Introduction to Communicative Disorders: Exam 1

Communication

How information is transmitted between a sender and a receiver; performed through many/various avenues including gestures, vocalizations, emotions, posture, movement, facial movements/expressions, spoken, or even written

How do children communicate before they speak verbally?

• Through emotions, crying, cooing, babbling, eventually moving into more meaningful language

• Communication is also culturally regulated (eye contact, pauses during speaking)

Avenues in which we communicate

Verbal, written/reading, ASL (American sign language)

Speech

The result of several physiological systems functioning at the same time; involving the entire respiratory system (inhalation/exhalation) in order to occur; how sounds are articulated or said

Which systems are required for speech production?

Requires the articulatory system (consisting of the mandible, lips, teeth, and tongue); also requires function of phonatory system including the vocal folds, larynx, and muscles within the larynx helping to vibrate the vocal folds effectively for producing sound

Differences between articulatory system and phonatory system

The articulatory system is responsible for the nuances of speech sounds while the phonatory system is responsible for producing sound by using the air that is pumped through the throat by the respiratory system

Phonology

The study of speech sounds/phonemes and the rules for combining these into words for language

Language

When sounds are transformed into words, and words are transformed into sentences; construction of what’s said; may be spoken, written, or signed

Linguistics

The study of language, its structure, and the rules that govern that structure

What do linguists believe?

• Language is influenced by the social context in which people are raised and taught

• Language development is innate, and the child should have pre-cursors in learning their language

• Language is a socially shared code system that contains the 5 parameters of language: phonology, morphology, syntax, semantics, and pragmatics

Morphology

• Stems from terminology “morphemes”

• Study of structures

• Describes how words are formed out of more basic elements of language

Morphemes

• Smallest meaningful unit of languages

• Contains examples such as “free morphemes” which stand alone such as — cat, man, child, walk and “bound morphemes” which must be joined to a free morpheme to convey meaning (unhappy, coming, smiles)

Phonology

• The study of the sound systems and patterns to create sounds and words of a language

• Contains phonemes which are the smallest unit of sound

• English language contains 44 phonemes

Syntax

• How sounds are placed correctly to form syllables and words

• How words are placed into acceptable sequences to form sentences

• Ex: Subject-verb-object word order (The boy kicked the ball)

Semantics

• The study of meaning of language

• Content expressed by the speaker and content understood by the listener

• Miscommunication occurs when this is not clearly defined; understanding idioms and figures of speech

Pragmatics

• Rules governing the use of language in social situations; very culturally based/influenced

• Ex: taking turns, maintaining a conversation or topic of discussion

• Function of language rather than the structure

What do behaviorists believe?

• Language is a form of verbal behavior that can be observed

• Children learn language through experiences with their environment

• Language is acquired through conditioning and imitation rather than innate cognitive abilities

Receptive language

• Understanding what is said (spoken language)

• Language understood; listening is receptive

Expressive language

• Talking; language produced by speakers

• Language produced; speaking is expressive

Congenital and acquired disorders

• Present at birth or an early stage of language development

• Occurring after a significant period of language development

Impairments stemming from speech/articulation

• Affects the way sounds are produced

• Can be caused from structural abnormalities like cleft lip/palate

• May also be developmental in nature with the speech disorder stemming from no known cause

• May be phonological in nature (groupings of sounds or disorders - stopping, fronting, gliding, final consonant deletion)

• May be caused from intellectual disability; may also stem from an accident that affects speech long after (Dysarthria)

• May impair voice production through pitch, quality, and loudness of voice

• May impair fluency of speech/stuttering

Impairments of language/cognition

• May be developmental from birth and noted during childhood or as infant is developing (CP, Down syndrome, language delay, Autism, Asperger’s)

• May be acquired, as seen in strokes, head injuries, or other trauma

• Strokes are also called CVA (cerebrovascular accident); loss of blood flow correctly through the brain; can affect the right or left hemisphere of the brain; high blood pressure is a common cause of stroke

Impairments of hearing

• Conductive hearing loss - middle ear problems in which fluid usually develops in the middle ear, causing some degree of hearing loss

• Sensorineural hearing loss - involves disease of the inner ear; the patient/client may be born with this or may stem from loud noise exposure over a lengthy time period

• Children may also demonstrate auditory processing disorders which are a type of language processing disorder

Prosody

Variations in rate, pitch, loudness, stress, intonation, and rhythm of continuous speech

Difference between conductive and sensorineural hearing loss

• Conductive hearing loss is due to a physical obstruction that keeps sound from reaching the inner ear (ex: earwax build up, fluid in the ear from a cold or allergies, a perforated eardrum, etc.)

• Sensorineural hearing loss is caused by damage to the auditory nerve or hair cells of the inner ear (ex: head injury, repeated exposure to loud noise, etc.)

Language difference

Variations in speech-pathology productions due to personal, historical, and social factors (dialects of the same language); should not be confused with a language disorder

Language disorder

• Persistent difficulty with learning and using language; can affect the 5 aspects of components of language

• Demonstrate difficulties with proper use of stress, intonation patterns, pitch, rate, and loudness

• Differences in the areas may be treated by the SLP

Dialect

• Includes variations in grammar, vocabulary, and pronunciation; also is a variation of language shared by a group of people and influenced by the cultural, social, or regional backgrounds

• Should be neutral, not considered a disorder, functional/effective to properly express needs/wants effectively, and provide communication and social solidarity/well understood by others and recognized well

Accents

Refer only to differences in pronunciation; natural part of spoken language; intimately tied to identity and communication

ASHA stands for:

American Speech-Language-Hearing Association

Code-switching

Changing from one language to another during a conversation (ex: switching between AAVE and standard English)

Language mixing

• May involve some words from the two languages used in a single sentence, or different sentences may be spoken in different languages

• Certain topics are, however, typically discussed in one language only

• Ex: Speaking Spanglish

Vocal folds

A pair of thin muscles in the larynx whose vibrations are the source of voice

Resonance

• Forced vibration of a structure that is related to the source of sound; vibration of cavities below and above the larynx (source of sound)

• Includes nasality and hyper-nasality

Articulation

Movement; in speech, movement of the speech mechanism to produce the sounds of speech

Respiratory system

• Includes the mouth, nose/nasal cavity, oral cavity, pharynx/throat, larynx/voice box, vocal folds, trachea/windpipe, lungs, diaphragm

Mouth

Entry way for inhalation and exit for exhalation; we inhale oxygen and exhale carbon dioxide

Oral cavity

Air travels over tongue; past tongue base

Pharynx/throat

• Serves as passageway for air to travel from nose/mouth to the larynx/vocal folds; eventually turns into the esophagus which eventually travels to the stomach

• Located behind the trachea/windpipe

Larynx/voice box/vocal folds (vf)

• Once air reaches this area, the vf are open for inhalation, close for speaking, and re-open for exhalation

• Primary function is protecting the airway and prevention aspiration

• Second function is to produce voicing

• Contains the epiglottis which is attached to the tongue base

  • Small musculature which upon swallowing, closes over the top of the larynx and vf to prevent any liquid or food from entering the vf and into the trachea

  • If this accidentally occurs, aspiration will occur often resulting in pneumonia

Trachea/windpipe

Tube leading to the lungs made up of 20 rings of cartilage

Lungs

• Housed within the ribs

• House the heart and lungs

• We have 12 pairs of ribs; first 7 are true ribs, 8-10 are false ribs, 11-12 are floating ribs

Diaphragm

• Separates the stomach from the chest/ribs/lung area

• Upon inhalation, it contracts/flattens allowing chest to rise and air to fill lungs

• Upon exhalation, it relaxes and returns to its original shape, pushing air out of the lungs

Phonatory system

Also known as the larynx or “voice box”; where sound is produced through the vibration of the vocal folds

Thyroid cartilage

Largest cartilage present on the front/side walls of larynx

Cricoid cartilage

Encircles the entire larynx, under thyroid cartilage, first ring of the trachea

Arytenoid cartilage

Very important cartilage; attached to the vocal folds and help with all vocal fold movement

Adduction

Closing of the vocal folds

Abduction

Opening of the vocal folds

Myoelastic Aerodynamic Theory

• Involved in phonation and explains how the vocal folds vibrate to produce sound

• Air is taken in through the vocal folds and as we want to speak, the vocal fold adduct, air pressure builds up under the vocal folds, and they are blown apart and continue to open and close to produce phonation/voicing

Nasality

• Added nasal resonance to voicing

• Should only be heard on the sounds /m, n, and ng/

Hyper-nasality

• Palatal/soft palate function is not working properly

• Palate is staying flat and not elevating/retracting back to touch the posterior pharyngeal wall (PPW) to block airflow properly resulting in most sounds being too nasally

• Patients who exhibit this quality have velopharyngeal insufficiency

What position does the soft palate have to constitute hyper-nasality?

Positioned too low or doesn’t move adequately upward and backward

Articulation

• Vocal tract movements for speech sound production; involves correct placement, timing, direction of oral movements, and speech of oral movements

• How vowels/phonemes are formed

Articulatory system

Part of the body that produces speech sounds by modifying the flow of air through the vocal tract

The proper articulators needed for speech/language include:

• Lips - needed for /b, p, w, oo, ee, m/ for example

• Teeth - needed for /th, f, v/ for example

• Alveolar ridge - needed for /l, t, d/ for example

• Hard palate/soft palate (velum)

• Uvula - structures saliva to keep mouth moist, triggers gag reflex, helpful in production of some german sounds

• Larynx - houses the vocal folds

• Vocal folds - when open, the are between is called the glottis

Normal/class I malocclusion

Individual teeth in the two arches are properly aligned and the upper and lower dental arches meet each other in a fairly symmetrical manner

Class II malocclusion

The upper jaw is protruded and the lower jaw is retracted or receded

Class III malocclusion

The upper jaw is receded and the lower jaw is protruded

What are the 3 types of nervous systems in relation to speech and language?

Central nervous system (CNS), peripheral nervous system (PNS), and autonomic nervous systems (ANS)

Central nervous system

• Houses brain and spinal cord

• Contains 4 lobes of brain (frontal, parietal, occipital, and temporal) and 2 hemispheres (left, right)

Frontal lobe

• Contains Broca’s area which is associated with speech production and articulation

• Motor cortex is responsible for controlling voluntary movements of the body

• Controls speech production, language, articulation, voice, and fluency

• Also controls behavior, movement, cognitive and executive functions, social skills, and memory

Executive functions

• A set of mental processes that help people manage everyday tasks and achieve goals

• Critical thinking, problem-solving, planning, decision making, and carrying out tasks

Parietal lobe

Controls pressure, pain, temperature, and touch

Occipital lobe

Visual cortex; helps receive and process visual information which is important for reading, recognizing body language, and facial expressions needed for communication

Temporal lobe

• Contains structures that are important for speech and hearing

  • Primary auditory cortex and Wernicke’s area

• Primary auditory cortex - receives the sound stimuli from the acoustic nerve; processes what the ear hears and determines the meaning of sound stimuli

• Wernicke’s area - responsible for both understanding and formulating speech

  • Patients with Wernicke’s aphasia speak fluently, but their speech does not make much sense

Left hemisphere of brain

Language-based hemisphere; controls speaking, reading, writing, listening, math, motor control, and aggression control

Right hemisphere of brain

Controls social interaction skills and behaviors; cognition, spatial awareness, emotions, creativity, self-awareness, humor, focus/attention, following multi-step directions, problem solving, planning, self-monitoring, organization, and prioritizing

Autonomic nervous system

• Controls involuntary actions

• Controls breathing, digestion, heart rate, and eye blinking

Peripheral nervous system

• Carries information from the body to brain and brain to the body

• Controls digestion, blood flow, and heart rate

• Helps us respond to temperature, light, touch, pressure, and vibration

• Contains the cranial nerves; the most important cranial nerves for speech, language, and hearing include: CN 5, 7, 8-12

CN V/5 (Trigeminal Nerve):

Largest cranial nerve; controls face muscles, eye muscles, upper lip muscles, and tongue/cheek muscles

CN VII/7 (Facial Nerve):

• Controls opening/closing mouth, lip/cheek movement, raising eyebrows, general facial movements

• If damage occurs here, the patient exhibits masked facial expression

CN VIII/8 (Vestibular Acoustic/Auditory Nerve):

Acoustic/hearing nerve; controls all hearing and balance

CN IX/9 (Glossopharyngeal Nerve):

Controls all tongue movements and pharyngeal/throat function

CN X/10 (Vagus Nerve):

Controls “everything” basically; heart/heart rate, lungs, digestion, larynx (VF), breathing, and gastrointestinal function

CN XI/11 (Accessory Nerve):

Controls muscles of the soft palate and pharynx, shoulders, head, and arm movements

CN XII/12 (Hypoglossal Nerve):

Controls tongue movements needed for both speech and swallowing function