talking brain final exam

oral cavity

lips, teeth, tongue, hard palate, soft palate, cheeks, jaw

pharynx

throat area behind mouth and nose

3 parts of the pharynx

nasopharynx, oropharynx, laryngopharynx

larynx

top of the airway, moves forward to clear airway, opens upper esophageal sphincter

airway protection mechanisms

epiglottis inverts, vocal folds adduct, larynx moves up and forward, brief pause in respiration

peristalsis

muscle contractions by esophagus to move bolus into stomach

4 phases of swallowing

oral prep, oral transit, pharyngeal, esophageal

oral prep

food/liquid chewed, bolus formed after mixing with saliva

oral transit

tongue moves bolus towards hard palate, mostly voluntary

pharyngeal

vocal folds adduct, larynx moves up and forward, upper esophageal sphincter opens

esophageal

upper sphincter closes, lower opens, peristalsis moves bolus into stomach

dysphagia

difficulty swallowing

signs of oral dysphagia

drooling, food in cheeks, oral residue, anterior spillage, slow bolus movement

pharyngeal phase dysphagia

coughing/choking, wet voice, multiple swallows, reduced laryngeal elevation

general signs of dysphagia

cough/watery eyes/runny nose, wet gurgly voice, lump in throat (globus sensation), pneumonia/chest congestion after eating, UTIs/dehydration

swallowing assessments

screening, behavioral assessment, instrumental assessment

screening

3 oz water swallowed without interruption, pass/fal

behavioral assessment

case history, SLP observation for signs of dysphagia through swallow trials

instrumental swallow

rules out silent aspiration, FEES and MBS/VFSS

FEES

fiber optic endoscopic evaluation of swallowing, pharyngeal phase visible

MBS/VFSS

x-ray swallowing movements, barium mixed w/ foods

treatment of dysphagia

rehabilitative, compensatory techniques

rehabilitative technqiues

oral exercises, electrial stimualtion, medical management

compensatory techniques

designed to make up for but not heal, eg. modifying feeding environment, position adjustment, changing strategy, puree or thicken foods

apraxia of speech

inability to plan/program movement of speech

dysarthria

inability to execute motor plans, generic term for neurologic speech disorders impacteing all 4 speech sub-systems

abnormalities of dysarthria

muscle tone/strength, speed, range of motion, movement coordination, involuntary movements

etiology of dysarthria

stroke, neurodegenerative diseases (ALS/Parkinson’s), damage to CNS or PNS

subtypes of dysarthria

spastic, flaccid, hyperkinetic, hypokinetic, mixed, developmental, ataxic

spastic dysarthria

too much tone, strangled voice, lower pitch variation

flaccid dysarthria

too little tone, hypernasal, breathy voice, decreased variation in pitch/loudness

hypokinetic dysarthria

slow movement, tremors, lower breath support, rapid bursts of speech, lower articulatory precision, lower range of motion

hyperkinetic dysarthria

hyperkinesias, irregular articulatory breakdowns, prosodic abnormalities, sudden changes in pitch/volume

hyperkinesias

involuntary movements disrupting speech

slow hyperkinesia

sustained involuntary movements that climax

ataxic dysarthria

uncoordinated, poorly timed movements, creates irregular articulatory breakdowns, rate and loudness variability

mixed dysarthrias

combination of neurologic etiologies

developmental dysarthria

congenital, results from damage to nervous system (eg. hypoxia, head trauma, cerebral palsy)

dysarthria vs. apraxia of speech

Apraxia: phonation/resonance unaffected, complex sounds substituted, unable to use complex words, non-speech movements intact

Dysarthria: phonation/resonance impaired, simplify complex sounds, lower strength/ROM for non-speech sounds, word length/complexity

assessment

case interview, oral mechanism exam, assessment of speech/non-speech tasks

DDK

diadochokinetic rates, repetition of specific sounds within time

treatment of dysarthria

can target overall intelligibility or specific sub-systems, both compensatory or restorative techniques

larynx

cartilaginous, below hyoid bone

vocal cords

abducted = open, adducted = closed,

3 main vocal characteristics

pitch, loudness, quality

perception of frequency

speed/rate of fold vibration, measured in Hz

phonation

cyclic, full motion of open and closed VF

pitch

psychological equivalent of frequency perception

determinant of frequency

vocal folds

as length of vocal folds increases

lower frequency

Fº

average rate of vibration

thicker vocal folds

lower avg. rate of vibration

more tension

higher frequency

vocal loudnes

based on perception of intensity, physical measure of sound intensity

more air in system

louder vocal noise

clarify of voicing

hypo/hypernasality, based on genetics, learned behaviors, qualitative

presbyphonia

typical aging, more effort for lower volume, lower quality

dysphonia

umbrella term for disordered voice

aphonia

completed loss of voice

organic structural dysphonia

physical changes, eg. paralysis of folds, edema, vocal nodules, polyps, cancer

vocal nodules

benign growths on vocal folds, caused by allergies, smoking, tense muscles, vocal strain, overuse of the voice, dehydration

vocal polyps

long term vocal abuse, single traumatic event, usually larger than nodules

neurogenic voice disorders

problems with CNS/PNS affecting function of vocal mechanism, eg. paralysis of vocal folds, spasmodic dysphonia

spasmodic dysphonia

abnormal, involuntary movmenets of the larynx, adductor type is most common, strained effortful tight voice, damage ot the basal ganglia and cerebellum

vocal fold paralysis

loss of muscular control one or both vocal folds, can still vibrate bc/ based on air flow not muscle contraction

functional voice disorders

result from improper or inefficient use of vocal mechanism when the physical structure is normal

psychogenic voice disorders

result of psychological stressors, causing habitual aphonia/dysphonia (eg. stress/GAD, depression)

assessment of voice disorders

examined by physician, before or after SLP, evaluate vocal characteristics, impact on function, identify causes and beneficial approach to improving

components of voice disorder assessment

case history, interview, oral mechanism exam, respiration assessment, auditory-perceptual assessment, instrumental

respiration assessment

measure coordination of respiration with phonation, maximum phonation time, s/z ratio for glottal insufficiency

auditory perceptual assessment

subjective assessment based on SLPs impressions (pitch, loudness, voice quality, resonance, perceptual features)

instrumental assessment

acoustic measures, aerodynamic measures, laryngeal imaging

treatment of voice disorders

vocal hygiene, manual tension reduction, improving breath support to reduce strain

vocal function exercises

muscular exercise while balancing respiratory, phonatory, and resonant sub-systems

transgender/gender diverse populations

focus on vocal health, resonance, voice, articulation, language, nonverbal communication