Final Exam Review

Speech

Acoustic representation of language

Articulation

How speech sounds are formed

Fluency

Smooth, forward flow of communication, influenced by rhythm and rate (prosody/suprasegmentals).

Voice Components

Pitch, Loudness, Quality

Pitch

Listener’s perception of how high or low a sound is.

Habitual Pitch

The pitch a speaker uses most of the time.

Intonation

Pitch movement within an utterance.

Loudness

Perceptual correlate of vocal intensity; how loud or soft a voice sounds.

Phonation Quality

Overall perceptual character of the voice (e.g., breathy, harsh, hoarse).

Respiration (voice)

Power source for speech; breath support that drives phonation.

Cul-de-sac Resonance

Muffled-sounding speech caused by sound trapped in oral, nasal, or pharyngeal cavities.

Resonance

Quality of voice determined by acoustic resonating cavities of the vocal tract.

Hyponasality

Too little nasal resonance, often due to nasal blockage.

Hypernasality

Excessive nasal resonance, often from velopharyngeal insufficiency.

Apraxia of Speech

Impairment of motor programming that prevents turning linguistic plans into coordinated speech movements; not due to weakness or paralysis.

Dysarthria

Neuromuscular speech disorder caused by weakness, paralysis, or incoordination of speech muscles.

Childhood Apraxia of Speech (CAS)

Neurological pediatric speech-sound disorder with impaired precision and consistency of speech movements without neuromuscular deficits.

Stuttering

Fluency disorder with repetitions, prolongations, and blocks that disrupt speech flow.

Cluttering

Fluency disorder characterized by rapid, irregular speech rate and reduced intelligibility.

Fluent Speech

Speech that moves along at an appropriate rate with easy rhythm; smooth and automatic.

Disfluency

Speech behavior (pauses, interjections, revisions) that disrupts fluent forward flow of speech.

Developmental Stuttering

Most common stuttering type; begins preschool years, gradual onset, affects content words and initial syllables.

Neurogenic Stuttering

Stuttering associated with neurological disease or trauma; affects function words, lacks secondary behaviors, no singing effect.

Phonology

Speech-sound problems resulting from a linguistic rule disorder in the child’s system.

Articulation (disorder perspective)

Speech-sound problems due to motor difficulties positioning the articulators.

Voice

The complex, dynamic product of vocal fold vibration that allows us to vocalize and verbalize.

Adduction

The state in which the vocal folds are closed (active)

Abduction

The state in which the vocal folds are open (at rest)

Voice Disorder

Abnormal pitch, loudness, or quality relative to age, gender, culture, or ethnicity.

AAC Assessment Considerations

○Motor abilities

○Cognitive abilities

○Potential vocabulary size

○Ease in learning new system

○Whether client and partners accept new system

○Flexibility

○Intelligibility

Unaided AAC

Communication methods that require no external equipment (e.g., gestures, sign).

Aided AAC

Use of external tools or technology to communicate.

No-Tech AAC

Aided AAC using readily available materials (e.g., paper, pencil).

Low-Tech AAC

Simple devices with few moving parts (e.g., picture boards).

High-Tech AAC

Computer-based, sophisticated devices (e.g., speech-generating devices).

Symbol (AAC)

Something that stands for or represents something else.

Types of AAC symbols

—Aided and Unaided

—Acoustic Symbols

—Graphic Symbols

—Manual Symbols

—Tactile Symbols

Direct Selection

○Physical pressure or depression

○Physical contact

○Pointing without contact

○Speech or voice input

Technique (AAC)

refers to the way in which messages are transmitted- that is how an individual selects or accesses symbols.

Dysphagia

Swallowing disorder involving delay or misdirection of a bolus from mouth to stomach.

Feeding Disorder

Impairment in food transport process outside of swallowing (e.g., refusal to eat).

Bolus

Food or liquid mass once it is in the mouth during swallowing.

Penetration (swallowing)

Entry of food/liquid into the larynx above the vocal folds.

Aspiration

Food or liquid passes below vocal folds into the lungs, risking pneumonia.

Anticipatory Phase (swallow)

Preparatory stage involving salivating, positioning, and sensory responses before food enters mouth.

Oral Phase

Oral preparatory and transport stages moving bolus to back of mouth and triggering swallow response.

Pharyngeal Phase

Phase where velum closes nasopharynx, larynx elevates, epiglottis lowers, and bolus moves through pharynx.

Esophageal Phase

Peristaltic contractions move bolus through esophagus to stomach.

lips (function for bolus transfer)

Closure builds intraoral pressure

velum (function for bolus transfer)

Seals nasopharynx from foreign bodies

true VF and false VF (function for bolus transfer)

provide airway protection

Pharyngoesophageal Segment (function for bolus transfer)

relaxes for bolus entry and closes to prevent regurgitation.

Lower Esophageal Sphincter (function for bolus transfer)

relaxes for bolus entry into stomach and closes to avoid reflux.

Modified Barium Swallow Study (MBS)

Videofluoroscopic X-ray procedure to examine oral and pharyngeal swallowing and guide treatment.

—Used for determining

○Oral vs. nonoral feeding

○Safest food textures

○Appropriate therapy

Dysphagia treatment

• Body and Head Positioning

• Modification of Foods and Bevarages

• Placement

• Medical/Pharm approaches

  • —Drug Treatments

    ○Medications can either help or cause/contribute to swallowing disorders

    —Prostheses and Surgical Procedures

    ○Prosthetic devices if swallowing mechanism not intact

    ○Remove cervical growths, increase vocal fold dimension, elevate larynx, suture vocal folds closed

Non-oral feeding treatment

Nasogastric tube, J-tube, PEG tube (G-tube)

Pediatric Feeding Disorder

a child’s “persistent failure to eat adequately” for a period of at least 1 month, which results in a significant loss of weight or a failure to gain weight

In addition to the failure to eat adequately, the child with a feeding disorder usually demonstrates one or more of the following:

•Unsafe or inefficient swallowing patterns

•Growth delay affecting height and/or weight

•Lack of tolerance of food textures and tastes

•Poor appetite regulation

Treatment Goals in Pediatric Feeding and Swallowing

—* To ensure that nutritional needs are met for healthy growth and development

—* To ensure that feeding and swallowing do not endanger a child’s life.

Cerebral Palsy (CP)

Neuromuscular disorder and significant risk factor for pediatric dysphagia.

Children who are unable to meet their own nutritional needs orally and whose growth is faltering require an alternative solution. Children who are candidates for supplemental or alternative nutrition are those:

—Who cannot meet 80% of their caloric needs orally

—Who have not gained weight or who have continuously lost weight for 3 months

—Whose weight and height ratio is below the 5^th percentile

—Whose feeding time is greater than 5 to 6 hours daily

Assessment Goals

• •Verification of communication problems (Diagnosis)

• Gather case history

• •Description and quantification of deficits and strengths

• Statement of Severity

• Identify Etiology

• Create a treatment plan

• Determine prognosis

Dysphagia can affect

• Planning

• Timing

• Coordination

• Organization

• Sensation

Which cranial nerves are involved in speech and swallowing?

• Trigeminal

• Facial Nerve

• Glossopharyngeal

• Vagus

• Accessory

• Hypoglossal

Is gagging a reflex or pattern elicited response?

Reflex

Indirect selection

○Scanning with single or dual switches

○Directed scanning

○Coded access

Is swallowing a reflex or pattern elicited response?

Pattern elicited response

Complex Communication Needs 

Exist when individuals cannot meet their daily communication needs through their current method(s) of communication

Complex Communication Needs emphasizes what?

•Needs and purposes of communication

•The development of meaningful treatment goals

Dysphagia etiology

It is a secondary disorder, meaning that it results from another primary cause