CD 277 Final
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CD 277 Final
Flashcards for CD 277 final
How are consonants classified?
Place, manner, and voicing
How are vowels classified
tongue height, tongue placement, tension
difficulty with physiological movements of articulators, coordination of air support, timing of phonation
child doesnt know which sounds are contrastive and which are not, kinds of positional constraints and sequential constraints placed on verious speech sounds
Characterizations of articulation disorders
substitutions, omissions, distortion, additions,
Describ the error "Tar" for the word "car"
error is in PLACE
Child says "tog" for dog
error in VOICING
Child says "PISH" for fish
error in PLACE and MANNER
Child says "ephant" for elephant
Child says "baftub" for bathtub
error in place
Causes of Speech Disorders
Structural, Genetic, Hearing Loss
What is fluency
Describes the flow of speech in a conversation'
Relates to the ease and smoothness of speech
Lower end of fluency continuum
-Trouble finding words
-Repetition of phrases to make time to think
Upper end of Fluency Continuum
-Being fluent and saying nothing
-Fluent speakers of foreign language
-Glib speakers (Robin Williams)
What are disfluencies?
-Speech behaviors that disrupt flow of speech
What is a fluency disorder?
When speech contains a high rate of stoppages that disrupt flow of communication must be severe enough to impact social communication
What is general awareness?
-Most people know what stuttering is
-Stuttering was the first disorder SLP's researched
-More research on stuttering than any other disorder
What is stuttering?
Disorder offluency characterized by certain types of disfluencies, excessive amounts of dysfluency in general, of excessive durations of dysfluencies
What is Cluttering?
Fluency problem that can affect intelligibility; it is characterized by breakdowns at the word or phrase level, poor cohension and coherence.
Core vs Secondary Features
Core- repetitions, prolongations, blocks
Secondary- eye blinks, filler words, emotional reactions
How many people stutter?
Are boys or girls more affected by stuttering?
When do most children start to stutter?
___% of children that stutter eventually stop
What are stuttering-like disfluencie?
-Occur on first few words of sentance
-Occurs on major cord content
What is the amount of disfluency in a stutterer
What are secondary features of stuttering?
motor behavior, tightening muscles of speech aparattus,
Impairment of speech
slower speech, unnatural speech, disruption of speech by associated behaviors
interference with basic communication skills
Not getting called on in class, not being selected for a play, being hung up on.
What causes stuttering?
Developmental has no known cause.
Other- predisposing + precipitating
Constitutional factors for stuttering
-Runs in the family
Precipitating factors for stuttering
predisposing factors must be present but precipitating factors determine whether or not predisposing factor is manifested, temperment, and stressors
What to collect during a speech sample for stuttering
-% of disfluencies per 100 words
- Rate of speech in syllables per minute
-Duration of blocks
- avoidance strategies
two different people see and hear the same thing
the same person makes the same observation at a different point in time
What are the 3 options for a beginning stutterer
-Wait, Watch, Re-evaluate
-Enroll in therapy but not necess stutter ther.
-Enroll in treatment with SLP
Treatment for intermediate stutterer
Enrol in therapy, ane make realistic expectations
What are overall goals of stuttering treatment?
1. speak normally without thinking about it
2.. Control and manage the problem
Teaching fluent stuttering, changing sttitudes and feelings about stutter, little emphasis on data collection and counting, speaking with less tension, gaining control.
Spontaneous fluency is goal, little time spent on attitudes, big emphasis on data collection, any stuttering after treatment is considered failure
What are fluency shaping techniques?
-Pause and talk
-Behavior Modification (punish disfluency)
-Computer aided home practice
What type of hearing screening is done by one month of age?
Hearing Identification by three months
Follow-up to confirm Hearing Loss
Early Intervention for hearing by six months
Medical treatment, early services, and family support
Over ___% of children are screened before they leave the hospital
What are rick factors for late onset or progressive hearing loss?
-Family History of HL
What does TORCH stand for?
Toxoplasmosis, Other Agents, Rubella, Cytomegalovirus, Herpes
What does ABR stand for?
Auditory Brain Response Test
What is an ABR
Electrodiagnostic test that requires application of elctrodes to skin and presentation of click like sounds through earphones. Used to assess inner ear and auditory pathways
What does OAE stand for
What does an OAE do?
Acoustic energy produced by cochlea and measured by ear canal, may be awake but better is asleep, moderate sensitivity.
What is the Soundfield Test?
Sounds are presented through loud speakers, assesses hearinf eaither aided or unaided, important to behaviorally confirm heraing loss, some tests can be done 3-6 months.
Battery of tests to assess immitance audiometry
tympanometry, acoustic reflex
(measure mobility of eardrum and how well muscles in ear contracts to loud sound)
What are the four components of hearing aids
microphone, amplifier, receiver, battery
Amplification for Infants/Children
-Electronic devices inside or behind ear, Do not restore hearing, Medical clearance needed from Physician
What makes a child a candidate for Cochlear Implants?
-Lack of progress of auditory skill
Benefits of hearing aid
-Improved audibilidy, improved communication, reduced handicap, increased participation in activities
Limitations of Hearing Aids
Noise, Fast Speech, Takes time to adapt
Overall satisfaction with hearing aids is __%
CIC Hearing Aid
In the ear, fits deep in canal
ITC hearing aid
in ear device, Small enough to fit almost entirely in canal (In The Canal)
ITE Hearing Aid
(In the ear) made to fit in external ear
BTE Hearing Aid
(behind the ear) fits snug behind the ear and is attacched to a custom earpiece
Open fit hearing aid
Ultra thin tubing is virtually invisible
RIC Hearing Aid
(Receiver-in-the-canal) the smallest BTE instruments
-Amplify sound wave after converting to an electrical signal
-Less precise tuning
-Amplify sound waves after they have been converted to a binary numerical code
What is the average life of a hearing aid
What can cause a hearing aid to whistle?
It may need to be adjusted
Average cost of a hearing aid
What does a cochlear implant do?
Bypasses a nonfunctional inner ear and stimulates a nerve with electrical current
What does microphone of cochlear implant do?
pick up sound
What does speech processor of cochlear implant do?
selects and arranges sounds
What does transmitter and receiver of cochlear implant do?
receives signals and converts them into electric impulses
What does the electrode of cochlear implant do?
collects impulses from the stimulator and sends them to the brain.
Cochelar Implant Vs Hearing Aid
-HA acoustically amplifies speech & relys on healthy inner hair cells
-CI convert speech info into electric signal, bypass hair cells, stimulate hearing nerve (8th cranial nerve)
What is Aural Rehabilitation?
Services designed to help individuals with HL realize their optimal potential. (can be in individual of group setting)
What are the components of Aural Rehabilitation?
HA operation, Assessment of self report, Psychological counseling, Communication strategies, Speechreading, assistive devices, auditory training
New trednt in AT
Reading disorders, mild dementia, cochlear implants/hearing aids, auditory processing disorders
Risk Factors for Laryngel cancer
-Tobacco, Alcohol, GERD (inflammation), Epstein-Barr, HPV
Symptoms of Laryngeal cancer
Hoarseness greater then 3 wks, lump in throat, persistent throat clearing, coughing, or sore throat, throat discomfort, difficulty breathing
Medical Evaluation of Larynx
Case history, indirect mirror laryngoscopy, flexible fiberoptic endoscopy, Biopsy, imaging studies
What does TNM stand for?
T- tumpr size
N- lymph node metastasis
/m- presence of distand metastasis
Treatment options for Larynx cancer
Rediation, Chemo, Laryngeal surgery, combination, laryngectomy
Respiration for laryngectomee
air is no longer flitered, moisturized or warmed
How are smell and taste affected after a laryngectomy?
smell impaired since can not breath through nose, which also affects taste
Speech Rehab after laryngectomy
loss of sound generator, pulmonary source disconnected from oral cavity
What is the most common artificial larynx?
Electro layrnx. When held against skin of jaw, converts vibration into electronic sound
Beck-type artificial larynges
Electronic Artifical Larynges
Oral Artifical Larynges
Cooper-Rand or P.O. Vox
Intra Oral Artificial Larynge
Ultravoice custom built into upper denture
Pneumatic Artificial Larynx
Memacon and Tokyo artificial Larynges (rarely used in US)
Advantages of Artificical Larynges
Easy to learn, Equal in intelligibility to esophogeal, more easity discriminated in noise than esophogeal, can be easy changed to intraoral
Disadvantages to Artificial Larynges
Robotic, costly, requires one hand for use, Mechanical Breakdown, Difficult to vary pitch and intensity
patient transports air into esopagus, air is forced back past PE to include resonance
Major method of air intake during esophogeal speech
Esophogeal Speech Advantages
No mechanical devices, both hands are free, more natural sounding
Disadvantages to esophogeal speech
takes 4-6 mo to learn, low sucess rate, phonation can be sustain for a short period, low intensity and pitch, limited pitch modulation
TE fistula puncture created at time of Laryngectomy
TE fistula puncture created months after laryngectomy (less successful)
inserted into trachea held by strap or collar
Advantages of Voice Prothesis
Long phnation sustainablity, more natural breathing action, easy to acquire and learn, hands free
Disadvantages to Voice Prosthesis
daily maintenance, semi-permanent, leakage, cost, requires additional surgery
aspects of movement that remain constant in different contexts
practice or experience leads to permanent changes in capability for movement
Process that defines and sequences articulatory goals prior to occurence
Process responsible for establishing the flow of motor information across speech production muscles
Process of activating relevant muscles during speech production
Motor speech disorder may include
neromuscular defect, motor control system defect, or both
Motor speech disorders may have deficit in
Motor planning/programming, Motor execution
Causes of motor speech disorder
Cogenital (Downs, Cerebral palsy), Acquired (CVA, TBI, Parkinsons)
modulates airflow, controls vocal folds, used for prosody
Inhale/Exhale, Airflow required for speech
Regulates airflow in oral/nasal cavitiy, nasality of speech, shape of VT impacts sound quality
regulate articulation, controls oral muscles
Disorder of motot planning
-inability to transform linguistic representation into appropriate movement of articulators
-Affects ARTICULATORY system
Primary Scharacteristics of Apraxia
Effortful slow speech, distortions of sounds, impaired prosody
Secondary Characteristics of Apraxia
groping articulatos, difficulty initiating speech, ex: hello is untomatic until on command
Causes of Apraxia
Neurobiological, Different lesion locations associated, may accompany aphasia
Dirorder of execution may affect any or all systems
Goal of dysarthria treatment
learn of re-learn accurate speech production, retention, generalization
To improve Resp. System impairments
Posture changes, respiratory exercises, speak at onset of exhalation
to improve phonatory system
exercise to increase vocal fold closure, use of easy onset voicing, increase volume
Improve impairments of resonatory system
improve impairment of articulatory system
oral motor exercise, sound production
improving impairments in prosody
rate control, stress training
Why do SLP work with dysphagia?
Speech is an overlaid function,
Dysphagia involves at least __% of all practicing SLPs
round, soft, mass of food
Implications of dysphagia
Malnutrition, dehydration, poor wound healing, pulmonary complications, aspiration risk, poor oral care
Voval folds must be (open/closed) when we swallow
closed to protect the airway
space between tongue and eppiglottis
located beside larynx and formed by shape of muscle attachments to pharyngeal walls
Sepeartes pharynx from esophagus
UES (upper esophogeal Segment)
Two ways to Examine swallow
FEES (Fiberoptic Endoscopic Evaluation of the Swallow)
MBS (Modified Barium Swallow)
4 stages of the swallow
Oral Prep Phase, Oral Phase, Pharyngeal Phase, Esophageal phase
Oral Prep Phase
Bolus formed, Variable and voluntary stage
Voluntary but not prolonged, lasts one second, breathing inhibited at beginning of stage, food moved to back of mouth
Bolus moves from mouth down throat to esophagus, airway protection, reflex, 1 second
INVOLUNTARY bolus is moved down esophagus, 3-20 secs,
Component Parts of Voice Production
Function of larynx
Sphicteric Muscular Organ degined to protect airway. Speech is an overlaid function
Membraneous sturcture that vibrates during phonation
Vocal Fold Microstructure
Causes of voice disorders
Vocal abuse, surgical trauma, chrinic illness,
Primary disorder etiologies for voice disorders
cleft palate, velopharyngeal insufficiency, deafness, cerebral palsy, etc
personal-related etiologies for voice disorders include
environmental stress, psychological conversions, identity conflict,
How do we diagnose voice disorders?
Larygology evaluation, Voice pathology evaluation,
Voice Pathology Evaluation of Voice Disorders includes:
Patient interview, Voice assessment (CAPE-V, Equal appearing interval screen), Acoustic Voice Assessment, Laryngeal videostroboscopy
Hygienic Voice Therapy
discover behavioral causes of voice disorder and modifies to improve vocal condition (throat clearing, shouting, speaking loudly)
Symptomatic voice therapy
modification of deviant vocal symptoms (breathiness, pitch, loudness, hard glottal attacks)
: tone focus, halthy shout
Psychogenic Voice Therapy
focus on emotional and psychological status of pt. that lead to voice disorder (muscle tention dysphonia, aphonia, falsetto)
Physiologic voice therapy
improve balnce among voice resp. system , muscle strength, (vocal function exercise, lee silverman voice therapy)
Eclectic Voice Therapy
Combination of any therpies
which type of hearing loss is the cochlear implant used for
sensorineural hearing loss
what does the cochlear implant stimulate
What four features characterize vowels
height, frontness, roundness, tension
what three features characterize consonants
place, manner, voicing
cause of phonological disorders
sings of hearing loss
ear pain, bleeding ear, sudden or progressive HL, unequal hearing by ears, HL after injury of loud sound, slow speech dvmt, balance disturbance
speech behavior that disrupts the fluent flow of speech
what is the hallmark of developmental stuttering
part and single syllable word repetitions
person tries to delay disfluency by talking around it
constitutional factors that make an individual susceptible to fluency disorder (genetics, or overly sensitive temperment)
developmental and environmental factors that can worsen stuttering such as age or stress
fluency shaping vs stuttering modification
FS tries to eliminate disfluency SM modifies stutter and decreases fear and anxiety
when vocal folds are closed at midline
when vocal folds are open, rested, so one can breathe
What three things determine vocal folds?
Length (longer=lower F)
Mass (thick=lower F)
Tension (Greater=higher F)
What is phonatory quality
how well two vocal folds work during vibratory cycle
strained, broken, breathy quality
Lack of voice
vocal folds that are under functioning
vocal folds that are pressed too tight and strained
Vocal folds produce two pitches simultaneously
in one min of speaking, vocal fold strike together over ________ times
inflamed ulcers around arytenoid cartilages
linked to emotional and psychological characteristics
Mutational falsetto or puberphonia
male with abnormally high voice