Intro to Communication Disorders Exam 2 Study Guide

Language

A conventional, dynamic, and generative system composed of several interrelated components; these components and the relationships between them are used to express ideas, feelings, and facts in communication with other people

speech

The expression of or the ability to express thoughts and feelings by articulate sounds

Speech disorders

• Articulation disorder

• Phonological disorder

• Apraxia

  • Adult apraxia of speech: usually a result of a stroke; cortical damage, in the left frontal lobe, is usually assumed to be the source of the disorder, although other regions of damage in the cerebral hemispheres may also result in adult apraxia of speech

  • Thought to be a planning (programming) disorder - inability to plan the sequence of actions (movements) required to produce speech fluently and without error

  • Speech characteristics

    • Articulatory groping, speech sound errors, speech that sounds labored and robotic, increasing speech errors and hesitations with increased phonetic complexity

• Dysarthria

Developmental language disorder / specific language impairment

• developmental language disorder

  • IQ of 70 and above

  • No hearing impairment

  • No motor deficits

  • No other conditions (e.g., psychiatric) that might explain the language disorder

  • Most frequently diagnosed disability in children

  • Associated with delayed reading skills, poor academic performance, and diminished career outlook

  • Language disorder can be limited to an expressive (production) disorder, or may include disorders of both comprehension and expression

• Typical profile:

  • Child did not produce first word until about 20 months of age

  • Unusually small vocabulary at 3 years of age (less than 200 words), just starting multi-word utterances

  • Minimal progress on mastery of grammatical morphemes (past tense, plural, possessive)

  • Both comprehension and production are delayed, with greater delay for production

  • Nonverbal IQ is in normal range

  • Child sounds “babyish” - much younger than his or her chronological age

DLD/SLI (fab 5 areas)

• phonology

  • More speech sound errors

  • Poorer phonological memory: ability to store speech sounds in short-term memory

    • Difficulties with non-word repetition task: poor phonological memory, word learning difficult → smaller vocabulary, deficit in sound sequencing/organization for word learning

• Morphology

  • “Signature” deficit

  • Near- normal vocab size for their age

  • Typically developing phonetic/phonological skills, expressive, expression + comprehension skills in grammatical morphology deficits

• Syntax

  • Sentence comprehension skills may be affected

  • Related to deficits in the expression of grammatical morphology

  • Is difficulty with sentence comprehension an ineffective “model” for development of grammatical morphology?

• Semantics

  • Smaller vocabulary size compared same-aged peers

  • More different in expressive (production) vocabulary

    • Vocab breadth, vocab depth, abstract/low frequency/nonliteral expressions

  • Resulting in challenge to language production (i.e., the comprehension vocab in SLI/DLD is closer to the typically developing profile, compared with the expression vocab)

• Pragmatics

  • There is evidence that some children diagnosed with SLI/DLD have difficulties in the social use of language

  • Initiation of conversations

  • Turn taking

  • Topic management

  • Comprehension of non-literal language

  • Increased risk of academic and social difficulties

Flaccid dysarthria

• Flaccid dysarthria: damage in brainstem nuclei and/or cranial nerves

  • Damage results in muscle weakness and paralysis, and wasting of muscles (lower motor neuron disease)

  • Speech characteristics: breathy voice, hypernasality, imprecise consonants

spastic dysarthria

• Spastic dysarthria: damage to descending fibers (called the corticobulbar tract) from cortical motor neurons to motor nuclei in the brainstem

  • Damage results in muscle weakness and hypertonic and hyper-reflexive muscles (upper motor neuron disease)

  • Speech characteristics: slow speaking rate, strain-strangled voice, mono pitch, reduced stress, imprecise consonants

ataxic dysarthria

• damage to cerebellum, and/or to fibers tracts connecting it to all parts of CNS

• Damage results in difficulty maintaining a consistent rhythm, and in controlling the force of muscle contractions; often the force of muscle contraction is inconsistent with the task (e.g., too much force), and movements are jerky, and uncoordinated

• Speech characteristics: excess and equal stress, irregular articulatory breakdown, “drunk-sounding” speech, and imprecise consonants

mixed dysarthria

• combination of two or more of the five types (flaccid, spastic, ataxic, hypokinetic, hyperkinetic) of dysarthria, presumably due to damage to two separate parts of the CNS or CNS + PNS

• Examples

  • Multiple sclerosis (MS) often has lesions (damage) in both the corticobulbar tract (upper motor neurons disease) and cerebellum; the expected missed dysarthria is called a spastic-ataxic dysarthria

  • Amyotrophic lateral sclerosis (ALS) may have damage in both the corticobulbar tract (upper motor neuron disease) and brainstem (lower motor neuron disease); the expected mixed dysarthria is called a spastic-flaccid dysarthria

Childhood apraxia of speech (CAS)

• a neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g., abnormal reflexes, abnormal tone)

• May occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder

• The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody

• Characteristics

  • Omission of word-initial sounds (“awg” for “dog”)

    • Inconsistent with typically developing speech patterns

  • (Variable) unintelligible speech

  • Language delays

  • Academic challenges in school

    • Persisting reading and writing problems

Speech sound error types

• substitution

  • Blue → bwoo

• Omission

  • Blue → boo

• Addition

  • Blue → baloo

Residual speech errors

• found in only a small number of teenagers and adults

• Typically include one or two sounds (usually from the late eight)

  • They are almost always distortions of the sounds rather than substitutions or omission (e.g., distorted /s/ and /r/)

• Not clear why such errors persist

speech delay

• Developmental speech sound disorders with no known cause

• Lags typical speech sound development

• No clear explanation for the delay

• Common during development

  • Prevalence of about 15% in 3 year olds

  • Many “catch up” by age 6

• Intelligibility increases as speech errors decrease

  • Children with speech delay = lower intelligibility when compared with typically developing same-aged peers

• Typical referred around 4-4 ½ years of age

  • Speech delay associated with reading delay, social consequences, general academic difficulties

  • Early intervention is recommended

• Most difficulties with the “late 8” speech sounds

  • Many frequently occurring sounds

  • May have a significant affect on a child’s speech intelligibility

    • This may be language-specific

Aphasia types

• Broca’s aphasia (expression difficulty)

  • Damage left frontal lobe near Broca’s area

  • Characteristics:

    • nonfluent aphasia, hesitation before speaking, effortful speech, anomia, agrammatism

    • good, possibly mildly impaired, comprehension, especially for syntactically-complex sentences

• Wernicke’s aphasia (comprehension difficulty)

  • Damaged temporal lobe just below the Sylvia’s fissure; the parietal lobe just above the Sylvia’s fissure may also be damaged

  • Primarily a receptive aphasia

  • Characteristics

    • Fluent aphasia

    • Difficult comprehending language: no problem with hearing, language-specific comprehension problem, extensive speech with occasional articulation errors, speech lacks meaning and is not responsive (in content) to questions

• Global aphasia (both expression and comprehension)

  • Damage is likely found in most of the perisylvian speech and language area

  • Global aphasia, at least immediately following a stroke and perhaps for hours and/or days, is one of the most frequent types of aphasia

  • Global aphasia usually evolves to a milder type of aphasia

  • Characteristics

    • Poor comprehension and expression, occasional comprehension and/or production of simple, automatic utterances (e.g., familiar names; greeting such as “hi”)

    • Residual anomia when most other language functions have recovered

• Conduction aphasia (disconnection between Broca’s and Wernicke’s)

  • Damage to arcuate fasciculus (ruins the connection between Broca’s & Wernicke’s)

    • Damage to other perisylvian areas of the left hemisphere likely

  • Lesions are not found in Broca’s or Wernicke’s areas

    • Expression and comprehensions “spared”

  • Characteristics

    • Impaired repetition: damage to the arcuate fasciculus prevents transfer of correctly comprehended info to Broca’s area

    • Conversational speech intact: occasional sound and word paraphasias

Difference between anterior vs. posterior lesions in the left hemisphere

• anterior is toward the front of the cerebral hemispheres; posterior is toward the back of the cerebral hemispheres

• The more anterior the lesion, the more likely the aphasia will be primarily of the expressive type

• The more posterior the lesion, the more likely the aphasia will be primarily of the receptive type

left neglect

brain fails to attend to information on the left side of the midline

Right vs. left hemisphere stroke differences

Autism Spectrum Disorder

• diagnostic criteria

  • Persistent deficits in social communication and social interaction across multiple contexts, currently or by history

  • Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following, currently or by history

    • Repetitive motor movements, use of objects, or speech

    • Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal or non-verbal behavior

    • Highly restricted, fixated interests that are abnormal in intensity or focus

    • Hyper or hypo -reactivity to sensory input to unusual interest in sensory aspects of the environment

  • Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capabilities, or may be masked by learned strategies later in life)

  • Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

  • Symptoms are not better explained by intellectual disability or global developmental delay. ID and ASD do frequently co-occur; to make comorbid diagnosis of ASD and ID, social communication should be below that expected for general developmental level

• Early identification

  • Multi-disciplinary assessment is the fold standard

  • Significant experience and training

  • Scope of practice guidelines for who can yield a medical diagnosis in any given state

Autism Spectrum Disorder continued

• gender differences and late diagnosis in females

  • 80% of autistic females remain undiagnosed at age 18

  • Only receiving “surface” diagnoses - ADHD, anxiety, sensory processing disorder, eating disorders, OCD

    • These diagnoses may be more related to the symptoms experienced by autistic girls and women, but the cause is missed

  • Girls are better at imitating social behaviors in early years “masking”

  • Difficulties manifest in later elementary & middle schools when autistic girls don’t understand the perspective of others and can’t determine others’ interior motivations

  • Masking at school leads to missed concerns by teachers

• Importance of medical identification for access to services

  • Used to access services, important for therapies, supports, etc.

  • Understanding neurodivergence can lead to the right supports and coping skills

  • Improved mental health

  • Improved employment outcomes

  • Decreased risk of abuse in adult life

• Neurodiversity movement

  • Neurodiversity affirming practices

  • Not a “puzzle piece”

  • Autism is a difference - not a disorder to be “fixed”

  • Autistic self advocacy network (ASAN)

  • No talk about us without us

intellectual disability

• chronic impairments of general mental abilities have an impact on adaptive functioning in three areas: (as presented in the DSM-5)

  • Conceptual skills: language, reading, writing, math, reasoning, knowledge, and memory

  • Social behaviors: empathy, judgement, interpersonal communication skills, making and maintaining friendships

  • Practical behaviors: personal care, job responsibilities, management of money, recreation, and organization of tasks

• Must be observed in childhood

• Formal ID diagnosis requires:

  • Standardized IQ tests (score < 70) and

    • IQ tests language skills

      • Bias d/t heavy language burden during testing

    • Non-verbal IQ tests

      • Estimate intelligence w/o burden of language abilities (non-verbal IQ scores higher than verbal IQ common in ID population)

  • Observation of social and practical skills

  • Non-verbal IQ tests are based cognitive skills such as memory and reasoning

cognitive disorders

• attention, memory, executive functioning; or specific areas of learning

  • Reading, math, writing, etc.

• Dyslexia, dyscalculia, dysgraphia, etc.

Down Syndrome

• genotype is called Trisomy 21 - three 21 chromosomes

• The leading genetic cause of ID, but it is not heritable (de novo mutation)

• Phenotype varies widely

  • Presence of characteristics and severity

• Characteristics

  • Facial differences, short stature, hearing loss, congenital heart disease, low muscle tone, mental illness, dementia (later in life), ID, speech and language impairment (common, 1 related to ID and hearing impairment)

• Phonetics

  • Delayed

  • Demo error patterns not observed in typically-developing children

    • Some error sounds persistent into adulthood

  • Leading to reduced speech intelligibility

• Morphology

  • Impaired morphological and syntactic development

    • Disproportionate to cognitive skill

  • Tense markers (-ed) and third person singular (he does) often impaired

• Syntax

  • Pronouns (e.g., “him likes her”)

  • Uses simple sentences

  • Delays remain present even with “cognitive age” matching

• Semantics

  • Strong vocabulary

    • Especially receptive vocabulary

    • Close to typically-developing mental age matched peers

  • Discrepancy in vocabulary versus morphological and syntactic skills

  • Lagging syntactic skills can influence development expressive vocabulary

  • Concept of “mental age”: the age corresponding to developmental skills, such as language, for typically-developing children

• Pragmatics

  • Pragmatic language skills are a weakness in children with DS

    • Extent of talking in social situations, topic choice, multiple repetitions of statements, initiation of conversation

  • Strengths in children with DS may include

    • Clarification, story narration, non-verbal communication skills

Fragile X syndrome

• genotype is mutation on X chromosomes of 23rd pair (more severe in males)

• Leading heritable cause of ID

• Phenotype

  • Varied characteristics, varied severity

  • Intellectual disability (accompanying speech and language impairment

  • Facial differences, anxiety, depression, other psychiatric issues, autism

  • Likely contributes to speech/language impairment

• Phonology

  • Speech sound development delay

    • Follows typical development patterns, speech sound errors impact intelligibility

• Morphology & syntax

  • Tense marking (wait-waited), verb use ex: “is” (he is-they are), mastery delayed (may persist in adulthood)

  • Morphology and syntax are found in both comprehension and expression (greater expressive deficits)

  • Use simple sentences

    • Mean length of utterance (MLU) is significantly lower

      • Reflects morphological and syntactic deficits

• Semantics

  • Comprehension and expression of words is delayed

    • Larger receptive vocabularies, smaller expressive vocabularies (just like typically-developing peers)

  • Receptive vocab development follows non-verbal cognitive skill development

    • Expressive vocabulary development does not (ex: receptive vocab seems to be predictable from the level of non-verbal skills; the expressive vocab is not)

• Pragmatics

  • Weakened pragmatic language skills

    • Especially prevalent for co-occurring FXS and autism/ASD

    • Recall that deficits in pragmatic skills are a requirement for a diagnosis of autism

  • Pragmatics are more severe in non-syndromic ASD (absence of FXS)

genetic contributions to language disorders

• chromosomes are “strings” of genes

• 23 pairs

  • The 23rd chromosome pair is the sex pair (XY=male; XX=female)

• Gene

  • Unit of DNA

  • Located on chromosome

  • Controls development of anatomical structures and traits

• Genes are passes from parent to child

• Genotype = the complete set of genes in an organism

• Phenotype = the expression, in an individual, of a genotype

  • Phenotypes can vary for a single genotype

communication development and milestones

• first word (about 12 months)

  • Expressive vocabulary size of about 50 words

  • Stronger comprehension skills when compared to expression

• 2-word combinations (about 2 yrs)

  • Vocab spurt

  • Two-word utterances toward the end of the period

  • 200-300 words

  • Stronger comprehension skills when compared to expression

  • Sentences understood in rich context

• 3+ word sentences (about 3 yrs)

  • Usage of grammatical morphemes

  • Three or four words

  • MLU about 1.5-2.5

  • Comprehend simple sentences

• Intelligibility (about 90% by 4 yrs)

  • Continued development of

    • Vocab growth

    • Expression - grammatical morphology, MLU ~ 3-4

    • Receptive/understanding - grammatical morphology more sophisticated

overextension

semantic categories too broad (all four legged creatures are “doggies”)

Semantic relations

• agent: the category of people who “do something” (can include toys, animals, etc.)

• Action: the category of actions (ex. Eat)

• Object: the category of objects (ex. Hat)

• Locative: the category of locations, directions, places (ex. Park)

• Frames for words from the different categories; the child learns different multiword utterances by plugging known words into the proper frames

communication expectations by age

• 12-18 months

  • 50 expressive words by 18 months (mostly nouns)

  • overextension

  • Underextension

    • Semantic categories are too narrow (the only doggie in the child’s world is Muffy, her dog)

    • Comprehension vocab larger than expressive vocab

• 18-24 months

  • Rate of word learning

    • 7-11 words per month to the expressive vocab

    • Added after many repetitions

    • Increases dramatically with “naming insight” leading to “fast mapping”

    • “Fast mapping” fuels a vocab spurt (20-40 new words per month) → 200-300 words at 24 months

    • Stimulates the production of two word utterances

    • Comprehension remains more advanced than expression

• Age 2

  • Multi-word utterances

    • Intention of gestures

  • Use grammatical morphemes (e.g., plural -s, past tense -ed)

• Age 3

  • 600-2000 words (mostly nouns)

  • Vocab size differs per language

  • Multi-word utterances

vocal fold nodules

• Benign (not cancer) masses (growths) 2 voice patterns

• first soft then become callous-like texture

• usually bilateral (both folds) located at the mid fold

• disrupt VF vibratory characteristics, VF closure

• result in breathy voice quality air

  • escape of air through the openings in front of and behind the nodules

• may lead to maladaptive strategies to compensate for voice issue

• Treatment: vocal rest (to allow the calluses to heal)

• etiology:

  • screaming (e.g., cheerleading)

  • overuse of high intensity voice (e.g., professional singing)

  • chronic clearing of the throat

  • chronic use of a low pitched, tense voice

vocal fold polyps

• benign (not cancer) lesions (growths)

• often unilateral (one fold)

• softer and larger than nodules

• treatment: surgery

• etiology:

  • screaming (e.g., cheerleading)

  • overuse of high intensity voice (e.g., professional singing)

  • chronic clearing of the throat

  • chronic use of a low pitched, tense voice

vocal fold paralysis

• nerve injured on one side (unilateral) of the larynx

• can be caused by

  • trauma (e.g., chest compression)

  • surgery

  • inflammatory disease

• a paralyzed vocal fold cannot make firm closure with healthy fold because it cannot be moved fully to the midline; note open part in posterior part of glottis

• a paralyzed vocal fold vibrates, but weakly'; the paralyzed fold “waves in the wind” as air flows through the larynx

• voice quality is weak, breathy, and strained

• treatment:

  • behavioral intervention: voice therapy

  • medical intervention: surgical techniques are designed to allow the speaker to achieve better closure for the closed phase

  • injection augmentation

  • laryngoplasty

Hyperfunction and pressed voice

• rough, “tense” voice

• too fast closing phase and too long and tight closed phase

• 2 excessive (hyperfunctional) behaviors

  • VF tissue damage

  • damage/irritation

  • tissue changes

  • altered VF vibration

Laryngeal cancer

• cancer can occur anywhere in the larynx

  • 50% of laryngeal tumors are located on or in the vocal folds

• higher in men compared with women (as much as 7 times more frequent in men at the age of 60)

• initial symptoms usually worsening voice changes

  • depend on lesion size

  • voice quality usually horse, rough, and irregular

  • dysphonia in cancer may sound same as other (non-cancer) causes of dysphonia

• treatment

  • surgery, radiation therapy

  • follow up voice therapy (e.g., prostheses)

voice disorder caused by phonotrauma

• results from excessive use of the voice that results in damage to vocal fold tissue, which may lead to nodules, polyps, and other lesions on the vocal folds

• nodules, vocal fold polyps, laryngitis, chronic influx, and vocal fold cysts (fluid-filled sacs)

• treatment

  • vocal hygiene education

  • nodules: vocal rest

  • polyps, cysts: surgery

  • laryngitis and reflux: vocal hygiene and medical management

Dysphagia symptoms

• Nervous system disorders: CNS

  • brainstem, subcortical, and cortical structures; damage may disrupt necessary timing and coordination

  • swallowing disorder can exist in the absence of a speech disorder, and vice-versa

• nervous system disorders: PNS

  • weakness and atrophy of the muscles involved in swallowing (including the esophagus)

  • swallowing requires pressure change

aspiration pneumonia

a lung infection that occurs when food, liquid, or other foreign substances are inhaled into the lungs

swallowing stages

• oral preparatory phase

  • jaw elevates and closes when bolus enters through the lips

  • tongue “cups” the bolus with a firm seal at the lips and in the region of the soft palate, preventing liquid or solids from leaking at either end

  • breathing stops momentarily to prevent aspiration; duration of the oral preparatory phase for solids may last from 3-20 secs

• oral transport phase

  • bolus transported back into the oral cavity

  • tongue, from front to back, moves the bolus by pressing against the hard palate in a “rippling” motion

  • velopharyngeal port closes, topmost part of esophagus begins to open

• pharyngeal phase

  • triggered when bolus reaches the back of the oral cavity, automatic control (like a reflux) begins movement to protect the airway; duration is about 0.5 secs

• esophageal phase

  • bolus enter esophagus and is transported to the stomach by peristaltic action of smooth muscle (8-20 secs)

• phases may overlap

  • coordination required

  • may result in aspiration

gold standard for diagnosis: videofluoroscopic study

• x-ray technique

• food mixed with barium sulfate for visualization

• various food/liquid textures, consistencies, volumes

• measurement of timing of phases, extent of movement, identification of aspiration

Endoscopic/FEES studies

• endoscopy

  • camera in the nose technique

  • regular foods, liquids, pills

  • no radiation exposure

  • no visualization of esophagus

Activities of daily living (ADLs)

• disruption in ADLs - personal care tasks

• eating/self-feeding

• bathing/hygiene

• dressing

• maintaining continence and toileting

• transferring - moving from place to place

Instrumental activities of daily living (IADLs)

• independent living tasks

• communication skills - phone, email, internet

• transportation - driving oneself, arranging rides, public transport

• meal prep - planning, prep, storage, safe use of kitchen equipment

• shopping - ability to make purchase decisions appropriately

• housework - laundry, dishes, hygienic and safe residence

• medication management - accurate and timely dosing, managing refills

• financial management - staying in budget, writing checks, paying bills, avoiding scams

congenital vs. acquired disorders

• congenital disorders

  • conditions present at birth, arising from structural or functional problems during fetal development

  • examples: down syndrome and fragile x syndrome

• acquired disorders

  • medical conditions that develop after birth and can arise from various factors like injury, illness, or exposure to certain substances

  • examples: aphasia, apraxia, dysarthria, stroke, TBI, dementia, and dysphagia

Post-lingual vs. pre-lingual deafness

• post-lingual deafness

  • hearing loss that occurs after a person has already acquired the ability to speak and understand language

  • usually after age 6

  • causes: trauma to the ear or head and prolonged exposure to loud noises

• pre-lingual deafness

  • hearing loss that occurs before a child develops speech and language, impacting language acquisition and social-emotional development

  • usually before age 1

  • causes: genetic factors and maternal infections

ischemic stroke

• occurs when a blood clot or plaque blocks blood flow to the brain, leading to brain tissue damage

• Long term effects

  • Vision problems, dysphagia, memory problems, thinking and reasoning difficulties, aphasia, and dysarthria

Hemorrhagic stroke

• occurs when a blood vessel in the brain ruptures, causing bleeding into the brain tissue

• Long term effects

  • Dysphasia, visual impairments, memory problems, aphasia, and cognitive impairments

Stroke in Broca’s area

• occurs when there is damage to the Broca’s area

• An ischemic stroke is the most common cause

  • Other causes can be a hemorrhagic stroke, brain tumor, or head trauma

• Can cause Broca’s aphasia

stroke in Wernicke’s area

• occurs when there is damage to Wernicke’s area

  • Damage can occur due to a stroke, TBI, brain tumor, or an infection

• Can cause Wernicke’s aphasia

Cerebral palsy

• brain damage before, during, or shortly following birth

• Most common motor disability in childhood

  • Prevalence (estimated) 1.5-4 cases per 1000 live births

• Motor speech disorders: 20-50% of CP cases

• Dysarthria

• Reduced speech intelligibility/understandability (common)

• Apraxia may also co-occur (rare)

• Intellectual disability (ID): 40-45% of CP cases

• Hearing loss: 40% of CP cases

• Speech motor control deficits, intellectual disability, and hearing loss complicates an understanding of the speech and language characteristics of children with CP

Subtypes of Cerebral Palsy

• spastic

  • About 85% of cases

  • Damage primarily to corticobulbar tracts

  • General characteristics

    • Excessive muscle tone, resulting in weak and stiff muscles

    • Hyperreflexia of muscles, resulting in unwanted movements

    • Distorted postures result from chronic hypertonic and hyperreflexia of muscles

  • Speech characteristics

    • Spastic dysarthria (strain-strangled voice; slow speaking rate; imprecise consonants)

    • Misarticulation of many speech sounds

    • Possible deficits in prosody (especially with more severe cases)

    • Poor speech intelligibility

• Dyskinetic

  • About 7% of cases

  • Damage to the basal ganglia

  • General characteristics

    • Constant movements occurring at rest or during purposeful movement

    • Impairs functional movement (ex: bring fork to mouth)

  • Speech characteristics

    • Constant, involuntary movements affect respiratory, laryngeal, and upper airway structures

      • Functional symptoms seen in speech, breathing, phonatory/voice, and articulatory deficits

• Ataxic

  • About 4% of cases

  • Damage to cerebellum

  • General characteristics

    • Relatively rare, results from damage to the cerebellum

    • Balance, gait, loss of ability to scale the force and accuracy of movements

    • Delayed developmental milestones (walking, sitting up)

  • Speech characteristics

    • Dysarthria

    • Little is known because type is rare

      • Similar speech characteristics adults with ataxic dysarthria

cognition

• attention, memory, executive functioning; or specific areas of learning

  • Reading, math, writing, etc.

    • dyslexia, dyscalculia, dysgraphia, etc.

Phonation

• the sounds made when the vocal folds vibrate - the sound source for speech

• We perceive phonation by

  • Pitch, loudness, and quality

• We measure phonation via acoustic measurements

  • Pitch = frequency

  • Loudness = decibels (dB)

  • Quality = math

Pitch

the number of cycles of vocal fold vibration completed in 1 second 

Vocal intensity

• may change throughout lifespan. Possible variables

  • Distance between speaker and listener

  • Level of noise in a speaking situation

  • Cultural factors

• Increased voice intensity is perceived as increased voice loudness (in general)

• Voice loudness that calls attention to itself (too soft; too loud) is not subtle