Praxis Study Guide

Typical Development

Linguistic Stages

Perlocutionary Period 0-8 months - unintentional communication

  • Reflexive Vocalizations 0-2 months

    • sounds reflect automatic responses of body that depend on the anatomy of the child (e.g., burping, crying, etc.)

    • nasalized vowel-like sounds w/ minimal resonance

  • Cooing 2-4 months

    • sounds made in the back of mouth

    • back vowels

  • Vocal Play 4-6 months

    • raspberries, growls, squeaks

    • begin to see CV syllables

  • Babbling 6+

    • Reduplicated Babbling - CVCV syllable chains (e.g., “dada”)

    • Variegated Babbling - CV chains (w/ variations in C’s & V’s)

Illocutionary Period 9-12 months - intentional communication

  • Emergence of Speech Patterns 9+ months

    • jargon, longer strips of variegated babbling

    • babbling is accompanied by sentence like intonation patterns

    • Phonetically Consistent Forms (PCFs)

Speech and Language Milestones

Receptive Milestones

  • Birth-3 months

    • reacts to loud sounds

    • smiles to familiar voices

    • quiets to familiar speakers

  • 4-6 months

    • recognizes changes in vocal tone

    • eyes move toward sounds

    • responds to toys w/ noise

  • 7-12 months

    • recognizes and turns to name

    • comprehension of simple words

    • plays games, listens to songs

  • 1-2 years

    • follows simple 1-step directions

    • understands simple questions

    • points to objects/pictures named

  • 2-3 years

    • follows 2-step directions

    • simples opposites (e.g., big vs. small)

    • easily comprehends new words

  • 3-4 years

    • simple concepts (e.g., colors, shapes)

    • responds to name (from other room)

    • understands family words (e.g., sister)

  • 4-5 years

    • understands order words (e.g., first)

    • understands time words (e.g., today)

    • follows longer multi-step directions

Expressive Milestones

  • Birth-3 months

    • cries for basic needs

    • begins to smile at familiar people

    • begins to make cooing sounds

  • 4-6 months

    • babbles and coos during play

    • sounds for various emotions

    • begins to laugh

  • 7-12 months

    • shows objects by pointing

    • begins to use gestures (e.g., waving)

    • first words emerge (around 12 months)

  • 1-2 years

    • begins to put two words together

    • asks simple questions

    • many new words emerge

  • 2-3 years

    • begins to put three words together

    • asks “Why?”

    • simple prepositions (e.g., in, on)

  • 3-4 years

    • puts up to four words together

    • asks “when?” & “why?”

    • simple pronouns & some plurals (-s)

  • 4-5 years

    • tells short stories, holds convos

    • code switches (based on listener, place)

    • naming of letters, numbers

Morphological Development

Brown’s Stages

  • Stage 1: 12-26 months

    • about 50 words in vocabulary

    • basic phrases

      • ex. “more juice/my doll”

  • Stage 2: 27-30 months

    • present progressive -ing

    • “in” and “on”

    • regular plural -s

      • “man running/in house/on book/my kids

  • Stage 3: 31-34 months

    • irregular past tense

    • possessive ‘s

    • uncontractible copula

      • “me drew/daddy’s hat/ her is sick”

  • Stage 4: 35-40 months

    • articles (a, the)

    • regular past tense

    • third person regular present tense

      • “the bucket/she shopped/he runs”

  • Stage 5: 41-46+ months

    • third person irregular

    • uncontractible auxiliary

    • contractible copula

    • contractible auxiliary

      • “doggy does tricks/ he was jumping/she’s happy/she’s dancing”

How do you calculate mean length of utterance aka MLU (average number of morphemes per utterance)?

MLU = total # of morphemes / total # of utterances

Normal Development: Aging Adult

White Matter → there are cortical changes

Gray Matter → volume loss

Presbycusis:

  • age-related hearing loss

  • sensorineural hearing loss

  • high frequency loss (hair cell damage)

Presbyopia:

  • age-related vision loss

  • farsightedness

  • treatment: reading glasses

Presbyphonia:

  • age-related voice changes

  • weaker, breathy voice; more breaks/stops

  • higher pitch in men, lower pitch in woman

  • reduced loudness, laryngeal tension, tremor

Presbyphagia:

  • age-related swallow changes

  • decreased strength and sensation (taste)

  • slower swallow response

  • laryngeal penetration is more common

Motor Changes:

  • general slowing of motor skills

  • voice changes

  • smaller, slower, more fatigued muscles

  • other health issues exacerbate motor

Cognitive Changes:

  • slowed processing

  • langauge typically remains intact

  • difficulty recalling new info/specific details

  • difficulty with multitasking/executive function

Normal Language Dev

Language - social, rule-governed tool used to send and receive messages

Receptive Language - language comprehension

  • listening and reading

  • develops before expression

  • understanding of langauge

  • vocabulary, questions, concepts, directions

Language Production - langauge production

  • speaking and writing

  • expression of wants and needs

  • words, nonverbal communication

  • gestures, pointing, expressions, grammar

Form:

  • Phonology - speech sounds

  • Syntax - word order

  • Morphology - word endings

Content:

  • Semantics - word meanings

  • vocabulary

  • how word meanings link

Use:

  • Pragmatics: social rules

  • matching language & situation

Theories of Development

Nature - Nativist-Generative View (Chomsky):

  • langauge is innate and pre-specified

  • we are born with LAD (acquisition device)

  • language is separate from other cognitive systems

  • Limitations:

    • non-literal langauge (i.e., idioms); strict focus on syntax; no single grammar to account for all languages

    • no evidence that children need adult-like rules to acquire language

  • Evidence supporting Nature:

    • deaf babies babble; speech ang langauge deficits may be inheritable

    • children follow sequence of developmental milestones

    • langauge aspects learned without direct instruction (e.g., grammar rules)

    • we are born with a Language Acquisition Device (LAD) which determines how we learn langauge

Nurture - Constructionist-Interactionist View:

  • environment guides language

  • no processor in brain specific for langauge

  • can’t separate langauge from cognitive systems

  • Evidence for Nurture - operant conditioning

Other Langauge Theories:

  • Cognitive Theory (Piaget) -

    • children learn langauge like other cognitive skills (concepts first, then langauge)

    • language is made possible by cognitive and other intellectual processes

    • observe child in play to determine level of representational thought

  • Semantic Theory (Filmore, Bloom) -

    • interpretation of messages requires consideration of meaning

    • acquisition stimulated by child’s desire to communicate and knowledge

  • Behavioral Theory (Skinner) -

    • children learn language through conditioning (only what they are exposed to)

    • stimulus-response drive language acquisition; Drill & practice → reinforcement

  • Social Interactionism

    • encourage social interactions; desire to communication & use drives acquisition

    • incorporate caregivers and multiple environments into learning

  • Emergentist Theory

    • data and pattern driven, child’s ability to use cues develops over time

    • neurologically based

Critical Period Hypothesis - MUST have adequate stimuli before “critical age” (5-7 years old) or full langauge command cannot be achieved

Phonology

  • shortest optimal/critical period

  • need exposure to phonology in first years of life to have native accent

Phoneme Development

  • 0-3 years: p, m, h, n, w

  • 0-4 years: b

  • 2-4 years: k, g, d

  • 2-6 years: t, ng

  • 2.5-4 years: f, y

  • 3-6 years: r, l

  • 3-8 years: s

  • 3.5-7 years: tsh, sh

  • 3.5-8 years: zj

  • 4-7 years: j

  • 4-8 years: v

  • 4.5-7 years: th voiced

  • 5-8 years: th voiceless

  • 6-8 years: dj

Phonetics

Distinctive Features

Classification: consonantal sounds (in English) are classified by 3 dimensions…

  • Voice - activity of vocal folds

  • Place - point of contact where sound is produced

  • Manner - configuration and interaction between articulators

Classification Systems

Acoustic Theory of Sound Production

  • Source-Filter Theory - sound source filtered and shaped by resonant vocal tract

    • Sound Sources: Glottal Source and Supraglottal source

    • Filter

      • Vocal Tract: Oral Tract and Nasal Tract

    • Speech Sounds: Distinctive Features

Sound Sources:

  • Sonorants - produced with uninterrupted air

  • Consonantal - partial or complete obstruction of airflow

  • Continuants - flow of air is not blocked at any point

  • Sibilants - high frequency “hissing” sounds, air forced through narrow opening

  • Stridents - production with constriction, airstream hits 2 surfaces (intense noise)

  • Obstruents - produced by some type of air obstruction/constriction

Speech Sounds:

  • Stops - complete vocal tract closure (pressure buildup) - sudden release

  • Fricatives - partial blockage of vocal tract, air forced through narrow channel

  • Affricates - start as a stop (air builds up), releases through narrow channel (fricative)

  • Nasals - Valium lowers and air flows through nasal cavity (closure of oral cavity)

  • Liquids - Airstream flows through sides of tongue (tip to mid alveolar ridge)

  • Glides - consonants with no stop or friction

Filter:

  • Bilabial - produced by using both lips

  • Labiodental - produced using both lower lip and upper front teeth

  • Interdental - tongue tip on/near/between inner surface of upper teeth

  • Alveolar - tip of tongue touches Ridge immediately behind upper front teeth

  • Palatal - front part of tongue to/near hard palate at the roof of the mouth

  • Velar - back of tongue to/near velum/soft palate

  • Glottal - produced by air passing through windpipe through vocal folds

Consonants and Vowels

Vocal Tract from most open to closed:

  1. Vowels and diphthongs

  2. Liquids and Glides

  3. Nasals

  4. Stops,fricatives and affricates

Vowels and Diphthongs - produced by selectively amplifying vocal tract

  • Produces distinctive formant patterns which listeners perceive

  • F1 and F2 are important for perception

  • Classified as: front, entral, back in high, middle, low

Liquids and Glides - produced with some constriction ( oral semi-vowels, vowel-like)

  • Liquids - /r/ palatal retroflex ; /l/ alveolar and only lateral in English

  • Glides - /j/ Palatal, High tongue ; /w/ starts high back position

Nasals - produced by occlusion of vocal tract and an open nasal port

  • Air flows through nasal cavity

  • Lower resonant frequencies; reduced intensity (nasal murmur)

Fricatives - produced by air flow through narrow constriction

  • Creates turbulent noise

  • Obstruent sounds

Affricates - produced by total occlusion of vocal tract and a slow release

  • Creates a noise burst, may also be called plosives

  • Perceived based on: frequencies of bursts and formant transitions

    • F2 and F3 (burst to vowel)

Foundations

Components of Communication

Extralinguistic:

  • Metalinguistic - study of language and relationship with other behaviors

  • Paralinguistic - communication aspects are not words (i.e., gestures)

  • Non-linguistic - sounds not relating to language (i.e., laughing)

Speech

  • Respiration - breathing, power and energy

  • Phonation - creation of voice sounds; vocal fold vibration

  • Resonation - modification of phonation; cavities and structures

  • Articulation - manipulation into distinct sounds and words

Language

  • Form

    • Phonology - sounds (no meaning attributed to individual sounds)

    • Syntax - word order (words strung together to form sentences)

    • Morphology - word endings (phoneme strings, smallest unit of meaning)

Speech Systems

Four systems of speech production:

  • Respiration - power and energy for speech; 2 phases (inhalation and exhalation_

    • Inhalation - diaphragm contracts an air rushes into lungs; abdomen expands and then chest expands

    • Exhalation - diaphragm relaxes forcing air back out of lungs

  • Phonation - rapid vibration of vocal Folds; creates acoustic energy (i.e., voice)

    • Pitch - frequency of vibration

    • Loudness - intensity of sound

    • Quality - the sound quality of voice

  • Resignation - modification of voice (i.e., by various cavities and structures)

    • Pharynx, nasopharynx, nasal cavity, oral cavity

  • Articulation - redefining and manipulating phonation into distinct sounds

    • Lips, teeth, alveolar Ridge, tongue, hard palate, soft palate/velum

Speech Science

Acoustics - branch of physics that studies properties of sounds

Acoustically

  • Fundamental frequency (Hz)

  • Intensity (dB)

  • Time

Physiologically

  • Endoscopy

  • Fluorography

  • Oral Facial sensory motor

Perceptually

  • Articulation testing

  • Listening to speech sounds

  • Spontaneous or prompted

Inertia - resistance when force is exerted upon an object

Elasticity - tendency for an object to return to its original state

Cycle - each individual vibration

  • Period - Time of one full cycle

  • Frequency - number of Cycles in one second

Amplitude - maximum displacement of particles in a medium

  • Perceptually related to intensity / loudness, not one-on-one relationship

Frequency - rate at which object vibrates; number cycles in one second (Hz)

  • Need period of wave to figure out the frequency

Pure Tones - has only one frequency

  • sinusoidal motion or simple harmonic motion

Sine Waves - periodic, cycles will repeat themselves identically

Complex Periodic Waves:

  • Complex - more than one frequency present

  • Periodic - The complex pattern repeats over time

Complex Aperiodic Waves:

  • Complex - more than one frequency present

  • Aperiodic - no cyclical or pattern behavior

Fundamental Frequency - lowest pure tone component of sound

Partials / Overtones - all other frequencies present in a sound excluding fundamental

Harmonics - whole number multiples of fundamental frequency

Anatomy and Physiology

Anatomical Terms

Nerves - axons bound together by connective tissue

  • Group of fibers outside the CNS

  • Spinal nerves contain fibers of sensory and motor neurons

Neurons - individual cells in the brain (dendrites, axons, cellbody)

Tracts - group of fibers inside the CNS (spinal tracts carry info up/down the spinal cord, to and from the brain)


Efferent - motor nerve

  • brain sends signal down to the nerve to innervate a muscle (exits)

Afferent - sensory nerve

  • signal comes up from sensory organ via nerve to brain (arrives)


Pyramidal - tracts that originate in cerebral cortex carry fibers to spinal cord/brainstem

  • voluntary control (body and face muscles)

Extrapyramidal - tracts that originate in the brainstem carry fibers to spinal cord

  • involuntary & automatic control (tone, balance, posture, etc.)


Upper Motor Neuron (UMN) - found in cerebral cortex/brainstem

  • transmits nerve impulses from brain to lower motor neurons

Lower Motor Neuron (LMN) - found in brainstem/spinal cord

  • transmit nerve impulses from upper motor neurons to muscles


Corticospinal - synapse/terminate in spinal cord

  • controls movements in limbs & trunk

  • corticospinal - spinal cord

Corticobulbar - synapse/terminate in brainstem

  • controls muscles of face, head, neck

  • corticobulbar - brainstem


Positional Terms

  • Unilateral - one side innervating

  • Bilateral - both sides innervating

  • Ipsilateral - same side of the body

  • Contralateral - opposite side of the body

  • Proximal - near given position

  • Distal - away from given position

  • Anterior - in front of

  • Posterior - behind

  • Superior - above

  • Inferior - below

  • Rostral - front, towards the nose

  • Caudal - back, towards the tail

Nervous Systems

Look at page 32 and 33

The Human Brain

What are the major divisions of the brain? Forebrain, Midbrain, Hindbrain (p. 34)


Forebrain - processes sensory info, reasoning/problem solving, automatic motor functions; largest brain division; has two subdivisions

  • Telencephalon - cerebral cortex (divided into 4 major lobes)

    • Frontal, Parietal, Temporal, Occipital

  • Diencephalon - connects endocrine with nervous system

    • Thalamus, Hypothalamus, Pineal Gland


Midbrain - regulates movement, processes auditory and visual info

  • connects forebrain to the hindbrain; 2 main parts: Tectum & Paired Cerebral Peduncles


Hindbrain - regulates autonomic functions, balance, equilibrium, relay of sensory info

  • 2 Subdivisions:

    • Metencephalon - pons and cerebellum

    • Myelencephalon - medulla oblongata


  • Cerebrum - thinking portion of the brain; most complex cognitive functions

    • Location - front area of skill, composed of two hemispheres (left/right)

  • Brainstem - automatic reflexes/vegetative functions (e.g., breathing, heart rate, etc.)

    • base of brain-cerebrum juncture + spinal cord; midbrain, pons & medulla

  • Cerebellum - voluntary movements; balance, coordination, posture, attention

    • hangs off back of brainstem under occipital lobe

  • Medulla - regulates respiration, heart rate + reflexes such as vomiting, swallowing

    • lower portion of brainstem, below pons

  • Pons - attachment between cerebellum and rest of CNS

    • middle portion of brainstem

  • Midbrain - houses substantial nigra (production of neurotransmitter - dopamine)

    • upper (superior) most part of brainstem

  • Basal Ganglia - fine0tunes voluntary body movements, motor coordination, posture

    • deep within body vertebral column, PNS begins here

  • Spinal Cord - allows afferent impulses to transmit to brain + efferent from brain→body

    • housed within body vertebral column, PNS begins here

  • Thalamus - relay center for sensory signals; and also motor

    • top of brainstem; core of diencephalon

  • Hypothalamus - homeostasis, regulates hunger/thirst, pain/pleasure, anger/aggression

    • below thalamus; posterior to optic chiasm

  • Hippocampus - responsible for new memories, emotions, spatial navigation

    • within inferior and medial section of temporal lobe

  • Amygdala - responsible for emotions, arousal, motivation

    • Nuclei, located within temporal lobes

  • Heschl’s Gyrus - auditory processing

    • Brodmann area 41

  • Angular Gyrus - involved in semantic processing, language and cognition

    • area 39


Neuroanatomy

  • Frontal lobe - primary motor area, controls executive function + motor

    • Broca’s area (speech production), memory, attention, motivation

  • Parietal - sensory motor area

    • spatial reasoning, math, reading, hearing, smell, taste, touch

  • Occipital - visual area

    • receives visual cues from opposite visual field, color identification

  • Temporal - auditory processing and comprehension

    • Wernicke’s area (language comprehension/processing), memory

  • Left Hemisphere - language dominant hemisphere

    • damage here can cause Aphasia

  • Right Hemisphere - supporting language hemisphere

    • damage here can cause higher-order language and perceptual damage

Blood Supply

  • Circle of Willis - connects the internal carotid and vertebral/basilar system

  • Anterior Cerebral Artery - extends upward and forward from internal carotid artery

    • blood supply to → frontal & parietal lobes, basal ganglia, and corpus callosum

      • stroke in ACA can cause opposite leg weakness

  • Middle Cerebral Artery - largest branch of internal carotid

    • blood supply to → Broca’s and Wernicke’s, temporal lobe, and primary motor cortex

      • MCA is the artery that is most often occluded in a stroke

  • Posterior Cerebral Artery - stem from basilar artery (in most people)

    • blood supply to → occipital lobes, cerebellum, and inferior temporal

      • CVA PCA: usually 2* to embolism from lower segments of vertebral heart

Connecting Fibers

  • Commissural Fibers - inter hemispheric (connects right ad left hemispheres)

    • interconnect identical and corresponding area of 2 cerebral hemispheres

  • Association Fibers - intra hemispheric (within the same hemisphere)

    • connect different regions of the cerebral cortex within same hemisphere

  • Projection Fibers - fibers that leave cerebral white matter

    • connect cerebral cortex to the brainstem and below

Cranial Nerves

There are 12 Cranial Nerves → but there are 6 main important Cranial Nerves needed for speech

  • Cranial Nerve 5 Trigeminal

    • Origin → pons

    • Sensory - sensation for face, lips, jaw

    • Motor - muscles for mastication

  • Cranial Nerve 7 Facial

    • Origin → pons

    • Sensory - taste (anterior 2/3 of tongue)

    • Motor - lips, facial movement, expression

  • Cranial Nerve 9 Glossopharyngeal

    • Origin → medulla

    • Sensory - taste (posterior 1/3 of tongue)

    • Motor - pharynx movement (superior portion)

  • Cranial Nerve 10 Vagus

    • Origin → medulla

    • Sensory - larynx, pharynx, abdominal viscera

    • Motor - larynx, pharynx, velum movement

  • Cranial Nerve 11 Accessory

    • Origin → medulla and spinal cord

    • motor - shoulder, neck, also assists vagus nerve movement

  • Cranial Nerve 12 Hypoglossal

    • Origin → medulla

    • motor - tongue movement

Muscles of Mastication

There are four groups of muscles responsible for chewing:

  • Masseter Muscle - connects mandible and cheekbone

    • elevates mandible and closes the mouth

  • Temporalis Muscle - large, fan-shaped muscle

    • retracts and elevates mandible, side to side movement

  • Medial Pterygoid - connects mandible with maxilla, sphenoid, and palatine bones

    • elevates mandible and protrudes the jaw

  • Lateral Pterygoid - two-headed muscle located in infra temporal fossa of skull

    • depresses and protrudes mandible to open mouth


The Elevator Muscles are… Masseter, Temporalis, Medial Pterygoid

Respiratory System

  • Respiration - gas exchange; the process of inspiration and exhalation

  • Lungs - porous, spongy organ of breathing located in thoracic cavity

  • Skeletal Structure - vertebral column

  • Vegetative Breathing - goal of life is sustenance, automatic and consistent

  • Speech Breathing - expiration more important than inspiration, speak on exhale

  • Ventilation - the process of inspiration and expiration


Process of Inspiration

→ air enters the lungs

→ contraction of inspiratory muscles

  • diaphragm contacts and pulls downward

  • external intercostal muscles contract

  • thoracic cavity expands

    • volume increases/pressure decreases

  • Air rushes into the lungs

    • through nose/mouth, down pharynx (between open vocal folds) → down through trachea → into the lungs


Process of Expiration

→ air exits the lungs

→ relaxation of inspiration muscles

  • diaphragm relaxes and rises

  • internal intercostal muscles relax

  • thoracic cavity collapses

    • volume decreases/pressure increases

  • air rushes out of the lungs

    • lungs recoil, chest wall returns back to its original state, and air expelled out of lungs

Phonatory System

Larynx - organ at the top of the neck involved in breathing, sound production, and aspiration prevention


Regions / Cartilages of the Larynx

  • Supraglottis (area above the vocal folds)

    • Cricoid - most inferior cartilage, ring-shaped; unpaired cartilage

    • Arytenoid - only paired major cartilage

  • Glottis (contains true vocal folds)

    • Thyroid - largest cartilage, Adam’s apple; unpaired cartilage

    • Corniculate - attach to apex of arytenoid cartilages; paired cartilage

  • Subglottis (area below the vocal folds)

    • Epiglottis - leaf shaped, protects airway during swallow; unpaired cartilage

    • Cuneiform - does not attach to any other cartilages (paired cartilage)


Muscles of the Larynx:

  • Extrinsic Muscles

    • Suprahyoid and Stylopharyngeus → elevate the larynx

    • Infrahyoid → depresses the larynx

  • Intrinsic Muscles

    • Posterior cricoarytenoid → VF ABduction

    • Lateral Cricoarytenoid, Transverse Arytenoid, Oblique Arytenoid, Cricothyroid, Thyroarytenoid → VF ADDuction


Vocal Folds (VF) - modulate the flow of air being expelled from the lungs during phonation

  • muscles do not actually vibrate → aerodynamic forces do → air pressure is the primary force

  • There are 3 pairs of vocal folds:

    • True Vocal Folds

    • Aryepiglottic Folds

    • Ventricular (False) Folds


Vocal Fold Vibration (one complete cycle)

  1. vocal folds are adducted (closed), air pressure builds up below them

  2. as air pressure rises, bottom of folds are forced apart

  3. pressure the forces folds apart at middle, then at top, until air freely flows

  4. presure decreases

  5. as pressure decreases, folds move toward midline (bottom first and top last)

ex. A complete cycle of vocal fold vibration is like a set of swinging doors. As pressure builds behind them (air pressure), the bottom opens first, followed by the middle and top, until they're fully open and air flows through. When the pressure drops, the doors swing back, closing from the bottom to the top, repeating the process.


  • Aryepiglottic Folds - tips of arytenoids to the larynx; separates laryngeal vestibule from pharynx

  • Velopharyngeal Closure - contraction of… Palatoglossus, Tensor Veli, Palatini, Levator Veli Palatini

  • Bernoulli Effect - change in pressures that pull vocal folds together caused by Bernoulli Effect; speed of air increases and “sucks” vocal folds towards one another → closure of folds

  • Mucosal Wave - wave-like motion of vocal fold cover; necessary for vibration → phonation

Head and Neck

  • Soft Palate - mobile flap of soft tissue; elevated during swallow to prevent food from entering nasopharynx

  • Pharynx - part of digestive + respiratory systems; connects nose, mouth, and throat

  • Nasopharynx - upper part of pharynx; connects nasal cavity and throat

  • Oropharynx - middle part of pharynx; starts at soft palate and goes down to base of tongue

  • Laryngopharynx - lower part of pharynx; above larynx and below oropharynx

  • Epiglottis - leaf-shaped flap; flaps to cover glottis of larynx during swallow; main function is to prevent aspiration

Professional Practice

Research Designs

Between-Subject Designs - performances of separate groups of subjects are measured and comparisons are then made between the two groups

  • Subject-Randomization - each subject has equal probability of being assigned to either the experimental or control group

  • Subject Matching - experimenter purposely attempts to match members of two groups based on all extraneous variables relevant to the experiment


Within-Subject Designs - performances of same group is compared in different conditions and/or in different situations; sequencing effect may occur

  • Subject Randomization - presentation of the experimental treatment conditions to the subjects in random order

  • Counterbalancing - technique that enables researcher to be able to control and measure sequencing effects by testing different participants in different orders


Sequencing Effect - may occur when subjects participate in several conditions (i.e., subjects participation in an earlier condition may affect their performance in subsequent)

Sampling Methods

Sampling Method - a technique of selecting individuals or a group of individuals from a population to use in research studies (probability and non-probability samples)


Probability Samples:

  • Simple Random Sampling - every member of population chosen randomly and has an equal chance

  • Systematic Sampling - sample members are chosen at regular intervals every nth member

  • Stratified Random Sampling - population divided into subgroups before random selection

  • Cluster Sampling - population divided into clusters based on demographics (e.g., location)

  • Multistage Sampling - every member of population chosen randomly and has an equal chance


Non-Probability Samples

  • Purposive Sampling - specific individuals are chosen to participate

  • Convenience Sampling - depends on ease of access and proximity

EBP: Levels of Evidence

What are the key steps to EBP?

  1. Frame clinical question

  2. Find the evidence

  3. Asses the evidence

  4. Make clinical decision


Informed Clinical Decisions:

  • internal clinical evidence

  • external research evidence

  • patient preferences


Credibility of Evidence levels and Types

  • Level 1 - systematic review/meta-analysis of all relevant RCTs; 3+ good quality randomized controlled trials with similar results

  • Level 2 - 1+ well designed randomized controlled trial(s)

  • Level 3 - well designed non-randomized quasi-experimental studies

  • Level 4 - well designed case-control or cohort studies

  • Level 5 - systematic reviews of descriptive and qualitative studies

  • Level 6 - single descriptive or qualitive study

  • Level 7 - expert opinion and/or reports of expert committees

ICF: International Classification

ICF - International Classification of Functioning, Disability, and Health → developed by the World Health Organization (WHO) and published in 2001

Epidemiology

Standardized Testing

Diagnostics

Speech and Language

Screening can involve…

  • Articulation and phonology

  • language and cognition

  • fluency and stuttering

  • voice and resonance

  • motor speech

  • neurogenic disorders

  • dysphagia and swallowing disorders


Assessment can involve…

  • case history

  • interview

  • oro-facial exam

  • informal testing

  • hearing screening

  • ongoing evaluation

  • formal standardized testing


What does a Case History entail? Medical and personal background history used to analyze & diagnose diseases, disorders, etc.

What do we want to know?

  • Onset and Development

    • age of onset

    • other conditions during onset

    • length since onset

    • variations since onset

    • awareness and reactions of onset

  • Medical History

    • history of hospitalizations

    • history of surgeries

    • medication list

    • vision, hearing, and motor abilities

  • Family History

    • blood relatives history of any related SLP conditions

  • Speech-Language Disorders and Concerns

    • previous speech/language therapy and outcomes

    • reason for SLP referral

  • Educational and Social History

    • highest level of education

    • jobs and/or hobbies

    • primary, secondary language(s) spoken

  • Prior Level of Function

    • if new (e.g., acute CVA) or not new onset

    • change(s) in function from baseline

    • who patient lives with, ADLs, daily communication needs, etc.

  • Signs and Symptoms → identify signs and symptoms such as…

    • difficulty chewing and/or swallowing

    • difficulty expressing self and/or understanding langauge

    • problems with memory a/o problem solving/reasoning

    • problems w/ attention a/o concentration

    • problems w/ reading a/o writing

    • difficulty w/ word retrieval and word finding

    • difficulty w/ topic maintenance and following directions


Speech and Language Sampling - provides diagnostic information and guides treatment plans

Analyzing the sample →

  • articulation errors and distortions

  • rate of speech

  • language errors and pattern of errors

  • speech intelligibility


Expressive Language

  • Morphology, Semantics, and Syntax

    • point to more than one of an object (plurals)

    • follow oral directions (varying # of steps)

    • verbalize/gesture serial tasks (e.g., counting)

    • name objects, pictures, etc.

  • Semantics/Syntax

    • identify spatial concepts (E.g., over/under)

Receptive Language

  • Morphology, Semantics, and Syntax

    • describe pictures

    • describe and tell stories

    • describe objects by features or relationships

    • explain sequence of events for daily tasks

    • role play scenarios

    • describe solutions to problems or situations


Kindergarten - 1st grade

  • Delve deeper into langauge pyramid

    • phonology, morphology, semantics, syntax in expressive and receptive language

    • analysis used for younger children will applies except for MLU (not valid after the age of 5 yrs./o.)

    • C-Unit analysis - conversational analysis for school aged

    • T-Unit monologue analysis for school aged


Older children

  • Analyze more global measures

    • receptive/general comprehension (listening and reading, expressive (pragmatics)

    • evaluation of pragmatics

      • appropriate attention of prosody

      • topic initiation and maintenance

      • conversational repairs and turn taking

    • evaluation of narratives

      • personal narratives, retelling stories, appropriate sequencing and details, etc.

Articulation and Phonology

What do we want for a comprehensive assessment?

  • Case History

  • Hearing Screening

  • Oral Facial Sensory Motor Exam (OFSME)

  • Formal Assessment

    • Standardized methods

      • Popular assessments:

        • Goldman-Fristoe Test of Articulation (GFTA-3)

        • Khan-Lewis Phonological Analysis (KPLA)

  • Informal Assessments

    • Identify strengths and weaknesses

    • Speech-language sample

      • Phonetic Inventory

        • explain which position(s) sound was seen during testing

        • assess and identify stimulable sounds

      • Speech Intelligibility

        • 24 mo: 50%

        • 36 mo: 75%

        • 48 mo: 100%

      • Rate and prosody

      • Number, type, and consistency of errors (classify based on most appropriate system)

        • Traditional SODA errors

          • substitutions

          • omissions

          • distortions

          • additions

        • Features

          • voice

          • place

          • manner

        • Phonological processes

          • typical vs atypical

          • typical vs typical but no longer age-appropriate

    • Evaluate etiology of articulation and phonological disorders

      • Organic (known physical cause) - e.g., cleft lip/palate, cerebral palsy

      • Functional (no known physical cause)

      • Unknown etiology

Language and Cognition

What do we want from a comprehensive assessment?

  • Case History

  • Hearing Screening

  • Oral facial sensory motor exam

  • Formal assessment

    • Expressive and receptive formal assessments

  • Informal assessment

    • Cognitive assessment

      • Piaget’s stages of cognitive development

      • Effective communicator profiles

    • Language assessment

      • Will depend based on communication level

    • Speech and language sampling

      • Analyze sample

      • Calculate mean length of utterance (MLU)

      • Calculate rate of speech (count # of words per minute)


Communication level

  • Prelingual/Nonverbal

    • Expressive language:

    • Receptive language:

  • Single-word user

    • Expressive langauge:

    • Receptive language:

  • Multi-word user

    • Expressive langauge:

    • Receptive language:

Fluency and Stuttering

Formal Analysis for FLUENCY

  • Severity Scale - assess degree of impairment

  • Covert Scale - assess degree of emotional component

  • The Overall Assessment of the Speaker’s Experience of Stuttering (OASES)

  • Test of Childhood Stuttering (TOCS)


Informal Assessment for FLUENCY

  • Determining the development of typical dysfluencies vs. a fluency disorder

    • Stuttering

      • irregular repetitions, prolongations, blocks that include secondary behaviors

      • person is usually aware of their dysfluency

    • Cluttering

      • rapid/irregular rate of speech, abnormal disfluencies, reduced intelligibility

      • individual is usually UNAWARE


Assessment of a YOUNG CHILD (2-6 yrs./o.)

  • Purpose → to determine if the child will need speech-language tx.

    • identify normal vs. abnormal fluencies

    • identify likelihood of recovery without therapy

  • Comprehensive Assessment

    • case history, speech sample, observation, and other speech-language comorbidities

    • speech and language sample:

      • type/frequency of disfluencies

      • duration of disfluencies

      • rhythm and rate of speech

      • secondary behaviors

      • parent interactions and reactions

      • awareness to stuttering/disfluencies


Assessment of an OLDER CHILD/ADULTS (7+ yrs./o.)

  • Purpose → to gather comprehensive information (i.e., nature/impact) of the disorder

    • identify readiness

    • identify desire for therapy

  • Comprehensive Assessment

    • case history, speech sample, observation, and other speech-language comorbidities

    • speech and language sample:

      • type/frequency of disfluencies

      • duration of disfluencies

      • rhythm and rate of speech

      • over features (core vs. secondary)

      • core behaviors (involuntary)

      • secondary behaviors (voluntary → but then turns into learned behaviors)

Voice and Resonance

Informal Assessment

  • Determine etiology

    • Team approach (refer to ENT for structure and SLP treats function)

      • Organic: problem w/ structure (e.g., cancer)

      • Neurogenic: innervation to structure impaired/damaged (e.g., VF paralysis)

      • Functional: non biological; behavioral/psychogenic (e.g., muscle tension)

  • Analyze conversation

    • Characteristics based on acoustic and perceptual factors

      • pitch, loudness, quality


Pitch

  • Acoustic evaluation

    • determine pitch

    • fundamental frequency

  • Perceptual evaluation

    • mono pitch, restricted range

    • excessive pitch variability

    • diplophonia, pitch breaks

Loudness

  • Acoustic evaluation - measure intensity level

  • Perceptual evaluation

    • lack of voice; range of loudness

    • inappropriate (soft/loud/monotone)

    • phonation breaks

Quality

  • Acoustic evaluation

    • jitter (frequency)

    • shimmer (amplitude)

    • s/z ratio

  • Perceptual evaluation

    • breathy

Resonance

  • Hypernasal - too much air going through nasal cavity

  • Nasal emission - look for pressure consonants

  • Hyponasal - not enough air going through nasal (i.e., sounds like a cold)

Respiration

  • type of breathing patterns → diaphragmatic, clavicular

  • stridor: VF paralysis may be present

  • number of words per minute (6 or less may indicate a problem)

  • maximum phonation time: sustained vowel

  • rate: words per minute, perceptual judgement of rate

Motor Speech

Neurogenic Disorders

Dysphagia and Swallowing

Etiologies

Functional Vs. Organic

Articulation and Phonology

Classifying Errors

Speech Sound Disorders

Phonological Processes

Language and Cognition

Disorder, Delay, Difference

Multicultural Differences

Neurogenic Communication

Disorders, Terms and Definitions

Damaged Regions

Aphasia Types

Dysarthria Types

Dysphagia and Swallowing

Physiology

Swallowing Disorders

Screening and Assessment

Treatment

Fluency and Fluency Disorders

Normal vs. Disordered

Stuttering and Cluttering

Voice and Resonance

Disorders

Voice Diagnostics

Voice Characteristics

Auditory System

Anatomy and Physiology

Audiometric Testing

Audiogram

Tympanometry

Genetics

Syndrome, Sequence, Association

Craniofacial Malformations

Disorders

Cerebral Palsy

Autism Spectrum Disorders

ASD Red Flags

ASD Speech and Language

Tracheostomy and Laryngectomy

Tracheostomy

Laryngectomy

Assistive Technology

AAC and Communication

SLP Service Delivery

Counseling and Legislation

Documentation and IEP

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