Exam 1_ALL lessons w/o the ones on paper

1. Schools

2. Universities/College

56% of SLPs work in education:

1. __ = 53%

2. __ = 3%

1. Nonresidential

2. Hospitals

3. Residential

39% of SLPs work in Health Care:

1. __ Facilities (outpatient clinics & home care) = 16%

2. __ = 13%

3. __ Facilities (skilled nursing facilities) = 10%

1. consultation

2. diagnostic

How SLP Jobs Differ Across Workplaces

Within Acute Care Hospitals

1. mostly ____ - little opportunity to start treatment

2. emphasis on assessment and ____ evaluation

1. treatment

2. physiologic

How SLP Jobs Differ Across Workplaces

Within Rehabilitation Centers

1. ____ focus - over weeks or even months

2. capitalize on ____ recovery

1. rehabilitation

How SLP Jobs Differ Across Workplaces

Within Home Care

1. continued ____

1. swallowing

2. abilities

How SLP Jobs Differ Across Workplaces

Within Nursing Home

1. monitoring of communication and ____ status

2. maintenance of ____ over time

1. voice

2. swallowing

3. trach

4. aac

5. neurologically

List the types of SLP specialty certificates (5)

1. ___, hint: vocal

2. ___, hint: food & liquid

3. ___ care

4. ___, hint: speech generated device

5. ____ based communication disorder

medical, communication

SLP can NOT make a __1___ diagnosis, but can diagnose a __2__ disorder and label it mild, moderate, or sever.

1. physician

2. nurses

3. PT

4. OT

5. RT

6. dietitian

7. psychologist

List members of the multidisciplinary, rehabilitation, team (7)

1. ___, oversees the general medical care of the patient, order imaging evaluation, prescribe medications

2. ___, keeps accurate records of the patients status overtime, they are the front line and with the patient all the time

3. ___, helps with difficulty in ambulating or use of the upper limbs

4. ___, helps with activities of daily living: writing, using utensils, fine motor control

5. ___, helps with compromise breathing capacity

6. ___, helps with the swallowing disorder to help prevent aspiration or pneumonia

7. ___, helps when they are struggling

welfare

Principle of Ethics 1

Hold paramount ___ of those they serve professionally.

1. competence

2. responsibility

3. planned

4. confidentiality

5. billing

6. ethical

Principle of Ethics 1

Hold paramount welfare of those they serve professionally by:

1. ____, using all appropriate resources & referrals, including other SLPs with more experience

2. SLP bears ____ when aides/technicians help in service

3. reasonable expectation of benefit from ___ service

4. ____ of patient records, don’t discuss outside the office even if you bump into them at the store

5. true and accurate ____ for services provided

6. report ____ breaches observed in colleagues

1. competence

2. performance

Principle of ethics 2

Achieve and maintain highest _1_ and _2_.

1. trained, qualified

2. education

3. training, certification

4. technology

Principle of ethics 2

Achieve and maintain highest competence and performance by:

1. only engage in tasks you are __1__ and __2__ for with the official certification

2. refine competence through continuing ___

3. administrators must not require clinicians to do tasks beyond their __1__ and __2__, push back and say NO

4. use ____ in ways consistent with professional guidelines

1. communication

2. swallowing

Principless of ethics 3

Advocate for unmet _1_ and _2_ needs; provide accurate info

1. misrepresent

2. conflicts

3. fraud

4. public

5. honesty

Principless of ethics 3

Advocate for unmet communication and swallowing needs; provide accurate info by:

1. do not ____ your credentials, competence, training

2. avoid ____ of interest - personal gain clouds judgment

3. no ___, whether through ignorance, negligence, or intent

4. give accurate information to the ____

5. full ___ in advertising services, training, competence, don't say we can do things we can't do

1. professions

2. inter

3. intra

4. self-imposed

Principles of ethics 4

Individuals shall uphold the dignity and autonomy of the _1_, maintain collaborative and harmonious _2_professional and _3_professional relationships, and accept the professions' (4)__-__ standards.

1. collaborate

2. independent

3. avoid

4. harassment

5. ethical

Principles of ethics 4

Individuals shall uphold the dignity and autonomy of the professions, maintain collaborative and harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards by:

1. ____ with others to provide highest quality care

2. use ____ judgment when administrator asks for conduct that may not be in the patient's best interest

3. ____ dishonesty, negligence, misrepresentation

4. avoid abuse or ____ of any kind with colleagues, aides, and/or patients

5. anyone you supervise must uphold these ____ standards

1. ASHA Leader Magazine

2. internet search for ASHA code of ethics violations

How are Code of Ethics breaches publicized? (2)

Censure

____ is the most common sanction and gives a black mark against you but does not block you from continuing professional work

1. educate

2. waver

If a patient does not agree with a suggested course of treatment, SLPs can ____ them to help them understand why it’s the best course.

If they still refuse, many facilities have a __2__ that can be signed showing the patient is refusing the course of treatment.

IT’S THE PATIENT’S CHOICE. DOCUMENT!

ex: swallowing = suggest thicker liquids

power, attorney

A durable ____ of ____ is a legal agreement that allows an agent or representative of the patient to act on behalf of the patient. It is usually someone who knows the patient’s desires and values.

1. treatments

2. life-saving

The power of attorney allows the agent to:

1. accept or refuse specific ____

2. decide on ___-___ measures

living will

A ____ _____ is a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. The patients CURRENT desires override this.

1. ventilation

2. nutrition

3. hydration

4. resuscitation

A living will outlines what measures are acceptable like:

1. ____, hint: breath with help

2. ____, hint: best foods to eat

3. ____, hint: getting enough water to drink

4. ____, hint: DNR

nerve, neuron

The basic unit of the nervous system is a ___ cell or a ___.

oxygen, glucose

Neurons rely on two things to function; they must have a constant supply of ___ and ___.

nerve impulses

___ ___ is how neurons communicate with one another

-We think of a this as an electro-chemical event like an electrical signal that gets sent down a wire

negative

The resting condition of a neuron, when it isn't actually doing anything, is that it has a ____ charge inside it relative to the fluid around it.

threshold

-Instead of the neuron staying negative inside, the incoming signals cause it to gradually become more positive.

-When it reaches a certain point, we call that reaching its ___.

-Once it has been reached, the cell is activated, or the nerve impulse is generated.

excitatory (excitation)

-An ___ input means that it's going to bring the cell away from its negative resting state and closer to its threshold, making it more likely to fire.

-So this is rather like it receiving some votes to say go ahead and fire.

inhibitory (inhibition)

-An ___ signal is going to make it more negative or take it further away from its threshold, making it less likely to fire.

-So that means the incoming signal is like a no vote, encouraging it not to fire.

action, depolarization

-Once threshold has been reached, the impulse that is generated is called the ___ potential, also known as ___

-That's just a fancy way of saying that the cell goes from being very negative to being very positive in its voltage.

impulse, action

-The thing with an ___ or an ___ potential, it's what we call an all or nothing event.

-So either it fires or it doesn't fire.

refractory

-A ___ period means the cell has to rest for a little while before it can fire again

-It might just be measured in milliseconds, but it does limit the rate in which the cell can fire.

Synapses

Neurons need to communicate with one another.

And the way they do this is via special connections called ___.

100 trillion

There are over ___ synapses in brain.

dendrites

The ___ receive incoming signals to a neuron

axon

The ___ takes the impulses out (of the neuron)

myelin sheath

The ___ ___ insulates the axon.

axon, dendrite, neurotransmitter

-In the majority of neurons, there isn't a direct electrical connection from one neuron to the next.

-But instead, the synapse actually has a gap.

-There's a space between the terminal button at the end of an ___ and the receptor site on the ___.

-And at this synapse, there is a release of a ____.

pruning

-We don't have to have each of our neurons connected in every possible way to every other neuron.

-Synaptic ____ occurs during development.

-So the pathways that are not going to be very helpful during learning are actually deleted, and other connections to specific neurons are strengthened as we learn new things.

brain, spinal cord

-The central nervous system consists of two main structures where processing of signals takes place, which are the ____ and the ____ ____.

-These both have gray matter and white matter within them.

1. frontal lobe

2. parietal lobe

3. temporal lobe

4. occipital lobe

List the brain lobes: (4)

1. cognitive

2. voluntary

3. personality, emotions

4. problem, judgment, memory, language

The frontal lobe is the part of the brain that:

1. is associate with ___ function

2. It's responsible for ___ motor control

3. And some people have even referred to it as the control panel for ___ and ___.

4. So, it involves such functions as ___ (p) solving, ____ (j), ____(m), and ___ (l) formulation.

1. sensory

2. touch

3. taste

4. movement

5. space

-The parietal lobe is the part of the brain that is responsible for processing __1__ (s) information.

-So this would include things like our sense of __2_ (t), __3__ (t), __4__ (m) and where the body is in __5__ (s)

1. hearing

2. sensory

3. sound

4. understand

5. comprehension

The temporal lobe is the part of the brain that:

1. responsible for our sense of ___

2. processing ___ input

3. recognize the presence of ___

4. ___ those sounds

5. it's important for the ___ of spoken language

visual, optic

-The occipital lobe is the part of the brain that is responsible for the processing of __1__ information.

-So the signals from the __2__ nerve will end up here so they can be further processed into understanding and interpreting the __1__ world around us.

motor

The cerebellum, which literally means the little brain, is not one of the brain lobes, but it's an important part of the ___ control system

midbrain, pons, medulla

The brainstem consist of of three main structures, the ___, the ___ and the ___

vision, auditory, eye

The midbrain has an important role to play in the processing of ___ and ___ information, and it also controls ___ movement.

motor, cerebellum

The pons has an important role to play in ____ control and has connections to and from the ___.

autonomic, breathing, heart, blood

-The medulla, or the medulla oblongata, controls a lot of our ____ functions.

-So it's responsible for things like ___, ___ rate, and ___ pressure.

soma, cranial

Within the brainstem, you will find the cell bodies, or the ___, of most of the ___ nerves.

cranial

The ___ nerves carry messages to and from the brain to control the head and neck functions, both sensory & motor, or both

gray, nerves

-The spinal cord runs through the bones of the spine and the vertebrae.

-Within the spinal cord, there is ___ matter, which consists of the soma, or the cell bodies, of the spinal ___.

inter-neurons

-There are numerous ___-___ in the spinal cord, which are the neurons that connect between other neurons within the central nervous system.

-They're involved in actual processing of information.

central, neural

One of the reasons you don't have to pay much attention to the spinal cord, is because of ___ pattern generators within the spinal cord.

These are ___ circuits that are responsible for repetitive actions that can be sometimes fairly sophisticated.

cell, glial

-The gray matter of the spinal cord is the ___ bodies.

-The white matter is the ___ (g) cells.

axons, motor

The insulating myelin sheath covers the ascending and descending ___ (a), which convey sensory and ___ (m) information to and from the brain.

reflex

The spinal ___ is one important processing function taken care of by the spinal cord.

ex: You've probably already noticed that if you accidentally touch something hot, your hand will withdraw very quickly before you can actually really think about it consciously. And the reason for this is that this reflexive behavior is mediated in the spinal cord. The sensory information that comes from your fingertip from the pain sensors will go up to the spinal cord, and will link almost directly to the cell body or the soma of the motor neuron that controls the muscles that cause your arm to move away. So there is some local processing going on here that doesn't involve sending a signal all the way up to the brain to have you then make an executive decision at the cortical level to withdraw your hand from the source of heat. That would actually take a little bit too long because it takes a certain amount of time for a nerve impulse to travel all the way through a series of axons and synapses to reach your cortex. So the response you get at the spinal level is very rapid, and it helps prevent further damage to the finger by quickly removing you from the source of heat.

override

Now while we can consider spinal reflexes to be basically automatic, there are times when we might need to slightly ___, or modify, those behaviors.

ex: So think about a situation where it's Thanksgiving dinner and your dear aunt Alice has brought along her favorite casserole in an heirloom dish, and it's in your oven, and you're taking it out of the oven, but you didn't have a thick enough towel and your fingers are starting to feel an intense heat coming from that dish. But in order to prevent you from just dropping it on the floor, as the reflexes might urge you to do, you're able to slightly override them and then quickly put the dish down even though it's hurt your fingers a bit on the way. So we do have the capacity to slightly modify some of our reflexes, but as a general rule left their own devices that work quickly and effectively to help us avoid dangerous situations.

1. sensory

2. motor

-The peripheral nervous system is responsible for:

1. bringing in _1_ information from all around the body

2. taking the _2_ commands out from the central nervous system to the muscles in the periphery

spinal, cranial

The main components of the peripheral nervous system are the ___ nerves and the ___ nerves

spinal cord

The spinal nerves originate in the ___ ___

arms, legs

The spinal nerves innovate the trunk, ___ and ___.

brainstem

The cranial nerves originate in the ___.

bulbar

___ refers to the cranial nerves.

corticospinal

-The ___ tract is the pathway in which the brain sends out signals that control movements.

-You could think of this as a sort of express route from the brain down to the spinal cord that doesn't stop to synapse and interact with other neurons during its pathway through the brainstem

spinal cord

The corticospinal tract originates in the cortex and goes to the ___ ___

abdomen, legs

-The corticospinal tract allows us to have volitional control of the muscles of the ___ and thorax, as well as the arms and the ___.

corticobulbar

The ___ tract is the pathway you would use if you wanted to open or close your mouth, stick out your tongue, cause your voice to start or stop, or do any form of articulation.

nuclei

The corticobulbar tract originates in the cortex and goes to the ___ of the cranial nerves

upper

All ___ motor neurons are contained entirely within the central nervous system, meaning that the cell body, the dendrites, the axon, and the terminal buttons at the end of the axon are all completely within the CNS.

movement

The upper motor neurons reside within the central nervous system and are responsible for initiating, processing, or coordinating ___ of any kind.

upper

Whether the neurons are at the cortical level, the brainstem level, or descending down as far as connecting to cells in the spinal cord, they are all still ___ motor neurons.

lower

A ___ motor neuron goes out to the muscles of the arms, legs, or trunk and will have its cell body, or soma, within the spinal cord.

peripheral

The lower motor neuron is considered a ___ nerve because the axon leaves the central nervous system and projects out into the body, reaching out to touch a muscle, and causing that muscle to contract once the nerve is activated.

unit

A single lower motor neuron that branches out many times is called the motor ___

fibers

The motor unit actually contains hundreds, or thousands, of muscle ___ that will contract together for one impulse that travels down the axon to move big muscles, like the leg.

-It’s not used when fine movements are needed, like with fingers.

Botox

___ is a toxin that destroys the neuromuscular junction.

FOR HELP

FOR HELP

Now when somebody has received Botox, the effects don't last forever. Usually they'll go away in a few months. And this is because the neuromuscular junction will regrow once again. So if a person needs Botox to treat their spasmodic dysphonia or vocal tremor, they'll need to go back every four to six months usually to get another dose because the symptoms will return as the neuromuscular junction regenerates.

hippocampus

The ___ is that region of the brain that's responsible for forming memories.

arteriovenous malformation

What does AVM stand for?

abnormal

-An arteriovenous malformation (AVM) is an ___ proliferation of blood vessels that could form in the brain, spinal cord, or sometimes elsewhere else in the body.

-They can be seen on a cerebral angiography.

pressure

Arteriovenous malformations (AVM) are fairly rare, 1% of the population, and can cause several serious problems because they occupy space and exert ___ on neural tissue.

stroke, seizure

With Arteriovenous malformation (AVM), a person may experience symptoms similar to a ___ or a ___.

rupture

With arteriovenous malformation, there's also a risk that these vessels could ___ and therefore hemorrhage blood into the brain, which is of course a very serious type of stroke.

neurosurgical

-There are a few ___ treatment options to treat AVMs (arteriovenous malformation).

-But the deeper inside the brain they are found, the more risky these procedures will be.

aneurysm

-An ___ is an abnormal swelling of a blood vessel, usually because the wall of an artery has become weakened, it bulges outward, and possibly ruptures.

-So it's important to be able to detect them in the brain.

computed axial tomography

What does CAT scan stand for?

CAT

The computed tomography (CT) scan is also called a ___ scan (3 initials).

blood brain

-The ___ ___ barrier is a fine interface between the blood and the cerebral spinal fluid.

-If it is damaged, contaminants carried in the blood might potentially make their way into the cerebral spinal fluid and cause a brain infection

Positron Emission Tomography

What does PET scan stand for?

isotope

-____ is a variant of an atom that has a different atomic number from the usual one.

-Some decay very rapidly by spinning off atomic particles.

glucose

Many of the isotopes will combine with ___ or with a specific neurotransmitter.

positron, electron

The isotope undergoes its natural decay in the brain and emits a ___, which is a subatomic particle.

-As this flies off in any random direction from its atom, it's going to eventually collide with an ___ that is orbiting another atom.

-The collisions are essentially random.

JUST HELP

An analogy might be that if you had a blindfold on and you started walking at some point in the woods, eventually you're going to run into a tree. That might be after the first three or four steps or you might go 20 or more steps, but at some point, you will bump into a tree.

gamma, 180

-When the positron collides with the electron, this collision destroys both of them.

-There is energy released, which is in the form of ___ rays.

-These rays go out in opposite directions from one another, ___ degrees apart.

glucose

-We could consider __1__ the fuel that drives the activity of the neurons.

-Since many of the isotopes used in Positron Emission Tomography (PET) scanning, incorporate themselves into __1__, then where __1__ is being more rapidly used, there will be a higher concentration of the isotope.

1. concentration

2. glucose

-Where there's a higher _1_ of isotope, there will be more positrons being given off to collide with local electrons.

-If a region of the brain is particularly busy, then it will be actively metabolizing _2_ more rapidly.

-Therefore, the activity that's picked up on a PET scanner in a particular location represents _2_ metabolism in the brain.

magnetic resonance imaging

What does MRI stand for?