Communication disorders test 2

Literacy

ability to communicate through written language, both reading and writing

Overlapping challenges

Children with spoken language problems frequently have problems learning to read and write

Children with reading and writing challenges often have problems with spoken language

Prevention

involved in efforts within schools

Assessment

collaborate to identify students and inform instruction and intervention

Intervention

provide appropriate __________ using variety of service delivery models

Compliance

federal and state mandates, Medicaid billing, report writing, therapy logs, etc.

Understanding speech

human auditory perception system is biologically adapted to process spoken words

Learning to read

human visual system is not biologically adapted to process written words

Shared book reading

can help increase reading proficiency in the future

Alphabet principle

idea that letters and combinations of letters represent speech sounds; speech can be turned into print; and print can be turned into speech

Phonological awareness

sensitivity to sound structure of spoken language

Oral language

grammatical , lexical, and narrative abilities

Alphabet knowledge

individual letters

Concepts about print

rules governing how print is used

Adult involvement

is essential in learning literacy

Phonics method for teaching reading

teaching to sound out of the words, heavily influenced by phonological awareness

Emergent writing

Scribbling

Orthography

Conventional literacy

transition into reading to learn

• by approx 8 years old or third grade

• Sight vocabulary and word-attack skills present

Literacy disorders (dyslexia)

Most common learning disability in children and adults

• 4 boys to one girl

Cause usually cannot be identified

Runs in families

Deficits in phonological processing

Problems with word recognition and spelling

Some children find letters, printed words, and reading incomprehensible

Reading disorder

dyslexia, developmental dyslexia, reading disability. Neurological origin

Writing disorder

dysgraphia. Motor and/or literacy disorder

Speech and language

Children are referred to SLPs for __________, not literacy problems

Multicultural considerations

Proactive intervention in minority cultures and children in poverty

Home literacy practices predict emergent literacy skills: shared book reading, maternal book reading, child’s enjoyment of reading, maternal sensitivity

Fluency

the effortless flow of speech

Disfluency

a disruption or breakdown in the flow of speech

Repetitions

My paper, my paper right there

Interjections

My paper is, um, right there

Revisions

My paper, that paper that I wrote last week is right there

Primary/core features

Largely within words

Sound repetitions

I-I-I-I want to go home

Syllable repetitions

the ba-ba-ba-baby is crying

Word or Part word repetitions

my p-p-p-paper is right here

Sound prolongations

tend to appear later in children beginning to stutter (mmmmmmy paper is right here

Silent blocks

…… the baby is crying

Secondary overt characteristics

Extraneous sounds and facial and body movements a person who stutters uses during moments of stuttering (ex. Repetitions of “uh” or “um”; eye blinks; and unusual head, hand, or other body part movements

Concomitant stuttering behaviors

they happen at the same time as the audible features

Covert reactions to stuttering

Reflect the more psychosocial impact

Risk factors for persistent stuttering

Stuttering like disfluencies differ qualitatively from normal disfluencies

Sound or syllable repetitions, tense pauses, dysrhythmic phonations

Risk factors for children to become chronic stutterers

• boys higher risk than girls

• Family history

• >6-12 months since onset and no improvements

• Age 3.5 years or beyond when disfluencies start

• Slower language development or co-occurring S and L impairment

2-6

90% of disfluencies children begging to stutter between ____ years old

Neurogenic stuttering

Stuttering caused by brain changes

Psychogenic stuttering

Stuttering caused by trauma or psychological origin

No significant differences other than respiration and heart rate increase

Are there any physical differences between stutterers and nonstutterers

Neural systems

___________ differ when stutterers are stuttering vs not stuttering.

hemisphere asymmetry

Stuttering particularly related to _______

Cluttering

a disorder of speaking rate

Speech is abnormally fast, irregular, or both

Some different disfluencies than seen in stuttering (rapid rate, sound or syllable deletion, inappropriate word segmentation)

parent interview

What happens first when a child is showing a stuttering problem

Speech sample and child interview

What is the second thing to happen when a child is showing a stuttering problem.

Quantity of stuttering

talked about in terms of a ratio. A good target is at least 100 words. Once you have a good sample the clinician can calculate the disfluency count (watching for 3% or above).

Quality for stuttering

paying attention to whether the disfluencies are within words. Are there any secondary behaviors. Stuttering severity scales can be used.

stuttering severity instrument

A tool used for identifying stuttering

Direct interviews

What happens when an adolescent or adult is experiencing stuttering

Primary prevention

When a child is at risk for stuttering, but not yet stuttering

Not direct therapy, but a prevention approach

Clinician works more with parents than with the child

Indirect treatments

Parent directed

Increasing desirable speaking behavior

Supporting easy tension, breathing, change to the communication environment

Direct therapy

Highly individualized

Relationship with clinician very important (trust, confidence, and understanding)

Potential goals addressed in direct therapy

Speaking behaviors (slow, smooth, relaxed pattern of speech)

Speaker’s reaction to their speech

Speaker’s interaction with their environment

There are some approaches that aren’t managed or conducted by SLPs. There are devices that can be used, medication, hypnotherapy, etc.

Fluency shaping

designed to modify all aspects of the client’s speaking behavior.

Train to speak with relaxed respiration, vocal folds, articulation muscles

Used with children and adults

Reduce rate, prolong vowels, slow and smooth initiation (easy onset, continuous phonation)

Stuttering modification

Designed to address individual moments of stuttering (react calmly)

Developed by Charles Van Riper

Recognize and confront fears, avoidances, and struggles

Reduce situational fears and negative attitudes

Stutter without unnecessary effort or struggle

Cancellation

pausing after stuttering and repeating the stuttered word

Pull-out

person hits that disfluency and continues

Less tension

identifying spots where there is extra tension and releasing that

Light contact

focusing on where tension is and having the articulators more lightly touch

Voice loudness

Qualitative description

Describes the sound level that is measured in decibels (the intensity)

Voice pitch

Qualitative description

Describes rate of vibration (the frequency)

Frequency is measured in hertz

Voice quality

Size and shape of oral and nasal cavities help determine the ______ of the voice

Qualitative descriptions of the voice

Hyper/hyponasality

too much or too little air flow through the nasal cavity

Breathiness

caused when space remains between the adducted vocal folds. Air passes with extra noise

Harshness

associated with excessive muscle tension

Hoarseness

voice is both breathy and harsh

Voice disorder

Any deviation of loudness, pitch, or quality

Outside the normal range for a person’s age, gender, or geographic or cultural background

Interferes with communication, draws unfavorable attention to itself, or adversely affects the speaker or the listener

Trait anxiety

anticipate threatening situations and respond with anxiety

Social anxiety

fear of social situations and interactions that brings in feelings of self consciousness, judgment, evaluation, and inferiority

Tension and secondary characteristics

Monolingual clinicians should be able to distinguish __________ of a bilingual child, even if they do not understand the child’s language

Less dominant

Amount of stuttered disfluencies often higher in _______ language

Voice

Is an integral part of communication

Is uniquely special to the individual

Can be perceived by others as unusual

Hyperfunction

excessive effort and tension (tense sounding voice and hard glottal attacks)

Hypofunction

inadequate muscle tone/tension (can affect intelligibility and endurance)

Vocal abuse

harmful acute or chronic vocal behaviors that are damaging VF and laryngeal/pharyngeal muscles and tissues (ex. Excessive yelling, screaming, cheering, coughing, hard glottal attacks)

Vocal misuse

harmful chronic vocal behaviors that have damaging effect on structure and function of laryngeal mechanism (ex. Inappropriate loudness or pitch, singing out of vocal range)

Functional voice disorders

General laryngeal anatomy is normal

Voice use contributes to a voice disorder

Can cause tissue changes impacting voice

Vocal nodes

AKA cheerleader bodes, screamer bodes, singer nodes

Harshness

Breathiness and lower pitch

Like a callus on vocal folds

Vocal polyps

Harshness, hoarseness, Breathiness and lower pitch

Like a blister on vocal folds

Can be caused by a sudden vocal trauma

Laryngitis

Hoarseness

Breathiness and lower pitch

A lot of swelling of the vocal folds

Acute laryngitis

often comes from a bacterial or viral infection or by some kind of trauma

Chronic laryngitis

impacting for over ten days. Often related to some repeated abuse or misuse issues. GERD

Voice treatment in children

• primarily physical cause - ENT involvement

• Parent counseling about abusive behaviors

  • Direct therapy usually deferred until elementary school

Hypoadduction

reduced closure of vocal folds (ex. Vocal fold paresis and paralysis)

Hyperadduction

increased closure of vocal folds

Parkinson’s disease

An example of Hypoadduction

monopitch, monoloudness, harshness, Breathiness. Voice comes across as weak sounding

Voice symptoms of Parkinson’s disease

Voice symptoms of Hyperadduction

harshness, pitch breaks, strained/strangled

Adductor

Type of spasmodic dysphonia. the vocal folds adduct involuntarily which leads to harshness. More common

Abductor

Type of spasmodic dysphonia. the vocal folds abduct involuntarily which lead to voice stoppages and breathiness

Organic voice disorders

Result of structural changes to larynx

Medical management may be necessary to treat the underlying problem

Vocal papilloma

Benign tumors that grow on the surface of the vocal folds.

Wart like growths

Caused by a virus

More common in children

Vocal carcinoma

Voice cancer/ Laryngeal cancer

Around 2% of cancer (mostly males)

Cause the voice to sound hoarse

Endoscopy

Rigid scope through oral cavity

Videostroboscopy

makes VF appear to vibrate in slow motion under a strobe light

Voice treatment for adolescents/adults

• diagnostic therapy

• Facilitating approaches (techniques)

Hygienic voice therapy

education, behaviorally oriented

Physiologic voice therapy

modifications of inappropriate physiology through exercises and shifts to speech subsystems