PCSD 201 - Intro to Comm. Chapters 12-15

motor speech disorder

an impairment of speech production caused by defects of the neuromuscular system, the motor control system, or both

systems of speech production

respiratory, phonatory, resonatory, articulatory

respiratory

regulates the inhalation-exhalation cycle for passive breathing and for producing speech

phonatory

regulates the production of voice and the prosodic, or intonational, aspects of speech

resonatory

regulates the resonation (vibration) of the airflow as it moves from the pharynx into the oral or nasal cavities

articulatory

regulates the control of the articulators within the oral cavity to manipulate the outgoing airflow in different ways, usually at very high speeds

speech motor control

motor planning

the processes that define and sequence articulatory goals prior to their occurence

motor programming

the processes responsible for establishing and preparing the flow of motor information across muscles for speech production and specifying the timing and force required for the movements

motor execution

the processes responsible for activating relevant muscles during the movements used in speech production

classification of motor speech disorders

developmental and acquired disorders

Acquired Apraxia of Speech (AOS)

an impairment of motor programming and planning that involves an inability to transform a linguistic representation into the appropriate coordinated movements of the articulators

Acquired Dysarthria

a group of speech disorders caused by disturbances of neuromuscular control of the speech production systems (disruption in the execution)

Characteristics of acquired dysarthria

abnormalities in strength, speed, range, and steadiness of speech

Types of acquired dysarthria

Flaccid dyarthria (muscle weakness), hypokinetic dysarthria (slowness of movement), hyperkinetic dysarthria

Developmental dysarthria

present at birth and accompany a disturbance in neuromuscular functioning

Characteristics of developmental dysarthria

hypertonicity (increased muscle tone), hyperreflexia (increased sensitivity of reflexes), impaired coordination of muscles

Types of developmental dysarthria

spastic dysarthria and dyskinetic dysarthria

Pediatric hearing loss

a condition in which a child or adolescent is unable to detect or distinguish the range of sounds normally available to the human ear

Classification of pediatric hearing loss (etiology, cause, age of onset, types of loss)

hearing loss can be genetic or environmental, meaning it was a result of an infection, injury, or illness in the prenatal, perinatal, or 28-day postnatal period.

Age of onset is differentiated by the terms prelingual and postlingual.

Type of loss could be conductive, sensorineural or mixed.

Conductive hearing loss

caused by damage to the outer or middle ear (that leaves the inner ear and cochlea intact)

Cause and risk factors of conductive hearing loss

cerumen blockage (ear wax), otitis media (viral or bacterial infection of the middle-ear space). The angle and length ot the eustachian tube in children make it easier for organisms to enter a move through the tube

What’s the most common cause of conductive hearing loss?

otitis media, which results from a viral or bacterial infection of the middle-ear space

Sensorineural hearing loss

caused by damage to the cochlea or auditory nerve (that leaves the outer and middle ear intact)

Causes and risk factors

causes are maternal health during pregnancy, the birth process, the child’s health at birth, hereditary factors, exposure to medications that are toxic to the ear and disease.

Risk factors are serious illness, drug use, in utero infections, noise exposure, etc.

Mixed hearing loss

caused by damage to the conductive and sensorineural mechanisms

Assessment process

Referral: early diagnosis of hearing impairment (EDHI)

Screening: newborn hearing screenings or conventional hearing screening (requires a child’s response)

Comprehensive audiological evaluation: assesses the type and degree of hearing loss

Audiometry

“pure tone testing”, provides relatively objective information about hearing acuity and depends on child’s participation

audiogram

air conduction

the way most sound waves are delivered: the sound waves pass along the auditory canal and then through the middle-ear space. Provides information about hearing acuity

bone conduction

transmits sound vibrations along the bones of the skull

Amplification and listening devices

hearing aids and other assistive listening devices make sounds accessible to a child’s auditory system. Most common is the FM system which relies on radio waves to send a signal from a speaker’s microphone or transmitter to the listener’s device. Cochlear implants are surgically placed devices that provide direct electrical stimulation to the auditory nerve.

What is adult hearing loss?

deviation or change for the worse in either auditory structure or function

Classification of adult hearing loss

etiology (affected area) and severity

Causes and risk factors of adult hearing loss

common causes include head trauma, tumors, illness, aging, noise exposure, etc. Severity is defined by decibels (dB)

Recruitment

a reduced tolerance for loud sounds

Tinnitus

a ringing, roaring, buzzing, or hissing sound in one or both ears. (Can be a result of damage to the inner ear)

signal to noise ratio loss

hearing loss and loss of speech clarity due to inner hair cell damage

Feeding and swallowing disorders

Normal swallow

includes four stages: the oral preparatory stage, the oral phase, the pharyngeal phase, and the esophageal stage

Phases of swallowing

oral prepatory stage (prepare substance to be swallowed, oral phase (move the bolus to the rear), pharyngeal phase (propel the bolus downward through the throat), esophageal (moves the bolus through the esophagus and into the stomach

Disordered swallow: Dysphagia

Penetration

food or liquid enters the larynx, where it can cause choking and respiratory distress

Aspiration

the food or liquid passes through the larynx and into the lung where it can interfere with the exchange of air in the lungs and cause asphyxiation or pulmonary infection, such as pneumonia

Pediatric feeding disorders

a child’s persistent failure to eat adequately for a period of at least 1 month, which results in a significant loss of weight or a failure to gain weight

Defining characteristics of inadequate feeding and swallowing

when a child is unable to achieve the nutrition needed for healthy growth and development

inefficiency

children who are unable to meet caloric and nutritional needs because the process isn’t productive; they tire easily, become breathless, or show a lack of persistence

overselectivity

children who are picky about the taste, type, texture, or volume of food they will eat and may reject all members of a particular food group because of taste or type

refusal

resisting to eat

feeding delay

because of developmental delays, illnesses or trauma, some children are slow to meet major milestones, such as the transition from a bottle to a cup or the emergence of finger feeding

Adult dysphagia

difficulty swallowing

characteristics of adult dysphagia

characteristics typically relate to: the phase of swallow affected, the underlying cause, and the severity of the disorder

Signs/symptoms of dysphagia

decreased lip closure causing leaks from the mouth, difficulty biting or chewing, difficulty moving the bolus, diminished tongue and pharyngeal muscle force,

Pathology

dysphagia is a secondary disorder, caused by neurological damage due to a stroke, brain injury, or disease.

Severity

can range from mild to severe. The degree of airway protection during a swallow is described on an 8-point scale.

Identification and treatment of Adult dysphagia

bedside swallow examination is administered, instrumental dysphagia examination (such as FEES)

Clinical swallowing exam

also known as a bedside swallow examination, the SLP reviews all medical records, administers a client interview, examines mouth and throat, attempts trial feedings, makes feeding recommendations, refers the client for instrumental assessment or to other professionals for specialized testing.

Instrumental dysphagia exam

evaluation of swallowing problems using technology or instrumentation

Compensatory approaches

strategies that compensate for a specific problem in order to make swallowing safe and efficient, like placing a mirror in front of the client while eating

Restorative approaches

intended to improve or restore swallow function

Nutrition and dietary considerations

clients should consider altering their diet to better accommodate the disorder

Characteristics of apraxia of speech

effortful, slow speech with pauses between syllables and sound prolongations, distortions of speech sounds, impaired prosody

Causes and risk factors of AOS

Neurological damage, possibly in the frontal lobe. Stroke, TBI, infections and neurodegenerative disease.

Spastic Dysarthria

increased muscle tone

Flaccid Dysarthria

muscle weakness, atrophy, and hypotonicity

Hypokinetic Dysarthria

slowness of movement, rigidity, and static tremor

Hyperkinetic Dysarthria

variable muscle tone and (slow or fast) involuntary movements

Ataxic Dysarthria

results from damage to the cerebellum causing incoordination and dysmetria

Unilateral Upper Motor Neuron Dysarthria

weakness of the lower face or tongue on one side

Measurement methods for documenting motor speech disorders

perceptual (perceptual judgements of intelligibility, accuracy, and speed of speech production), acoustic (a visual representation of the speech sound wave), and physiological measures (quantitative data on aspects of the speech motor system such as muscle strength, endurance and airflow)

Treatment goals for motor speech impairment

learn or relearn accurate production of speech, maintain a new skill over time, generalization (application or transfer of a skill to related but untrained movement patterns), to improve the impaired system, and to teach compensatory strategies

Cause of adult hearing loss

cerumen blockage, foreign objects, etc. Sensorineural hearing loss is most common. It’s a progressive condition.