CD 225 Test 3 Studyguide

Frontal Lobe

Thinking problem-solving, emotions, speech (Broca's area)

Parietal Lobe

Sensory processing, spatial awareness

Temporal Lobe

Hearing, language comprehension (Wernicke's area)

Occipital Lobe

Vision processing

Aphasia Definition

A language disorder caused by brain damage

Cranial Nerve V

Trigeminal; Sensory & motor, face sensation, mastication

Cranial Nerve VII

Facial; Sensory & motor, facial expression, taste

Cranial Nerve IX

Glossopharyngeal; Sensory & motor, taste, gag reflex

Cranial Nerve X

Vagus; Sensory & motor, gag reflex, parasympathetic innervation

Cranial Nerve XI

Accessory; Motor, shoulder shrug

Cranial Nerve XII

Hypoglossal; Motor, motor, swallowing, speech

Aphasia

Without language

Hyperfluent speech

Rapid speech rate that is incoherent, inefficient, and programmatically inappropriate

Hemiparesis

Weakness on one side

Hemiplegia

Paralysis on one side

Hemianopsia

Blindness in a visual field

Dysphagia

Difficulty chewing or swallowing

Agnosia

Difficulty understanding sensory information (Auditory or Visual)

Agrammatism

Omission of grammatical elements (e.g., articles, prepositions, morphological endings)

Agraphia

Difficulty writing (full of mistakes or poorly formed)

Alexia

Reading problems (unable to recognize common words they use in speech)

Anomia

Difficulty naming/word-finding difficulty (can't find the right word)

Jargon

Meaningless or irrelevant speech with intonation (client may continue to produce incorrect responses even when aware they are wrong)

Neologism

Novel word used for everything (creates and uses words that may not exist in the language)

Paraphasia

Word substitutions (may substitute a word related by sound or meaning, e.g., tar for car or truck for car)

Verbal Stereotype

Expression repeated over and over (e.g., repeating "I know I know I know" or an obscene expletive repeatedly)

Apraxia

Difficulty planning movements for speech production

Dysarthria

Difficulty carrying out motor movements of speech production

Hemisensory Impairment

Loss of ability to perceive sensory information

Seizures

Affect 20% of adults with aphasia

Fluent Aphasia

• Typical rate, intonation, pauses, and stress patterns

• Word substitutions, neologisms, verbose verbal output

• Posterior Left Hemisphere

Non-fluent Aphasia

• Slow rate, less intonation, inappropriate and abnormally long pauses, less varied stress patterns

• Labored speech characterized by difficulty retrieving words and forming sentences

• Frontal Lobe

Wernicke’s Aphasia

• Speech production- fluent or hyper-fluent

• Speech comprehension- imp­aired to poor

• Speech characteristics- verbal paraphasia, jargon, unaware of difficulties

• Reading comprehension- impaired

• Naming- impaired to poor

• Speech repetition- impaired to poor

Broca’s Aphasia

• Speech production- nonfluent

• Speech comprehension- relatively good

• Speech characteristics short sentences, agrammatism, slow and labored, articulation, and phonological errors

• Reading comprehension- unimpaired to poor

• Naming- poor

• Speech repetition- poor

Primary Causes of Aphasia

Stroke, head injury, brain tumor

What 4 areas does ASHA recommend be used for a functional assessment of communicative abilities with adults with aphasia? (Table 6.2 in text)

• Social communication

• Communication of basic needs

• Reading, writing, and number concepts

• Daily planning

What is Primary Progressive Aphasia?

• Degenerative disorder of language

• Cognitive fx and comprehension remain relatively intact

• Progresses from a motor speech disorder to near-total inability to speak

What are characteristics of Right Hemisphere Brain Damage?

• Neglect information from left side

• Unrealistic denial of illness or limb involvement

• Impaired judgment and self-monitoring

• Lack of motivation

• Inattention

Right Hemisphere Brain Damage may have deficits in what areas?

• Poor auditory and visual comprehension of complex information

• Reduced activation of word meanings and categories

• Difficulty suppressing irrelevant information

• Pragmatics most impaired

• Topic maintenance

• Appreciation of communication situation

• Determination of listener needs

• Misinterpret intended meanings

• Thinking is concrete; Difficulty with metaphors/idioms

• Aprosodia

• Reduce­d ability or inability to comprehend or produce emotional language (joy/sadness, anger/delight)

What areas will be assessed in Right Hemisphere Brain Damage?

• Visual scanning and tracking

• Auditory and visual comprehension

• Direction following

• Response to emotion

• Naming and describing

• Writing

• Observation is essential for pragmatics

• Portions of aphasia batteries, standardized measures for RHBD, and non-standardized measures can be used

Hypoxia

Lack of oxygen

Hematoma

Focal bleeding

Infarction

Death of tissue due to deprived blood supply

What are the characteristics of TBI?

Difficulty with:

• Physical abilities

• Cognition

• Communication

• Psychosocial factors

Focus of tx of TBI in the Early Stages

Orientation, sensorimotor stimulation, recognition

Focus of tx of TBI in the Middle Stages

Reduce confusion, improve memory and goal-directed behavior

Focus of tx of TBI in the Late Stages

Comprehension of complex information and directions, conversational and social skills

What is Dementia?

Intellectual decline due to neurogenic causes

Cortical Dementia

• Visuospatial deficits

• Memory problems

• Judgment and abstract thinking disturbances

• Language deficits in naming, reading, and writing, and auditory comprehension

• Alzheimer’s

• Pick’s

Subcortical Dementia

• Deficits in memory

• Problem-solving

• Language

• Neuromuscular control

• Multiple Sclerosis

• AIDS-related encephalopathy

• Parkinson’s

• Huntington’s

What is Alzheimer’s Disease

Microscopic changes in the neurons of the cerebral cortex

Fluent speech

the consistent ability to move the speech production apparatus in an effortless, smooth, and rapid manner

Stuttering

characterized by involuntary repetitions of sounds and syllables, sound prolongations, and broken words

Secondary characteristics of stuttering

Eye blinking, facial grimacing or tension, exaggerated movements of head/shoulders/arms, interjected speech fragments

Developmental Stuttering

• Most common form of stuttering

• Begins in the preschool years

• Onset gradual, increasing in severity

• Usually occurs on content words, initial syllables

Neurogenic Stuttering

• Typically associated with neurological disease or trauma

• Usually occurs on function words, widely dispersed through utterance

• No secondary characteristics

• No improvement with repeated readings or singing

Phase 1 of Developmental Stuttering (2-6 years)

Sound/syllable repetitions; generally, not aware or bothered

Phase 2 of Developmental Stuttering (elementary school)

Stuttering on content words, more habitual; child refers to self as stutterer

Phase 3 of Developmental Stuttering (8 years - young adult)

Stuttering in response to situations; little fear, avoidance, embarrassment

Phase 4 of Developmental Stuttering

Most advanced; fearful anticipation, avoidance of words/situations; embarrassment

Organic Theory of Stuttering

Proposes an actual physical cause

Behavioral Theory of Stuttering

Stuttering is a learned response

Psychological Theory of Stuttering

Contends stuttering is a neurotic symptom

Direct Therapeutic Techniques

• For children stuttering at least a year; mod-severe

• Explicit attempts to modify speech

• “Hard” and “easy” speech

• Strategies to increase easy speech and change from hard to easy speech

Indirect Therapeutic Techniques

• For children just beginning to stutter; mild

• Provide a slow, relaxed speech model; play-oriented activities

• Goal: Facilitate fluency through environmental manipulation

Voice

Sound produced by vocal folds

Resonance

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

VPI

Failure to separate the oral and nasal cavities is called velopharyngeal inadequacy

Pitch

Adjusted by vocal fold tension

Loudness

Controlled by airflow and vocal fold pressure

Monopitch

Lacks normal variation in pitch, sometimes unable to change pitch. May indicate neurological impairment, psychiatric disability, or personality factors.

Inappropriate Pitch

Pitch is outside the normal range for age and sex

• Too high May indicate underdeveloped larynx.

• Too low May be linked to hormonal issues.

Pitch Breaks

Sudden, uncontrolled changes in pitch.

• Common in males during puberty.

• Can be caused by laryngeal pathologies or neurological conditions.

Monoloudness

Lacks normal variations in intensity or ability to change loudness.

• May reflect neurological impairment, psychiatric disability, or personality factors.

Loudness Variations

Extreme fluctuations in vocal intensity.

• Loss of neural control of the respiratory/laryngeal mechanism or psychological problems

Hoarseness/Roughness

Voice lacks clarity and sounds noisy.

• Can be due to pathologies that affect vocal fold vibration

• Can be temporary; minor misuse/abuse produces edema

Breathiness

The perception of audible air escaping through the glottis during phonation

• May be a lesion that prevents closure of a neurological impairment

Vocal Tremor

variations in pitch and loudness that are under voluntary control

• Usually loss of CNS control over the laryngeal mechanism

Strain and Struggle

Related to difficulties initiating and maintaining voice

• Related to neurological impairments or psychological problems

Stridor

Noisy breathing or involuntary sound that accompanies inspiration and expiration

• Indicative of narrowing somewhere in the airway and is always abnormal and serious

• Excessive throat clearing

Vocal nodules

Localized growths resulting from frequent, hard vocal fold collisions

Contact ulcers

Reddened ulcerations on posterior surface of the vocal folds near the arytenoid cartilages

Vocal Polyps

Fluid filled lesions that develop when blood vessels in rupture and swell

Chronic laryngitis

Inflammation of the vocal folds that can result from exposure to noxious agents, allergies, or vocal abuse; Vocal abuse during acute laryngitis; can lead to serious deterioration of vocal fold tissue

Acute laryngitis

Inflammation of the vocal folds that can result from exposure to noxious agents, allergies, or vocal abuse; Temporary swelling; hoarseness

Parkinson disease

• Monopitch, monoloudness, harshness, breathiness

• Intensive therapy that improves adduction improves

• Loudness and intelligibility

Unilateral and bilateral vocal fold paralysis

• Caused by damage to the recurrent branch of CN X

• Hoarse, weak, and breathy voice

• Diplophonia

• Collagen or Teflon injections to build up mass

• Voice therapy after surgery (vf implantation)

Spastic dysarthrias

• Bilateral damage to the brain

• Great difficulty speaking and swallowing, lability

• Harshness, pitch breaks, strained/strangled quality

Spasmodic dysphonia

• Abnormal adductor laryngospasm that causes a strained, effortful, tight voice, and intermittent voice stoppages

• Voice tremor

• Can be neurological, psychogenic, or idiopathic

• Botulism toxin injection for neurological or idiopathic

Laryngeal Cancer

• Persistent hoarseness in the absence of colds or allergies

• Frequently necessary to remove the entire larynx

• Trachea is repositioned to form a stoma for breathing

• Removal of the larynx requires alternate methods of producing voice

Esophageal Speech

Alternate for regular speech, air flow from the esophagus.

Electrolarynx

sometimes referred to as a "throat back", is a medical device about the size of a small electric razor used to produce clearer speech by those people who have lost their voicebox, usually due to cancer of the larynx.

Conversion disorders

• Psychogenic voice disorders that result from emotional suppression

• The vocal folds are structurally normal and function normally for nonspeech behaviors

Conversion aphonia

• Individuals whisper even though they are capable of phonation.

• May be avoidance of personal conflict or unpleasant situation

• May require psychotherapy or psychiatric treatment

Cleft

An abnormal opening in an anatomical structure caused by failure of the structures to fuse or merge correctly early in embryonic development

Hypernasality

Occurs when the velopharyngeal mechanism fails to decouple the oral and nasal cavities. This type of resonance makes the patient sound as if he or she is talking through the nose.

Hyponasality

When there is an insufficient amount of nasal resonance; occurs when there is a blockage somewhere in the nasopharynx or oral cavity

Nasometer

Measures simultaneously the relative amplitude of acoustic energy being emitted through the nose and mouth during phonation

Resonance Disorders Treat: Medical Management

• Treatment of hypernasality secondary to VPI in individuals with cleft palate typically begins with surgical intervention

• Children born with palatal clefts undergo surgical closure of the cleft between 9 and 12 months of age

• Surgery to repair a cleft lip occurs before 3 months ◦ Prosthetic Management

Resonance Disorders Treat: Prosthetic Management

• Palatal obturator

• Speech bulb obturator

• Palatal lift