SLP praxis exam
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What is Aphasia?
- an acquired neurologically based language disorder
- can be fluent, nonfluent, or subcortical
What are the characteristics of fluent aphasia?
- relatively intact fluency but less meaningful speech
- easily initiated, well articulated, good prosody and phrase length
List 4 types of fluent aphasia
- Transcortical sensory
Describe Wernicke's aphasia
- posterior temporal gyrus in left hemisphere
- rapid speech with normal prosody
- severe word finding issues
- extra syllables
- empty speech (this stuff, that thing)
- poor auditory comprehension, repetition, writing
Describe Anomic aphasia
- posterior temporal gyrus in left hemi (same as Wernicke's)
- word finding difficulty during fluent speech
- verbal paraphasias
- use of vague, nonspecific words
- good auditory comprehension
- most language functions (except for naming) unimpaired
Describe Conduction aphasia
- Arculate fasciculus - which carries info from wernicke's to broca's
- impaired repetition
- word finding issues
- empty speech due to omitted content words
- normal auditory comprehension
Describe Transcortical sensory aphasia
- temporoparietal region
- paraphasic and empty speech
- severe naming problems
- good repetition but poor comprehension
- echolalia of grammatically incorrect forms, nonsense syllables
- can repeat phrases started by clinician - good automatic speech
What are the characteristics of nonfluent aphasia?
limited, agrammatic, effortful, halting, and slow speech with impaired prosody
List 4 types of nonfluent aphasia
- Transcortical motor
Describe Broca's aphasia
- posterior, inferior frontal gyrus of left hemi
- nonfluent, effortful, slow uneven speech
- limited word output
- short phrases
- misarticulation or distorted sounds
- agrammatic or telegraphic speech
- poor reading and poor comprehension of read material
Describe transcortial motor aphasia
- anterior superior frontal lobe left hemi below broca's
- perseveration of repetition
- absent or reduced spontanous speech
- intact repetition skill (specific to TMA)
- nonfluent, paraphasic, agrammatic, telegraphic speech
- good comprehension
- impaired writing
Describe Mixed aphasia
- watershed area or arterial border
- limited spontaneous speech
- automatic unintentional conversation
- severe echolalia (parrotlike repetition)
- severely impaired auditory comprehension, reading, writing
Describe Global aphasia
- Massive damage in middle cerebral artery
- severe deficits in all areas
- expression limited to a few words, exclamations, and serial utterances
What is subcortical aphasia?
- lesion in area surrounding basal ganglia and thalamus
- damage to basal ganglia: fluent speech with pauses and hesitations, intact repetition and auditory comprehension, articulation problems
- damage to thalamus: hemiplegia, intial mutism, severe naming problems, good auditory comprehension
What are Literal paraphasia?
(Phonemic) - transposing sounds in a word such as tevelision for television
What are verbal paraphasias?
(Semantic) - incorrect word such as saying knife for fork
What is an Embolism?
artery abruptly occluded by traveling material (more frequent)
What is a thrombosis?
artery slowly occluded by collection of material
What is an aneurysm?
pouch formed by a weakened artery wall - leaking can be easier to repair, but ruptured is not
What is an infarct?
a loss of blood supply
What is a TIA?
a transient ischemic attack - mini stroke, change in blood supply to a particular area of the brain resulting in brief neurological dysfunction
What are two different kinds of strokes?
- ischemic: blocked or interrupted blood supply to the brain caused by thombosis (slow collection of material) or embolism (traveling clot)
- hemorrhagic: bleeding in the brain due to ruptured blood vessel
Describe information about strokes.
- 750,000 new cases of strokes a year
- 50% of those who survive have aphasia
- 2/3 stroke patients over 65 years
- Blacks have a higher incidence
What is the function of CN I?
What is the function of CN II?
What is the function of CN III?
What is the function of CN IV?
What is the function of CN V?
- mastication, facial sensation
What is the function of CN VI?
What is the function of CN VII?
- facial movement and sensation
What is the function of CN VIII?
- hearing and balance
What is the function of CN IX?
- tongue/pharynx movement and sensation
What is the function of CN X?
- heart, blood vessels, movement larynx/pharynx
What is the function of CN XI?
- Spinal accessory
- neck muscles
What is the function of CN XII?
- tongue muscles
What are the different types of acquired communication disorders?
- Motor speech - 41%
- Aphasia - 19%
- Other Cognitive - 11%
- Anatomic deficiency - 8%
- Voice - 8%
- Idiopathic - 8%
- Psychogenic - 4%
- Other - 1%
Describe flaccid dysarthria
- Lower motor neurons
Describe spastic dysarthria
- Bilateral upper motor neurons
Describe ataxic dysarthria
Describe hypokinetic dysarthria
- Basal ganglia
- rigidity or reduced range of movement
- Parkinson's, Alzheimer's, Pick's
Describe hyperkinetic dysarthria
- Basal ganglia
- abnormal movements
Describe unilateral upper motor neuron dysarthria
- Unilateral upper motor neurons
- weakness, incoordination, spasticity
What is a motor speech disorder?
A speech disorder resulting from neurological impairment affecting the motor planning, programming, neuromuscular control, or execution of speech - they include the dysarthrias and apraxia of speech
What is dysarthria?
A disturbance in muscle control over the speech mechanism due to damage of the central/peripheral nervous system
What is apraxia of speech?
Impaired capacity to plan or program speech - NOT muscle weakness
What are the subsystems assessed with motor speech disorders?
What is right hemisphere dysfunction as it related to the manifestation of speech and language?
For most people the right hemi is the non dominant hemi for speech and language. They typically have both communication and cognitive deficits which can be addressed in S/L therapy.
What are some deficits that can be seen in right hemi dysfunction?
- Left neglect
- executive function difficulty
- inability to integrate information
- literal/figurative meanings
- flat affect
- disorientation to time and direction
What is dysphagia?
The interruption in eating pleasure or in the maintenance of nutrition and/or hydration - the inability to transfer the bolus from the mouth to the stomach
What are some common etiologies of dysphagia?
- head injury
- cervical spinal cord injury
- progressive neurological disease
- head/neck cancer and/or radiation
What are the primary concerns of dysphagia?
- quality of life
What is aspiration?
the entry of food/liquid into the airway below the vocal folds
What is penetration?
food/liquid enters the laryngeal vestibule at the level of the true vocal cords
What are the 4 stages of swallowing?
- oral preparatory stage
- oral transit stage
- pharyngeal stage
- esophageal stage
What are the 6 stages of the pharyngeal swallow?
- prompt trigger of the pharyngeal swallow
- velar elevation/velopharyngeal closure
- base of tongue retraction
- epiglottic retroflection
- laryngeal elevation
- cricopharyngeal opening
What are some compensatory strategies for dysphagia?
- chin tuck
- head rotation
- head tilt
- multiple swallows
- alternate solids and liquids
- effortful swallow
- cough/clear throat
- modify bolus size
- modify food consistency (last option)
What are the 2 components of the respiratory system?
- UPPER nose
- Nasal cavity
- LOWER larynx
What the components of the Gastro-intestinal tract?
- small intestine
- large intestine
What is respiration?
Breathing - supplies the energy needed for speech
What is phonation?
involves voicing and the structures and processes that create voice
What is resonation?
the processes by which the voice or laryngeal tone is modified by various supralaryngeal cavities and structures
What is articulation?
the process of making speech sounds
What structures support the process of inhalation, exhalation, and speaking?
- spinal column
- rib cage
What are the key laryngeal structures from superior to inferior positioning?
- hyoid bone
- thyroid cartilage
- arytenoid cartilage (pyramid)
- corniculate (tip of arytenoids)
- cricoid cartilage (top tracheal ring)
What is the myoelastic-aerodynamic theory?
the vocal folds vibrate because of the forces and pressure of air and the elasticity of the vocal folds
What is the Bernoulli effect?
sucking motion of the vocal folds towards one another - caused by the increased speed of air passing between the VF
What are the 3 sections of the pharyngeal cavity?
What cranial nerves are involved in articulation?
- CN V: trigeminal
- CN VII: facial
- CN X: vagus
- CN XI: spinal accessory
- CN XII: hypoglossal
What are neurons?
central building blocks of the nervous system - they include the cell body, dendrites, and an axon
What are the structures of the brainstem?
- Midbrain: CN III, CN IV (eye mvmt)
- Pons: CN V, CN VII (speech production)
- Medulla: CN VIII-XII
What is the reticular activating system?
- structure in the midbrain, brainstem, and upper portion of the spinal cord
- execution of motor activity
- attention and consciousness
- sleep-wake cycles
What are the functions of the basal ganglia?
- regulate and modify cordically initiated motor movements - including speech
- damage here can lead to: hypo, hyperkinetic dysarthria, unusual body postures, uncontrolled movement, lead to involuntary movements
What speech and language structure is located in the frontal lobe?
- primary motor cortex
- motor strip
- Broca's area
What speech and language structure is located in the temporal lobe?
- primary auditory cortex
- Wernicke's area
What is phonetics?
the study of speech sounds
What are the 7 manners of articulation?
- nasals - /m, n, ng/
- stops - /p, b, t, d, k, g/
- fricatives - /f, v, th, s, z, j, sh, h/
- affricates - "j" "ch"
- liquids - /l, r/
- glides - /w, j/
- laterals - /l/
What are the places of articulation?
What are suprasegmentals?
- add meaning, variety and color to running speech
- they include: stress, length, rate, pitch, intensity, juncture
What is amplitude?
the strength or magnitude of a sound signal - the greater the amplitude the louder the sound signal
What is frequency?
rate of vibratory motion measured in cycles per second (Hz) - 1 cycle per second is 1 Hz
What is an octave?
an indication of the interval between two frequencies
What is sound?
sound is the result of a vibration or disturbance in the molecules of a medium (solid, liquid, air) that is potentially audible
What are acoustics?
the study of the physical properties of sound
What is linguistics?
the study of language
What are the subfields of linguistics?
What is morphology?
The study of word structure
What is syntax?
the arrangement of words to form meaningful sentences
What is semantics?
the study of the meaning of language
What is pragmatics?
the use of language in a social context
What is the behaviorist theory of language development?
- verbal behavior as a form of social behavior
What is the nativist theory of language development?
- children are born with language acquisition device
What is the cognitive theory of language development?
- language acquisition made possible by general intellectual process
- knowledge of mental processes
What factors are associated with language problems in children?
- children with specific language impairments (language-learning disabilities)
- children with language problems associated with other clinical conditions (intellectual, autism, HL, TBI, CP)
- children with language difficulties related to a combination of factors (poverty, neglect, abuse, alcohol, ADD)
Why do children with SLI have issues with morphological features of language?
- Perceptual problems: children do not perceive morphological features as well as they do other features because they are produced with less intensity
- Syntactic problems: the syntactic complexity involved in sentence comprehension and production may have a negative effect on morphology
What pragmatic skills do children with SLI have difficulty with?
- topic initiation
- turn taking
- topic maintenance
- appropriate conversation repair
- discourse and narrative skills
- staying relevant during conversation
What is an intellectual disability?
formally called mental retardation, this is significant limitations both in intellectual functioning and adaptive behavior as expressed in conceptual, social, and practical adaptive skills
What is Autism?
- impaired social interactions, disturbed communication, stereotypic patterns of behavior, interests, and activities
- because of wide variation in the symptom complex of autism, it is described as a spectrum disorder
- most experts support genetic or neurophysiological theories of autism
What are the (2) subgroups of brain-injured children?
- those who sustain injury due to head trauma
- those who have cerebral palsy
What are the main causes of TBI in children?
- vehicular accident
- sports-related accident
- physical abuse
- gunshot wounds
What is cerebral palsy?
- disorder of early childhood in which the immature nervous system is affected
- not a disease
- group of symptoms associated with brain injury in still-developing children
What are the types of cerebral palsy?
- ataxic: disturbed balance, awkward gait, uncoordiated movement (cerebellar damage)
- athetoid: slow, writhing, involuntary movement (indirect pathway, basal ganglia damage)
- spastic: increased spasticity, tone, rigidity of muscles, stiff, abrupt movements (motor cortex, direct motor pathway damage)
What are patterns of interference/transfer from one language to another?
an error in a student's second language that is directly produced as a result of influence from the first language
What are the functions of the cuneiforms?
cone-shaped cartilages that are located under the mucous membrane that covers aryepiglottic folds
What is the role of the tensor palatini?
muscle that opens the Eustachian tube during yawning and swallowing
What is the response cost method?
a token is given for each fluent production, and one is withdrawn for each disfluency
Based on Spanish influences, what is NOT typical for a Spanish speaking, English language learner?
v/f substitutions in medial position of words
What muscle is primarily responsible for the vibration that produces sound in the vocal folds?
What are the categories of cerebral palsy?
What is auditory memory?
child's ability to mentally sort speech stimulu or remember what he has heard
What is an octave?
an indication of the interval between two frequencies
What is the social interactionist theory?
the idea that the structure of language may have arisen from language's social communication function in human relations
When is -ed mastered in typical developing children?
Describe Blom-Singer's prosthetic device that is used with laryngectomy patients.
shut the air from the trachea to the esophagus so that the patient can speak on pulmonary air that enters the esophagus
What is a jitter?
variation in vocal frequency, or frequency perturbation
What is a submucous/occult cleft?
surface tissue of the soft or hard palate fuse but the underlying muscle or bone tissues do not
Which is a pattern in English you would NOT expect to find in a student who speaks Korean?
substitution of t/k such as "tea/key"
Describe neurogenic stuttering?
disfluencies on function words and in imitated speech, lack of adaptation minimal or no effect of masking noise
At what age should typically developing children be able to understand agent-action relationships?
At what pecent disfluency in speech rate would you diagnose a disorder in fluency?
5% of the words spoken
What is McDonald's sensory approach?
articulation therapy approach which emphasizes both the syllables as the basic unit of speech and the concept of phonetic environment
What does the ~ mark mean when placed above a phoneme?
non-nasal had become nasalized
Descibe Von Langenbeck surgical method?
surgical method of a cleft palate repair that involves raising two bipedicled flaps of mucuperiosteum, bringing them together and attaching them to close the cleft
What is a stroboscopy?
procedure that uses a pulsing light to permit the optical illusion of slow-motion viewing of the vocal folds
What cranial nerve is primarily responsible for innervating the larynx?
In the scientific method, what is the inductive method?
this is the experiment first and explain later approach
How would you distinguish Asperger's versus Autism?
lower IQ and language skills in Autism and the reverse with Asperger's
the ability to learn a new word on the basis of just a few exposures to it
According to Halliday, what are 4 of the 7 functions of communicative intent that develop between 9 and 18 months?
What is a thrombus?
stationary blodd clot that blocks the flow of blood
Which is NOT predictable based on a student's first language of Mandarin?
confusion of /r/ and /l/
What did Brutten and Shoemaker hypothesize?
that stuttering is caused by classically conditioned negative emotions
What did Piaget state?
concrete operations state that the child employs logical causality
What properties affect sound transmition?
mass and elasticity
Repetition skills are better preserved in which aphasia?
Transcortical motor aphasia
Describe basic interpersonal communication skills - BICS.
are developed to a level commensurate that of native English speakers for those developing English as a second language in 2 years
What does the cricothyroid do?
raises pitch of voice by lengthening and tensing the vocal folds
What pattern is NOT typical for a Spanish-speaking student in terms of predictable productions based on Spanish influence?
What articulation difference is NOT commonly observed among Asian speakers of English as a second language?
t/k substitutions such as "tin/kin"
What is concurrent validity?
researchers developing a new test of language acquisition correlated the scores of children studied with the score on an established test of known validity
What is signal-to-noise ratio?
in social situations such as parties, people don't speak loudly enough and noise creates a problem for him in hearing what people are saying
Describe ex-post facto research.
a type of research in which independent variables have occurred in the past and the investigator tries to find potential causes of the dependent variables
Sensitivity to sound of the normal ear of a young adult is limited to what frequencies?
20 Hz - 20,000 Hz
What is split-half reliability?
in developing a test with 100 items, a test developer correlated responses to the first 50 items with responses to the last 50 items
What is coarticulation?
the influence of one phoneme upon another in production and perception, wherein two different articulators move simultaneously to produce two different speech sounds
Describe the positive features of conduction aphasia.
- fluent aphasia
- good syntax, prosody, articulation
Describe an indirect laryngoscopy.
specialist uses a bright light source and a small, round 21-25 mm mirror angled on a long slender handle to list the velum and press gently against the patient's posterior pharyngeal wall and the mirror is maneuvered to view the laryngeal structures during quiet respiration and while the patient is producing /i/
What is an example for telegraphic speech in a child?
a child saying "dog bark" instead of "the dog is barking"
What is juncture?
- vocal punctuation - such as pausing and intonation
- "What did you eat?" vs "What, did you eat?"
- "night rate" vs "nitrate"
- "I scream" vs "ice cream"
What is adequate construct validity?
test scores are consistent with theoretical concepts or expectations
What does a visi-pitch measure?
frequency range, optimal pitch, and habitual pitch
What is a myringoplasty?
surgery used to repair the tympanic membrane after it has been ruptured
What is otosclerosis?
a spongy growth that starts on the footplate of the stapes and causes it to become rigid
According to Brown, what is the last morpheme to be acquired by a typical child?
What is otitis media?
- also known as middle ear effusion
- infection in the middle ear associated with upper-respiratory infections and eustachian tube dysfunction
What is external otitis?
- bacteria or viral infection of the skin of the external auditory canal
- causes conductive loss
What is a myringotomy?
surgical procedure in which small incisions are made in the tympanic membrane to relieve pressure caused by chronic otitis media
What is stenosis?
birth defect resulting in extremely narrow external auditory canal
What is aural atresia?
birth defect in which extrenal ear canal is completely closed
What is Carhart's notch?
- frequently found in patient's with otosclerosis
- specific loss at 2,000 Hz as indicated by bone-conduction testing
What is content validity?
when a test measures what it is supposed to measure because the scores are progressively higher across age groups
What muscles contribute to velopharyngeal closure?
- tensor veli palatini
- levator veli palatini
Stuttering is preschool children tends to occur somewhat more frequently on which words?
function words more than content words
What is the muscle that's used to create the /th/ sound?
ordering and organizing utterances in a message so that they build logically on one another
What is vital capacity?
the volume of air that a person can exhale after a maximal inhalation
What is a leukoplakia?
- benign growth of thick, whitish patches on the surface membrane mucosa
- leads to soft, hoarse, low pitched, and breathy voice
What is the fluency shaping method?
teaching a client to use normal prosodic features of speech for those who stutter
What is the adaptation effect?
when the frequency of stuttering decreases from a first to subsequent reading
What is a granuloma?
unilateral localized inflammatory vascular lesion that developed on the vocal process of the arytenoid cartilage
What are Halliday's 7 functions of communication intent?
What is dysarthria?
speech disorder associated with muscle weakness or paralysis
What are the characteristics of Broca's aphasia?
nonfluent, effortful, agrammatic, and slow speech
What is reduplication?
when a child repeats a pattern such as (wawa/water)
What is a papilloma?
a pink or white wart-like growth that can be found anywhere in the airway and can make a person's voice hoarse, breathy, and low pitched
At what age does the concrete operations stage of cognitive development occur according to Piaget?
What is the discrete trial procedure?
recording the correct and incorrect responses on each attempt you ask the child to make
What is PL 94-142?
children and youth with disabilities from age 3-21 years are guaranteed free and appropriate publich education (FAPE) in the least restrictive environment including special education and related services
What is alternate-form reliability?
administering two versions of a test (Form A and Form B) to selected children
What is electromyography?
a procedure that studies the pattern of electrical activity of the vocal folds by inserting electrodes into the patient's peripheral layngreal muscles to measure laryngeal function
Which are the 2 muscles in the middle ear that dampen vibrations of the tympanic membrane and ossicular chain?
- tensor tympani
- stapedius muscle
What is holophrastic speech?
one word is used to communicate a variety of meaning
What is the lingual frenum?
the structure at the inferior portion of the tongue that connects the tongue with the mandible
Apraxia of speech is commonly associated with lesions in which area?
Which muscle adducts the vocal folds?
What are some limitations of standardize testing?
- inadequate national sampling in the normative process
- inadequate response sampling
- contrived test situations that don't represent naturalistic communications
- limited participation of families assessment
- general inappropriateness for ethnoculturally diverse children
Where is the primary motor cortex in the frontal lobe located?
What is rarefaction?
when vibrating objects return to equilibrium and air molecules become thinner
What is a type-token ratio?
represents the variety of different words the child uses expressively
What is the TTR for a child between 3-8 years?
1:2 or .5
What are some factors involving an established risk of developing language disorders?
- mostly biological or disease related
- congenital malformation, genetic syndrome, neurological disorders, chronic illness, infections
What are some conditions that place children at risk for developing language disorders?
- environmental or genetic factors
- serious pre, peri, post natal complications, behavioral disorders, low parental education, substance abuse, unstable living condition
What are some characteristics of children with language problems?
- difficulty in comprehending spoken language
- slow/delayed onset of language
- limited language output or expressive language
- problematic syntactic skills
- problematic pragmatic skills
- problematic learning of grammatical morphemes
What are different types of intervention techniques available?
- one one one intervention
- small group intervention
- whole classroom intervention (in which the child is worked with as part of his/her class in the classroom setting)
- indirect intervention (in which the clinician sets the goals and a peer, parent, teacher's aide, interpreter)
What are some basic behavioral techniques that are used in a comprehensive language treatment program?
- manual guidance
- immediate, response-contingent feedback
What is expansion?
- expanding a child's telegraphic or incomplete speech into a more grammatically complete utterance
- if the child says "doggy bark" the clinician can say "yes, the doggy is barking"
What is telegraphic speech?
- preserving the meaning of the utterance while omitting the smaller grammatical elements
- saying "cat eat food" for "The cat is eating the food"
What is extension?
the clinician commenting on a child's utterance by adding new and relevant information
What is the milieu teaching?
teaching functional communication skills through the use of typical, everyday verbal interactions that arise naturally
What are the parameters used to classify consonants?
What are some finding on speech sound acquisition?
- vowels are acquired first
- nasals mastered between 3-4
- stops mastered between 3-4.5
- glides /j, w/ mastered between 2-4
- fricatives/affricates mastered 3-6, but /f/ usually first around age 3
- liquids /r, l/ mastered late around 3-7
- consonant clusters are last
What is vocalization?
- a vowel is subbed for a consonant
- saying "bado" for "bottle"
What is gliding?
- a liquid is produced as a glide
- saying "wing" for "ring"
What is velar fronting?
- an alveolar or dental replaces a velar
- saying "tea" for "key"
What is stopping?
- fricative or affricate is replaced by a stop
- saying "to" for "shoe"
What is depalatization?
- child subs an alveolar affricate for a palatal affricate
- saying "wats" for "watch"
What is affrication?
- affricate is produced in place of a fricative or stop
- saying "chun" for "sun"
What is deaffrication?
- fricative replaces an affricate
- saying "sip" for "chip"
What is backing?
- posteriorly placed consonant is produced instead of anteriorly
- saying "boak" for "boat"
What is assimilation?
- sounds are changed by the influence of neighboring sounds
- reduplication, regressive, progressive, voicing
What are possible syllable structure processes that can affect words?
- unstressed syllable deletion
- final consonant deletion
- epenthesis (adding schwa)
- consonant cluster reduction
- diminutization (adding /i/)
- metathesis (reversing sounds in word)
What is ankyloglossia?
What is a malocclusion?
deviation in the shape or structure - in this case it usually refers to a dental malocclusion
What is class I malocclusion?
arches are properly aligned but individual teeth are misaligned
What is class II malocclusion?
overbite - maxilla is protruded
What is class III malocclusion?
underbite - mandible is protruded
What is an orofacial myofunctional disorder OMD?
any anatomical or physiological characteristics of the orofacial structures that interfere with normal speech, physical development
What are some characteristics of childhood apraxia of speech?
- slow, effortful speech
- prolongation of speech sounds
- repetition of sounds and syllables
- difficulty with consonant clusters
- omissions and substitutions
- voicing errors
- groping and silent posturing
How many utterances are in an optimal speech sample?
What is stimulability?
refer's to a child's ability to imitate the clinician's model
Describe Van Riper's traditional approach.
- auditory discrimination/perceptual training
- phonetic placement
- drill-like repetition and practice
Describe McDonald's Sensory-motor approach.
- based on the assumption that the syllable, not the isolated phoneme, is the basic unit of speech production
- coarticulation is important in this approach
- helpful for children with oral-motor coordination difficulties
Describe the Hodson and Paden Cycles approach.
- phonological pattern approach designed to treat children with multiple misarticulations and highly unintelligible speech patterns - 4O% or greater
- clinician introduces correct patterns, gives the child limited practice with them, and returns to them at a later date
What is phonological awareness?
explicit awareness of the sound structure of a language, or attention to the internal structure of words
What are some characteristics of English as Foreign Language learners?
- 25-3O% refere themselves for other conditions involving fluency, voice, and possibly dyspraxia
- impact of the first language on English is so great that their English intelligibility is reduced
What are different types of fluency disorders?
- neurogenic stuttering
- psychogenic stuttering
What are different types of secondary behaviors?
- muscular tension
- breathing abnormalities
- negative emotions
- avoidance behaviors
What are the 3 definitions of stuttering?
- 1. anticipating trouble in speaking situations
- 2. what a person does to avoid stuttering
- 3. social role conflict
List the different types of dysfluencies?
- sound prolongation
- silent prolongation
- broken words
- incomplete sentences
What percentage of speech needs to be dysfluent to be judged as "dysfluent" or "stuttered"?
More statistics on stuttering.
- 5% of population has instance of stuttering
- 1% of US population
- generally begins between 3-6 years
- onset of stuttering after 12 yrs is rare
- onset in adults is rare, usually occurs after neurogenic incidence
- 3:1, male to female
What is concordance?
the occurance of the same medical conditions in both members of a twin pair
What is spontaneous recovery?
disappearance without professional help
What abnormal motor behaviors may be associated with stuttering?
- excessive motor effort
- various facial grimaces
- various hand/foot movements
- rapid eye blinking
- rapid opening/closing of mouth
- tongue clicking
In what instances/loci is stuttering most likely to occur in adults and school-age children?
- consonants over vowels
- first sound/syllable of a word
- first word/phrase in sentence
- longer words
- less frequently used words
- content words over function words for adults
- function words over content words for kids
- this can be due to the fact that adults usually start with content words and kids start with function words - this further strengthens the idea that position of words rather than the actual class of words affects stuttering
What is the adaptation effect?
frequency of stuttering is reduced when a short passage is repeatedly read aloud
What is the consistency effect?
- the occurance of stuttering on the same word or loci when a passage is read aloud repeatedly
- 65% of stuttering may be consistent
What is the adjacency effect?
occurance of new stuttering that occur on word surrounding previously stuttered words
What is the audience size effect?
the frequency of stuttering increases with an increase in audience size
What are the main theories of stuttering?
What is the fluent stuttering method?
the focus is not on normal fluency, but on making stuttering more fluent
What is the fluency shaping method?
establish normal fluency by teaching various skills of fluency (appropriate management of airflow to produce and sustain fluent speech, slower rate of speech, and gentle onset of phonation)
What is neurogenic stuttering?
stuttering with documented neuropathology such as cerebral vascular disorders causing strokes and head trauma, extrapyramidal diseases (Parkinson's), drug toxicity
What is cluttering?
- disorder of fluency that often coexists with stuttering
- speaking highly disfluently, rapid, unclear, and disorganized manner that is jerky and monotonous
What is the glottis?
the opening between abducted vocal folds
What is the primary CN involved in laryngeal function?
- CNX - vagus nerve
- superior and recurrent laryngeal nerve branches that innervate larynx
What can happen with damage to the recurrent laryngeal nerve?
- it supplies all sensory information below the vocal folds
- if damaged, patient may experience difficulty adducting the vocal folds
What is the cricoid cartilage?
- uppermost tracheal ring
- completely surrounds the trachea
What are the arytenoid cartilages?
- supraposterior surface of the cricoid cartilage on either side
- pyramid shaped
- vocal process are the most anterior angel
What is the average fundamental frequency for men? Women?
- 125 Hz (men)
- 225 Hz (women)
What is presbyphonia?
an age related voice disorder characterized by perceptual changes in quality, range, loudness, and pitch in the older voice
What are the 3 sets of vocal folds?
- aryepiglottic folds
- ventricular folds (false)
- true vocal folds
What are 3 important characteristics of the voice?
What is pitch?
the perceptual correlation of frequency
What is volume?
perceptual correlation of intensity or loudness
What is fundamental frequency?
a person's habitual pitch
What is amplitude perturbation or shimmer?
cycle-to-cycle variation of vocal intensity
What is quality?
- the perceptual correlation of complexity
- can be measured by hoarseness, harshness, strain-strangled, or breathiness
What is glottal fry?
- heard when vocal folds vibrate very slowly
- sound occurs in slow but discrete bursts and is extremely low pitch
What is diplophonia?
- two distinct pitches during phonation
- "double voice"
What is stridency?
voice sounds shrill, unpleasant, and somewhat high pitched
What is an indirect laryngoscopy?
bright light source and small mirror to lift the velum and press gently against the patient's posterior pharyngeal wall during phonation of /i/
What is a direct laryngoscopy?
- performed by surgeon under general anesthesia
- can observe direct microscopic view of the larynx but no phonation so vocal function can't be observed
- valuable tool for biopsy
What is a flexible fiber-optic laryngoscopy?
thin, flexible tube containing lens and light source passed through patient's nasal cavity, over velum, to view larynx
What is an endoscopy?
- flexible (nasally) and rigid (orally) where patient can do variety of things
- can study laryngeal anatomy and physiology in detail
- endoscopy can be attached to a camera (videoendoscopy) or a stroboscopic (flashing) light source can be used
What are two ways vocal fold patterns can be measured?
- electroglottography (EGG): noninvansive indirect measure
- electromyography (EMG): invasive direct measure
What is resonance?
the modification of sound by the structures through which the sound passes
What are the voice disorders of resonance?
- hypernasality: excessive nasality
- hyponasality: denasality
- assimilative: nasal consonant carries over to adjacent vowels
- cul-de-sac: backward retraction of tongue, often seen in the deaf population
What is metathesis?
spread of cancer to other regions
What is a laryngectomy?
- removal of the larynx due to cancer
- patient may need radiation or chemotherapy
Describe types of alaryngeal speech.
- VF are gone after laryngectomy so normal voicing is not possible
- may need stoma or opening in lower part of neck connecting to trachea
- vocalization types: external device, esophageal speech, surgical modification
What is a granuloma?
- localized, inflammatory, vascular lesion composed of granular tissue is a firm, rounded sac
- frequently develop on vocal process of arytenoid cartilage
- caused by vocal abuse, injury, intubation, GERD
What is a hemangioma?
- soft, pliable, filled with blood
- occur in posterior glottal area
- caused by intubation or hyperacidity
What is leukoplakia?
- benign growths of thick whitish patches on the surface membrane of the mucosa
- caused by tissue irritation from alcohol, smoking, vocal abuse
What is hyperkeratosis?
- rough, pinkish lesion occurring in the oral cavity, larynx, or pharynx
- caused by tissue irritation
What is laryngeomalacia?
soft, floppy laryngeal cartilages - usually the epiglottis is affected
What is subglottal stenosis?
narrowing of the subglottic space which can be acquired or congenital
What is a papilloma?
- wart-like growths caused by the human papilloma virus
- pink, white, or both found anywhere in the airway
What is ankylosis?
A stiffening of the joint
What is multiple sclerosis (MS)?
progressive and diffuse demyelination of white matter - impaired prosody, pitch, and loudness
What is myasthenia gravis?
a neuromuscular autoimmune disease producing fatigue and muscle weakness
What is amyotrophic lateral sclerosis (ALS)?
also known as Lou Gehrig's disease, is a progressive, fatal disease involving degeneration of the upper and lower motor neuron system
What is parkinson's disease?
- lack of dopamine in the substantia nigra of the basal ganglia
- can sound breathy, low pitched, or monotonous
What are vocal nodules?
small nodes (fibrous) that develop on the vocal folds that develop over time as a result of prolonged vocal abuse behaviors
What are polyps?
masses that grow (fluid filled) on vocal folds due to vocal abuse
What are contact ulcers?
sores or craterlike areas of ulceration, granulated tissue that develop along glottal margin
What is dementia?
an acquired neurological syndrome that is usually accompanied by progressive deterioration in intellectual functioning, language, memory, emotion, behavior
What is Huntington's disease?
- kills the brain cells that control movement
- loss of neurons in the basal ganglia
What is Parkinson's disease?
- 35-55% of Parkinson's patients have dementia
- brainstem deterioration
- slow voluntary movements, muscle rigidity, masklike face
What is Alzheimer's?
- type of cortical demetia
- intellectual and language deterioration precedes motos deficits
- causes 50% of irreversible dementia
What is Wernicke-Korsakoff syndrome?
alcohol abuse related dementia
What is right hemisphere syndrome?
- group of characteristics related to perceptual and attentional deficits that also affect communication
- visual/spatial perception, facial recognition, arousal, attention, orientation, emotional experience, musical harmony, prosody
What is traumatic brain injury?
- injury to the brain due to external force or physical trauma
- caused by: falls, auto accidents, struck by an object, assults, alcohol/drug abuse
- open and closed injuries
What is alexia?
loss of previously acquired reading skills
What is agraphia?
loss in previously acquired writing skills
What is agnosia?
impaired understanding of the meaning of a certain stimuli
How long does it take CDL children to develop basic interpersonal communication skills (BICS) and cognitive-academic language proficiency (CALP)?
What is construct validity?
what theories were used in the test's creation
What are some theories regarding stroke recovery in bilingual patients?
- synergistic and differential recovery theory: L1 and L2 recover equally, most common
- antagonistic recovery theory: one recovers at expense of other
- successive recovery theory: one lang recovers after other lang is completely recovered
- selective recovery theory: only one recovers
What are the components of the outer ear?
- auricle/pinna: part you can see
- external auditory membrane: from pinna to tympanic membrane/eardrum
What are the components of the middle ear?
- tympanic membrane: vibrates in response to sound pressure
- ossicular chain: malleus, incus, stapes
- eustachian tude: opened by tensor veli palatini and levator veli palatini, connects middle ear to nasophaynx
What are the major structures of the inner ear?
- vestibular system: movement, balance, posture
- cochlea: connects to auditory branch of acoustic nerve
What are the degrees of hearing loss?
- Up to 15 dB: normal
- 16-40: mild
- 56-70: moderately severe
- 71-90: severe
- 90+: profound
What is central auditory processing?
the effectiveness and efficiently with which the central auditory nervous system utilizes auditory information
What is retrocochlear pathology?
damage to the nerve fibers along the ascending auditory pathways from external auditory canal to cortex
What is acoustic immitance?
transfer of acoustic energy
What is tympanometry?
acoustic immitance is measured with an electroacoustic instrument
What are some ways that sound and speech can be amplified?
- hearing aids
- cochlear implant
- tactile aids
- assistive devices
What is evidence-based practice in speech-language pathology?
ensures that clients receive services that are known to be based on reliable and valid research and sound clinical judgment
What are the standard components of any assessment?
- case history
- hearing screening
- orofacial examination
- speech language sample
What is validity?
- if a test measures what it's supposed to measure
- concurrent: degree a new test related to a test of established validity
- construct: degree test scores are consistent with theories
- content: degree of validity based on exam of all items
- predictive: degree test can predict future performance
What is consistency?
degree to which a test can replicate what is measured
What are different types of rating scales?
- nominal: measures categorically without numerical relationship
- ordinal: measures using a numerical relationship
What is a functional assessment?
evaluates day-to-day communication skills
What is a dynamic assessment?
assesses child's ability to learn when provided with instructions
What is treatment?
teaching, training, and any type of remedial or rehabilitation work
What is reinforcement?
selecting and strengthening behaviors arranging immediate consequences unders specific stimulus conditions
What is booster treatment?
- treatment offered any time after initial dismissal from services
- important for maintenance
What is the Hawthorne effect?
the degree to which the participant's awareness of the participation in a study affects the outcome of the study
List the reactions and emotions related to communication disorders.
- shock and disbelief
What is copralalia?
- inappropriate use of swear words or obscene language
- usually seen in Tourette syndrome
Which muscles contribute to velopharyngeal closure through velar elevation?
- tensor veli palatini
- levator veli palatini
Which muscle is involved in making the /th/ sound?
What is oscillation?
the back and forth movement of air molecules because of a vibrating object
What is McDonald's sensory-motor approach?
an articulation therapy that emphasizes the syllable as the basic unit of speech production and heavily utilizes the concept of phonetic environment
Which muscles adduct the vocal folds?
- lateral cricoarytenoids
- transverse arytenoids
Damage to the recurrent laryngeal nerve would benefit from what vocal treatment?
vocal fold adduction
What is the hearing level?
the lowest intensity that will stimulate the auditory system
What is simple harmonic motion?
back and forth movement of particles when the movement is symmetrical and periodic
What is speechreading?
deciphers speech by looking at the face of the speaker and using visual cues to understand what the speaker is saying
What is the 3rd convolution of the left cerebral hemisphere?
What is the correlation coeffecient?
suggests the ways in which 2 variables are related to each other
What is "delay" as a treatment procedure?
the clinician waits for the child to initiate a response, prompts or models if there is no response, and gives the desired objects if no response after 3 months
What is the direct stuttering reduction method?
stuttering is directly reduced without teaching fluency skills
What would you like to do?
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