CSD Final Exam

The pyramidal tract is the direct pathway to the brain in the CNS TRUE

Dysarthria is a neurological condition including having an impaired ability to plan or program motor commands needed for speech FALSE (APRAXIA)

Aspiration is used to describe food or liquid that enters the airway and reaches below the vocal folds TRUE

Difficulty protecting the airway when drinking liquids refers to an impairment to the oral transit phase FALSE (PHARYNGEAL)

Assessing an individual hearing loss only requires determining the decibel threshold FALSE (DECIBELS AND FREQUENCY)

The primary treatment for conductive hearing loss is amplification via hearing aids TRUE

A common cause sof hearing loss in young children is otitis media TRUE

Intact cognitive abilities are necessary for individuals to use an AAC system FALSE

Normal conversation typically occurs around 60 dB

The most common type of dysarthria for an individual with Parkinson's disease is hypokinetic dysarthria (lack of movement)

An individual with dysplasia may require advanced diagnostic imaging such as Videofluoroscopic Swallowing Study (VFSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Audiologic assessment that directly stimulated the cochlea BONE CONDUCTION

STRAINED, STRANGLED SOUNDING VOICE is not associated with flaccid dysarthria

The middle ear is TYMPANIC MEMBRANE ANS OSSUCULAR CHAIN

The pharyngeal phase of swallowing is AUTOMATIC

Loud noise can cause conductive hearing loss FALSE

Oral Preparation Phase

• Mastication (chewing) and forming bolus

Oral Transit Phase

• Bolus moves from the front of the mouth to the back of the mouth

Pharyngeal Phase

• Velum raises and covers the nasal cavity

• Epiglottis covers airway

Esophageal Phase

• Bolus enters the esophagus

• Wave-like contractions that help to get the bolus down the esophagus into the stomach

Hearing loss in Children

• Profound hearing loss results in no access to speech sounds without amplification

• All degrees of hearing loss interfere with ability to do well in school, academically, and socially

~Children with mild hearing loss have more difficulty in challenging listening environments

~Have to rely more on memory and attention abilities

• Greater risk for delays in phonological development

• Unilateral hearing loss results in difficulty localizing and hearing sound in noise

• Children with profound hearing loss do better when the loss is diagnosed and amplified early

Dysarthria

Flaccid Dysarthria

• Damage to the cranial or spinal nerves in PNS

Physical characteristics

• Weakness or muscle atrophy

• Flaccidity (hypotonia)

• Fasciculations

• Hypoactive gag reflex

Perceptual characteristics

• Nasal-sounding speech

• Rapid deterioration of performance

• Short phrases

• Breathy voice

• Imprecise AMRs/SMRs

Spastic Dysarthria

• Often resulting from damage to the cerebral cortex-pyramidal system, CNS

• Increased or hyperactive muscle tone

Physical characteristics

• Increased muscle tone (hypertonia)

• Hyperactive gag reflex

Perceptual characteristics

• Slow speaking rate

• Strained or hard vocal quality

• Slow but regular AMRs/SMRs

• Common causes:

~Cerebral palsy or other conditions where brain damage occurs

~ALS

~Stroke

Ataxic Dysarthria

• Damage to cerebellum

• Cerebellum = coordination

Physical characteristics

• Tremors

• Poor coordination in jaw, face, tongue

Perceptual characteristics

• Excess and equal stress

• Excessive loudness

• “Drunk” speech

• Irregular AMRs/SMRs

• Common causes:

~Lesions to the cerebellum (stroke, tumor, etc.)

~Can be seen in cerebral palsy

Hypokinetic Dysarthria

• Damage to the basal ganglia, which controls movement, and extrapyramidal tract

Physical characteristics

• Masked facial expression

• Resting tremors

• Reduced range of motion

• Rigidity

Perceptual characteristics

• Monopitch

• Monoloudness

• Short rushes of speech

• Reduced loudness

• Rapid, “blurred” AMRs/SMRs

• Common causes:

Parkinson’s disease

~Chronic, progressive neurological condition that causes problems with voluntary movements

~Decreased dopamine production in the basal ganglia

~Early signs: tremor, stiffness, slow movements

~Later signs: poor balance, speech and swallowing difficulties, slow movements, poor gait, possible dementia

~Second most common degenerative brain condition

Hyperkinetic Dysarthria

• Damage to the basal ganglia and extrapyramidal tract

Physical characteristics

• Cannot inhibit unwanted movement

• Motor tics

• Sudden, involuntary jerking

Perceptual characteristics

• Excessive loudness

• Transient vocal strain and/or breathiness

• Inappropriate vocal noises

• Fast speaking rate

• Sudden changes to pitch

• Irregular AMRs/SMRs

• Common causes:

Huntington’s disease

~Rare, inherited condition passed down from a parent (50% change)

~Symptoms begin in 30s or 40s most commonly

~Characyerued primarily by movements that can’t be controlled, called chorea → increase in dopamine

~Invoulantary movements affecting all muscles of the body notably the arms, legs, tongue, and face

~Symptoms: muscle contractures, trouble walking and with posture, speech and swallowing difficulties

~Also common to have cognitive and mental health impairments

• One of the most common tasks a therapist will ask their patient to do is called diadochokinetic rate:

~Pa-pa-pa-pa-pa

~Ta-ta-ta-ta-ta

~Ka-ka-ka-ka-ka

~Then combined: pataka-pataka-pataka

~All sounds are stop sounds, all sounds require a different part of the mouth to make them

~Alternating motion rate (AMRs) (pa-pa-pa)

~Sequential motion rate (SMRs) (pataka)

Types of AAC

No-tech AAC

• Do not involve technology 

• Use readily available materials

~Paper and pencil for writing

~Alphabet boards

~Picture Exchange Communication System (PECS)

Low tech AAC

• Simple to use technology

• Limited number of pragmatic functions

• Few moving parts or electrical components

~BIGmack

~Quicktalker 1

Mid tech AAC

• Have some amount of electrical power

• Have speech generation capabilities but limited programming or customization options

~Go Talk 20+

High tech AAC

• Most complex and sophisticated electronic devices

• Requires training to operate programmatic features

• Often uses work prediction software to improve communication efficiency

~iPads

~Tobii Dynavox

• Systems will only continue to advance

Audiology

• Conductive hearing loss: outer and middle ear

• Sensorineural hearing loss: inner ear (cochlea/auditory nerve)

• Mixed hearing loss: both conductive and sensorineural loss

Anatomy of the Hearing System

• Can be divided into the outer ear, middle ear, inner ear, the vestibulocochlear nerve, the auditory brain stem, and the auditory cortex of the brain

~The first four areas are the peripheral auditory system

~The latter two make up the central auditory system