Exam #2 - COMD242

**Terms that cannot be found in book/slides are intentional! Professor wants us to tell the difference between right/wrong answers for multiple choice questions

Cultural competence

To recognize, honor, + respect beliefs, interaction styles, behaviors of individuals + families

Challenges in serving adults with Culturally and Linguistically Diverse (CLD) Backgrounds

• Low income

• Poor diet

• Lack of health insurance

• Lack of access to medical services

• Barriers to service delivery

Barriers to Service Delivery

• Limited English

• Lack of health insurance

• Lack of transportation

• Differing beliefs about optimal health care

Ethnocentrism

View that members of a culture do things the “right way”

• ex. Assuming your own language is superior, or that everyone should speak your language

Cultural tendencies

Patterns of behavior + values commonly observed among a culture; Recognizes heterogeneity + diversity within cultures

• ex. Religion, age, beliefs

Cultural relativism

Other people’s ways of doing things are different yet equally valid

• ex. In some cultures, bowing is the preferred greeting form; in others, handshakes are the preferred greeting

Code switching

Using different linguistic styles for different situations

• ex. Speaking politely to parents, yet using slang around friends

Language difference

Regional, social, or cultural variations of language, such as a specific regional dialect

• ex. In Spanish, the adjective is placed after noun, whereas in English the adjective is before noun

Dynamic Assessment

Analyzes how much + what types of support/assistance needed to bring individuals’ communicative performance to higher level; Rooted in theories from Leo Vygotsky

Static testing

An individual is assessed at given point in time, + results of test determine what they can/cannot do on their own

• Norm referenced + Criterion referenced fall under this

Systematic observation

Process of observing how individuals use communication for functional purposes in real world activities; Allows professionals to examine one’s communicative performance at home, school, work, in the community

Steps to interpret assessment findings

1. Diagnosis (differential diagnosis)

2. Determining severity of disorder (very mild-very severe)

3. Characterizing client’s prognosis

Differential diagnosis

Diagnosis that differentiates a person’s disorder from other similar disorders

• ex. Spastic dysarthria differs from flaccid dysarthria

Language disorder

Impaired comprehension and/or use of spoken, written, and/or other symbol system

• Impacts semantics, syntax, morphology, phonology, or pragmatics

• Can affect children/adults

• Can compromise reading development (reading disabilities)

*Language deviance

A child's language development that differs from normal expectations; A unit of language that doesn't follow grammar rules

• ex. Using an question mark instead of a period when writing

Specific language impairment (SLI)

Primary developmental language disorder; Impairment of expressive/receptive language in (pre)school-age children that cannot be attributed to other causal conditions (with no known cause); Language skills seem poor relative to intellectual capabilities

Language delay

Children exhibiting problems with language achievements get a late start with language development + can be expected to catch up with their peers; Late talkers who end up catching up with other children

Silent period

Little to no talking when exposed to second language

• ex. Father speaks Spanish to child, yet child solely responds in English (or does not respond to second language at all)

Simultaneous bilingual acquisition

Under 5 years of age; Two languages acquired simultaneously from birth

Sequential bilingual acquisition

Over 5 years of age; First language learned from birth + second language learned later

Language loss

Skill reduction of first language when learning second language; Second language becomes dominant

• ex. If a child who experienced this concept tests in the first language, they may show low scores in first language than in their second language

Error transfer

Errors in second language caused by influence of first language

Anomia

Means “no name”; Word-finding problems/inability to retrieve a word; Persistent deficit in aphasia, word retrieval problems may remain even after recovery

Telegraphic speech

Phrases/sentences made of content words (nouns + verbs) with function words omitted; Seen in Broca’s aphasia + transcortical motor aphasia

• ex. “Tom go store”

Word-finding problems (Anomia)

Inability to come up with words/names of items in spontaneous conversation/naming tasks; Seen in Broca’s aphasia, transcortical motor aphasia, global aphasia, Wernicke’s aphasia, conduction aphasia, transcortical sensory aphasia, anomic aphasia

Jargon

Production of language that is meaningless + may run ongoing; Seen in Wernicke’s aphasia

Neologisms

Making up a new word; Seen in Wernicke’s aphasia

• ex. “The bramble-thingie is over here”

Agrammatism

Leaving out grammatical markers in sentences/phrases, like verb inflections, articles, + prepositions; Seen in Broca’s aphasia, transcortical motor aphasia

• ex. “He go store”

Semantic/Verbal paraphasia

Substituted word, likely in same category as targeted word

• ex. Identifying a photo of a sofa as “furniture” or “chair”

Phonemic/Literal paraphasia

Substitution or transposition of a sound

• ex. Identifying a sofa as a “tofa” or “fosa”

Standard Scores

Index that identifies how a person’s test performance compares to their normative peers

Screening tools

Designed for quick administration; Given to large number of children

Echolalia

When one frequently repeats auditory stimuli

Evidence-based practice

Process where clinician integrates these areas for a client’s best action plan:

1. Scientific evidence

2. Clinical expertise

3. Client perspective

Clinical expertise

Knowing how to do a method; Evidence that it works

Client perspective

When a client believes a method does not work for them, prompting to try new method

Norm-Referenced Test

Compares performance with same-age peers; Is standardized, has normative sample

Norm-Referenced Test Differences

• Ranks students based on test achievement, scores given as rank based on other students’ scores

• Assesses large number of students

• Takes longer period of time

• Normed for certain group (ex. Testing individuals across USA) → can cause issues that may not be normed for other populations

Criterion-Referenced Test

Determines achievement levels in particular area/criteria; Requires establishment of a clear performance standard, specific design tasks, + provide guidelines for interpretation

Criterion-Referenced Test Differences

• Measures skills + knowledge a student has mastered

• Student scores are given as 100%

• Assesses small number of students

• Lasts a class period usually

Family-centered approaches/intervention

Based on family systems theory; Emphasizes the “family as a whole is greater than sum of its parts”

Family centered approaches/intervention: Treatment goals

• Emphasize an individual’s participation within + access to family activities/contexts

• Incorporate family members’ perspectives on viable treatment approaches

Child-centered approaches

Child sets pace + chooses the materials; Professional seeks ways to facilitate language form, content, or use in child-selected activities

Behaviorist approaches

Based on learning theory; Emphasizes how environment shapes behavior + influence of consequences on behavioral change

Behaviorist approaches: Clinicians’ responsibilities

• Identifying observable + measurable goals

• Specify level of mastery at each goal

• Controlling each intervention session

• Collecting data in each session

Clinical-directed approaches

Adult (therapist, teacher, parent) selects activities, materials, + sets instruction pace

Naturalistic environment

Intervention for children is effective when it engages them in environments where they must use their skills

• ex. Environments include homes, child-friendly classrooms, etc.

Natural Environment characteristics

• Increases carryover

• Increases discourse skills

• Respects least restrictive environments when consultant/collaborative model is used

• Involves family

• Produces functional outcomes

• Enhances access to curriculum

Intervention

Action plan to improve individuals’ communicative abilities

Purpose of Intervention

1. Prevention

2. Remediation

3. Compensatory

Comprehensive Language Evaluation

Determines if a language disorder is present:

• Profiles linguistic strengths/weaknesses

• Identifies supports to improve language skills

• Involves case history + comprehensive analysis of child’s language

False positive

Child who doesn’t have a language disorder is diagnosed as having one

False negative

Child who has a language disorder isn’t accurately identified as having one

False positive/negative causes

Poorly constructed tests, or linguistically/culturally biased tests; Child’s illness, shyness, underlying conditions, etc. may cause poor test results

Reading + Writing goals

Addressed within language intervention; Emphasize skills foundational to reading achievement (decoding/comprehension); Includes:

• Phonological awareness

• Alphabet knowledge

• Print-concepts knowledge

• Alphabetic principles

• Reading fluency

Alphabet knowledge

Knowledge of letters, upper/lower case correspondence, letter-sound correspondence

Print-referencing

When reading books/texts, adults refer to letters by pointing to them + commenting on them so child learns letters

Motor learning

How practice/experience leads to “permanent changes in capability for movement”; Important for understanding normal + disordered speech motor control

Phonological awareness

Awareness of rhyme patterns; Syllabic composition of words; Onset + rime boundary in single-syllable words; Initial, medial, + final sounds in words

Print-concept knowledge

Knowledge about rules that govern print; Includes:

• Knowing how books are organized (ex. cover page, title page, text)

• Functions of print in various genres (ex. lists, invitations)

• Major print units (ex. letters, punctuation, words)

Language disorders classification

• Etiology

• Manifestation

• Severity

Etiology

Cause of language disorders

Primary disorder

Impairment attributable to no other cause; Occurs in absence of any other disability

• ex. Autism can cause language disorders, but language disorders do not cause autism

Secondary disorder

Impairment caused by another primary source; Occurs in presence of another disability

• ex. Hearing loss causes language disorder

Manifestation

Language disorders classified according to affected language aspects

• Does disorder affect: comprehension, expression? Form, content, use? Spoken language or reading/writing?

Severity

Language disorders range from mild to profound; Extent it hinders child’s abilIties to use language for social and/or educational functioning

ASD

Autism Spectrum Disorder; Developmental conditions characterized by:

• Repetitive behaviors

• Difficulties w/ social relationships + communication

• Restricted interests

ASD risk factors

• MMR vaccine said to have linkage, but studies proved it does not

• Prenatal/perinatal complications

  • maternal rubella + anoxia

Purposes of Assessment

1. Identify skills one has/doesn’t have in a communication area

2. Guide design of intervention for enhancing one’s skills in a communication area

3. Monitor one’s communicative growth/performance over time

4. Qualify one for special services

TBI

Traumatic brain injury; Caused by car accidents, falls, recreational sports; Most common type: Closed-Head Injury (CHI)

TBI Characteristics

• Open-head: Penetrated skull + meninges

• Closed-head: Brain jostled within skull, yielding diffuse brain injury

• Polytrauma: Mix of open + close-head injuries, etc

Aphasia

Language disorder acquired after one has developed language competence; Absence of language

Dysarthria

Motor speech disorder

Right-hemisphere dysfunction (RHD)

Damage to right cerebral hemisphere:

• Language + cognition impacted, symptoms differ from aphasia

• Cognitive-linguistic disorder

RHD Characteristics

• Lack of awareness of cognitive-linguistic deficits + denial of problem areas

• Lack of awareness of left side of body + external stimuli to left side

• Difficulty recognizing faces

• Compromised pragmatics

• Wordy expression

• Difficulty understanding/using higher-level cognitive-linguistic skills

• Dysarthria, Dysphagia

Dementia

Chronic + progressive decline in memory, cognition, language, + personality; Results from central nervous system dysfunction

Mild Dementia

• Forgetfulness of basic info/common routines

• Losing/misplacing items

• Missing appointments/plans

• Decreased vocab

• Reduced/verbose conversation, anomia

Moderate Dementia

• Increasingly disoriented in time + place

• Poor attention + memory

• Marked language difficulties

• Deficits of language (anomia, difficulty repeating)

• Misunderstanding humor + empty conversations

• Restlessness + roaming

Severe Dementia

• Extreme disorientation

• Minimal cognitive ability

• Language skills compromised (limited meaningful communication)

• Frequent repetitions + jargon

• Comprehension skills impaired

• May be unable to control bladder/bowel functions + may need wheelchair

3 Dementia Traits

1. Memory impairment

2. Cognitive skills impairment

3. Presence of aphasia, apraxia, agnosia

Broca’s Aphasia

Damage to frontal lobe, causing:

• Slowed, halting, labored, + telegraphic/robot-like speech

• Mild to moderate auditory comprehension problems when messages increase in length + complexity/when contextual cues removed

• Nonfluent + expressive

• Motor aphasia

Transcortical Motor Aphasia

Damage to superior + anterior frontal lobe portions, causing:

• Good repetition skills, better than spontaneous speech

• Strong oral reading performance

• Good language/auditory comprehension

• Nonfluent

Global Aphasia

Damage to large brain region or multiple sites of brain injury in language-dominant hemispheres, causing:

• Deficits across all language modalities

• Non-fluent

• Poor language comprehension

• Naming/word finding problems

Wernicke’s Aphasia

Brain injury to superior + posterior temporal lobe regions (can reach parietal lobe of language-dominant hemisphere), causing:

• Spontaneous speech + flow with normal prosody

• Fluent + receptive

• Poor language/auditory comprehension

• Sensory aphasia

Transcortical Sensory Aphasia

Injuries to language-dominant hemisphere (border of temporal/occipital lobes, or parietal lobe’s superior region), causing:

• Echolalia

• Fluent

• Jargon + naming difficulties

• Poor language/auditory comprehension

Conduction Aphasia

Injury to brain’s temporal-parietal region, Arcuate fasciculus, causing:

• Difficulties w/ repetition + reading aloud

• Fluent

• Naming difficulties

• Normal prosody + articulation

Anomia aphasia

Damage to multiple potential lesion sites, causing:

• Fluency

• Word-finding problems

Rancho Levels of Cognitive Functioning Scale

• Level I-III [1-3]: Severe (early recovery phase)

• Level IV-VI [4-6]: Middle (middle recovery phase)

• Level VII-X [7-10]: Mild (late recovery phase)

Treatment settings

• Aphasia therapy not limited to clinic or office

• Therapies encompass other environments to facilitate carryover + generalization of progress different settings

• Group approach may help

Fluent

Aspect of communication/speech describing forward flow, phrasing, intonation, + rate

• Easy, smooth, + well paced

• Correlates with posterior brain damage (ex. temporal-parietal regions)

Non-fluent

• Short/choppy phrases

• Slow/labored speech production

• Grammatical errors

• Telegraphic quality

• Correlates with anterior brain injury (ex. frontal lobe)

Polytrauma

Mixture of open + closed-head injury, multiple medical concerns, + posttraumatic stress

Compromised pragmatics

Inability to take turns, read others’ cues, recognize others’ communication interests, + use physical space + affect during communication

Dysphagia

Swallowing disorder; Difficulty chewing/managing food + triggering/maintaining a swallow

Types of Strokes

• Ischemic strokes

• Hemorrhagic strokes

Ischemic strokes

When blood supply to brain is inhibited because of artery occlusion

Hemorrhagic strokes

When blood vessel/artery ruptures + excessive amounts of blood enter brain

Intellectual disability

Arrested/incomplete development of mind; Impairment of skills during developmental period

Intellectual disability risk factors

• Prenatal/perinatal damage

• Viral infections

• Environmental influences, abuse

• Biomedical + psychosocial factors

• Trauma, infection, poisoning

• Heredity

Brain injury

Damage/insult to one’s brain; Can occur in utero, perinatally, or acquired