Exam 2 SHS 2230

How are SSDs classified?

Functional

Organic: motor, structural, or sensory/perceptual

Organic disorder

cause is known for SSD

Functional disorder

no known cause for SSD

Types of misarticulation errors

SODA

• substitution, omission, distortion, addition

What types of structural issues can cause speech errors?

cleft palate, microglossia, and macroglossia

SSD due to structural anatomy is a ______ type of disorder

organic

Is SSD due to structural issue an articulation or phonological disorder?

articulation

Articulation errors

1. Speech is usually well understood by others

2. NOT due to structural differences

3. Problem typically restricted to a few sounds

4. Usually not associated with other problems

Phonological errors

1. Speech is difficult to understand

2. Cause of the problem is not known

3. Affects whole classes of sounds

4. Often associated with other language problems

Residual articulation errors

errors occurring that should be resolved by age 8 or 9

Phonological processes (developmental)

All children use early in development, only become a concern once they persist past a certain age

1. Final consonant deletion

2. Cluster reduction

3. Stopping of fricatives

Phonological processes (atypical)

 deviate from typical development errors, cause for concern.

1. backing

2. initial consonant deletion (instead of final)

3. fricatives replacing stops (instead of stopping of fricatives)

4. stopping of glides

Relationship between receptive/expressive language and literacy skills

Language -> taught for reading and writing

• Oral language skills lay the foundation for literacy skills

Medical conditions associated with language disorders in children

Intellectual disability, down syndrome, TBI, fetal alcohol syndrome

Down syndrome

mild-moderate intellectual disability.

1. Phonology and speech sound mastery is delayed

2. Morphology and syntax are impaired

3. Semantics = relative strength

4. Pragmatics = relative weakness

TBI

traumatic brain injury; blow or jolt to the head or penetrating head injury. range of severity

1. Full language recovery is rare

2. Semantics may be a relative strength

3. Pragmatic language is a relative weakness (responding, turn-taking, topic maintenance)

4. Decoding and comprehending written language can be severely impacted

DLD risk factors

1. Premature birth

2. Low birth weight

3. Infants needing hospitalization

4. Family history of language or literacy problems (very important) 

5. Children who are “late talkers”

DLD difficulty areas

1. form: phonological impairment, morphology and syntax errors

2. content: smaller vocab, encode fewer semantics, need more trials to learn new words

3. use: immature social communication, difficulty understanding and applying pragmatic rules in conversation

Case history assessment

collecting information about the client and their communication disorder

• presenting problem/complaint

• social context of child

• medical or birth issues

Norm-referenced assessment

comparing client’s performance to a sample of peers; standardized testing and scoring

Criterion-referenced assessment

comparing client’s skills to a certain predetermined expectation

• Helpful in determining communicative skills client does or doesn’t have

• can be standardized test form or natural environment test

Observational tools assessment

wholistically observing communication strengths and needs in a real setting

• Home, classroom, interacting with peers or teacher

Main principles and guidelines of intervention

1. Goals: individualized and functional

2. Prioritize language goals beyond what will yield the greatest benefit now

3. Follow developmental sequence

4. Family-centered

5. Use activities appropriate for age, culture, and cognitive level

6. Activities should target social and academic communication skills 

Service delivery models for SLP service

1. Pull out services

2. Classroom-based instruction

3. Consultative

What is dementia?

progressive decline in memory and other cognitive areas that interfere with daily living and independent functioning

• Behavioral problems (paranoia, hallucinations) can interfere with communication

What is the most common type of dementia?

Alzheimer’s disease

What language, cognitive, and other changes can be seen in a person living with dementia?

1. Repeated poor judgment and decision making

2. Repeated inability to manage a budget

3. Losing track of the date or season

4. Difficulty having a conversation, understanding visual and spatial relationships

5. Misplacing things and being unable to retrace steps

6. Memory loss disrupting daily life

7. Difficulty completing familiar tasks

8. Changes in mood and personality

9. Withdrawal from work/social activities

Assessment of dementia

Differentiate normal vs typical aging

1. MOCA: assesses short term memory, working memory, visuospatial abilities, attention and concentration, language, time and place orientation 

2. Drawing a clock; visuospatial abilities

3. Trail making abilities

Treatment of dementia

Help individual maintain independence for as long as possible

• Compensatory therapy

• Provide caregivers with resources and support

• Make a meaningful difference in the person’s life

TBI

traumatic brain injury; blow or jolt to the head or penetrating head injury, disrupts normal brain function

• Mild to severe

Main causes of TBI

1. Falls (children and elderly)

2. Motor vehicle accidents

3. Assaults

4. Self harm

5. Other accidents

What are the effects of TBI on thinking, behavior, emotions, language, sensation, etc.?

1. Lifelong needing help performing daily activities

2. Changes in behavior, thinking, sensation, emotions

3. Increased seizure risk

4. Increased alzheimer’s and parkinson’s risk

What are some common additional consequences people with TBI experience (vocational, personal, etc.)?

Social

• Theory of mind, social cues, code switching (friends vs boss), perception of facial expressions, social anxiety

SLP related

• Language (aphasia), speech (dysarthria), attention, memory, problem solving, reasoning, temporal awareness, visuospatial skills

What is the “fingerprint” of TBI/what does this refer to?

most damage is common in the frontal lobe area for TBI patients

• impacts behavior and personality

What types of neurobehavioral impairments and other impairments might a person with a TBI experience?

Impulsivity, disinhibition, confabulation, impaired self-regulation, personality changes, restlessness, agitation, aggression, lack of motivation

TBI treatment approaches

achieve highest level of independent function for participation in daily living

1. Expressing thoughts

2. Understanding written material

3. Improving attention during tasks, memory with tools, problem solving, planning, organization, and social skills

What are the 3 ways blood flow can be changed during a stroke?

1. Thrombus: blood clot in brain blocking blood flow

2. Embolus: blood clot somewhere in body that travels to brain blocking blood flow

3. Hemorrhagic: bleeding in the brain causing pressure on brain cells

What are the effects of a right hemisphere stroke?

More motor and cognitive deficits, not really language: 

• Loss of movement and attention to left side of body

• Quick and impulsive behavior

• Memory problems

• Issues with swallowing 

• Impaired emotional expression and perceptual skills

• Decreased insight into deficits

What are the effects of a left hemisphere stroke?

• Loss of movement and attention to right side of body

• Problems swallowing

• Aphasia: Problems using and/or understanding language

Why are these patterns of difficulty seen for a RH vs. LH stroke?

different sides of the brain do different things, motor and attention are contralaterally controlled

Aphasia

total or partial loss of the ability to use or understand language. acquired communication disorder

• Usually from stroke, brain disease, or injury

• not an intelligence deficit

• can impact understanding, speaking, reading, writing

three tasks that help differentiate aphasia subtypes

1. Is speech fluent?

2. Does the individual comprehend speech? Nonverbal

3. Can the individual repeat speech?

most mild aphasia

anomic aphasia; struggles to find words at times but has fluency, comprehension, and repeatability

most severe aphasia; does not have fluency, comprehension, or repeatability

global aphasia

non-fluent aphasia

Broca’s aphasia - intact comprehension, impaired expression of language

• Hesitant speech when searching for words

• Single words, slow and broken up speech

fluent aphasia

Wernicke’s aphasia - intact speech production, impaired comprehension

• Normal speech prosody and flow

• Might use nonsense or real words that have no meaning in context

• Unaware speech is not meaningful

aphasia assessment

Case history and chart review

Motor speech, cog-comm, dysphagia concerns?
Language:

1. Word, sentence, and paragraph comprehension (spoken/signed and written)

2. Naming objects

3. Repetition

4. Spontaneous speech

5. Discourse

6. Word, sentence, and paragraph writing

7. Gestures

aphasia treatment

Many specific treatment options to improve language and communication

• Comprehension, expression, reading, writing, social, communication

AAC if needed

Community-based programs

• Socialization, practice communicating in natural environments

Therapy:

• Rehabilitation and compensatory therapy

aphasia prognosis

Starting treatment earlier is better

• When symptoms persists longer than 2-3 months, complete recovery is unlikely

PPA and its relationship to dementia

Primary Progressive Aphasia - neurodegenerative disease. Frontotemporal disorder, can progress into frontotemporal dementia or remain isolated to language

• Affect ability to understand and use words/sentences, repeating words, using grammar

motor speech disorder

Affect the planning, programing, control, or execution of speech

two types of MSD

apraxia and dysarthria

dysarthria

impaired control or execution of speech, due to a problem in CNS and/or PNS

• Lots of possible areas of damage that determine subtypes

flaccid dysarthria

paresis/paralysis in speech movement. PNS damage

• Hypernasal speech CN X (Vagus)

• Breathy voice CN X (Vagus)

• Severely atrophied tongue/no tongue movement CN XII Hypoglossal

• No lip movement/closure CN VII (Facial)

ataxic dysarthria

uncoordinated speech movements. Difficulty coordinating breathing and speech 

• CNS specifically; cerebellum

• Multisyllabic word errors and excess stress

apraxia

planning and programming impairment, due to a problem in the left frontal lobe (broca’s area and motor areas).

what part of the nervous system affected in dysarthria/apraxia?

Dysarthria: many areas, can be CNS and/or PNS

Apraxia: CNS, specifically left frontal lobe

common causes of dysarthria in adults

Neurodegenerative disease, stroke, infections, autoimmune disorders, tumors, trauma

Why does task complexity influence speech accuracy in apraxia?

More complex = requires more programming and planning to correctly articulate the speech, leading to more errors

voice disorder defined

Voice quality, pitch, and/or loudness differ or are inappropriate for an individual’s age, gender, cultural background or geographic location

• The Individual expresses concerns about having abnormal voice

functional voice disorder

inefficient or improper use of vocal mechanism despite normal anatomy

organic voice disorder

neurological or structural problem resulting in voice disorder

who diagnoses functional vs organic voice disorders

functional: SLP

organic: MD

muscle tension dysphonia

Using the ventricular folds to produce voicing instead of regular vocal folds

• functional voice disorder

functional aphonia

when someone with a normal larynx loses their voice completely

neurological organic voice disorders

1. Vocal fold paralysis

2. Parkinson’s: vocal folds become weak, initiating movement is difficult and slow

3. Spasmodic dysphonia: vocal folds spasm open or closed uncontrollably

structural organic voice disorders

1. Presbylarynx: vocal folds lose bulk, get thinner. Vocal fold closure is difficult, part of normal aging

2. Vocal fold lesions: any damage to vocal folds. nodules, polyps, cysts

3. Laryngitis: inflammation of the larynx, hoarseness, sore throat, and difficulty speaking.

4. Hemorrhage: rupturing or bleeding within the vocal folds

hyperfunctional voice disorders

strained, unhelpful muscles trying to contribute to voice

• Related to overuse/abuse/misuse

hypofunctional voice disorders

weak, helpful voice muscles are not strong enough

vocal fold paralysis definition and causes

one (unilateral) or both (bilateral) vocal folds are paralyzed

• “Fixed into an open position (abducted) or closed (adducted position)

• Damage to the cranial nerve X (vagus): surgery, trauma, tumors, infection

assessment of voice disorders

Case history -> always collected!

Vocal hygiene inventory

Instrumental - how do the vocal folds look?

• The scope!

treatment of voice disorders

1. Hydration

2. Use

3. Diet and drinking

3. Smoking