COMD 303 Final Study Guide

Aphasia

Meaning "without language"

Acquired disorder from neurological injury to the language dominant hemisphere of the brain (Left)

Mainly caused by strokes but also TBI (Traumatic Brain Injury)

Fluent Aphasia

Speech is normal but it lacks meaning

Non Fluent Aphasia

Speech is effortful but limited in output

Paraphasia

Words may be jumbled or meaningless

Ex: Saying "pot" instead of spot"

"markbook" instead of "bookmark"

Language Testing Modalities

Spontaneous Speech and Auditory Comprehension

(Repetition, naming, reading, writing)

Prognostic Indicators

The site and size of the brain injury

Time since injury

Type and severity of aphasia

Age

Pre-injury health

Motivation for treatment

Treatment Goal for Aphasia

Maximizing their communicative effectiveness

Impairments observed for cognition issues

TBI (Traumatic Brain Injury) and Right Hemisphere Damage

Cognition

Mental processes including memory and orientation

Right Hemisphere Damage

Affects non-verbal communication and spatial awareness

Left side neglect

Damage tends to be focal

Right Hemisphere Process

Non-linear spatial and visual information

Dysarthria

Motor speech disorder affecting articulation

Can be caused by right hemisphere damage

Right Hemisphere Cognitive Symptoms

Left neglect: impairment of response to stimuli on the patient's left

Perceptual impairments

anosognosia: denial of illness (poor insight)

Recognition and expression of emotion

Flat effect

Can fail to appreciate changes in emotional tone, e.g. at a wedding Attentional impairments

Difficulty focusing, maintaining attention and shifting attention

Difficulty determining what’s and what’s not important

Right Hemisphere Communicative Symptoms

DIMINISHED SPEECH PROSODY

Slower than normal speech rate, robot-like quality
Reduced emphatic stress in phrases and sentences

ANOMALOUS CONTENT AND ORGANIZATION OF CONNECTED SPEECH

Speech is often excessive, confabulatory, and inappropriate

IMPAIRED COMPREHENSION OF NARRATIVES
Difficulty with implied meanings, often concrete interpretations only
Interpret metaphors and idioms literally

PRAGMATIC IMPAIRMENTS
Begin and end conversations abruptly
Talk excessively and without regard for their listener

Right Hemisphere Damage Tests

Right Hemisphere Language Battery (RHLB)

Mini Inventory of Right Brain Injury (MIRBI)

TBI (Traumatic Brain Injury)

Damage to the brain caused by external force (blow to the head)

Damage tends to be diffuse

Primary Injury

Immediate damage from the initial impact

Skull fracture

Contusions

Hemorrhage

Concussion

Secondary Injury

Subsequent Damage from swelling or bleeding

Ischemia

Hypoxia

Meningitis

Seizures

Orientation

Awareness of time, place purpose and person

TBI Prognostic Indicator

Rapidity of emergence from post-traumatic amnesia indicates the severity of the ongoing injury

Assessment Scales

Glasgow Coma Scale (eye opening, verbal/motor response)
Neurological assessment
GOAT (orientation)
SCATBI (standardized test)

Memory Aids

Visual Imagery

Smartphones

Calendars

Timers

Voice Disorder

Abnormalities in voice quality or function

Vocal Cords Primary Biological Function

Producing the sound of your voice by stretching the front and back of the larynx

Intra Oral Pressure

Air pressure between lips and glottis

Sub Glottal pressure

Air pressure below glottis

Stroboscopy

Procedure used to examine vocal cords movement and vibration during phonation

Voice Parameters

Roughness: irregularity in the voice

Breathiness: audible air escape

Strain: impression of hyperfunction during voicing

Pitch: pitch deviation relative to the client's gender

Quality Voice Parameters

Roughness: irregularity in the voice

Breathiness: audible air escape

Strain: impression of hyperfunction during voicing

Lifestyle factors when assessing someone's voice

Physical factors: breathing and breath control

Functional factors: how the voice disorder impacts daily activities (quality of life)

Emotional factors: how the client feels about their voice

Aphonia

Complete loss of voice

Etiological Categories

Organic: structural cause i.e. changes in the vocal folds (phonotrauma)

Neurologic: caused by or affecting the central or peripheral nervous systems (progressive diseases like parkinsons)

Functional: non-organic cause (differences and voluntary changes, e.g.transgender voice transition)

Phonotrauma

Voice damage from excessive or improper use

Occupations associated with Phonotrauma

Teachers

Sport Coaches

Stage Performers

Organic Disorders

Voice issues due to structural damage

Organic Disorders

Vocal nodules

Vocal polyps

Papilloma (virus)

Neurogenic Voice Disorders

Vocal fold paralysis

Spasmodic dysphonia

Hypophonia associated with PD

Functional Voice Disorders

Puberphonia

Muscle tension dysphonia

Conversion aphonia

Vocal Hygiene

Eliminate phonotraumatic behaviors and replace it with behaviors that will sustain and support the voice

Reasons for Vocal Surgery

Option for organic lesions

Cut out lesions that are: Blocking airway, cancerous

Resistant to voice tx

Voice Therapy Approaches

Pharyngeal Strengthening Exercises

Laryngeal Relaxation

Facilitating Techniques (yawn-sigh)

Physiologic (vocal function exercises)

Dysphagia

Disorder of swallowing

The ability to safely and/or efficiently use the swallowing mechanism is compromised

If swallowing isn’t safe___

Food/liquid enters lungs

If swallowing isn't efficient___

Nutrition is compromised

Social and Physiological Impacts of Dysphagia

Avoidance of certain foods

Changes to routine

Modifications in food prep requires time

Swallowing Stages

Oral (oral prep and oral transport)

Pharyngeal (Anterior faucial pillars -> Pyriform sinuses)

Esophageal (stomach)

Signs and Symptoms of Dysphagia in Oral Stage

Does not accept food off of spoon
Unable to close lips, food leaks onto chin (poor labial seal)
Drooling of saliva or food/liquid
Pocketing in cheeks
Residue spread throughout mouth
Weak chewing
Minimal tongue movement

Signs and Symptoms of Dysphagia in Pharyngeal Stage

Wet, gurgly voice
Wet, gurgly breath sounds
Facial redness
Eyes tearing up
Runny nose
Little to no movement of larynx
Complains of food stuck in throat
Requires multiple swallows for one bite

Signs and Symptoms of Dysphagia in Esophageal Stage

Food comes back up throat
Can't swallow
Feels like something is stuck in throat all the time, even when not eating

False

SLPs can treat Esophageal Dysphagia

Clinical Swallow Exam Steps

Case history & interview
Oral-mechanism exam
Trial feedings w/observation
Make feeding recommendations or NPO

NPO (Nothing by Mouth)

Temporary measurement used to determine someone with difficulty swallowing or undergoing a medical procedure requiring it
Not a treatment for communication disorders

Penetration

Swallowed material enters the airway but stays above the vocal folds

Aspiration

When swallowed material enters the airway and passes below the vocal folds

Silent Aspiration

Aspirating food or fluids without coughing or choking

Swallowing Instrumental Exams

Modified Barium Swallow (MBS)

Fiberoptic Endoscopic Examination of Swallowing (FEES)

Laryngeal Structures

Hyoid

Epiglottis

Thyroid

Cricoid

Dysphagia Direct Treatment

Treatment of swallowing through exercises and maneuvers designed to strengthen and coordinate the throat muscles

Used with food

Dysphagia Indirect Treatment

Treatment of swallowing without directly producing a swallow through strengthening exercises or sensory stimulation

Used without food

Masako Maneuver

Pharyngeal strengthening exercise used to improve swallowing function

Specifically made for dysphagia

Compensatory Strategies for Dysphagia

Small bites/sips

Alternate liquids and solids

Turn head to weaker side while eating

Concern of modifying solid foods to liquids

Loss of function without use

Alternative Feeding Options

NG Tube (nasogastric tube): Short-term feeding tube inserted through nose into stomach

PEG Tube (percutaneous endoscopic gastrostomy tube): long-term feeding tube inserted directly into stomach through abdominal wall

True

Aspiration can still occur during tube feeding

Peripheral Auditory System

Outer ear to auditory nerve

Central Auditory System

Auditory nerve to auditory cortex

Cranial Nerve VIII

Auditory Nerve

Vestibule-cochlear nerve

Hearing Process Steps

Outer ear collects sound waves and sends down the ear canal

Middle ear, movement of the tympanic membrane causes ossicles to vibrate

Inner ear, cochlea turns vibrations into neural impulses

Neural impulses travel along auditory nerve to auditory cortex

Frequency/Pitch

Measure of how many times per second, a sound wave repeats itself
Measured in Hertz (Hz)

Relative highness or lowness of a sound

Incr pitch = incr frequency

Intensity/Loudness

How quickly a sound wave is transferring energy over a given area

How loud or soft a sound seems to a listener

Incr loudness = incr intensity

Measured in decibels (dB)

True

Pitch and loudness are perceptual to humans

Pure Tone

Sound consisting of one single frequency

Complex Sound

Number of different frequency waves superimposed on one another

Conductive Hearing Loss

Sound transmission through outer/middle ear

Disrupts sound flow to inner ear

Not permanent

Sensorineural Hearing Loss

Damage to the inner ear or nerve pathways from the inner ear to the brain

Permanent

Slight Hearing Loss

16-25 dB

Difficulty hearing soft sounds, whispers, or conversations

Can understand most speech in quiet situations, but struggle a bit in noisy environments

Moderate Hearing Loss

41-55 dB

Difficult to hear and understand normal speech, especially in loud environments

Constantly asking others to repeat themselves to hear it clearly

Profound Hearing Loss

91+ dB

Inability or difficulty hearing loud sounds

Challenge to understand speech without amplification

Outer Ear Disorders

Atresia

Obstruction of the ear canal

Otitis externa (infection of the outer ear)

Middle Ear Disorders

Perforated eardrum

Otitis media (inflammation in the middle ear cavity, usually affects children)

Otosclerosis

Inner Ear Disorders

Prenatal causes (virus during pregnancy)

Meningitis

Ototoxic drugs

Acoustic Neuroma

Tumor on the acoustic nerve

Affects balance

Unilateral

Auditory processing disorder signs and symptoms

Difficulty localizing sound

Difficulty understanding speech in noisy environments

Struggling to follow directions

Auditory processing disorder potential causes

Genetic determinants

Neurological disorder

Disease or damage

Hearing Loss Types

Conductive hearing loss

Sensorineural hearing loss

Cochlea

Spiral-shaped organ for hearing in the inner ear

AAC (Augmentative and Alternative Communication)

Methods to help people with communication problems communicate through techniques and strategies and not just devices

AAC use may be___

Temporary or permanent

Unaided and Aided Communication

Intrinsic to oneself
Gestures, vocalizations, sign language
Nothing to carry around to make language happen

External 'thing' is necessary to make language happen
Simple as pencil and paper

Complex as a computer

Physical Aspects of AAC Systems

Portability: Carry or mount to wall

Durability: External case & internal parts subjected to lots of wear and tear

Mounting Capability: Where is display when moving and not moving

Memory/Back-up Capability: Vocab size

Low Tech Devices

Simple assistive technology devices such as pen and paper or buttons

High Tech Devices

Complex assistive technology devices that uses computers or computer chips to aid in communication

SGD (Speech Generating Device)

An electronic device (tablet or computer) that produces synthesized or digitized speech for people with speech impairments

Populations that can benefit from AAC (Augmentative and Alternate Communication)

Children with autism, CP (Cerebral Palsy) and genetic disorders
Adults who survived strokes, TBI (Traumatic Brain Injury), neurological/progressive diseases, head and neck cancer survivors

Voice Banking

Recording voice for future speech synthesis