CSD exam 3 study guide

Fluency

describes the flow of speech during communication.Fluent speech is smooth, effortless, and automati

Disfluency

disrupt rate, rhythm, smoothness, effort, and/or automaticity,Pause Interjection Revision

Nobody is fluent all of the time.

Adults and children usually have a number of disfluencies.e.g. um, like, uh, ya know Young children's speech contains a great number of disfluencies.e.g. "I want, I want ice cream too."

Word repetition

"I like that...that book"

Phrase repetitions

"I want a...want a big one"

Sentence repetitions

"Watch me! Watch me! Watch me!"

Hesitations

"He took...my juice."

Interjections

"We, um, got to go too"

Prolongations

"I ssssssee a rainbow"

Blocks

"I.............see a rainbow"

Sound repetitions

"I s s see a rainbow"

Syllable repetitions

"I see a rain, rainbow"

Word repetitions

"I see, see a rainbow"

May see a distinction in other reading

'Disfluency' referring to "normal" non-fluency'Dysfluency' referring to disordered fluency

Our text book uses 'disfluency' throughout

'Disfluency' referring to both typical and disordered fluency

Fluency disorders can be developmental or acquired.

DevelopmentalEmerge in childhoodCause unknown ('functional')Most common type AcquiredNeurological in naturee.g. Adult with TBI, stroke

Fluency disorders are characterized by abnormally high frequency and duration of disfluencies

Disfluencies inappropriate for the speaker's age, culture, and linguistic background, including dialect. Disfluencies significant enough to affect social communication and educational/occupational performance. Disfluencies are often marked by struggle and tension.

Fluency disorders include stuttering and cluttering.

StutteringMore common(And developmental stuttering is the most common) Cluttering

Stuttering is characterized by core and secondary behaviors.

Core behaviorsDisfluent speech patterns presentMay include various types of disfluencies including stuttering-like (SLDs) and non stuttering-like disfluencies SLDs include repetitions, prolongations, and blocks// Secondary behaviors Responses to core behaviorsInclude behaviors and attitudes resulting from disfluencies experienced

Sound repetition

"W-w-w-wait for m-m-m-e."

Syllable repetition

"Some-some-some-sometimes I can't say my regular thing."

Word repetition

"We went on a hike and-and-and saw Ravi and Maria."

Phrase repetition

"I want-I want- I want."

_________ are one type of core behavior

repetitions

Secondary behaviors are responses to core behaviors

Escape behaviors Physical e.g. facial or body movements Verbal e.g. interjections, circumlocution Avoidance behaviors Avoiding sounds, words, or speaking Avoiding situations Negative feelings and attitudes

Negative feelings and attitudes are secondary responses to disfluencies.

These can affect participation and achievement in school, home, and work environments Can affect quality of life

Predisposing and precipitating factors cause stuttering

Predisposing factors make a person susceptible to stuttering. MUST be present for an individual to stutter e.g. family history/genetic predisposition, sex, differences in brain morphology and neural physiology, differences in motor speech coordination Precipitating factors make a person's stuttering appear or worsen. e.g. age, communicative stressors, interpersonal stressors, other child factors

Predisposing factors make a person susceptible to stuttering

Family history & genetics 50% of PWS have an immediate family member who stutters 70% of PWS have an extended family member who stutters

Predisposing factors make a person susceptible to stuttering

Differences in brain shape and connections Studies found differences between the brains of PWS and their non-stuttering peers. These changes might occur early in development to cause stuttering?OR Anatomical differences might emerge as a response to stuttering? Differences in motor speech coordination There may be differences in speech timing and coordination which make PWS more vulnerable to fluency breakdowns

Certain age ranges precipitate stuttering.

Stuttering mostly affects children between the ages of 2-10 years old Age of onset is usually _______ years old Mean age for boys = 3 years old Mean age for girls = 2.5 years old Rapid speech/language growth occurs at ages 2-4 Increased dysfluencies appear in all children Even more in those predisposed to stuttering!

Communicative and interpersonal factors may precipitate stuttering

Communicative stressors (from others) fast rate complex language Interruptions overuse of questions short wait time following questions Interpersonal stressors (within child) competing to speak hurrying when speaking having many things to say

Certain levels of self-awareness or temperaments may precipitate stuttering.

Children who stutter are more aware of disfluencies in their speech.This may then contribute to emergence of stuttering. Heightened awareness may cause tension with each disfluency that then increases each additional time the child is disfluent

Cluttering is another fluency disorder.

People who clutter have rapid or unusual rates of speech that result inDysfluenciesFrequent and unusual pauses in speechA blending of sounds in words

Cluttering has different characteristics from stuttering.

Fewer repetitions (whole word, initial sound) Frequent errors due to increased rate of speeche.g. Interjections, pauses, phrase repetitions, incomplete word productions, articulation errors No awareness of errorsSubsequently, no signs of struggle, tension, or avoidance.

Assessment of fluency disorders may include..

Referral Case history and interview Observation Questionnaire and survey Direct testing

Assessment of fluency disorders should examine core AND secondary behaviors

Evaluate Core behaviorsCore behavior analysis Evaluate Secondary behaviorsEscape behaviorsAvoidance behaviorsAttitudes/feelings toward disfluencies

A core behavior analysis is completed to examine core behaviors of fluency disorders

Determine the percentage of syllables stuttered# of dysfluent syllables/total syllables e.g. 30 dysfluent syllables/300 total syllables = 10% syllables stuttered Also note the types of dysfluencies present, including any tension present

A fluency disorder is more likely to be diagnosed when the following are observed

10% syllables stuttered or more 3% or more SLDs (stuttering-like dysfluencies) The presence of physical escape behaviors The presence of verbal avoidance behaviors

Typical Disfluency

18 months - 3 years Children may have repetition of sounds, syllables, and words 3-5 years Children may have repetition of words and phrases Disfluencies come and go Increase with fatigue, excitement, upset Children remain unaware of disfluencies

Stuttering

3-5 years Children may have frequent repetition of sounds, syllables, and words Children may have prolongations or blocks Disfluencies persist Children are often aware of disfluencies As a result there may be secondary behaviors, struggle, and tension

Current evidence argues that ________ should be implemented to prevent/treat stuttering

Advocates of early intervention argue it will prevent children from progressing to more advanced levels of stuttering.

Direct and indirect approaches are both used in treating fluency disorders.

DirectClinician provides therapy IndirectClinician guides parent/teacherUsually provided in conjunction with direct therapyExamples: Parents use "easy talking" Parents reduce stressful activities Teachers avoid putting child "on the spot"

Fluency Shaping

Goal: To _______

Teaches to modify speech in certain ways so that dysfluencies don't occur

Strategies include slow rate of speech, easy onsets, light articulatory movements

Does not focus on feelings/emotions

Stuttering Modification

Goal: to ______

Teaches to manage and modify the dysfluency in the moment

Teaches to manage and modify the dysfluency in the moment

Counseling is an important part of this approach.

Direct treatment may teach stuttering modification, fluency shaping, or a combination of the two

Treatment may emphasizeFluency buildingUsing fluency shaping and/or stuttering modificationStuttering Modification (or mixed approaches) may also addressStuttering education To understand, demystify, and confrontReduction of negative feelings To reduce fear, embarrassment, and discomfort with stuttering To resist word and situation avoidances

Other facts about stuttering

PWS generally do not stutter when they SingWhisperSpeak or read in chorusDo not hear their own voice

General rules for working with people who stutter

Don't finish sentences or fill in words for the person. Don't make remarks like "Slow down," "Take a breath," or "relax." Set a relaxed pace when possible, using a moderate rate of speech yourself. Let the person know by your manner and actions that you are listening to what they're saying and not how they're saying it. Be yourself. Be patient. Be a good listener. Ask!

Hearing is the

perception of sound

Sound begins as vibrations in air

1. A sound source creates a set of vibrations in surrounding air particles2. The vibration of air particles create sound wavesHow fast the air particles move back and forth is the frequencyHow far the air particles move back and forth is the intensity

In hearing we receive these sound waves to our ears and transfer them to signals in the brain

The ear receives the sound waves Converts them into neural impulses4. The brain (temporal lobe) processes the sound impulses Frequency and intensity are perceived as pitch and loudness Differentiates between speech and nonspeech sounds

The outer ear is made up of the auricle, EAC, and tympanic

Auricle aka pinna Visible part of outer ear External auditory canal (EAC) Conducts sound waves inward Produces cerumen to protect inner ear Tympanic membrane aka eardrum

Physiology of Hearing

Sound waves are directed by the pinna into the ear canal.2. Waves strike the eardrum and cause it to vibrate.

Tympanic membrane

ka eardrum Boundary between the outer and middle ear

Eustachian tube

Runs from the middle ear to the pharynx Serves as a pressure equalizing tube for the middle ear e.g. ears popping

Ossicles

The three smallest bones in the body Malleus, Incus, Stapes

Physiology of Hearing

Sound waves are directed by the pinna into the ear canal.2. Waves strike the eardrum and cause it to vibrate.3. The eardrum is connected to the malleus (first ossicle), which moves the ossicular chain back and forth.1. This is the mechanical part of the process.4. The stapes (third ossicle) knocks on the oval window to the cochle

The inner ear is a fluid-filled cavity

Complex system of fluid-filled canals and cavities Three major cavitiesVestibuleSemicircular canalsOrgans of balanceCochleaOrgan of hearing

The cochlea is the organ of hearing

Cochlea Snail-shaped Fluid-filled Contains sensory hair cells Converts energy into a code that can be interpreted by the brain

The cochlea converts mechanical energy into neural energy

"Knocking" from stapes to oval window transmits mechanical sound energy into cochlea Basilar membrane of cochlea vibrates in response Hair cells (in Organ of Corti of cochlea) are stimulated by this vibration. Hair cell stimulation is "Tonotopically organized"High frequency sounds stimulate the baseLow frequency sounds stimulate the tip

Physiology of Hearing

Vibration (from middle ear) causes the basilar membrane of cochlea to vibrate, moving the hair cells in the Organ of Corti.

The cochlea converts mechanical energy into neural energy

Stimulation of hair cells triggers auditory neurons to fire (along auditory nerve). Auditory information is transported along the auditory nerve to the brain, in the form of neural energy.

The auditory cortex of both hemispheres processes incoming auditory information

Heschl's gyrus receives speech and language stimuliLinguistic comprehension involves Wernicke's area

Physiology of Hearing

Vibration (from middle ear) causes the basilar membrane of cochlea to vibrate, moving the hair cells in the Organ of Corti.6. The movement of the hair cells generates nerve impulses.7. The nerve impulses are passed on to the auditory nerve and transmitted to the auditory area of the brain.

Hearing loss

affects an individual's ability to detect or distinguish the range of sounds normally

Hearing loss is classified by etiology, manifestation, and severity

Etiology Genetic vs environmental Age of onset Developmental vs acquired Prelingual vs postlingual Type of loss Manifestation Decreased hearing acuity Decreased speech perception Severity Minimal to profound

Etiology: Hearing Loss can be caused by genetic or environment factors

Genetic50% of pediatric hearing loss is geneticIf one or both parents have hearing loss, child more likely EnvironmentalHearing loss can be caused by infections, injuries, noise, and medicationsThese can be prenatal, perinatal, or postnatal

Etiology: Hearing Loss varies by age of onset

Age of onsetDevelopmental vs acquiredHearing loss can present from birth or occur laterPrelingual vs postlingual"Adult vs pediatric"

_______hearing loss can result from sudden events or gradual processes

Trauma Tumor (e.g., acoustic neuroma) Ototoxic drugs Infection or disease Illness Noise exposure Aging

Etiology: Hearing Loss varies by type of loss

Conductive hearing lossAffects the outer or middle ear Sensorineural hearing lossAffects the inner ear or the auditory nerve Mixed hearing lossSensorineural and conductive loss together Auditory processing disorderAffects the processing of speech sounds in the auditory center in the brain

Causes of conductive hearing loss in adults may include...

Otitis mediaLess common in adults but happens Damage to outer and middle ear structuresHead trauma that tears the eardrum or dislocates the ossicles ________abnormal bone growth around the ossicles

Individuals with sensorineural hearing loss experience reduced

Also associated with deficits in speech perception, decreased ability to distinguish speech from background noise, and tinnitus

In children, causes of sensorineural hearing loss can be genetic or environmental

Illness, infections, drug use, or other maternal problems during pregnancy Complicated birth or poor infant health Family history of pediatric hearing loss Noise exposure Some syndromes are associated with hearing loss (e.g., Down Syndrome) Recurrent or persistent otitis media with fluid for at least three months

Causes of sensorineural hearing loss in adults may include...

__________ Degeneration of the inner ear and other auditory structures as a result of normal aging Noise-induced hearing loss Caused by exposure to damaging levels of noise (greater than 85 dB) Single exposure may not be enough to cause permanent damage, but ongoing exposure will _________ drugs Certain antibiotics, aspirin in large quantities, diuretics, and chemotherapy drugs Diseases and infections Meniere's disease, labyrinthitis, cerebral-vascular disease, diabetes, tuberculosis, kidney disease, autoimmune diseases, HIV, herpes

Mixed hearing loss is conductive and sensorineural loss together

A child with a congenital sensorineural hearing loss who also has a conductive hearing loss because of otitis mediaAn adult with a sensorineural hearing loss who has a build-up of cerumen

Hearing loss is classified by etiology, manifestation, and severity

Etiology Genetic vs environmental Age of onset Developmental vs acquired Prelingual vs postlingual Type of loss Manifestation Decreased hearing acuity Decreased speech perception Severity Minimal to profound

Manifestation: Hearing _____ is hearing precision at different volumes.

Determine the volume threshold at which a person can detect sound on pure tone audiometry. Classified in decibels (dB)

Severity: Hearing loss severity is categorized by hearing acuity

Normal hearing: ____ dB for all frequencies 16-25 dB: Minimal hearing loss 26 to 40 dB: Mild hearing loss 41 to 55 dB: Moderate hearing loss 56 to 70 dB: Moderately severe hearing loss 71-90 dB: Severe hearing loss 91dB+: Profound hearing loss

The threshold of hearing is plotted on a graph called an __________

audiogram

Bone Conduction

Tones delivered through vibrations to mastoid bone behind the

Air Conduction

Tones presented to ear across a range of frequencies and intensities

Assessment of Hearing Disorders may include...

Referral ScreeningNewborn hearing screeningsConventional hearing screenings Comprehensive audiological evaluationCase history and interviewOtoscopic examinationAudiometry

but many infants who fail the initial hearing screening do not receive follow-up

When early identification and intervention fail, the hearing loss will affect language development. Expressive and receptive language will be delayed*

Untreated pediatric hearing loss affects language development across domains

Semantics Children with hearing loss tend to learn nouns, but articles, conjunctions, and verbs are more difficult. Syntax Long and complex sentence structures are difficult Morphology Past tense -ed, plural and possessive -s, and present progressive -ing are difficult to hear because they are quieter. Phonology It is difficult for children with hearing loss to (accurately) produce the sounds that they cannot hear. Pragmatics Children with hearing loss miss parts of the conversation, which can make it difficult for them to interact with peers, initiate communication, and navigate turn-taking.

Pediatric hearing intervention may involve communication choices, amplification and listening devices, and aural habilitation

Communication choicesSome families decide to maximize hearing so their child can hear and speak.Other families decide to communicate through sign language.Some families will do both. Amplification and listening devicese.g. Hearing aids, Cochlear implants, FM systems Aural (re)habilitationIndividualized intervention

Hearing loss can affect social-emotional, psychological, and physical well-being

Hearing loss goes undetected or untreated in more than 75% of adults. Unmanaged hearing loss leads to greater rates of Depression Anger and frustration Paranoia Denial Feelings of loss of control Pretending to understand others when they do not Violating communication norms

Adults with hearing loss

Environmental challenges (e.g., background noise, large groups, phones) Speaker challenges (e.g., conversations with too many speakers, unfamiliar topics) Listener challenges (e.g., isolation, trying to concentrate, even when

Partners

Speaking challenges (e.g., Remembering to get the person's attention, facing the person) Interpersonal challenges (e.g., Not knowing when the person understands, having to repeat a lot, being patient even when fatigued, acting as interpreter)

Adult hearing intervention may involve amplification and listening devices and aural rehabilitation

Amplification and listening devicese.g. Hearing aids, Cochlear implants, FM systems Aural rehabilitationIndividualized interventionMay include strategies for clients and significant others

Voice refers to the use of the vocal folds and breathing to produce sound

Allows people to make sounds and share language through speech!

Voicing happens as exhaled air moves through the vibrating VFs

. Air is exhaled from lungs2. Air moves up trachea to the adducted VFs3. Pressure makes the VFs blow apart and start to vibrate to create voice4. The voice resonates as it moves up through the pharynx and oral & nasal cavities

Resonance

Affected by the shape and size of the space where sound waves vibrate

Three characteristics of voice

Frequency Intensity Quality

Frequency is the rate of VF vibration and is perceived as

Expressed as cycles per second (hertz or Hz) When vocal folds vibrate, they vibrate at many different frequencies at the same timeThe mean frequency is called the fundamental frequency and written as F0

F0 relates to three characteristics of the vocal folds

Length Longer vocal folds contribute to a lower fundamental frequency Mass Thicker vocal folds contribute to a lower fundamental frequency Tension Lower tension contributes to a lower fundamental

Pitch differences exist due to differences in VFs

Females tend to have shorter, thinner VFs F0 Range is 180 - 220 Hz Males tend to have longer, thicker VFs F0 Range is 120 - 140 Hz Pitch changes at puberty VFs lengthen Pitch decreases as we age

Intensity is the measure of sound pressure and is perceived as

Reported in decibels (dB) Intensity is determined by: How far the vocal folds separate How quickly they come back together Controlled by: The amount of airflow from lungsThe amount of resistance from the vocal folds

Quality refers to how well the VFs work during the vibratory cycle

When VFs work together, voice is clear and unremarkable When VFs do not work together, voice is affected

Vocal fry (aka glottal fry) is the lowest vocal register

The vocal anatomy is not damaged by speaking in vocal fry. However, it can become a habit Vocal fry can affect how others perceive you

Voice Disorders

A voice is considered disordered when its pitch, loudness, or quality differs significantly from that of persons of similar age, gender, cultural background, and racial/ethnic group.Difference serious enough to draw attention/detract in some way from performance in daily life (i.e. school, home, community, work)

Non-disordered voices

If voice quality is different from others', but does not attract negative attention or detract from ability to function, then it is not disordered Examples of non-disordered voices, with atypical qualities