Exam 3 Intro to communications

Pitch definition

Frequency (wavelength)

Loudness Definition

Amplitude

Fundamental Frequency definition

Refers to the lowest frequency of a sound wave produced by the vocal folds during phonation, key to assessing voice quality

Stridor defintion

Air is needed when speaking

Aphonia definition

Loss of the ability to speak

Aphonia consistency

Persistent absence of voice and perceived as whispering

Aphonia Episodic

Is uncontrolled, unpredictable aphonic breaks in voice that can last for fraction of a second or longer

Diplophonia definition

a person produces two different pitches at the same time while speaking

Monopitch

No or less voice variations

Inappropriate Pitch

Gender, Age, or Culture

Monoloudness

No change in loudness

Inappropriate loudness

too high or too low

Quality definition

Clarity

Quality Breathiness

Abnormal breathing pattern (in speech)

Quality Tremor

shaking in voice

Quality Strain/Struggle

Raspy, Harsh, hoarseness

Organic voice disorder

Structural abnormalities

Functional Voice disorder

Muscle tension dysphonia, Conversion Aphonia, Mutational Falsetto

Structural voice disorder

Organic voice disorders that results from physical changes in the voice mechanism

Neurological voice disorder

Organic voice disorder that results from problems with the central or peripheral nervous system innervation to the larynx that affect vocal functioning

Vocal Nodule

Growths that form on vocal folds, not cancerous, caused by using your voice the wrong way and vocal folds swelling; features are hoarseness and breathiness

Vocal polyp

Fluid filled lesions that develop when blood vessels in the vocal folds rupture and swell, unilateral, larger than nodules, vascular and prone to hemorrhage; features are hoarseness and diplophonia

Resonance disorder

Quality of the voice that is produced from sound vibrations in the pharyngeal, oral, and nasal cavities

Velopharyngeal Dysfunction

Failure to separate the oral and nasal cavities

Nasal emission

Air escaped through the nose during speech, usually with nasla sounds like /m/ or /n/

Hypernasality

Speech sounds overly nasal because too much air escapes through the nose

Hyponasality

Speech sounds are muffled or blocked

SLP assessment of voice disorders

Case history, Perceptual evaluation of voice, Objective evaluation of voice instrumentation

Direct voice treatment

Modify vocal behaviors by changing pitch or loudness

Indirect voice treatment

Intervention that balances the subsystem for voice production

Hypokinesia

Reduced slow muscle movement, muscle rigidity, difficulty initiating and stopping movement

Spasticity

Weak, increased muscle tone; hyperactive reflexes

Flaccidity

Weak, soft, slow muscle tone, decreased reflexes; flaccid paralysis atrophy

Tremor

Involuntary quivering movement

Tics

sudden repetitive movements or sounds that are difficult to control

Dystonia

a neurological movement disorder that causes involuntary muscle contractions

Groping

to feel with your hands

Primary motor cortex

Main area responsible for motor function and is located in the frontal lobe

Pyramidal tract

rapid, discrete, volitional movement of limbs and articulations, fine/smooth movement other organs to make the movement (blinking)

Extrapyramidal tract

Regulates reflexes, maintains posture, muscle tone (facilitate pyramidal tract) AKA Indirect activity pathway

Upper motor neuron

Pyramidal tract Extrapyramidal tract

Lower motor neuron

Neurons that directly innervate muscles (spinal cord)

Basal ganglia

Subcortical structure responsible for motor functioning maintaining posture, muscle tone

Nervous system

12 cranial and 31 pairs spinal nerves

Motor planning

The brain’s ability to plan and sequence these movements before speaking

Programming

turning a speech plan into detailed muscle movement instructions for speaking. It ensures the timing, strength, and coordination needed for smooth speech production

Coordination

The smooth organization of muscles and movements needed to produce clear and fluent speech

Timing

Precise control of when speech movements occur to ensure fluent and accurate speech

Execution of speech movement

physical performance of planned speech movements to produce spoken language

Dysarthria definition

Neuromuscular impairment resulting from disturbances in the CNS and PNS that control the muscle of speech production

Dysarthria deficits

1. speech sound distortions

2. consistent speech errors

3. No groping

4. rapid or slow rate

5. no islands of fluency

6. reactive speech and violation speech are both affected

7. muscle weakness or paralysis

8. Voiced quality affected

Types of Dysarthria with lesion

1. Flaccid: lower motor neuron

2. Spastic: Upper motor neuron

3. Ataxic: Damage to cerebellum or cerebellar control circuit

4. Hypokinetic: Damage to the basal ganglia or basal ganglia circuit

5. Hyperkinetic: Multiple brain structures

Speech characteristics

1. Flaccid

2. Spastic

3. Ataxic

4. Hypokinetic

5. Hyperkinetic

Flaccid

Breathy voice, monopitch, hypernasality, imprecise articulation, short phrases

Spastic

Strained/strangled voice hypernasality, imprecise articulation, excess and equal stress

Ataxic

Irregular breakdown and imprecise articulation, excess, equal and prolonged stress

Hypokinetic

Accelerated speech rate, breathy/harsh/hoarse voice, reduced loudness, disfluencies

Hyperkinetic

Imprecise articulation, slow rate, harsh voice, monopitch/monoloudness, excess and equal stress, hypernasality

Etiology Flaccid

Bell’s palsy, Progressive bulbar palsy, Myasthenia Gravis, Muscular dystrophy

Etiology Spastic

Strokes

Etiology Ataxic

Cerebellar stroke

Etiology Hypokinetic

Parkinson Disease

Etiology Hyperkinetic

Amyotrophic Lateral sclerosis

Apraxia of speech

Neurological speech disorder that impairs the ability to plan or program the sensory and motor commands needed for speech production

Cerebral Palsy definiton

Heterogeneous group of non-progressive, permanent disorders of movement and postural development

Cerebral Palsy causes

• Oxygen deprivation

• Brain hemorrhages

• Infections/toxins

• Malnutrition

• Accidents during pregnancy or drug use

Cerebral Palsy types

Spastic(most common), Athetoid(involuntary movements), and Ataxic

Structure

• Symmetry

• Configuration

• Color

• General appearance

Function of speech subsystem

Movement, Range, Force, Speed, Direction during movement

Speech tasks

Single words, sentences, reading, spontaneous speech, rapid repetition (/Pa Ta Ka/)

Treatment in Dysarthria

1. Respiration: Pausing/Phrasing (improve their respiration)

2. Phonation:LSVT, Voice amplifier

3. Resonance: Continuous positive airway pressure, Palatal lift

4. Articulation: Drills, Electropalatography

5. ACC, Maximizing prosody

Treatment for Apraxia of Speech

1. Integral stimulation

2. Melodic intonation therapy

3. Contrastive stress

Dysphagia

Disorder swallowing (at any phase)

Gastroesophageal reflux

When stomach acid flows back into the esophagus, causing irritation that can affect swallowing

Bolus

A small rounded mass of a substance

Odynophagia

swallowing causes pain, often due to irritations injury, or infection in the throat or esophagus

Oral Preparation phase

1. Food is prepared for swallowing

2. Food is kept in mouth by sealing of lips (from fork, spoon, bottle)

3. Food ground up by lingual muscles and muscles mastication

4. Food mixed with salira to a bolus in preparation for swallowing

Oral phase

1. Bolus is pushed back to oropharynx

2. Tongue retracts mandible stops moving

3. Anterior tongue elecates (increasing and re pressure)

4. Bolus is compresses posteriorly initiation swallow reflex

Pharyngeal phase

1. Bolus reaches faucial pillars and pharynx

2. Soft palate elevates

3. Respiration ceases

4. Tongue retracts and lips are sealed

5. Vocal folds close

6. Upper esophageal sphincter relaxes which receives bolus

7. Return to pre swallow positions

Esophageal phase

1. Purely reflective stage

2. Involves peristaltic movement of the bolus through the esophagus

3. Bolus of food enters the stomach

Deficits oral preparation and oral phase

1. Poor lip seal: drooling

2. Poor muscle tone (paralysis): poor chewing

Deficits Pharyngeal phase

1. If swallowing not triggered: aspiration

2. Nasal cavity not closed: food goes into and comes out of nose

Deficits Esophageal phase

1. Peristaltic waves are slow or absent: Bolus may not reach stomach

2. Residue of food on esophageal walls: infection

Causes of dysphagia pediatric:

1. Neurological conditions

2. Congenital disorders

3. Gastroesophageal reflux disease

4. Prematurity

5. Infections

Causes of dysphagia Adults

1. Neurological disorders

2. Structural abnormalities

3. Muscle disorders

4. Inflammatory conditions

5. Foreign bodies or trauma

6. Aging related changes

Components of clinical swallow eveluation

• Patient history

• Oral exam

• Cranial Nerve function

• Swallow trials

• Observation

• Clinical judgment

Instrumental evaluation of swallow function

• Modified Barium Swallow: X-Ray test where a person swallows barium-coated foods to check for swallowing problems and aspiration

• Ultrasound: sound waves to visualize tongue and throat movements

• Endoscopy: thin flexible camera to view the throat and esophagus

Treatment for swallowing disorders:

• compensatory strategies

  • Feeding environment

  • Positioning

  • Modification of food

• Indirect rehabilitation strategies

  • strengthening exercises

• Direct rehabilitation strategies

  • Effortful swallow

  • Supraglottic or super supraglottic swallow

  • Mendelsohn Maneuver

Definition of Audiology

Discipline involved in prevention, assessment and rehabilitation of auditory, vestibular, and related impairments

Outer ear anatomy

Pinna and ear canal

Inner ear anatomy

Cochlea and semicircular canals

Middle ear anatomy

Temporal muscle + ME bones + Tympanic cavity

Auditory pathway and auditory processing

• Medial geniculate

• Inferior colliculus

• Superior olive

• Cochlear nucleus

Hearing loss

Reduced ability to hear sounds , ranging from mild to complete inability, caused by problems in the ear or auditory system

Hearing loss types

• Conductive

• Sensory Neural

• Mixed

Conductive hearing loss

Reduction in hearing sensitivity due to a disorder of the inner ear

Sensory Neural hearing loss

Reduction in hearing sensitivity due to a disorder of the inner ear

Mixed hearing loss

Reduction in hearing sensitivity due to a disorder of the outer/ inner AND inner ear

Hearing degree of loss

1. Normal -10 to 15

2. Slight 16 to 25

3. Mild 26 to 41

4. Moderate 41 to 55

5. Moderate severe 56 to 70

6. Severe 71 to 90

7. Profound 91+

Otoscopic examination

Visual inspection of the ear canal and eardrum using an otoscope