CDIS 3050 Quiz #3

respiratory
phonatory
articulatory/resonatory

systems of speech

phonatory system's main biological function

to prevent foreign objects from entering the trachea and lungs

the phonatory system is the main \_____ \_________ for speech production

sound generator

what is the larynx

air valve composed of cartilages, muscle, & other tissue

where is the larynx

it sits on top of the trachea
(appears to be suspended from the hyoid bone/and opens up to the pharynx

the larynx consists of

thyroid, arytenoid, cricoid, & corniculate cartilages
(is attached via ligaments and membranes)

what are the vocal folds

intrinsic muscles of the larynx (aka vocal cords)

abduct

open during respiration

adduct

close during respiration

what a voice tells you about a person

emotions, gender, confidence level, interesting or boring, pitch, professions: coach or preacher, race/ethnicity, intellect, religion, etc.

definition of voice disorders (dysphonias)

any deviation of loudness, pitch, or quality that is outside the normal range for a person's age, gender, or geographic or cultural background, and that interferes with communication, draws unfavorable attention to itself, or adversely affects the speaker or the listener.

most frequent diagnoses of voice disorders

acute laryngitis, nonspecific dysphonia, benign vocal fold lesions (nodules, polyps, contact ulcers), chronic laryngitis

laryngeal cancer

approximately 2.2% (mostly males/adult population)

teachers (professors)

profession that is most prone to developing a voice disorder

causes of voice disorders: abuse/misuse

screaming, excessive use, untrained singing, etc.

causes of voice disorders: medical

nervous system damage, cancer, virus, physical trauma

causes of voice disorders: psychogenic

emotional stress, unresolved psychological issues, etc.

organic classification of voice disorders

related to some physical abnormality in the larynx

vocal fold abnormalities

nodules, polyps, contact ulcers, papillomas, & carcinoma

neurological

paralysis & spasmodic dysphonia

functional classification of voice disorders

related to faulty use of a normal vocal mechanism

functional voice disorders

conversion aphonia/dysphonia, puberphonia, and muscle tension dysphonia (MTD)

conversion disorders

due to psychological suppression, a person is converting emotional conflicts into physical symptoms

conversion aphonia/dysphonia

total loss of voice, whisper, extremely abnormal voice(dysphonia), not a common condition

puberphonia

high pitch voice by postpubertal male, easily corrected

vocal nodules

most common form of vocal fold abnormality, benign, develops over time, 20% of patients

causes of vocal nodules

excessive/prolonged loudness, yelling, screaming, speaking and singing in a smoke-filled environment, excessive speaking and singing while using irritants, grunting, and speaking with inadequate breath support

physical attributes of vocal nodules

usually bilateral, sometimes unilateral, whitish bumps

vocal polyps

like blisters, develop when blood vessels in the vocal fold rupture and swell, unilateral, larger than nodules (sessile or pedunculated)

sessile

closely adhering or attached to the vocal fold tissue

pedunculated

attach to the vocal fold by means of a stalk & can be found on the margins of the vocal fold

voice evaluation

Best managed by team:
ENT-SLP
Patient interview
Judgment of Quality
Instrumental Evaluation
-Endoscopy
-Stroboscopy
-VisiPitch

patient interview

case history: health history, family situation, dietary habits, use of stimulants, level of concern

judgement of quality

voice quality:
The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)
The Voice Handicap (VHI)

endoscopy

imaging procedure within the scope of practice for SLP
-minimally invasive, topical anesthetic
-flexible camera, through nostril

stroboscopy

an examination of the vocal folds during phonation, or the production of sound
-rigid scope in oral cavity
-specific type of light (strobe light)
-aka "videostroboscopy"

visi-pitch

captures acoustic sound signals (fundamental frequency)
-can be used for assessment and treatment

assessment of vocal disorders

case history
hearing screening
qualification of voice
-auditory-perceptual assessment
-instrument evaluation (endoscopy/visipitch)

foundations of voice treatment

understanding of speech systems
thorough evaluation
understanding of various techniques
auditory and visual discrimination
"good ear"
technical experience (psychology and counseling)
knowledge of voice disorders

voice therapy in children

preschool-age and early elementary school-age
parent counseling

voice therapy in adolescents/adults

diagnostic therapy
facilitating approaches (techniques)

voice therapy approaches

hygienic voice therapy
physiologic voice therapy
symptomatic voice therapy
auditory feedback
counseling
elimination of vocal abuses and misuses

specific exercises in voice therapy

counseling
ear training
feedback
altering loudness
yawn-sigh
open mouth
respiration training

surgical procedures for voice disorders: microsurgery

The surgeon makes a very small incision away from the vibrating edge of your vocal cord,and a tiny flap of tissue is lifted so the growth can be removed. "phonomicrosugery"

surgical procedures for voice disorders: vocal cord laser surgery

The surgeon inserts a thin scope into your nose and throat and uses laser beams to shrink the lesion. Voice rest and voice therapy are usually necessary after this procedure.

surgical procedures for voice disorders: medical management

Prescribe medications to treat chronic cough, acid reflux, allergies, and other medical problems that may contribute to voice disorders.

laryngectomy

Surgical removal of the larynx due to cancer Trachea redirected to stoma

laryngectomy options for speech

esophageal speech, electrolarynx (artificial larynx), & tracheoesophageal puncture (TEP)

esophageal speech

Force air down into the esophagus
Past an area known as the neoglottis

fluency

the forward flow of speech
a fluent speaker has a consistent flow of speech without any interruptions

dysfluency

the interruptions in the flow of speech
categorized into a hierarchy that ranges from least to most severe or least to most tension/struggle

stuttering hierarchy

least to most severe

Hesitations
Interjections
Revisions
Phrase Repetitions
Whole Word Repetitions- 2+ syllables
\------------------------------------------
Whole Word Repetitions -1 syllable
Part-Word Repetitions
Prolongations Blocks

above the line is not considered dysfluent, below the line count as stutters (core behaviors)

secondary characteristics

These include any physical struggle or tension someone feels during their stuttering
eye blinks, facial tension, head turning, foot stomping, etc.

stuttering iceberg

The factors above the iceberg are ones that people can see from the outside
The factors below the iceberg are internal factors. These factors are ones that others cannot see from the outside, but the individual internally deals with

stuttering snowball

Stuttering starts out in younger years as core behaviors. During this time, a stutterer does not have any emotional ties towards stuttering and its impact on the life. Emotions are added in the form of secondary characteristics. These must be treated first before the core behaviors.

pseudo stuttering

"fake" stutter
when used appropriately, this can help a clinician model strategies for a client

stuttering therapy 2 main sides

fluency enhancement & stuttering modification

fluency enhancement

These strategies take someone's already present fluency and help enhance and expand upon it.

stuttering modification

These strategies take the stutter and modify it. This style of therapy takes the exact moment of the stutter and attempts to modify it.

language disorder

a language disorder is impaired comprehension and/or use of spoken, written (graphic), and/or other symbol systems.

language delay

implies that children may have a slow start at developing language, but that they will eventually catch up with their peers

language disorders

do not always eventually catch up with their peers; the gap may in fact widen

language difference

Expressive language that is influenced by cultural and linguistic diversity ESL, dialects & accents

impairments of language: form

-(0-2) low frequency of vocalization/lack of syllable productions and babbling
-(2-5) immature or disordered phonology/grammatical morphology errors
-(5-18) difficulties with complex sentences/poor narratives and expository texts

impairments of language: content

-(0-2)-understands few words in context/less than 50 words by age 2
-(2-5)-restricted vocabulary size/reduced comprehension of basic concepts
-(5-18)-incoherent stories/difficulties with figurative language

impairments of language: use

-(0-2)- lack of intentionality/restricted range of communicative functions
-(2-5)- limited assertiveness and/or responsiveness/difficulty initiating and maintaining topics
-(5-18)-inappropriate references/poor topic maintenance

language disorders in children

difficulty:
-understanding increasingly complex verbal information
-communicating narrative information
-learning to read and write
-reading to learn

specific language impairment

refers to significant receptive and/or expressive language impairments that cannot be attributed to any general or specific cause or condition-characterized more by absence of other disorders

SLI: receptive language

-Contributes to weak vocabularies
- Literal interpretations- Difficulty with abstract concepts
- Affects academic progress
- At-risk for behavioral difficulties

SLI: expressive language

-Difficulty expressing wants, needs, feelings, etc.
-articulation and phonological problems
-morphological and syntactic problems
-vocab/semantic problems

learning disabilities (specific learning disorder)

difficulty in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities
(cannot be explained by other disability categories)

types of learning disabilities

dyslexia
dyscalculia
dysgraphia
visual processing disorder
auditory processing disorder

intellectual disability

-significantly subaverage general intellectual functioning (IQ

autism spectrum disorders

pervasive impairments in:
-reciprocal social interaction
-communication skills
-stereotypical behaviors, interests, and activities
-0.5%

mild

language disorders have some effects on a child's ability to perform in social or educational situations but do not preclude participation in normal, age-appropriate activities in school or community

moderate

language disorders involve a significant degree of impairment that necessitates some special accommodations for the child to participate in mainstream community and educational settings

severe

language disorders usually make it difficult for a child to function in community and educational settings

profound

language disorders imply that a child has little or no ability to use language to communicate and is unable to function in community and educational activities

language disorders assessment

distinguish between children who have a disorder and those who do not, should be comprehensive so all possible concerns are identified and described as accurately as possible

case history-language disorders

language development, language environment, possible causes for language impairment

observation-language disorders

as many contexts as possible, note interests, caregiver communication style, method of behavior control

testing-language disorders

norm-reference tests are standardized tests, determine whether a problem exists or not, should not be the only factor

sampling-language disorders

challenging conversations, variety of discourse types, collect samples of different conversations, narratives, peer-conflict resolution, analysis in quantitative/qualitative ways, code switching

dynamic assessment

test-teach-restest, initial evaluation, identify possible therapy procedures, characteristics and solutions

intervention-language disorders

should focus on stimulating language acquisition beyond the immediate target, can include caregivers

evidence-based practice for childhood language impairments

early intervention characterized by engaging parents/caregivers

intervention should be intensive and individualized

intervention of more than 8 weeks is effective, direct instruction-imitation, modeling, guided practice, independent demonstration

computerized input strategies/apps alone are not effective

collaboration among educators are effective

clinician-centered approaches

behavioral principles (stimulus, response, reward)

structured activities

child-centered approaches

language facilitation through play

modeling, self-talk, parallel talk

hybrid approaches

a mix of the aforementioned approaches

model

\_____ the desired behavior for the child

cue

\___ the child to respond

respond, corrective feedback

\_______ to the child in the form of reinforcement and/or \__________ \_________

plan

\____ for generalization

expansion

repeat the child's utterance and complete it

extension

add information to what has been said

recast

say the same meaning in a different form (statement becomes a question)

build-ups and breakdowns

expansion plus breaks utterance into component parts

literature-based intervention

pre-reading discussions, multiple readings of the books, reinforcing concepts, mini-lessons focusing on semantics, syntax, morphology, narration and phonological awareness

classroom collaboration

SLPs and teachers work together