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75 Cards in this Set
- Front
- Back
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Name the 3 subsystems involved in the voice production
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respiration
phonation resonance |
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Name the 3 types of voice disorders
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Functional
Organic Neurological |
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Functional
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muscle tension
dysphonia vocal fatigue phonotrauma puberphonia transgender voice |
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Organic
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mass lesions
nodules cysts polyp papilloma carcinoma reinke's edema granuloma/contact ulcer |
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Neurological
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VF paralysis
Vocal tremor |
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main components of a voice eval
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case history
perceptual eval instrumental eval (Imaging, acoustic assessment, aerodynamic assessment) |
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Two treatment approaches
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Behavioral
Medicine |
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Behavioral
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•Vocal hygiene
Proper care of VF tissues •Therapy for hyperfunctional voice Reduce strain and tension •Therapy for hypofunctional voice Improve vocal strength and efficacy |
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Medicine
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Medicine
surgery radiation psychiatry |
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TEP
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Tracheo-esophageal puncture
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Breath in through the _______
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Stoma
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The _________ vibrates and the sound gets shaped by the________________
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The esophagus vibrates and the sound gets shaped by the pharynx and mouth
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Types of Ventilators
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• Negative pressure
• Rocking beds • Abdominal pneumobelts • Phrenic nerve pacers • Positive Pressure |
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Pressure Ventilator
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Iron Lung
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Positive pressure
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Non-invasive
Invasive |
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Noninvasive positive pressure ventilator
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Face mask
Nose mask Mouthpiece |
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Invasive positive pressure ventilator
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Endotracheal intubation
Tracheostomy |
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Aphasia is an acquired ___________ impairment caused by _______ ______
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Aphasia is an acquired language
impairment caused by brain damage Aphasia is NOT an intellectual or memory impairment |
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People with aphasia may also have:
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Hemiparesis/hemiplegia
Motor speech impairments -dysarthria -dyspraxia Sensory impairments |
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Etiology of aphasia
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most common= stroke
Also •Tumor •Traumatic brain injury •Other neurologic disease |
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Risk factors for stroke
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• Age
• Sex • Race • Family history • Previous strokes or transient ischemic attacks • Sickle cell anemia • Heart disease • Diabetes • High cholesterol • High blood pressure • Obesity • Smoking • Excessive alcohol consumption |
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Types of stroke
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Ischemic (thrombo-embolic) - most common 84%
Hemorrhagic |
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Ischemic
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blood flow cut off to brain
thrombo-plaque build up forms a clot embolic- clot forms elsewhere and travels main treatment- thin blood *risk- high cholesterol |
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Hemorrihagic
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blood vein burst and blood gets on brain tissues
tend to be more severe, damage more brain harder to control bc blood can spread *risk-high blood pressure |
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Signs of a stroke
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• Sudden numbness or weakness
• Dizziness • Loss of balance • Loss of coordination • Sudden difficulty speaking or understanding • Confusion • Sudden difficulty seeing • Severe headaches |
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Site of lesion for most
aphasias |
left cerebral hemisphere
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Non fluent aphasia
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Broca’s aphasia
Global aphasia |
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Fluent aphasia
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Wernicke's
conduction (Anomic aphasia) |
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Nonfluent aphasia
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•Short utterances
•Reduced grammatical complexity (nouns predominate) •Halting articulation and pauses •Groping articulation (dyspraxia of speech) |
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Broca's
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•Speech is nonfluent
•Auditory comprehension is relatively good •Repetition (imitation) is impaired |
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Global aphasia = worst
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•Speech is nonfluent
•Auditory comprehension is impaired •Repetition is impaired |
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Fluent aphasia
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Longer utterance length
• Little difficulty with articulation • Paucity of nouns (“empty” speech) • Jargon (unintelligible speech) • Neologisms (nonsense words; e.g. “trimer”) • Paraphasias (errors of word or sound selection) • Semantic paraphasias • Phonemic paraphasias |
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Wernicke’s aphasia (fluent)
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•Speech is fluent
•Jargon and neologisms common •Auditory comprehension is poor •Generally unaware of errors |
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Conduction aphasia (fluent)
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•Similar to Wernicke’s, but good auditory
comprehension •Often aware of errors and attempts to self- correct •Paraphasias and neologisms common •Very poor imitation |
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Anomic Aphasia = mildest
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•Impaired word-retrieval is the prominent
sign/symptom •Comprehension is good •Anomia is present in almost all types of aphasia |
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WERNICKE’S aphasia
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fluent speech and poor auditory comprehension
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• BROCA’S aphasia is characterized by
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non-fluent speech and
relatively good auditory comprehension |
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• CONDUCTION aphasia is characterized by
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fluent speech that
sounds similar to Wernicke’s aphasia but with relatively good auditory comprehension |
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Evaluation of aphasia
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Informal- bedside
Formal- diagnostic battery |
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Bedside aphasia evaluation
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•Case history
• Evaluate: Expressive language (repetition, naming) Auditory comprehension Reading and writing Other (gesture, facial expression, speech, swallowing, visual disturbances..) •Determine: Deficits Successful strategies |
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Formal evaluation
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•Standardized aphasia batteries:
•Western Aphasia Battery (WAB) •Boston Diagnostic Aphasia Examination (BDAE) |
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Evaluation and management
schedule |
•Natural recovery more rapid first few months
•re-evaluate often •modify management strategies frequently •provide education and counseling •Natural recovery slows •less frequent evaluation needed •management strategies more stable |
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Management of aphasia
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•Determine goals by considering
•client’s wants/needs •caregiver’s wants/needs •results of evaluation (capitalize on strengths) •Examples of management strategies •Self-cueing for anomia •Functional communication |
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Self-cueing for anomia
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•Semantic self-cueing
•Phonemic self-cueing |
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Semantic self-cueing
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•Word is related to
•Functions •Attributes •Superordinate category •Members of same category Semantic map •Example: “banana” •You eat it •It’s yellow, has a skin, grows on a tree •It’s a kind of fruit •Oranges and apples are like it |
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Phonemic self-cueing
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•Develop a target word for each letter
Example: Dog - D - /d/ Mike - M - /m/ Key - K - /k/ •Example •Client attempts to retrieve “money” •Knows it starts with an “m” •Teach client to think “m”, “Mike”, /m/ •Produces /m/ •Self-cues production of “money” |
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Alternative treatment strategies
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•Gesture
•Drawing •Writing •Communication books |
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Group therapy for aphasia
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•Many benefits for members
•Role of the facilitator (SLP) •Facilitate conversations/activities •Maximize communication •Promote group independence •Teach •Encourage support among members |
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Deficits of Right Hemisphere damage
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• Denial of deficits
• Attention deficits • Left neglect (a type of attention deficit) • Visuoperceptual deficits • Communication deficits • Emotional and behavioral deficits |
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• Denial of deficits
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• Results in fewer referrals for treatment
• Makes it challenging to treat these clients! |
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• Attention deficits
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• Difficulties include:
• Concentrating on a task • Working on a task for more than a few minutes at a time Stroop task (color words) • Being easily distracted • Doing multiple things at the same time • Affects cognition and communication |
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• Left neglect (a type of attention deficit)
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letter cancellation
line bisection task writing task reading task clock drawing task unconscious perception (house on fire) |
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Left neglect can cause difficulty
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• Grooming left side of body
• Navigating hallways • Using appropriate margins when writing • Understanding television • Reading • Attending to environment (safety issues) |
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Theories of neglect
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• Representational
Faulty internal representation of space • Attentional Inattention to leftward stimuli |
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Visuoperceptual deficits
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unusual orientation
incomplete picture overlapping images Figure – ground relations |
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Communication deficits
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• Prosodic
• Linguistic |
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Prosodic deficits
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• Linguistic prosody
• Linguistic stress (word or syllable emphasis) • Pitch contours (statement vs question) • Emotional prosody • High loudness (anger, surprise) • High pitch (excitement, fear) • Low loudness and lack of pitch variation (sadness) * Deficits in production and comprehension * |
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Linguistic deficits
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• Difficulty with divergent language tasks
• Divergent: Large number of possible answers • Tell me all the things you can think of that are soft • Convergent: Limited set of possible answers • Who was the first President of the United States? • Difficulty with discourse |
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Discourse
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• Discourse consists of communicative events in which
information is conveyed by a speaker to a listener or listeners • Examples • Conversation • Telling a story • Explaining how to do something |
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Discourse deficits after RHD
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• May have...
• Verbosity and/or reduced content • Tangentiality • Difficulty with inferences • Confabulation • Difficulty understanding figurative language • Difficulty with procedural discourse • Poor pragmatic language skills |
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Emotional deficits
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• Difficulty understanding
and expressing emotions • Difficulty understanding emotional „tone‟ |
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Behavioral deficits
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• Impulsive
• Disorganized • Exhibiting poor judgment • Confabulate (fabricate information to fill in gaps in memory) |
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Management of clients with RHD
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• Denial of deficits
increase awareness of deficits • Attention deficits focus on treatment tasks • Left neglect require attention to left visual space raise awareness of neglect • Visuoperceptual deficits real objects, realistic pictures, normal orientation |
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Management of clients with RHD
• Affective/emotional and behavioral deficits |
have caregivers explain their moods/emotions verbally
help client, caregivers, and healthcare team understand limitations in judgment, organization, compulsivity |
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Management of RHD
• Communication deficits |
•Prosodic production
imitation, biofeedback •Prosodic comprehension identification of emotion in speech •Discourse deficits video feedback, groups, conversational scripts, procedural descriptions, figurative language interpretations |
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Fluency disorders
Definitions: |
• Dysfluency – disorder of fluency
• Disfluency – speech is not fluent • Not indicative of a disorder • Occurs in normal speech • Speech vs. language |
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Stuttering
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Frequent speech disruptions in the fluency of
verbal expression characterized by involuntary repetitions, prolongations, or blocks in short segments of speech Features: • Usually identified between ages 2-4 years • Unknown cause • Different expectations re: communication • Overt and covert symptoms |
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Signs and Symptoms
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• Overt signs
• Repetitions (especially of sounds or part-words) • Prolongations • Blocks • Excessive tension • Covert signs and symptoms • Avoidance of sounds or words • Self-perception as a speaker • Expectations of communication |
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What makes it worse?
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• Speaking on the telephone
• Speaking to audiences • Speaking to authority figures • Saying one’s own name • **situations where the person has experienced embarrassment** |
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Amiloride氨氯吡脒
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Meca: K sparing diuretic. Inhibits Na channels in the CCT.
Tox Hyperkalemia |
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General goals of treatment
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Changing the way the person who stutters:
• talks • feels • interacts with the environment |
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Other Types of Fluency Disorders:
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• Acquired Neurogenic Dysfluency
• Acquired Psychogenic Dysfluency • Cluttering |
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Acquired Neurogenic Dysfluency:
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• No history of fluency problems
• Identifiable brain injury • E.g., traumatic head injury • Characteristics may include: • Sound repetitions • Word finding difficulties • Palilalia • Whole word and phrase repetitions |
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Acquired Psychogenic Dysfluency
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• No history of fluency problems
• Sudden onset • Related to traumatic event • Possible history of psychological problems |
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CLUTTERING:
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• Dysfluency
• Repetitions of words and phrases (less struggle) • Speech rate • Rapid bursts of speech • Language tends to be: • Run-on and disorganized • Poor syntax and Word-retrieval problems • Difficulty responding to listeners • Articulation errors: • Omission of sounds and syllables; Slurring of sounds • Poor self-monitoring |
