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181 Cards in this Set
- Front
- Back
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What are six organic and neurogenic speech disorders?
A CC DD H |
apraxia of speech in adults
cerebral palsy cleft lip and palate developmental (childhood) apraxia of speech dysarthria hearing impairment |
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What is apraxia of speech?
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a motor programming disorder resulting from neurological damage
muscles normal but have difficulty with volitional movement |
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How do you test for oral apraxia?
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have patient try to imitate oral movement
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What are the three types of apraxia?
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oral (volitional mouth movement)
limb verbal |
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What is a symptom of limb apraxia?
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wide-based gait
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What are characteristics of apraxia? (8)
AAAA HMRV |
anticipatory substitutions
articulation errors (mainly distortions, then substitutions, omissions) automatic speech less affected than volitional speech aware of the speech problem highly variable speech errors metathetic errors regressive substitutions volitional sequencing of movements for speech are notably affected |
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What is the difference between automatic speech and volitional speech?
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automatic speech consists of words not directly under the control of person's conscious mind, and are spoken without thought (days of the week, counting)
volitional speech requires active thought |
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What is anticipatory substitution?
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a phoneme that occurs later in a word affects one that occurs earlier
pospital for hospital |
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What is regressive substitution?
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a phoneme that occurs earlier in a word affects one that occurs later
tatle for table |
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What are metathetic errors?
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switched position of phonemes in words
tephelone for telephone |
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Developmental Apraxia of Speech (DAS) is also called
(pg 353) |
developmental verbal apraxia (DVA)
childhood apraxia of speech (CAS) (insurance company preferred term) suspected developmental apraxia of speech |
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Childhood apraxia of speech (CAS) is
(page 354) |
a childhood articulation disorder of unknown etiology
unlike apraxic adults there is no brain damage but the speech characteristics are very similar primarily a descriptive term |
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Speech characteristics of CAS/DAS
(pg 355) IMS UU |
Inconsistent or variable sound errors in the same word over repeated trials
Moderate to severe intelligibility Slow DDKs Unusual artic errors (additions, prolongations, nonphonemic sounds) Usually gap in receptive/expressive language skills |
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What is the difference between apraxia and dysarthria?
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apraxia is a motor programming dysfunction
dysarthria is a motor movement dysfunction |
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What is dysarthria?
(pg 361) |
a neuromotor speech disorder affecting one, various, or all parameters of speech production: respiration, phonation, resonance, articulation, and prosody
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What is prosody?
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the stress, rhythm, and intonation patterns of speech
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What are the seven types of dysarthria?
(pg 364) AF HH MSU |
1. Ataxic
2. Flaccid 3. Hyperkinetic 4. Hypokinetic 5. Mixed 6. Spastic 7. Unilateral Upper Motor Neuron |
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What is another name for flaccid dysarthria?
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bulbar palsy
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What type of dysarthria will a person with Parkinson's disease exhibit?
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hypokinetic
(from basal ganglia damage) |
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What type of dysarthria will a person with Huntington's disease exhibit?
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hyperkinetic
(from basal ganglia damage) |
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What dysarthrias are associated with:
Parkinson's Huntington's ALS (Lou Gehrig's) multiple sclerosis Wilson's |
hypokinetic
hyperkinetic flaccid/spastic spastic/ataxic ataxic/spastic/hyperkinetic |
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What type of dysarthria will a person with ALS (Lou Gehrig's disease) exhibit?
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flaccid/spastic (mixed) dysarthria
(most common of this type) |
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What type of dysarthria will a person with multiple sclerosis exhibit?
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spastic/ataxic (mixed) dysarthria
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What type of dysarthria will a person with Wilson's disease exhibit?
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ataxic/spastic/hyperkinetic (mixed) dysarthria
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What causes flaccid dysarthria?
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lower motor neuron damage
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What causes spastic dysarthria?
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bilateral upper motor neuron damage
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What causes ataxic dysarthria?
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cerebellar damage
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What causes hypo/hyperkinetic dysarthria?
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basal ganglia damage
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What causes unilateral upper motor neuron dysarthria?
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unilateral lesion to the upper motor neurons involved in speech
similar to spastic but only unilateral damage |
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When is a better time to assess for dysarthria?
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in the morning
patients are easily fatigued so as testing continues their performance will decrease |
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What is cerebral palsy?
(pg 373) |
nonprogressive neuromotor disorder resulting from brain damage before, during, and after birth
2:1000 live births |
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What are some prenatal etiologies of cerebral palsy?
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drugs
radiation fetal anoxia |
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What are some perinatal etiologies of cerebral palsy?
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use of forceps during delivery
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What are some postnatal etiologies of cerebral palsy?
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premature birth
asphyxia head trauma |
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What are the categories of limb paralysis for cerebral palsy? (5)
(pg 373) |
Quadriplegia (trunk and all extremities)
Diplegia (paralysis of the identical part on both sides of the body) Paraplegia (lower trunk and legs) Hemiplegia (one side of the body) Monoplegia (single extremity) |
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What are the neuromuscular categories of cerebral palsy? (5)
(pg 374) |
Spastic (50%)
Mixed (30%) Athetoid (10%) Ataxic (5-10%) Rigid (1%) |
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What is ATNR?
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asymmetrical tonic neck reflex
associated with athetoid CP |
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What is athetoid CP?
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slow, writhing involuntary movements
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What is ataxic CP?
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balance problems but normal reflexes and muscle tone
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What is the most common type of mixed CP?
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spastic and athetoid CP
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How common is cleft lip and palate?
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1:600-750 live births
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What is cleft lip and palate usually associated with?
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an autosomal dominant syndrome
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The causes of cleft lip/palate are
(pg 381) |
multifactorial
genetic, teratogens, embryonic development |
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What are articulation characteristics of cleft lip/palate?
(pg 381) CDD NVV |
Compensatory errors
Decreased intraoral pressure Difficulty with voiced sounds Nasal emissions Velopharyngeal inadequacy Vowel Distortions |
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Outside of communication problems, what is another problem a child with cleft lip/palate may have?
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feeding issues
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During gestation, when do the lips normally fuse?
(pg 380) |
5th-6th week of gestation
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During gestation, when do the hard and soft palates normally fuse?
(Pg 380) |
8th-9th week of gestation
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What is the percentage breakdown of cleft lip/palate?
(pg 380) |
about 50% with have both
about 25% have cleft lip only about 25% have cleft palate only |
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What is the most probable site of brain damage resulting in apraxia?
(pg 351) |
Broca's area in the left hemisphere
58% of cases result from stroke |
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Apraxia is often accompanied by
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aphasia
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What is oral astereognosis and what is it associated with?
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the inability to identify types and locations of objects in the oral cavity
(decreased oral awareness) CAS/DAS |
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What are four stages of articulation and phonological development?
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Stage 1 - 0-12 months
Stage 2 - 12-24 months Stage 3 - 2-5 years Stage 4 - 5 years and beyond |
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Developmental stages refer to
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a child's artic and phonological development which may or may not be the same as chronological age
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What is the primary purpose of STAGE 1 therapy?
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practice vocal skills that are the basis for later speech development
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What is the primary purpose of STAGE 2 therapy?
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facilitate acquisition of sounds and syllables in specific words
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What is the primary purpose of STAGE 3 therapy?
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elimination of errors affecting classes of sounds
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What is the primary purpose of STAGE 4 therapy?
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eliminate errors affecting late-acquired consonants, consonant clusters, and unstressed syllables in more difficult multi-syllabic words
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What are facilitative techniques for Stage 1 therapy?
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use motherese
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What are facilitative techniques for Stage 2 therapy?
REM |
request confirmation or clarification
expansions and parallel talk modeling |
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What are facilitative techniques for Stage 3 therapy?
REMS |
request confirmation or clarification
expansions and parallel talk modeling strategic errors |
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What are facilitative techniques for Stage 4 therapy?
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direct instruction
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What is motherese?
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baby talk
used in Stage 1 therapy serves to capture and maintain an infant's attention |
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What are expansions?
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elaborate or add to a child's utterance to make it longer and more grammatically correct
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What are strategic errors?
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clinician uses a child's own artic/phono errors in conversation with the him/her
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What is modeling?
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use of another person to exhibit correct speech production
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What is parallel talk?
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clinician talks about and describes what the child is doing
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What is bombardment?
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a clinician takes a few minutes to read the practice words they will use, at a slightly elevated sound level, to the child
good for all stages |
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What are metaphors?
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compare something familiar to an aspect of speech
used for stages 3 & 4 |
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What are descriptions?
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actually explaining to a child what the articulators need to do to make a sound
used for stages 3 & 4 |
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What are touch cues?
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actions that draw attention to the place of articulation
originally designed for oral-motor dysfunctions good for stages 3 & 4 and the hearing impaired |
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What is another term for word pairs?
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minimal pairs
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What is shaping?
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Using a sound a child already knows to learn a new sound
example: /s/ to /th/ by opening mouth and moving tongue forward good for stage 4 and possibly 3 |
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Physical prompts are not the same as
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manual guidance or phonetic placement
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Phonetic placement is used to teach
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the placement of the articulators
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What is stimulability?
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when a client is able to produce a sound when given maximum cuing
if a client has age appropriate errors, you probably won't do stimulability testing on those |
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What are ways to select treatment targets?
SPEK |
stimulability
phonetic placement & shaping emerging sounds key word |
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What is an emerging sound?
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a sound produced correctly 10% - 49% of all occasions
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What is a key word?
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client successfully produces target sound in a word at least 90% of the time but not in other words
part of the paired stimuli approach |
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In a traditional approach, how many treatment targets do you use per session?
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one
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If there are more than one treatment targets in a session, what do you alter?
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activity
environment method |
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When do you switch from one sound to another?
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flexibility criterion
percentage criterion time criterion |
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What is the flexibility criterion?
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work on a phoneme until a client becomes disinterested
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What is the most used criterion for changing treatment targets?
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percentage criterion
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What is the time criterion?
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work on a phoneme for a specific time period then move on
works well for both traditional and phonological therapy |
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What is the percentage criterion?
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work on a sound until a specified percentage level of mastery is achieved
most used criterion |
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What are the linguistic levels of complexity?
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Isolation
Nonsense syllables Words Phrases Sentences Spontaneous speech |
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Stimulability testing tells you
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what linguistic level to start therapy at
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When a child has reached a specified level of mastery at one level then
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move them to the next linguistic level
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What is meant by phonetic environment?
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word position
syllable position (initial, final, intervocalic, stressed, unstressed) |
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What are administrative decisions to be made for therapy?
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types of sessions (group vs individual)
frequency of sessions length of sessions length of activities format of activities |
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What is the ideal session time for an individuals and groups?
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20 minutes for individual
45 minutes for group |
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Length of therapy activities is dependent on
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age of client
attention level behavior group or indiv therapy interest level |
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Frequency of therapy sessions is dependent on
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client availability
insurance authorizations severity of disorder time availability |
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What is a very important format for therapy activities?
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DRILL!
more drill-more progress |
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What is evidence-based practice associated with?
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assessing treatment
if client is more intelligible, that is evidence your treatment is effective |
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What are ways to assess treatment?
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pre/post tests
intelligibilty and severity testing ongoing data tracking |
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Ongoing data reporting is required by
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most schools and clinics
hospitals insurance companies |
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What are baselines?
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measured rates of behaviors in the absence of treatment
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What are baselines used for?
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evaluate a child's progress
establish treatment effectiveness establish clinician accountability |
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What are the steps in obtaining baselines?
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specify targets in measurable terms (write a goal)
prepare stimulus items (at least 20 per target, catered to child's needs) prepare a recording sheet administer the baseline trials |
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What do you consider when preparing stimulus items for baseline testing?
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client's age
cultural background linguistic abilities |
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Before you see a client and obtain baselines, you need to develop
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daily goals
short term goals long term goals |
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What else do you need for therapy sessions besides goals?
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criteria for each daily goal
reinforcement plan activities for each goal courage and enthusiasm planning time therapy materials |
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Why do we need artic goals?
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provides direction
document progress help parents/clients see progress insurance companies require them |
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Based on your professional judgment, how do you select artic goals?
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developmental charts
family concerns intelligibility normative data personal gut feeling stimulability |
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What are long term goals?
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what the client will accomplish when therapy is completed
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What four pieces of information are essential in a short term goal?
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phoneme
position level of complexity (isolation, words, etc.) criteria (percentage) |
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Short term objectives are also called
(pg 464) |
treatment objectives
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Short term (treatment) objectives can be defined as
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the skills the clinician plans to teach on the way toward achieving the selected long term goals
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Short term goals must be
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justified by test results
attainable |
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When writing goal progress
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progress on each goal must be reported
include baseline data, therapy approach, and post data |
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What is the sandwich approach to therapy?
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easy tasks
hard tasks easy tasks |
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What would be included as additional comments when writing goal progress?
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specific material
reinforcers reinforcement schedules parent participation client behaviors affecting therapy |
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What do you need to prepare before a therapy session?
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plan goals, reinforcement, and activities
plan criteria for advancement use Daily Therapy Plan and Log Sheet |
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What do you need to do during a session?
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follow your plan
be flexible since a child may complete tasks earlier than planned |
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What do you do after a session?
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determine daily performance (%)
fill out Daily Therapy Plan and Log |
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The traditional approach works well for...
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a client with few articulation errors
disorder is development in nature |
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What are guiding principles of traditional therapy?
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treat one or a few sounds at a time
comprised of a series of steps training is progressive (isolated through conversational) baseline and stimulability testing tell you where to start |
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What are the five steps in traditional therapy?
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1. Discrimination training (ear training)
2. Stimulability (sound elicitation) 3. Sound stabilization 4. Generalization 5. Maintenance |
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What is discrimination training?
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can a client listen and tell if a phoneme is correct or incorrect?
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What are the two types of discrimination training?
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clinician - client
client - client (clients listens to himself) |
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What items can be used to aid in stimulability (sound elicitation)?
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mirror, diagrams
See-Scape Video Articulator Sound-level Meter Spectrographs Straw FM system Tongue depressor (/k/, /g/) |
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What can be used for nasal sound feedback?
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See-Scape
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What are stimulability approaches?
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Auditory stimulation/imitation
Use of context (co-articulation effects) Moto-kinesthetic Sound approximation (shaping) |
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What is an example of coarticulatory effects?
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when teaching /r/, do not use a word where the /r/ is followed by a rounded vowel
e.g. road use "read" instead |
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What sounds lend themselves to the moto-kinesthetic approach?
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velar
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What is an example of sound approximation (shaping)?
(also called successive approximation) |
using /t/ to produce /s/
or /s/ to produce /sh/ |
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What is sound stabilization?
(pg 401) |
achieving correct sound productions through the progressive linguistic levels
(isolation through conversation) |
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What is generalization (transfer)? (pg 405)
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when a client can use clinic-trained skills outside of the clinic in other settings
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What are ways to improve generalization?
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clear speech time periods
involve parents speech assignments (give a report, read aloud) speech buddy |
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What is maintenance?
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check up of client at different intervals to verify correct sound production
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What are important criteria for selecting target behaviors?
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behaviors that will have an immediate and socially significant impact
sounds produced and reinforced outside of therapy communication skill expansion linguistically and culturally appropriate for client |
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What are possible ways to choose which sounds to work on?
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sounds that are:
functional for the child are stimulable occur in key words are visible occur more frequently |
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What are possible ways to choose which sounds to work on?
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sounds that:
affect intelligibility most are inconsistently mispronounced are acquired earlier (developmental) are part of the child's phonetic inventory cognates |
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How many sounds should you target?
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training deep approach (traditional):
a small number of sounds are taught intensively training broad approach (phonological): simultaneous teaching of multiple targets |
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What are three traditional therapy approaches?
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Deliberate Speech Approach
Minimal Contrast Approach Paired-Stimuli Approach |
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Who developed the Paired Stimuli Approach?
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Irwin and Weston 1971-1975
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What is the method of training in the Paired-Stimuli Approach?
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through behavior modification, a target sound is taught with a key word
training occurs at the word level, sentence level, then conversation level |
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What happens in the Word Level step of the Paired-Stimuli Approach?
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four key words are selected with a target sound (2 initial, 2 final) produced correctly at least 90% of the time
ten training words with correct sound production of 2/3 are chosen to alternate with each key word client progresses when 80% accuracy is achieved |
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What happens at the sentence level of the Paired-Stimuli approach?
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key words are paired with training words but the clinician asks questions about the training words to evoke an answer in the form of a sentence
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What happens at the conversation level of the Paired-Stimuli approach?
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during conversation with the child the clinician will stop the conversation when the child produces a target sound in four words
or mispronounces a target sound in any word |
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When is training done in the Paired-Stimuli approach?
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child produces target correctly on 15 consecutive opportunities in conversation during two sessions separated by at least one day
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What is a training string?
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In the Paired-Stimuli approach:
a successful pairing of the key word with each of the ten training words |
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The minimal contrast approach is also known as
(pg 433) |
the minimal pair method
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What is the Minimal Contrast approach?
(pg 433) |
a method that focuses on contrasting error production with target production through word meaning not phonetic differences
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What is the Deliberate Speech approach?
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getting the child to slow the rate of speech down to become more aware his errors
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What are the steps in Deliberate Speech approach?
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describe the concept of rate reduction and accurate production
demonstrate how it's used discrimination training to recognize slow speaking production starts at word level |
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In order for an ESL student to be considered disordered
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the child must be disordered in both languages
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When dealing with ethnocultural communication, a clinician needs to know
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the language and phonological characteristics, properties, and rules of the child's primary language
how the primary language affects second language learning how to determine if there is a disorder |
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African American English developed as a
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pidgin, which is a simplified type of language that develops when speakers who do not share a common language come into contact
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What is a creole?
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pidgins become creoles when speakers pass them down through generations as a first language
creoles are more complex than pidgins in that they have associated linguistic rules |
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What are phonological characteristics of African American English?
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/l/ and /r/ reduction or omission
/f/ replaces /θ/ in word final or medial position /d/ replaces /ð/ in possibly all word positions /v/ replaces /ð/ in word final positions differing syllable stress patterns metathetic productions (aks/ask) devoicing/deletion of final consonants |
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How do you select treatment targets for AAE therapy?
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first priority:
choose phonemes that have the same pattern of usage in both SAE and AAE then: choose phonemes that are not used or misused in AAE |
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Which Native American tribes have the highest usage of their native languages?
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Navajo
Pueblo Eskimo |
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What are communication style characteristics of Native American languages?
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may avoid eye contact out of respect
mothers (Navajo) may be silent with their infants believe that listening and observing is more important language and hearing disorders are five times more prevalent (otitis media) may be time lag between a question and answer |
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What are seven major Spanish dialects?
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Caribbean
Castilian (Spain) Central American Chilean Highlandian Mexican & SW U.S. Southern Paraguayan, Uruguayan, Argentinean |
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What are the differences between Spanish and English?
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Spanish has 5 vowels vs 15 in English
Spanish has 19 consonants vs 24 In Spanish, there are none of the following sounds: /v/, /ð/, /θ/, /z/, or /ʒ/ |
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What are artic characteristics of Spanish?
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/t, d, n/ may be dentalized
final consonants often devoiced b/v substitutions ʧ/ʃ substitutions d/ð t/θ schwa (ə) before word initial consonant clusters (/s/ usually) initial /h/ is silent front /s/ is more frontal than in English vowel substitutions since they have less vowels |
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What are some standardized tests for Spanish speakers?
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Spanish Artic Measures
Austin Spanish Artic Test Assessment of Phonological Processes-Spanish PLS-3 or 4 Spanish Artic Screener (preschool language scale) |
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What are characteristics of Asian/Pacific Islander communication?
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final consonant deletion
truncate polysyllabic words or emphasize wrong syllables devoice voiced cognates r/l confusion /r/ omitted no /θ/ or /ð/ epenthesis b/v substitutions |
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What is bidialectal?
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able to speak two dialects of the same language (AAE and SAE)
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What is bilingual?
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able to speak two languages
simultaneous bilingualism is two languages are learned at the same time successive bilingualism is one language is learned first and then another learned later in life |
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What is code switching?
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switching between two languages during conversation
code mixing: combining two languages during conversation |
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What is the difference between translation and interpretation?
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translation conveys written forms of two languages
interpretation conveys oral forms of two languages |
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What requires the use of an interpreter during language assessments?
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IDEA (1997)
Individuals with Disabilities Education Act requires the assessment be done in the child's native language, if it's feasible |
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What type of interpretation is used most in educational settings?
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consecutive interpretation
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What types of interpretation is used with ASL?
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simultaneous interpretation
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What are the types of interpretation and translation?
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consecutive interpretation
simultaneous interpretation prepared translation sight translation |
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What are criteria for selecting an interpreter?
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interpreter must be culturally and linguistically competent
must be able to communicate verbal and nonverbal messages needs experience in the educational/clinic setting trained in interpreting avoid family members or friends of client |
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What is a way to check the interpretation skills of your interpreter?
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Use translate/back-translate tasks
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What skills should an interpreter have?
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ability to convey the same meaning in two languages
knowledge of SLP terminology familiar with dialectal differences ability to recognize a speech disorder in another language |
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After selecting an interpreter, what are three steps you need to go through before an assessment?
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Briefing-formulate a plan w/ interpreter before session
Interaction-talk to the parents, not the interpreter Debriefing-review outcomes of the session |
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What are four challenges of standardized testing for ESL?
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words
structures intonation discourse |
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What are examples of word differences in standardized testing?
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a word may not have a counterpart in the other language
one word may designate multiple items in another language words may carry different meanings in other languages some words cannot be translated |
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What is phonological (phonemic) awareness?
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the knowledge of meaningful sounds (phonemes) in our language and how they blend together to form syllables, words, phrases, and sentences
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In what order does phonological awareness develop?
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words (age 2 or 3)
syllables (age 4 or 5) phonemes (age 6 or 7) |
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How do you informally assess phonological awareness?
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alliteration
phoneme isolation (where a phoneme occurs in a word) phoneme manipulation (deleting, adding, etc. sounds to create new words) rhyming sound segmentation sound and syllable indentification sound and syllable blending |
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What is ataxic?
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lack of muscular coordination, disturbed balance
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What is flaccid?
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weakness and reduced muscle tone
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What is spastic?
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too rigid, increased tone
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What is hypo/hyperkinetic?
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reduced muscle movement
increased or exaggerated body movement |
