Card Set Information
What are the multicultural constructs?
Degree of acculturation
What are terms used to describe language?
Acquiring a second language
Dual Language learners
English Language Learners (ELL)
Bilingual (speak two or more languages)
L2- second language
What is code switching
ALternating use of each language/dialect depending on context or listener needs
What are the statistics of CLD
Population in US = 25%
CLD in schools = 14%
Projected to increase over 30% by 2015
Pevalence rate of com dis = 6.2 million
-China and eastern europe inadequate nutrition, lack of stimulation = signiicant developmental impairments
Describe socioeconomic status
Ranking by position in society on class, status, power, financial resources, level of education, and occupation.
Described as high, middle, or low
Predictor of school performance, crime
SES may be a better predictor of cognitive-communicative behaviors than other factors such as racial-ethnic background
SES is ___ predictor than cultural/ethnic
low educational progres
more behavior probs
What are clinical considerations for children
Acquisition of LD
L1 influences L2 (language interference transfer, language loss.
What is BICS and CLAPS
Basic Interpersonal Communication Skills- Social 2-3 years to develop
Cognitive Academic Language Proficiency Skills- academic learning 5-7 years to develop
What are the 2 patterns of 2nd language acquisition.
Simultaneous- exposed to and acquires L1 and L2 from birth.
Sequential/ Successive - L2 is introduced later in childhood, usually after 3 y/o
What are the Educational models
what are the clinical considerations for adults with CLD
The same type and severity of aphasia may be present in both languages OR severity may be greater in one language for bilingual speakers.
Emphasize a cross-linguistic approach to enhance recovery
Use similar words from both languages for word retrieval practice.
Conduct tx in language common to clinician and client, but home practice in other language.
Discuss the initiation of any assesment
Initiated for a reason
Chief complain or presenting issue or problem
Assessments are initiated in different ways (self referral, teacher, parent, physician, another professional.
What are initial questions to ask for assessment
Are the clients speech, language, and hearing within normal limits
Is the client at risk for developing a disorder
What are the characteristics of impairment, disability, and handicap
What is the cause of the behaviors constituting the communication disorder
Is there any reason why the clinician cannot or should not provide treatment?
If the referral is medical it comes from who? if it is clinic it comes from who?
Self, parent, friend, other professional
What is the process of referral for educational setting?
Referral by teacher or parent
Process starts may be changed due to RTI tears
: BIT/SAT team suggests other interventions. May include screening.
If regular ed interventions are not successful...
Refer to specialist for dx
Get a CMAP as and ORDER to start evaluation process
IEP process dictates the timeline by which all work is completed.
When an SLP gets a referral they need to...
: permission papers must be signed, IDEA, HIPAA
: permanent/confidential file; medical chart- do before you see client or patient.
Discuss the process of making a dx plan
Interview teacher, parent, client, significant others (case history)
Standardized, norm-referenced assessment instruments
Observation of typical behavior in functional environment (know normal behavior and development)
Screen other disorders or differences if not the "chief complaint"
What are informal assessments
incldue dynamic assessment
what other disorders may you screen?
voice, pragmatics, language
oral mechanism screening
After the Dx plan, what is the next step in schools
MDT, multidisciplinary team or MDET
Minimally:SLP, reg ed teacher, parent
: Special ed teacher OT, PT, Social worker case manager, nurse
Looks at results of textsing
determines whether student is eligible for school-based tx
Describe the evaluation report.
Should stand on its own
State what was assessed and how
Interpret what the scores mean in functional terms
use clinical judgment to state the significance of the findings
use language non-professionals will understand
Describe the IEP
Individual education plan
decides upon the goals and objectives to be addressed in tx
goals must be related to regular or general education curriculum
states time allotted for tx and where
Accommodations in regular ed classroom
Cultural and not a disorder
What are the two approaches for choosing treatment targets for children with articulation or phonological disorders. Describe each
1. developmental approach
: Identify targets based on normal ages of acquisition os speech sounds, typically present error sounds in order that normal children learn sounds.
2. non-developmental approach
: Client specific, degree of perceived deviance associated with child's errors, phonological
Describe the client specific appraoch
targets relevant to child
targets most stimulable, regardless of typical development
Targets most visible when produced.
Describe the degree of perceived deviance associated with childs errors.
Articulatory (omission, substitutions, distortions, initial position errors, medial position errors, final position errors. Errors on most frequent sounds
Phonological (most unintellibillity, initial consonant deletion, gloattal replacement of medial consonants.)
Describe the verticle goal strategy
Intense practive on limited number of targets
Target /l/ first until mastered then move on to /r/
good if client only has few errors
traditional artic treatment
Isolation, syllables, words, sentences, conversation
Describe the horizontal goal strategy
Simultaneous exposure to a wide variety of targets will facilitate a client's ability to produce phonemes or sound patterns
Less intense practice to a large number of targets, even in same seesion.
Appropriate for clients with multiple errors.
Describe the Cyclical goal strategy
Combine vertical and horizontal approaches
Practice intensely on target for given amount of time, then move to another target
Cycle is repeated until targets emerge into spontaneous speech.
Change targets regardless of progress and keep repeating cycle.
there is no significant evidance or connection between _____ and speech sound production.only recomended for _____
Oral motor exercises
awareness of oral mechanism
Describe an articulation disorder and the 2 kinds.
Phonemes produced incorrectly. This is a motor component of speech
Functional (without cause) and Organic (cause)
Describe a functional articulation disorder
Speech production errors in the absence of identifiable etiology (normal hearing, no significant structural anormalities, No neurological dysfunction.
Selection of tx targets from either developmental or non-developmental approach
What are the speech characteristics of a functional articulation disorder
What are helpful hints for treating a functional articulation disorder.
Don't include more than one error sound in a stimulus word in initial stages of tx.
Pay attention to phonetic context of words--some consonant-vowel sequences are more difficult
Motor skill- so more practice is needed
Counsel parents about responses to errors to avoid
Describe phonological disorders
The phonological system governs the ways in which sounds in a language can be combined to form words
Difficulty in acquiring a phonological system, not necessarily in production of the sounds.
Describe the phonological disorder treatment approaches
1. phonological processes strategy used by 1..5 - 4 y/o children to simplify production of classes of speech sounds- persistance using this is disorder and treat by teaching rule.
2. distinctive features -artic and acoustic properites- teach place manner and voicing.
What are three organic articulation disorders.
Childhood apraxia of speech (CAS)
Describe Cleft Palate
Congenital malformation of palate and/or lip
bilateral or unilateral
Surgical repair of lip, palate and pharyngeal flap
Speech treatment begins both before and after surgery
What are the speech characteristics of Cleft palate
Velopharyngeal incompetence (VPI): Audible emission of air, hypernasal resonance, articulation errors. Most freqent errors on fricatives, affricates and plosives distortions and omissions.
Describe a hearing impairment
Significant loss in auditory acuity
Sensorineural, mixed, conductive
the more severe the less articulation
midl to moderate patients tolerate tx best
Speech intelligiibility affected by profound HL
What are the speech charicteristics of a hearing impairment
Omission of initial and/or final consonants, blends
substitution of voiced consonants for voiceless
Substitution of stops for nasals, fricatives, and affricates
Substitution and insertion of schwa
nasalization of vowels.
What are the treatment approaches for hearing impairment
oral-emphasizes spoken language
manual emphasizes ASL
Total communication combination
Cochlear implants with speech therapy.
Speech motor planning disorder with reduced ability to volitionally sequence movements of articulators for speech perhaps from neuologic diysfunctions.
Receptive language aboilites are better than expressive
Can be unintelligible to not verbal
what are the speech characteristics associated with CAS
Repertoir of phenemes is extremely restriceted
Reduced ability to imitate sound- especiall muliti syllables
Most omission, substitution, distortion (inluding vowels) addition prolongation
Errors on sounds requiring complex artic movements.
struggling or grouping movements
Errors increase with length and complexity
Ability to sequence phonemes is reduced.
CAS treatment approaches
Progress is slow
Repeated practice --systeatic drill necessary
shorter, more frequent session
must use visual, tactile and auditory cues,
work on melody and rhythm
Consider AAC system temporarily.
How is accent reduction the same, and how is it different
place manner and voicing
Includes cultural education
: idioms, humor,
Syntax, stress intonation
Adults, generally as clients
What are accent reduction treatment approaches.
Careful analysis of differences
Often vowels and prosody are different
Determine what differences contribute most to intelligibility problems and target these first
Define a language disorder
The abnormal acquistion, comprehension, or use of spoken or written language
Includes receptive and expressive language skills.
May involve any aspect of the form, content or use of linguistic system
Primary vs Secondary disorder (autism and language)
Developmental vs acquired
Delayed vs deviant acquisition
Range of severity
*SPOKEN AND WRITTEN
Look at p151
2. parts of words that go togehter
3. how words are ordered and combined for sentences
4. social skills
5. systems and rules of how sounds are put together in words.
Describe emergent literacy and metalignuistic awareness
Awarenss of world of print and understanding of functions of literacy.
: awareness of and ability to manipulate aspects of the linguistic system (eg: phonological awareness)
Vocabulary and word retrieval (rapid naming for decoding)
Deficits in vocab and word retrieval most common characteristics of language impairment.
What is literacy, reading, writing.
: development of reading and writing skills
: decoding, comprehension, vocabulary, fluency, phonemic awareness
: spelling, conventions, compose text at sentence level and beyond.
What is the basis of development for literacy?
Tx approaches vary according to theoretical orientations which are
what is the intervetion for birth to 3 years with a language disorder
Go to home
provide intervetion indirectly (monitoring, stimulation and prevention
Family centered approach
: Services delivered at home or center based, interdisciplinary model, repeated exposures and stimulation.
Early intervention critical for childre at risk for language due to:
prematurity, low birth weight, family history, medical complications, hearing
What are the treatment targets for birth - 3 years
joint action and routines
non-symbolic play and symbolic play
What is the intervention for 3-5 years
Most development of linguistic system
Rapid growth in vocabulary
Morphological forms emerge
Can understand and produce sentence forms
Emergent literacy continues
What are examples of emergent literacy
shared book reading and sense of story
alphabetic letter knowledge
adult modeling of literacy activities
experience with writing materials.
What do we know about language development of elementary school.
MLU is increasing until about 9 years old
More complex sentences, relative clauses, passive voice
Learning to decode, comp. should be developing.
What are the treatment targets for school age with language disorder
exression and comprehension(narrative/expository)
k-3 you ___ to ____
3rd to 12th you ____ to _____
learn to read
read to learn
Goals are programmed to addess....
the demands and expectations of educational curriculum
Describe treatment activities
Activities need to be functional --related to educational curriculum. (drills, memory card game)
What are classroom like activities
Books, reading, writing.
What are treatment targets for adolescents?
expression and comprehension.
What are treatment targets for adolescents 10-14?
What are treatment targets for adolescents 14-16?
What are treatment targets for adolescents 16-20?
Communication skills for academic and personal-scocial
Communication skills for academic and personal social and career.
Communication skills for personal social and career.
Goals for adolescents are
Programmed to address the demands and expectations of academic, social, and career
What are treatment activities for adolescents.
textbooks, magazines, newspapers, interest area
Motivation is key, adolescents must feel that they have choices and must take ownership for achieving those goals.
What are the stages of swallowing?
Describe the Anticipatory phase?
Occurs before any food reaches the mouth
Decisions made regarding type, rate, and quantity of oral intake
Describe the Oral Preparatory phase
Food manipulation in mouth, forming bolus
sufficient saliva production
Labial (lip) seal maintained
Buccal (cheek) musculature
Describe the Oral Transport phase?
Tongue begins posterior (back of mouth) movement of the bolus
Labial (lip) and Buccal (cheek) muscles contract
Tongue elevates from front to back and bolus is propelled toward oropharynx (through the oral cavity and pharynx)
Describe the Pharyngeal phase
Triggered when bolus approaches the anterior faucial arches and tongue base
closure of velopharyngeal port
Contraction of pharyngeal walls and posterior tongue base movement
Laryngeal closure (airway closure)
Opening of upper esophageal sphincter.
Describe the Laryngeal closure (Airway closure).
True and False vocal folds contract
Larynx and Hyoid Elevate and move Anteriorly
Arytenoid cartilages approximate base of epiglottis
Top third of epiglottis folds down horizontally.
Describe the Esophageal Stage.
Long, flaccid muscular tube with tonically contracted muscle at both ends
Esophageal transit times vary from 8-20 sec
Peristallic wave pushes bolus through esophagus until the LES opens to allow bolus to enter stomach.
Define aspiration, penetration, residue
Aspiration = entry of food or liquid into the airway below the true vocal folds.
Penetration = entry of food or liquid into the larynx at some level down to but not below the true vocal folds
Residue = food or liquid that is left behind in the mouth or pharynx after the swallow.
What are the etiologies associated with Dysphagia?
What are the Clinical implications of Aspiration
Pneumonia or poor lung condition
low grade fevers
abnormal pulse oximetry
increased oxygen requirement
decreased overall respiratory status
What are the signs and symptoms associated with dysphagia and aspiration risk
Wet voice/poor vocal quality
Decreased oral motor function
Patient complaints (weight loss, lengthy meals)
Describe the Bedside exam
Patient History/ Chart Review (medical status, respiratory status, current feeding methods)
Interview/ Observation (Level of responsiveness, behavioral characteristics, positioning)
Oral Mechanism Exam (Lips, tongue, soft palate, cheeks, mandible, and larynx, strength, coordination, range of motion)
Non Instrumental Clinical Evaluation (dry swallows, trials swallows, oral motor function, observations after swallow)
Describe the modified barium swallow
study of anatomy and physiology
Oral, pharyngeal, and cervical esophageal stage s of the swallow
Define management and treatment strategies that will improve swallowing safety and efficiency.
Compare Bedside and Modified evaluation
*Typically complete prior to MBSS
*Purpose is to identify aspiration risk and determine need for further evaluation
*Provides subjective signs.
*Purpose is to identify impairments and determine appropriate mgt and treatment
*Trial postures/ maneuvers
*Provides obective evidence
What are the Compensatory Strategies and describe them.
: liquid (thin, nectar thick, honey thick) Solid (blenderized, puree, mechanical soft)
: Chin down, tilting head backward, rotating head, head tilt to side, lying on side or back.
Increased Sensory Input
: Modifiny presentation of bolus, thermal tactile stimulation
: supraglottic swallow, super supraglottic swallow, effortful swallow, mendelsohn maneuver, masako maneuver
What are the Therapy techniques and describe them.
Oral Motor Exercises
: range of motion tongue exercises, resistance exercises, bolus control exercises.
: Vocal fold adduction exercises, tongue base exercises, laryngeal elevation
Describe Neuromuscular Electrical Stim
Combined with OM and Pharyngeal Exercises, swallowing trials
due to brain damage (usually a hemorage or blockage)
results in impairment in comprehension and/ or formulation of language.
can affect oral and written language
What is the etiology of Aphasia
Cerebrovascular accident (CVA)- stroke
Head trauma (TBI)
What are the deficits of aphasia?
Damage to language area of brain (usually left hemisphere)
Motor and sensory deficits (hemiplegia, hemiparesis, hemianopsia
What are the two categories of aphasia
: poor comprehension with relatively spared speech, impaired word-retrieval, paraphasisas, neologisms, perseveration (wernicke's)
: poor output with relatively spared comprehension, reduced vocab, agrammatism, impairments in artic rate and prosody speech is labored and effortful
What is the tx efficacy of aphasia
may have spontaneous recovery (2-3 months or 1 yr)
Need frequent treatment of 2 or more hours per week)
More improvement in receptive, then speech production, then expression
What are the goals for tx of aphasia?
goal is to improve communicationskills within constraints of neurological damage
Focus is on care not cure
Establish compensatory/maintenance strategies for functional language skills
Consider pre-morbid status.
What are the two theoretical orientations of aphasia tx
: intensive and repeated sensory stimulation. direct instruction , gain as much as possible
: use whatever modalities available to communicate. used when there is more damage.
Describe group tx and self curing for word retrieval
: social setting, family members
Self-cuing for word retrieval
: Automatic sequences (days of week) Paired verbal associates (salt and pepper) sentance completion (use a broom to sweep the ____)
Describe constraint induced language therapy and stimulation facilitation.
Constraint induced language therapy
: massed practice (30 hrs in 2 weeks), shapig, constrain-no non verbal (tie hands down)
: Focus on semantics and syntax, intensive auditory stimulation, high number of responses.
*Both are Restorative linguistic
Describe the Melodic intonation therapy and the amer-ind approaches.
Melodic intonation therapy
: restorative linguistic, recuits participation of right hemisphere to improve verbal production in left hemisphere, rythm and unision
: sutitutive/compensatory, gestural system based on american indian hand talk, telegraphic, no grammar
Describe visual Action therapy and promoting aphasics communicative effectiveness (PACE)
Visual Action Therapy
: substitutive/compensatory, non-vocal, single gesture level to communicate.
Promoting Aphasics communicative effectiveness (PACE)
: Substitutive compensatory, convey message by whatever means
Life Participation Apprach to Aphasia
: Functional compensatory, maximize clients reengagement in life based on clients and families decisions of what is important.
imaired muscular control over speech mechanism
Result of central or peripheral nervous system damage
: stroke, brain tumor, tbi, toxins, chemo.
inaccurate and/or labored performance in rapid, repetitive movement of articulators (slurred)
can affect respiration, phonation, resonance, articulation, prosody
: paralysis, weakness, decreased tone, incoordination
Can be reduced range of motion or invlountary and unihibited movement.
What is the prognosis of dysarthria?
No spontaneous recovery with some
Remission can occur for some neuromuscular diseases
Degenerative disease-prognosis is pore.
Co-occuring with aphasia
TX is generally effective.
Describe the behavioral prosthetic and medical procedures for approaches to dysarthria>
: verbal reinforcemtn, metronome pacing, biofeedback, delated auditory feedback, pacing boards
: palatal lift to decrease hypernasal resonance
: Medicaitons, pharyngeal flap, phonosurgery, pallidotomy
Deep brain stimulation
: Surgically implanted device to electrically stimulate targeted area of brain.
: for worst cases
Define Apraxia of speech
Inability to plan and sequence volitional motor movements
Due to CNS damage despite intact muscle strength and coordination
can affect limbs or articulation
difficulty positioning speech muscles, sequencing muscle movements for voluntary production of speech but no muscle weakness.
What is the etiology of Apraxia
Lesion in left frontal lobe near broca's area
CVA, TBI, tumors, disease processes
Frequently co-occurs with aphasia
unpredictable and inconsistent errors
substitutions and transpositions are more frequent errors
complex consonant blends often substituted for simpler phonemes
difficulty initiating speech
Accuracy deteriorates as word length increases
automatic speech better
speech rate slowed
What is the prognosis of apraxia and the tx efficacy.
spontaneous recovery follows initial neurological insult
No good evidence at this point
What is the goal of apraxia treatment>
increase voluntary control over articulatory movements for speech
severe/profound- intelligible speech not realistic, try alternative communication
Structure of tx
drill, repeated practice
8 step task continuum-integral stimulation
clinician provides model then fades prompting
content of tx
: work from cough to prolonged phonation
Increase smoothness and length of speech
: automatic speech
nnnn to na to nana to new to nine