UNIT 2 EXAM

What are “locus” and “focus” and why are they important?

Two treatment approaches

Restore lost fx: Involves an effortful swallow or the Masako maneuver, which involves moving the tongue all the way forward past the teeth and swallowing your saliva. This is meant to strengthen the muscles in the throat and improve swallowing functions.

Compensate for lost fx: Effortful swallow, altered consistencies based on the IDDSi scale, and a secondary swallow to clear residue.

Functional etiology: what is muscle tension dysphonia?

• Strained vocal quality

resulting from increased

laryngeal muscle tension

-can be psychological and caused by stress

Vocal misuse leads to what?

a. Nodules-growths that are formed on the vocal cords (not cancerous) BREATHINESS AND LOWER PITCH

b. Cysts-hardened growth on the vocal cords containing fluid (benign)

c. Edema-swollen vocal folds causing a deeper or raspy voice, thick and heavy vocal folds cause by misuse or acid reflux. (benign) LOWERED PITCH

d. Polyps-damage to the labia propria of the VFs that can be sessile or pedunculated. It can look like a blister on the vocal folds. Can be hemorrhagic, translucent, or fibrotic. BREATHINESS AND LOWER PITCH

e. Hyperemia-inflammation of the vocal folds which can appear red

Hemorrhage of Vocal Folds (VFs)

Organic: what are some neurogenic voice disorders?

Caused by damage to the nervous system.

○ Vocal Fold Bowing

■ Parkinson’s Disease (primary) MONOPITCH

■ (non-neurogenic: age-related)

○ Paresis / Paralysis of VF (unilateral or bilateral)

■ Nerve damage (CN X)

■ Amyotrophic Lateral Sclerosis

■ Primary Lateral Sclerosis

○ Paresis / Paralysis of Velum

■ Nerve damage (CN IX)

■ Amyotrophic Lateral Sclerosis

■ Primary Lateral Sclerosis

○ Spasmodic Dysphonia VOCAL STRAIN/STRUGGLE

■ Adductor Spasmodic Dysphonia

■ Abductor Spasmodic Dysphonia

What is a neoplasm?

Laryngeal neoplasms are cancer located in the vocal cords and involve growths in the vocal cords.

What are the parts of an assessment?

Subjective Assessment: entails listening

and observing the patient while they

are speaking. (how does it effect them?)

Includes:

• Voice History Form (a.k.a. Intake or

Case History) -possible things that stress them out or an event that happened, divorce,etc.)

• Voice-Related Quality of Life Scale

(Likert Scale)

• Voice Quality Rating (e.g., GRBASI

Scale)

• Observation of Body Movements

• posture

• Objective Measurements using Voice Analysis Software (e.g., PRAAT)

• Jitter: amount of variation from average F0 (in Hz)

• Shimmer: amount of variation from average amplitude (in dB)

• CPP (Cepstral Peak Prominence): variation from average frequency

• Vizualization of Vocal Anatomy

• Indirect and Direct Laryngoscopy

What is the GRBASI scale?

Stands for grade, roughness, breathiness, asthenia, strain, and instability. REFER TO IMAGE FOR EXPLANANTION

Diagnosis What are some symptoms?

-breathiness, lowered pitch,

-monopitch and reduced loudness

-hoarseness, strain/struggle

Treatment: What are some treatment options for vocal disorders?

Forms of direct therapy

LSVT (Lee Silverman voice treatment): Involves intensive effort to increase loudness. Common for Parkinsons. Patients increase loudness in order to help others understand what they’re saying and create stronger communication.

SOVT (Semi-occluded vocal tract exercises): Increase back pressure by obstructing the vocal tract, which helps the vocal cords vibrate more efficiently. (straw exercise)

-Narrowing the mouth builds positive air pressure

Parts of the brain

• Nervous System: central and peripheral

• Frontal Lobes: important in the planning of

physical movement.

 Broca’s Area: speech production

• Temporal Lobes: important for perception

 Wernicke’s Area: speech comprehension

 Heschl’s gyrus: primary auditory center

• Parietal Lobes: process incoming sensory

information.

• Occipital Lobes: process of incoming visual

information.

Brodmanns areas for Broca and Wernicke’s area

-44-45 Brocas area 

-22 Wernickes area

What are the fluent types of aphasia? Symptoms and etiologies?

1. Wernicke’s: Very wordy speech, and from a distance it may seem okay, but once you come closer, the speech doesn’t make sense. Sentences have no meaning, and words can be made up. Sounds like a sentence, but there’s no content. ETIOLOGY: damage to Wernicke’s area of the brain due to possible accidents such as a TBI and stroke (CVA)

2. Anomic: Difficulty naming words, patients tend to produce grammatically correct yet empty speech, and language comprehension tends to be preserved. ETIOLOGY: stroke (CVA) or a traumatic injury

3. Conduction: Difficulty repeating words or phrases back to someone but doesn’t affect the ability to understand others.

ETIOLOGY: stroke

What are some non fluent aphasia types?

1. Broca’s: Broken speech and may struggle to say words and form a sentence. Omit small words such as “is” “and” “the”. Can be easily frustrated by it due to being aware. ETIOLOGY: damage to brocas area of the brain, TBI or a stroke

2. Global: May be nonverbal or use facial expressions/gestures to communicate. May understand some words. ETIOLOGY: stroke, TBI, or tumor.

What are some right hemisphere disorder symptoms?

Damage to the right side of the brain and includes:

 Word retrieval difficulty, sometimes using the incorrect word.

 Poor topic maintenance during a conversation, including turn-taking.

 Difficulty understanding and appreciating word-based humor.

 Misinterpretation of sarcasm.

 Flat affect or inappropriate emotional expression

 Flat/monotonous prosody (aprosodia)

 Poor nonverbal communication, such as facial expression or body language.

 Problems recognizing faces (prosopagnosia), leading to awkward

communication exchanges.

 Visuospatial difficulties affecting reading and writing.

 Problem solving difficulties.

 Decreased awareness or insight of their communication difficulties.

Why is it important to get a baseline function?

It determines the patients speech abilities and evaluates their skills such as speech sounds. It helps measure progress and helps the slp know their notes and goals

What is Boston Diagnostic Aphasia Exam?

Boston Diagnostic Aphasia Exam-Diagnoses aphasia and looks for specific symptoms

1. Word-naming (tests for Anomia)

2. Repetition

3. Expressive Language (morphological and sentence structure)

4. Receptive Language (comprehension)

Differential diagnosis between apraxia and dysarthria

How are they different?

Dysarthria involves an effect on muscle tone or function, while apraxia affects the individual’s neural control of those muscles. Dysarthria is NEUROMUSCULAR, and apraxia is NEUROLOGIC.

Dysarthria-

Etiologies: Parkinsons disease, multiple sclerosis, and amyotrophic lateral sclerosis.

Symptoms: Slurred or slow speech

Apraxia-brain doesn't communicate properly with muscles

Etilogies: stroke, TBI, (childhood: genetic or neurological impairment)

Symptoms: pauses and unclear vowels/consonants. Sound substitutions and sound additions.

Treatment: sound sequencing and Dynamic temporal and tactile cueing, and prompt.

What are some ways we can assess to determine if it is apraxia, for example

1. Varied utterance length (looking for more errors in longer utterances)

2. Look for inconsistent errors

-rule out muscle weakness or language comprehension problems

What are the types of dysarthria?

1. Hyperkinetic (e.g., Huntington’s Disease & Tardive Dyskinesia)

a. Basal ganglia damage

SYMPTOMS: problems with involuntary movement and unpredictable speech/variation of loudness.

TREATMENT: LSVT LOUD

2. Hypokinetic (e.g., Parkinson’s Disease)

a. Substantia nigra – dopamine production

SYMPTOMS: Monotone speech pattern or quiet

TREATMENT: Motor learning intensive practice

3. Spastic (e.g., Cerebral Palsy)

a. Upper motor neuron damage

SYMPTOMS: Problems with executing fine motor movements and slowed or strained speech.

TREATMENT: LSVT LOUD

4. Flaccid (e.g., Guillain-Barre Syndrome)

a. Lower motor neuron damage

SYMPTOMS: Problems with vocal fold movement (paralysis) involve breathiness and hypernasality.

TREATMENT: Motor learning intensive practice

5. Ataxic (e.g., Friedrich’s Ataxia)

a. Cerebellar damage

SYMPTOMS: Problems with regulating force, timing, rhythm, speed, and overall coordination of movement. Slurred speech and trouble swallowing.

TREATMENT: Motor learning intensive practice

6. Mixed

a. E.g., Mixed Spastic-Flaccid (e.g., ALS, a.k.a. “Motor Neuron Disease” –

why?)

SYMPTOMS: Associated with motor degenerative diseases such as Lou Gehrig's disease. Strained vocals and slurred speech

TREATMENT: Motor learning intensive practice

What are the anatomical parts related to swallow and their function?

i. Cricopharyngeal muscle and the UES:

ii. Epiglottis:

iii. Anterior faucial pillars (what muscles are these?): The palatoglossus and the palatopharyngeus. The palatopharyngeal arch raises the back of the tongue, while the palatoglossal arch helps raise the larynx and pharynx.

What are the phases of the swallow?

1.Oral Phase

Food/drink enters oral cavity

 Manipulation of lips, jaw, tongue

 Mastication (chewing)

 Manipulation of food to grinding

surface (jaw, cheeks, tongue, and teeth)

-Oral transport: bolus forms and mastication stops

-tongue dorsum lowers

2. Pharyngeal Phase

Bolus makes contact with anterior faucial pillars

Involuntary initiation of pharyngeal swallow (automatic)

Velum elevates (levator veli palatini)

 Tongue activity continues to propel

bolus toward pharynx and

esophagus

3. Esophageal Phase

UES is sealed after bolus passes

through

 Peristaltic movement of bolus

toward LES, muscles of LES then

relax to allow bolus to move into

the stomach.

What is penetration and aspiration? Compare them

Penetration is when the bolus enters the airway but not below the true vocal folds. (can be cleared by a cough). Aspiration is when the bolus passes through below the true vocal folds and enters the breathing airway.

What is VFSS/MBSS? What can you see and how is it performed?

What is FEES What can you see and how is it performed?

What are some compensatory strategies?

i. Effortful Swallow

ii. Thickening thin liquids

What are some rehabilitative/restorative stratgesis?

i. Masako maneuver