hdfs 314 exam 2

phonology

sound system of a language and the rules that govern the sound combinations

• when to use the ‘s’ sound and when to use the ‘z’ sound (helps vs crabs)

morphology

system that governs word structure and construction of word forms

• study of stems, root, prefix (happy, unhappy, happiness)

syntax

system governing word order and combination to form sentences, and the relationships among the elements within a sentence

• english: how old are you vs spanish: how many years do you have (cuantos anos tienes)

semantics

system that governs word meaning and sentences

• crash can mean accident, to attend party without invitation, waves hitting shore, etc

pragmatics

system that combines all language components in functional and socially acceptable conversation

• its raining cats and dogs, crack the door open

prosody

tool of human expression conveyed acoustically by way of durational, intensity, and frequency cues, planned and programmed in speech

• the melody of language

receptive language

a person's ability to understand and process spoken, written, or nonverbal communication, such as gestures and visual cues

input or auditory comprehension

expressive language

the ability to put thoughts, ideas, and feelings into words or other communication forms so that other people can understand them

diagnostic classifications, general - articulation disorder

speech sound disorder w no known cause, difficulty producing speech sounds resulting in sound omissions, substitutions, or distortions of speech sounds

• wed for red, nana for banana, lisp

phonological disorder

difficulty learning the sound system of a language and the rules for combining sounds

rule-based errors must affect MORE than one sound (stopping, fronting, final consonant deletion)

diagnostic classifications, general - childhood apraxia of speech (CAS)

severe speech sound disorder, inability of a person to perform voluntary/skillful movements of articulators without paralysis

characteristics of childhood apraxia of speech

Severe and persistent speech difficulty and/or unintelligibility

Vowel misarticulations; reduced production of consonants

Difficulties in sequencing the phonemes in syllables and words

Difficulties in producing volitional oral movements and movement sequences: silent periods during tries

Inconsistent timing control of nasality and prosody

Inappropriate use of prosody, especially syllable stress

diagnostic classifications, general - developmental dysarthria

Difficult or unclear articulation of speech that is otherwise linguistically normal.

Due to motor incoordination or weakness of the muscles needed to articulate intelligible speech

diagnostic classifications, general - spoken language disorder (SLD)

language disorder focusing on oral communication—specifically listening and speaking

diagnostic classifications, DSM - language disorder

Persistent difficulties in acquisition and use of language

• Reduced vocabulary

• Limited sentence structure

• Impairments in discourse

diagnostic classifications, DSM - speech sound disorder

Persistent difficulty with speech sound production which interferes with intelligibility or prevents verbal communication

Disturbance limits effective communication and interferes with social participation, academic achievement, or occupational performance

diagnostic classifications, DSM - childhood-onset fluency disorder

Disturbances in normal fluency and or timing that persist overtime and cause anxiety about speaking

Sound and syllable repetitions, Sound prolongations of consonants as well as vowels, Broken words, Circumlocutions (word substitutions to avoid problematic words), Words produced with excess physical tension, Monosyllabic whole-word repetitions

diagnostic classifications, DSM - social (pragmatic) communication disorder

Persistent difficulties in social use of verbal or non-verbal communication

difficulty using communication for social purposes, inability to change communication to match context, difficulty following rules for conversation, trouble w idioms, metaphors

speech

how we say sounds and words

those with speech problems may not say sounds clearly, repeat sounds, pause when speaking (stuttering), hoarse/ raspy voice

language

the words we use to share ideas and get what we want

those with language disorder may have trouble understanding, talking, reading, writing

speech disorders

impairment of the articulation of speech sounds, fluency and/or voice

language disorders

impaired comprehension and/or use of spoken, written, and/or other symbol systems

involves form (phonology, morphology, syntax) content (semantics) or function (pragmatics) of language

when to refer for speech/language disorders?

when a child misses key developmental milestones (such as no babbling by 12 months, no single words by 16–18 months, or speech that is mostly unintelligible) or shows regression in speech, language, or social skills at any age

when not to refer for speech/language disorders?

if speech differences are normal, developmentally appropriate, or due to an illness or infection

Who can/should be part of a multidisciplinary assessment team for speech and/or language difficulties?

SLP, pediatrician, audiologist, occupational therapist, learning specialist, psychiatrist, psychologist

common treatment approaches for language disorders

• social language skills (pragmatics): staying on topic, conversational turns, recognizing and repairing breakdowns

• vocabulary (semantics): vocab is taught with a developmental sequence, organization of lexicon

• grammar (morphology and syntax): awareness of syllables and sounds, roots/affixes, relationships w/ other words, verbs tenses, pronouns, etc

common treatment approaches for speech disorders

• motor-based approach: if articulatory based, discriminate and contrast the sounds in error, produce sounds in isolation followed by single syllables, words, phrases, and sentences, produce target sounds correctly in conversational speech

• Linguistic phonological approach: used when one has inadequate knowledge of the sound system, teach phonological rules, sound contrasts, and phonological patterns of the language

eye anatomy - iris

thin, ring-shaped, colored part of the eye located between the cornea and the lens

eye anatomy - lens

transparent, biconvex structure inside the eye that helps focus light onto the retina

eye anatomy - pupil

dark, circular opening in the center of the Iris that allows light to enter the eye

eye anatomy - cornea

transparent, dome-shaped outer covering at the front of the eye

eye anatomy - retina

a thin, light-sensitive tissue lining the back wall of the eye

eye anatomy - choroid

vascular, pigmented layer of the eye located in the middle layer of the eyeball wall (the uvea)

eye anatomy - optic nerve

a sensory nerve that carries visual information from the retina to the brain

eye anatomy - optic disc

circular to vertical-oval exit point at the back of the eye where retinal ganglion cell axons bundle together to form the optic nerve.

strabismus

misalignment of the eyes (esotropia, exotropia, or vertical misalignment)

strabismus - esotropia

eye turns inward (crossed eyes)

strabismus - exotropia

eye turns outward (wall eyes)

strabismus - hypertropia

eye turns upward

strabismus - hypotropia

eye turns downward

nystagmus

back-and-forth movement of the eyes due to poor vision, neurologic conditions, or idiopathic

abnormal head posture

related to vision impairment, due to strabismus, ptosis, astigmatism, or nystagmus

abnormal color vision

related to vision impairment, seen in colorblindness (1 in 12 males) and retinal/optic nerve disorders

photophobia

related to vision impairment, an abnormal intolerance, discomfort, or eye pain caused by exposure to light

seen in infantile glaucoma, aniridia, albinism, and achromotopsia

refractive errors

The shape of your eye does not bend light correctly, resulting in a blurred image (3 main: myopia, hyperopia, astigmatism)

refractive errors - myopia

nearsightedness, difficulty seeing far

refractive errors - hyperopia

farsightedness, difficulty seeing close

refractive errors - astigmatism

irregular curve in cornea or eye lens

refractive correction - myopia

eyeball too long = concave lense deflects rays

refractive correction - hyperopia (farsightedness)

eyeball too short = convex lens

refractive correction - astigmatism

eyeball correct size, cornea misshaped = cylindrical lens

amblyopia

lazy eye, happens in just 1 eye, breakdown in brain + eye teamwork, brain can’t recognize sight from 1 eye

starts in childhood, most common cause of vision loss in kids

refractive errors, cataracts, strabismus can lead to lazy eye

cerebral visual impairment (CVI)

Visual deficit due to disorders affecting the visual cortex

• Ocular exam can be normal

• ranges from mildly impaired to completely absent

Causes due to hypoxic ischemic encephalopathy, CNS malformations, neoplasia, infection, metabolic neurodegenerative disorders, underlying genetic causes

• Vision may improve with time

optic nerve hypoplasia

disorder from birth, underdevelopment of optic nerve

most have abnormal eye movements (nystagmus), vision ranges from no light to functional vision or full vision in one eye

uncorrectable with glasses

may be associated with pituitary abnormalities

associated with other disabilities

optic nerve atrophy

interferes with optic nerve’s ability to transmit impulses

caused by tumor, glaucoma, etc

symptoms: blurred vision, trouble w/ peripherials and colors, reduction in sharpness

retinopathy of prematurity (ROP)

Abnormal vessel growth leading to tractional retinal detachment if untreated.

• Vision loss due to high refractive error or retinal damage

treated with retinal laser, surgery, anti-VEGF injections

chorioretinitis

inflammation of the choroid, which is a lining of the retina deep in the eye

can be cased by infection or autoimmune disease

symptoms may not appear for 10-20 years

symptoms: pain, redness, blurred vision, floating objects, light sensitivity, glare, tearing, sparks/flashes, impaired night + color vision, distortion of objects

cataract

defect in lens clarity, appearing as white spot on pupil, can require surgery

blindness

Corrected visual acuity of 20/200 or worse in the better eye, and/or a limited visual field of 20 degrees or less

low vision

corrected vision of 20/70 to 20/200

causes of blindness

cerebral visual impairment

optic nerve hypoplasia

inherited retinal disorders

retinopathy of prematurity

cataract

glaucoma

poor nutrition

infection

microphthalmia

birth defect in which one or both eyes did not develop fully, so they are small

1 in 5200 babies, causes unknown

charge syndrome prevalence

8500 to 10000 newborns

anophthalmia

birth defect where baby is born without one/both eyes

CHARGE syndrome

Coloboma of the eye

Heart defect from birth

choanal Atresia

Retarded growth/development

Genital abnormalities

Ear marformations (w/ or w/out hearing loss)

CHARGE syndrome - coloboma

gap or hole in one of the structures of the eye, forms during early development

present in one or both eyes

treatment for visual impairment - refractive error correction

• glasses: may need atropine drops, straps, tinted lenses, special frames

• contact lens: used in high hyperopia and anirdia

• refractive surgery if glasses not tolerated

treatment for visual impairment - amblyopia

refractive error correction, eye patching, atropine eye drops, penalization of better eye, surgery

works well, usually prevents long-term vision problems

not effective after first decade of life

treatment for visual impairment - ophthalmic surgeries

catract removal, strabismus repair, glaucoma surgery, ptosis repair, retinal surgery

• in some cases, surgery must be done in infancy for vision to develop properly

causes of visual impairments

ocular

• light must pass clearly through cornea → lens → vitreous and strike a functioning retina in order to see

optic nerve

• connects the eye to the brain, any nerve damage decreases vision

cortical/cerebral

• occipital lobe in the posterier brain = visual processing center, damage results in poor vision

interventions for visual impairments

clinical, rehabilitation, educational

increases skills in other senses, improves body concept and awareness, promote locomotion and environmental exploration

• home based sessions/school based preschool programs

• optical aids and devices, braille, computers, audio/orientaiton/mobility techliques

• assistive tech, voice recognition, global positioning

• genetic advances (gene replacement)

impact of visual impairment on development - motor

abnormal movements, hands fisted longer, head lower, crawling + standing + walking at a later age, fine motor skills / balance affected, decreased mobility = obesity

impact of visual impairment on development - language

imitates sounds earlier, less facial/body language, fewer questions, delay in combining words, difficulties with pronouns, less adjectives

impact of visual impairment on development - psychosocial

poor eye contact impacts attachment and socialization, isolation, poor-self image, higher rates of mental health issues

ear anatomy - pinna (or auricle)

the visible, outer portion of the ear that projects from the side of the head

ear anatomy - ear canal

s-shaped tube that connects the outer ear (pinna/auricle) to the eardrum

ear anatomy - malleus

hammer-shaped bone in the middle ear

ear anatomy - incus

middle bone of the small auditory ossicles in the middle ear

ear anatomy - stapes

smallest and lightest bone in human body, serves as the innmost middle ear ossicle

ossicles

the three smallest bones in the human body, located inside the middle ear, which transmit and amplify sound vibrations from the eardrum to the inner ear

ear anatomy - tympanic membrane (eardrum)

thin, cone-shaped tissue that separates the outer ear canal from the middle ear, vibrates when sound waves hit

ear anatomy - cochlea

snail shell-shaped, fluid-filled organ in the inner ear that turns sound waves into electrical signals for the brain

ear anatomy - labyrinth

complex system located deep within the petrous part of the temporal bone, responsible for both hearing and balance

ear anatomy - auditory nerve

sensory nerve that transmits sound signals from the inner ear to the brain

1-3-6 guidelines

hearing screening by 1 month

diagnosis by 3 months

intervention by 6 months

critical window for language development

early identification → early intervention → supports language development

diagnostic overshadowing - underdiagnosis

• Incorrectly attributing hearing loss as the reason for a developmental difference

• Lack of diagnosis often translates into a lack of early intervention, which can impact long-term outcomes

• Child and family misses out on appropriate services

diagnostic overshadowing - overdiagnosis

• Incorrectly attributing to a developmental disability

• Supports and intervention, if not appropriate, may not help needs nor prepare families

• Schools and programs may not accept the child

interventions - language learning

auditory-oral: no sign, use residual hearing

auditory-verbal: hearing aids or implants, play-based

cued speech: sign and mouth movements

sign supported speech: sign and speech

ASL: sign only

interventions - amplification

hearing aid or cochlear implant

types of hearing loss - sensorineural

inner ear, caused by damage to hair cells of spiral ganglion neurons of cochlea

sound cant be converted into signals

often permanent

treatment for sensorineural hearing loss

amplification via hearing aids or cochlear implants

types of hearing loss - conductive

outer or middle ear, sound waves cant go thru outer ear canal to eardrum

reduction in sound levels

can be corrected surgically/medically

bone conduciton hearing aids

types of hearing loss - combine or mixed

combination of sensorineural and conductive

problems transmitting sound thru outer/middle ear, reduced cochlear function

conductive may be treated, sensorineural often permanent

treatment: hearing aids (unless infection)

types of hearing loss - neural hearing disorders

auditory nerve, sound processed by inner ear but signal transmission to brain is impaired

trouble w/ speech perception

audiogram

frequency/pitch (Hz) = x axis

intensity/amplitude/loudness (dB) = y axis

types of hearing screeners - auditory brainstem response (ABR)

tests how inner ear and brain pathways work

used for kids who cant complete typical hearing screening

used if symptoms are due to hearing loss in the brain/brain pathway

test done at rest, no verbal responses needed

types of hearing screeners - otoacoustic emissions (OAE)

used to find out how well inner ear works

measures otoacoustic emissions (sounds given off by inner ear when responding to a sound)

hair cells in inner ear vibrate

types of hearing screeners - pure tone testing

pitch - most humans can hear from 20-20,000 Hz

risk factors for D/HH children

neonatal factors

• prematurity

• intraventricular hemorrhage

• necrotizing enterocolitis (NEC)

• prolonged ventilation

bacterial meningitis

some genetic syndromes

family history of learning disabilities or attention problems

causes of hearing loss - genetic

1 in 2 cases of hearing loss, 80% autosomal recessive

feature of many syndromes: treacher collins, waardenburg, bardet-biedi, usher, down, trisomy 13, trisomy 18

commmon non syndromic - mutation on connexin 26