Rehab - Speech Language Pathology

What disorders do SLPs Treat?

• articulation disorders

• voice disorders

• swallowing disorders

• language disorders

• fluency disorders

• cognitive communication impairment

Where do SLPs work?

•Schools

•Hospitals

•Nursing homes

•Private practice

•Academia/research

•Children’s treatment centres

•Patient/client homes (CCAC - community care access centre)

•Centres for the developmentally disabled

what are the steps/stages of the Clinical service specturm

1. Prevention (primary/secondary)

2. Assessment/identification

3. Treatment/management

4. Consultation

5. Discharge planning

The clinical service spectrum - primary prevention

• purpose

• target

• objectives

purpose

• elimination/inhibition of onset of development of disorder

target

• broader population

Objectives

• increase awareness

• reduce incidence

• prevention of disease

List 3 examples of primary prevention on the clinical spectrum

parent education

• educating parents on the importance of talking, reading and singing ot thier children from birth to support early language skills

community outreach

screenings

The clinical service spectrum - secondary prevention

• purpose

• target

• objectives

purpose

• early detection of disorders

target

• high risk groups

objectives

• early detection/treatment

• minimize severity/effects

examples of secondary prevention

early screening and diagnosis

speech therapy for at risk populations

intervention for mild disorders

targert support for individuals with specific needs

parent and caregiver education for early intervention

The clinical service spectrum - assessment/identification

• what is the scope of practice?

• diagnosis

• compariosn to normal population

• strength/weakness identification

• prognosis

• treatment

are SLPs able to diagnose underlying conditions?

• no but they can diagnose communicative difficulties

Simultaneous treatment and example

• addressing multiple speech or language goals at the same time within therapy sessions

• ex. a child with both speech sound disorder and lanugae deley may work on both goals simultaneously during the same treatment session

Sequential treatment

focusing on addressing one goal or issue at a time before moving onto the next

ex a child with both speech sound disorder and fluency disorder may first focus on improving speech clairty and then later move on to fluency once the speech sound issues are resolved

individual therapy

focusing on one on one sessions between the SLP and the client, addressing the clients specfic needs and goals

Group therapy

inolves a small group of individuals working otgther with a SLP on common goals

provides opportunities for peer interaction

The clinical service spectrum - Consultation

Providing expert advice, guidance and support to individuals, educators, caregivers or other professionals regarding speech, language or communication challenges

The clinical service spectrum - Consultation

• what are the four pillars? of consultation

• collaborative support

• providing expertise

• developing strategies

• advocacy

The clinical service spectrum - discharge planning

preparing and transition a patient from therapy to independent functioning or to other appropriate care, ensuring continued progress after therapy ends

• •Ensures a smooth transition from therapy to daily life, supporting the maintenance of skills.

  •Reduces the likelihood of relapse or regression in communication abilities.

  •Enhances patient satisfaction and empowers caregivers to take an active role in continued care

  

what are the different refulatory colleges/organizations for SLPS

• speech language audiology canada (SAC)

• college of audiologists and speech language pathologists of ontario ( CALSPO)

What are the 4 systems/structures that make speech work?

1. Respiratory system - in/exhalation muscles involved in air flow

2. laryngeal system: -phonation( production of voice, larynx ( voice box)

3. resonating chamber : moth chamber, oral and nasal cavity

4. articulatory system: movement of articulators

features of breathing for life/vegative breathing

• 50% inhalation and 50% exhalation

• typically via nose

• largely passive

• exhalation relies on gravitational forces

Features of breathing for speech

• allows for larger volume of air at a more rapid rate

• 10% inhalation and 90% exhalation

• typically via mouth

• finely graded exhalation thanks to accessory musculature

breath group

sequence of words or syllables produced on a single expiration

in normal speech we typically speak for no more than 10 seconds per breath which maximally translates to about 20 - 30 syllables \

in conversational speech we replenish our air supply more often

Dysarthria

muscle weakness and abnormal reflexes

Functions of the laryngeal system

• Regulation of air entry to and exit from lungs during breathing

• protection of lungs during swallowing

• allows bearing down and maintance of air pressure in thoracic cavity

what is resonance

• the unique quality of sound that a phenome possesses based on its unique vocal tract shape and accompanying vibratory pattern

resonance varies according to what features?

• size of articulatory chamber

• size of nasal cavity

• amount and density of tissues

draw and label a diagram if the mouth/nose/throat with articulators

Articulators: Lips

• greek/latin term

• adjective

greek latin term: labia

adjective: labial

Articulators: teeth

• greek/latin term

• adjective

greek latin term:

adjective: dental

Articulators: alveolar ridge

• greek/latin term

• adjective

greek latin term:

adjective: alveolar

Articulators: hard palate

• greek/latin term

• adjective

greek latin term:

adjective: palatal

Articulators: soft palate

• greek/latin term

• adjective

greek latin term: velum

adjective: velar

Articulators: tongue tip

• greek/latin term

• adjective

greek latin term: apex

adjective: apical

Articulators: tongue blade

• greek/latin term

• adjective

greek latin term: lamina

adjective: laminal

Articulators: tongue body

• greek/latin term

• adjective

greek latin term: dorsum

adjective: dorsal

Articulators: tongue root

• greek/latin term

• adjective

greek latin term:

adjective: radical

Articulators: uvula

• greek/latin term

• adjective

greek latin term:

adjective: uvular

Articulators: upper throat

• greek/latin term

• adjective

greek latin term: pharynx

adjective: pharyngeal

Articulators: vociebox

• greek/latin term

• adjective

greek latin term: larynx

adjective: laryngeal

where is the primary auditory cortex located ?

temporal lobe

what is the function of the primary auditory cortex

• processes sound and is essential for understanding spoken language

• involved in decoding auditory information

what is the damage impact of the primary auditory cortex

• can lead to difficulty processing speech sounds

• impacts ability to comprehend spoken language

Where is wenicke’s area located?

Left hemisphere, frontal love

what is the function of wernickes area?

• language comprehension

• allows for the understanding of spoken and written language

What is the damage impact for wernicke’s area?

• leads to wernicke’s aphasia

  • being fluent but having meaningless specch with impared understanding

  • may produce speech normal grammar and syntax but the content lacks meaning

where is brocas area located?

left hemisphere in the frontal lobe

what is the function of brocas area

• speech production

• language expression

• helps in forming grammatically correct sentences and controlling the muscles needed for speech ex mouth, tongue and vocal cords

what is the damage impact of broca’s area

• leads to brocas aphasia

  • difficulty speaking but comprehension remains relatively intact

  • speech is often slow and effortful

where is the Motor cortex located

Frontal lobe

what is the function of the motor cortex

• controls voluntary movements - including movements involved in speech production

• sends signals to the muscles used in speaking ex in mouth, face and vocal cords

What is the damage impact

• difficulty producing speech or controlling the muscles necessary for speech

what are the 12 cranial nerves and location?

dysphagia

difficulty swallowing

swallowing disorders

Barium Swallow Assessment / videofluroscopy

• mix food or drink with barium and give to patent

• helps see if theres choking or aspiration

What is an SLPs role in swallowing management?

• create personalized therapy plans - to improve swallowing by strenghtening muscles, ehnacing coordination and addressing impairments

• use techniques such as posture adjustments and swallowing maneuvers to ensure safe and efficient eating

• work with nutritionists to reccomend safe food textures and liquid consistencies to reduce choking risk and teach safe swallowing strategies

• educate individuals and caregivers on managing dysphagia at home

What 3 categroies do speech disorders fall into?

• articulation

• phonological

• motor

what is speech ?

• neuromuscular process of producing sounds for transmitting verbal messages

how many speech sounds are used in english

44

vowels

sounds produced without any constriction or blockage of airflow within the vocal tract

consonants

sounds in which air flow is completely blocked, greatly restricted or orally blocked and diverted through nose

intelligability/power/loudness: vowels vs consonants

vowels:

• have the power

consonants:

• carry main information

articulatory movement: vowels vs consonants

vowels:

• more open

consonants:

• more restricted

sound source generation: vowels vs consonants

vowels:

• voiced by default

consonants:

• voiced or voiceless

length/duration: vowels vs consonants

vowels:

• vowels longer (can vary)

consonants:

• brief and fleeting

frequency specifications: vowels vs consonants

vowels:

• most info up to 2000 Hz

consonants:

• info up to 8000Hz

size of resonating chamber : vowels vs consonants

vowels:

• within oral cavity

consonants:

• reduce size of oral cavity

stand alone capabilties : vowels vs consonants

vowels:

• can stand alon ex I

consonants:

• cannot stand alone

Syllable structure : vowels vs consonants

vowels:

• are nucleus

consonants:

• onset or coda of syllable

classification: vowels vs consonants

vowels:

• tongue height, tongue front -back, tense/lax, lip rounding/spreading

consonants:

• manner, place and voicing

Articulation

motor processes involved in the planning and execution of speech, acquisition and production of specific sounds, movement of articulators

articulation disorder

Problems with motor production aspects of speech, or an inability to produce certain speech sounds

what is the basic unit of articulation

the speech sound

articulation errors are called?

Phonetic errors

Phonology

• the function and organization of phonemes within a given language system

• the study of the linguistic rules of speech sound system of language, rules for combination of speech sounds

what is the basic unit of phonology

phenome

phonological disroder

problems with the language specific function of phonemes

phonology errors are called ?

phonemic errors

how are speech disorders classified?

• developmental (chiildren)

  • articulation

  • phonological

• Dysarthria (children and adults)

• apraxia (chidlren and adults)

Speech disdorders presentation in children vs adults

children

• structural abnormalities

• faulty learning

• hearing loss

• unknown cause

Adults

• residual childhood errors

• PNS damage

• structural change

• CNS damage

Are phonological errors a normal part of language development?

yes, as children learn to speak, they may make mistake in pronunciation but these usually lessen as they continue to develop their speech skills

Phonological processes - Assimilation

• sound changes where 1 sound or syllable influences another sound or syllable

• ex velar assimilation, nasal assimilation, prevocalic voicing, postvocalic devoicing

• approx age of elimation 3 yrs

• ex gog for dog, nunny for bunny , beach for peach

Phonological processes - reduplication

repetition of a complete or inccomplete syllable in substitution for a word

ex bottle pronounced as baba or water as wawa

outgrown by age 3

Phonological processes - denasalization

• the substitution of nasal consonant ( ‘n’ or ‘m’) with a non nasal consonant ( b’ or d’)

• ex nose pronouced as doze

• typically eliminated by 2.5 years

Phonological processes - substitution gliding

• the substition of a liquid sound ( ‘l’ or ‘r’r) with a glide sound ( ‘w’ or ‘y’)

• ex rail pronounced as wail, play pronouced as pway

• usually outgrown by age 5

Phonological processes - substitution vowelization

• the substitution of a vowel sound for ‘l’ or ‘er’ sounds

• ex apple pronounced as appoh or river pronouced as rivuh

• age of elimination varies from child to child

Phonological processes - substitution backing

• substitution of a sound produced in the front of the mouth (‘t’ ot ‘n’) with a sound produced in the back ( k’k or ‘g’)

• ex duck pronouced as kuck or dog pronouced as gog

• this is atypical - typically only occurs in chidlren with more severe phonological delays

Phonological processes - substitution fronting

• the term used when sounds that should be made in the back of the mouth (velar) are replaced with a sound made in the front of the mouth ( alveolar)

• ex cookie pronounced as tootie or gate pronouced as date

• usually eliminated by ages 3 -4

Phonological processes - substitution stopping

• The substitution of a stop sound ('b', 'p', 't', 'k', 'g') for a fricative sound ('f', 'v', 's', 'z', 'h', 'th', 'sh', and 'ch')

• ex wish pronuced as wit or puzzle pronounced as puddle

• depending on the fricative sound this process is eliminated between the ages of 3 - 6 years

phonological proccess - syllable structure are?

sound chnages that cause sounds or syllables to reduced in number, deleted or repeated

phonological processes - syllable structure - cluster reduction

• reduction of a consonant cluster ( two consonants next to one another) to one consonant

• ex tree pronouced as tee or stay pronouced as say

• usually outgrown by 4 years old except for words starting with s

consonant clusters ( consonants blends)

S blends:  st, sm, sn, sw, sl,sp, sc, sk

L blends:  pl, bl, gl, cl, sl, fl

R blends:  pr, br, cr, gr, tr, dr, fr

phonological processes - syllable structure - final consonant deletion ( FCD)

• elimination of the final consonant in a word

• ex road pronounced as roh or cat pronouced as ca

• usually eliminated by age 3

phonological processes - syllable structure - initial consonant deletion

• elimination of beginning consonant of a word

• ex belly pronouced as elly

• atypical - typically experienced by children with more severe phonological delays

phonological processes - syllable structure - syllable reduction

• elimination of a syllable from a word that contains two or more syllables

• computer pronocued as puter or vanilla pronouced as nilla

• unstressed syllabke is usually the oen children eliminate

• typically resolves between age 4 and 5

dysarthria and apraxia are examples of what type of speech disorder?

Motor speech disorders

What is dysarthria in children

• characteristics:

• Speech difficulties due to motor control issues from neurological impairments (e.g., cerebral palsy).

• speech difficulties due to muscle weakness

• no structural abnormalities

• characteristics: Slurred, slow speech with inconsistent patterns. Affects articulation, breathing, and pitch. Speech difficulties improve with development. Treatment focuses on muscle control and clarity.

  

What is dysarthria in adults?

• speech difficulties due to muscle weakness

• no structural abnormalities

• speech problems caused by conditions like stroke or parkinsons disease

• Characteristics:

  Speech is often monotone, slurred, or weak. More stable once the condition is diagnosed.

• treatment focuses on improving communication and managing symptoms

  

Apraxia in children

• have difficulty planning an coordinating the movements needed for speech

• no muscle weakness or paralysis

• characteristics: Inconsistent errors in speech sounds.

  Difficulty with longer words and complex sentences. Speech may be slow, with gaps between words or syllables

• treatment focuses on improving speech planning and motor coordination through targeted therapy

apraxia in adults

• caused by brain damage, often stroke or brain injury, affecting the ability to plan and produce speech movements

• no muscle weakness or paralysis

• characteristics : Difficulty pronouncing words correctly, especially with longer or unfamiliar words. Speech is often slow, effortful, and may include inconsistent errors. Groping or struggle with articulating sounds. May affect fluency and prosody (rhythm of speech).

• treatment focuses on relearning speech patterns and improving articulation through specch therapy

  

screening vs assessment

screening

• consists of activities that identify individuals who may need further evaluation

Assessment

• clinical evaluation of a client’s disorder