator Veli Palatini

• The most important muscle for providing

A

adequate velopharyngeal closure for speech

50
Q

VP Closure:

Inherently disrupted in infants with

A

cleft palate,due to lack of palatal structures

51
Q

VP Closure

– After palate repair, structures may be

A

intact and muscles repaired but function of the VP mechanism may or may not be optimal for speech

52
Q

VP Closure

• VP closure may be different (is typically “better”) during

A

swallowing, gagging, etc. than during speech because these behaviors are under separate neurologic control

53
Q

VP closure

• Never make conclusions about VP closure for

A

speech based on observations during nonspeech activities

54
Q

VP Insufficiency

A
  • Short soft palate
  • Congenital or following palate repair
  • Post-adenoidectomy
  • Palatopharyngeal dysproportion (deep retropharynx)
  • 22q11.2 deletion syndrome
  • Palatal resection due to cancer
  • Trauma to the palate
55
Q

VP Incompetency

A 
Dysarthria
– Congenital
• Cerebral palsy
• Myotonic dystrophy
– Acquired • TBI
• CVA
• Degenerative neuromuscular diseases • Apraxia
– Childhood/Developmental
– Acquired
56
Q

Articulation Profiles of

Persons with Cleft Palate/VPD

A

Reduced variety of speech sounds • Especially infants/toddlers
• Articulation errors
• Speech distortions related to VPD:
• Audible nasal air emission (air escaping through the nose, make sound “turbulent”)
• “Weak” oral pressure consonants
• Hypernasality (Excessive nasality)

57
Q

Compensatory Articulation Errors

A

The most common articulation errors of children with cleft palate or VPI:

58
Q

• Glottal stops:

A

created by adducting vocal folds abruptly and releasing a “stop-like” consonant at the level of larynx

59
Q

• nasal fricatives:

A

substitution of nasal airflow for oral airflow on fricative sounds

60
Q

Treatment of Resonance Disorders / VPD

A

Speech therapy is NOT effective
• Typically requires surgical management
• Prosthetics are an option for non-surgical cases
• Importance of accurate diagnosis and appropriate management for best outcomes
• Standard age of treatment of VPD is 4 years of age but if concerns are present, referral should occur at any time

61
Q

Dental Issues in CLP

A

May have delayed dental eruption • Missinglateralincisorsincleftsite
• May be missing on noncleft side too
• Malformed/hypoplasticteeth
• Supernumeraryteeth,typicallynearorinsiteofcleft

62
Q

Orthodontic Issues in CLP

A

Malocclusioniscommon
• Maxillary transverse collapse and crossbite on the
side of the cleft (“arch collapse”) in CLP • Class III malocclusion common in CLP
• Class II more common in children with CPO
• Patients with CLP tend to have maxillary/midface hypoplasia

63
Q

Orthodontic issues in CLP

A

Maxillaryanteriorocclusalradiographsneedtobe obtained

• Mostpatientsneedmaxillaryarchexpansiontocorrect the transverse maxillary relationship prior to alveolar bone grafting

64
Q

Articulatory distortions related to dental-occlusal hazards

A

Most commonly affected sounds= – S,Z, then SH, CH, J
• Anterior Crossbiteor Underbite (ClassIIImalocclusion) – Distortions of S, Z, SH, CH, J
– Reversed placement for F, V sounds
• Overjet (ClassIImalocclusion)
– May make P,B,M,likeaForVinstead
• Missing,excessivelyspaced,ormalpositionedteeth(or due to some orthodontic appliances) and openbite
– Distortions of S, Z

65
Q

Therapy in the presence of

dental-occlusal hazards

A

• Many children with dental-occlusal problems will still benefit from traditional articulation therapy approaches
• Some children will not be able to eliminate the distortions until the dental-occlusal situation improves
• Alwaysinitiateatrialperiodoftherapyforalltheaffected phonemes before assuming that therapy will not be successful
• Better to target in schoolage children (vs preschoolers)
• Maydefertherapyifdental/orthodontic/surgical
correction of the hazard will occur soon

66
Q

Orthodontics

A
  • Needed for all patients with clefts through the alveolar ridge, usually when patient is in mixed dentition stage (~age 6-9)
  • Braces, headgear, etc.
  • Prep for Alveolar bone grafting

• Orthodontia

67
Q

Alveolar bone grafting

Goal

A

unite the dental arch, provide sufficient boneto stabilize the alveolar ridge, support dentition, and achieve adequate dental alignment and occlusion

68
Q

Alveolar bone grafting

A

• Cancellous cranial or iliac crest bone is grafted into the alveolar area of the cleft site, gives support for arch and eruption of teeth adjacent to the cleft (or support for later pros/implant)

69
Q

Alveolar bone graft: Timing

• Usually completed around

A

5-9 years of age (called “secondary grafting”), during mixed dentition, but timing is dependent on dental development

70
Q

After grafting…

A

• Reassessocclusion
• Orthodontic tooth movement into the grafted area can
begin approx 3 months after grafting • Realignanteriorteeth

71
Q

Orthognathic Surgery

• Goal =

A

treat skeletal malocclusion and reverse overjet and improve facial form and function

72
Q

Orthognathic surgery;

• Approximately

A

30%ofCLPpatientsrequire orthognathic surgery

73
Q

Orthognathic surgery:

• Timing based on

A

determining when facial growth is complete (approx 15-16 yrs)

74
Q

Orthognathic Surgery

• Importanceofpre-opspeecheval

A
  • Risk for VPD (or worsening VPD)

* Need for post-op articulation therapy

75
Q

Prosthodontic Issues in CLP

• Obturation of

A

fistulae or unrepaired cleft • Speech Prostheses for VPD

76
Q

Prosthodontic Issues in CLP

• Replacement of

A

missing teeth

77
Q

Palatal (fistula) Obturators

Goal =

A

to provide adequate velopharyngeal closure for speech and swallowing, close off communication/leakage from fistula

78
Q

Palatal obturators;

• Typically made of an

A

acrylic or metal palatal plate with retention clasps

79
Q

Palatal obturators;

• Teeth may be modified to

A

facilitate retention

80
Q

Palatal obturators;

• Can add

A

prosthetic teeth to the applicance

81
Q

Nasometry

A

The Nasometer-II is a computer-based acoustic, objective instrument that provides a measurement of oral and nasal sound energy.
• Normative values are available for interpretation in children, adults, and for a variety of dialects and languages based on standard passages and
stimuli.

82
Q

Nasopharyngoscopy

A

• Asmallfiberoptic/CHIP TIP nasopharygoscope (attached to a camera and light source) is inserted in the child’s nares and advanced to above the velopharyngeal port
• The velopharyngeal port is observed during specific
……………s…p…..e…e…c……h……ta…s……k…s……….

83
Q

Videofluoroscopy

A
  • Oftencalled“multiviewvideofluoroscopyduring speech”
  • Lateral view, frontal view, base view, Towne’s view
  • Exposure to radiation, but minimally invasive
  • Usually involves administration of barium via the nasal cavity
84
Q

Role of Speech Therapy

A

Primarily aimed at correcting articulation errors.
• Does not reduce hypernasality.
• There are no exercises that will “strengthen” the lips/tongue/palate for speech
• Oral-motor therapy is not an evidence-
based practice.

85
Q

SLPs provide treatment to improve

A

articulation of individual sounds or reduce errors in production of sound patterns

86
Q

Articulation treatment may involve

A

demonstrating how to produce the sound correctly, learning to recognize which sounds are correct and incorrect, and practicing sounds in different words.

87
Q

These treatment approaches/tools will NOT improve for speech:

A 
horn-therapy program
• straw blowing/lip strengthing program
• palate massage/stimulation program
• yawning/sighing exercises
• whistle blowing exercises
• tongue movement exercises
• “cookbooks” to improve resonance
88
Q

Surgical Treatment

• Surgery to “correct” VPD, often referred to as

A

“secondary surgery” or “speech surgery” (~20-30% of pts)
• Usually done at 3 1⁄2 years or later
• Goal: improve velopharyngeal closure for speech
• Most common types: Pharyngeal flap (superior)
• Sphincter pharyngoplasty
• Furlow z-palatoplasty
• Main risk of surgery (flap or sphincter): obstructive sleep
apnea (~5% of cases)

89
Q

Speech Prostheses

• Prosthodontic approach is a

A

viable treatment option for selected patients with VPD

• More commonly used in adults with VPD, or cases of neuromuscular origin

90
Q

Speech Prostheses

• Speech bulb

A

• Palate too short

91
Q

Speech Prostheses

• Palatal Lift

A

• Soft palate of sufficient length but lacks adequate movement

92
Q

• ! Refer all children with suspected VPD to

A

Craniofacial (plastic surgery) clinic for evaluation with craniofacial SLP and team

Physio Exam 3 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions