SLP Lecture

What is SLP ?

  • impairments and functional limitations in:

    • speech and language production

    • aural rehab

    • voice production

    • cognitive-linguistic skills

    • general communication abilities

    • swallowing function (dysphagia)

    • compensatory communication abilities

  • medically necessary to help restore functional speech, swallowing and language following onset of impairment

  • abilities may have been impaired as a result of disease, injury, developmental delay or surgical procedure

Left vs Right Hemisphere

  • Left side is more language skills

  • Right side is more higher level cognitive skills

Aphasia

  • typically happens after stroke or head injury which can lead to language barrier

  • is a condition that can rob a person of the ability to communicate

  • does not lower or change IQ

  • injury to L cerebral hemisphere: frontoparietal region

  • pt is aware but has trouble communicating

  • can affect all areas of language

  • Types

    • Fluent (receptive difficulty): poor comprehension; words may lack meaning

      • understands sometimes

    • Non-Fluent (expressive difficulty): good comprehension; difficulty finding words (Broca’s)

    • Global: significant deficits in both receptive and expressive aphasia (Wernicke’s)

Left Hemisphere Injuries

  • a person w/ aphasia may:

    • speak in short or incomplete sentences

    • speak in sentences that don’t make sense

    • sub sounds or words for another (paraphasia)

    • may or may not recognize errors

    • speak unrecognizable words (word salad)

    • not understand directions or conversations

    • write sentences that don’t make sense

    • not be able to read or identify pictures (depending on level of disability)

A: ask simple, direct questions

P: provide multiple communication options

H: help communicate if asked

A: acknowledge frustration

S: speak slowly and clearly

I: if you don’t understand, say so

A: allow extra time to respond

Apraxia

  • motor speech disorder, associated w/ L hemisphere damage

  • characterized by impaired planning and programming of sensorimotor movements for speech

    • mis-articulation

    • decreased rate of speech

    • repeated attempts to correct incorrect productions

    • difficulty stringing syllables together in appropriate order to make words

    • difficulty with complex or longer words

    • NOT muscular weakness

    • can be developmental or acquired

  • Oral Apraxia: difficulty with volitional “smiling” “kissing” “puckering”

    • more difficulty w/ on command

    • spontaneously w/o prompt is easier

  • delays w/ fine and gross motor skills

  • Ideational Apraxia: using a fork to comb hair

Dysarthria

  • condition w/in the muscles used for speech are weak or you have difficulty controlling them

  • characterized by slurred or slow speech that can be difficult to understand

  • MUSCLE WEAKNESS

  • reduced movement

  • inability to speak louder than a whisper OR speaking too loudly

  • rapid speech - difficult to understand

  • nasal, raspy or strained voice

Auditory Processing or Comprehension

  • difficulty following simple, multistep or complex directions

  • difficulty multi-tasking in auditory situations; like taking notes while listening

  • spelling, reading, writing

  • difficulty following conversation on the phone

  • difficulty with rapid speech

  • social issues and difficulty reading others

Cognition

  • identification of knowledge, ability to understand it and ability to perceive it

  • 8 CORE Cognitive Capacities

    • sustained attention

    • response inhibition

      • ability to suppress actions that inappropriate in a given context and interfere w/ goal driven behavior

    • Speed of information processing

    • Cognitive flexibility and control

    • Multiple Simultaneous Attention

      • ability to multi-task successfully

    • Working memory

      • focuses on memory in-action

      • ability to remember and use info while in the middle of activity

    • Category formation

      • ability to organize info, concepts and skills into categories

    • Pattern Recognition

      • making the connection btwn memories and information perceived = identification

Executive Functions

  • set of mental skills: inhibitory control, working memory and mental flexibility - makes self control possible

  • Range of skills include:

    • planning and organizing

    • concentrating and focus

    • analyzing and processing information

    • controlling emotions and behavior

    • remembering details

    • managing time

    • multi-tasking and problem solving

  • People w/ executive function issues may have these symptoms:

    • trouble controlling emotions or impulses

    • problems w/ starting, organizing, planning or completing tasks

    • trouble listening or paying attention

    • STM issues

    • inability to multi-task

    • socially inappropriate behavior

    • difficulty learning or processing new info

Attention

  • Selective: focusing on 1 thing at a time

  • Divided: focusing on 2 or more events at once

  • Sustained: focusing for extended period of time

  • Executive: focusing on completing steps to achieve a goal

    • paying better attention —> better memory

Memory

  • attention deficits can negatively affect memory and recall

  • person may experience impairments in:

    • language

    • communication

    • focus

    • reasoning

Mild Cognitive Impairment (MCI)

  • forgets things more often: appointments and social engagements

  • loses train of thought or thread of convo, books or movies

  • increasingly overwhelmed by making decisions, planning steps to accomplish tasks or understanding instructions

  • trouble w/ pathfinding

  • become more impulsive or has increasingly poor judgement

  • depression, anxiety, frustration, irritability and aggression

Dysphagia

  • certain conditions can weaken throat muscles, making it hard to move food to swallow

  • person may choke, gag or cough when swallowing or have aspiration

  • aspiration can lead to pneumonia which could lead to death

  • symptoms to look out for:

    • drooling

    • food/liquid remains in mouth after swallowing

    • inability to maintain lip closure, leading to food/liquids leaking from mouth

    • food/liquids leak from nose

    • complaints of food “sticking”

    • globus sensation or c/o “fullness” in neck

    • painful swallowing (odynophagia)

    • wet/gurgling voice quality during or after eating/drinking

    • coughing

    • SOB after eating/drinking

    • difficulty coordinating breathing and swallowing

    • recurrent aspiration pneumonia

    • weight loss (sweet is last taste bud to go) or dehydration (#1 reason people get admitted to the hospital)

Voice

  • causes of voice problems:

    • strokes (vocal cord paralysis)

    • aging (presbylaryngeus)

    • neurological (brain injuries, PD and many others)

    • cranial nerve X damage (surgeries to head/neck/chest)

    • head and neck cancer (radiation)

    • prolonged intubation (bowing of the VF or granulomas)

    • GERD (ALANA)