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93 Cards in this Set

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How do you differentially diagnose aphasia?
An impairment due to brain damage that interferes with the capacity to interpret and formulate language symbols across all modalities.
-not attributed to dementia, sensory loss, or motor dysfunction
Describe apraxia.
An articulatory disorder. Impairment of the capacity to program the positioning of speech muscles and the sequencing of muscle movements for the volitional production of phonemes.
-No significant weakness, slowness, or in-coordination of these muscles in reflex and automatic acts.
-Prosodic alternations may be associated with articulation problems, possibly for compensation.
-Inability to plan and program.
How do you differentially diagnose language of confusion?
An impairment of language accompanying neurologic conditions.
Characterized by reduced recognition and understanding/responsiveness to the environment, faulty memory, unclear thinking, and disorientation in time and space.
-often traumatically induced
-Structured language events are usually normal
-Open-ended language situations elicit irrelevance, confabulation.
-ex.- do not know the time of day, confused about what they ate for dinner
Describe dysarthria.
A group of speech disorders resulting from disturbances in muscular control-weakness, slowness, or in-coordination of the speech mechanism due to damage to the central or peripheral nervous system or both.
-The term encompasses several or all of the basic processes of speech: respiration, phonation, resonance, articulation, and prosody.
-Not having the speed and accuracy to do what you need to do.
What are the 5 stages the authors of the text propose to improve communication among the medical team?
Stage 1: No detectable speech disorder
Speech features: No observable changes
Intervention: Confirm normalcy, outline future intervention needs and resources
Page 324: Client may report that extra attention or effort is needed to produce speech. Listeners are unaware of changes but patients are concerned about changes.
Stage 2: Obvious speech disorder when intelligible speech
Speech features: No reduction in intelligibility, speech disorder is obvious, probably interferes with naturalness
Page 325: Intervention is focused on assisting them to maintain or enhance their communicative participation by analyzing patterns of communicative needs, as well as success and failure in common situations
Stage 3: Reduction in Intelligibility
Speech features: Some reduction in intelligibility, perhaps alternatives in speaking rate, probably unnatural
Page 327: People with reduced speech intelligibility can improve their communicative participation by providing their partners with extra information. Techniques for enhancing comprehensibility into three general categories: those techniques that are managed by the speaker with dysarthria, those that are the primary responsibility of the communication partner, and those that require interaction between the speaker and the partner.
Stage 4: Natural Speech Supplemented with AAC Techniques
Speech features: Natural speech is no functional for all speaking situations, short rushes of poorly articulated speech
Intervention: To improve comprehensibility. Topic supplementation, alphabet supplementation, portable typing systems
Page 335: Simultaneous use of natural speech and low-tech augmentative strategies (alphabet boards, topic supplementation, and gestures).
Stage 5: No Useful Speech
Speech features: Natural speech not functional for any speaking situations
Intervention: Augmented communication, multi-modal AAC approaches
hypokinetic movement
lesion in basal ganglia circuit. Characterized by limited range of movement, bradykinesia, fatigue, difficulty initiating movement, and disordered rates of movements
dystonia
characterized by slow hyperkinesis in which individual muscles or muscle groups exhibitinvoluntary tonic contractions of variable duration. Muscles may contract involuntarily and fail to relax when not in use. Characteristic of hyperkinetic disarthria. Etiology: lesion in basal ganglia circuit
discoordination
related to cerebellar disfunction/lesion, characteristic of Ataxic Dysarthria.
bradykinesia
a slowness of movement, characteristic of hypokintetic dysarthria. Either drug induced or related to Parkinson’s. Etiology: lesion in basal ganglia circuit.
chorea
Rapid involuntary, purposeless movements of the extremities, head, neck, or trunk. Movements are irregular and asymmetrical. Etiology: lesion in Basal ganglia circuit.
athetosis
type of dystonia most commonly seen in children with cerebral palsy. Caused by contraction of already hypertonic muscles and characterized by continuous, writhing movements. Etiology: lesion in Basal ganglia circuit
resting tremor
Signal comes out of basal ganglia causing tremor when there is not motion happening
*Lesion in basal ganglia
*Part of hypokinetic dysarthria
rigidity
Lesion of the basal ganglia
*Equal contraction of the tensor and flexor muscles so that the body part will not move
intention tremor
Triggered by voluntary movement
*Lesion in basal ganglia
*Part of hyperkinetic dysarthria
flaccidity
- Due to lower motor neuron damage
- Lesions: Intermedulary -- within the brainstem (Low: 10th cranial nerve; High: 5th or 7th cranial nerve)
extramedullary
outside the brainstem but in the brain (Cranial nerves as they exit the brain)
extracranial
outside the cranium (peripheral cranial nerves; motor endplates)
spasticity
Loss of motor/reflex inhibition; excessive motor contraction
*Lesion in motor cortex (upper motor neuron bilateral) corticobulbar tracts
*Speech characteristics: rough phonation, strained-strangled, short breath groups, hyperynasality, imprecise articulation
dysmetria
No notion of range in space (over/under shooting targets)
*Part of Ataxic dysarthria
*Lesion in cerebellum
What is the chronic disability model?
Conceptualization of the various levels of a chronic disability (impairment, activity, participation)
Describe the impairment level of chronic disabilities model.
Cellular to Subsystem Levels, Loss and/ abnormality of mental, emotional, physiological, or anatomical structure or function
Level – Organs and organ systems
Examples: atrophy of muscles, imprecision of movement, reduced movement rate of respiratory, laryngeal, velo-pharyngeal, or articulatory subsystems
Give examples of impairment intervention.
- Reduce Impairments,
- Eliminate maladaptive behaviors
- Learn behavioral compensations
- Receive prosthetic intervention (palatal lift)
Describe activity level of chronic disabilities model.
restriction of lack of ability to perform an action or activity in the manner of within the range considered normal that results from impairment
Level – Organism – action, activity, performance
Assess – Intelligibility, Rate, Naturalness
Give examples of activity intervention.
- Clear speech,
- proper phrasing,
- appropriate stress patterning,
- optimal speaking rate
Describe participation level of chronic disabilities model.
constricted involvement in life
Level – societal situations
Example – Communication effectiveness in communicative situations
Give examples of participation intervention.
optimize communication effectiveness in social situations
- Control Audience size,
- Reduce noise,
- amplify voice,
- manage breakdowns,
- prepare listeners
Give an example of activity related to quality of communication life.
how well you are getting by talking to someone on the phone.
Relationship among levels of chronic disability
The various “levels of disability” may or may not be correlated, as many different factors influence the functional capabilities and the societal acceptance of an individual with chronic disability
- just because you improve at one level, doesn’t necessarily carry over to all
What are the five classifications of dysarthria?
1) Flaccid dysarthria
2) Spastic dysarthria
3) Ataxic dysarthria
4) Hypokinetic dysarthria
5) Hyperkinetic dysarthria
symptoms of flaccid dysarthria
• *breathy voice
• *inspiratory stridor
• hypernasality
• *nasal emission
• imprecise articulation
• short breath groups
symptoms of spastic dysarthria
• *phonation rough, strained-strangled
• breathy groups short
• hypernasality
• imprecise articulation
symptoms of ataxic dysarthria
• voice symptoms-normal, unsteady, excessive loudness, voice tremor (4-7 HZ)
• resonance-usually normal
• *articulation-irregular articulatory breakdowns
symptoms of hypokinetic dysarthria
• monoloudness
• reduced loudness
• monopitch
• breathy/rough phonation
• *excessive rate
• *rushes of speech
• *difficulty initiating speech
What is the associated neuropathology with flaccid dysarthria?
o pathophysiology-weakness, hyptonia, slowness, fatigue
o lesion location-trigeminal, facial, vagus, and hypoglossus cranial nerves
What is the associated neuropathology with spastic dysarthria?
o pathophysiology-spasticity, hyper-reflexia, hypertonia, slowness, reduced range of
o motion
o lesion location-motor cortex, upper motor neuron (bilateral)-corticobulbar tracts
What is the associated neuropathology with ataxic dysarthria?
o lesion location-cerebellar loop, cerebellum, cerebellar pathways
o pathophysiology-discoordination, dysmetria, slowness
What is the associated neuropathology with hypokinetic dysarthria?
o lesion location-basal ganglia loop, basal ganglia, basal ganglia pathways
o pathophysiology-limited range of movement, bradykinesia (slowness of movement),
o fatigue, difficulty initiating movement, disordered rates of movements
What is the associated neuropathology with hyperkinetic dysarthria?
o lesion location-basal ganglia loop, basal ganglia, basal ganglia pathways
pathophysiology-chorea, athetosis, dystonia
What are the similarities and differences between spasticity and rigidity?
-Rigidity is an increase in muscle tone, not dependent on rate. Felt
in both agonist and antagonist muscles. Generally associated with
basal ganglia damage (Parkinson's disease) and hypokinetic dysarthria.
"inflexibility or stiffness"-yahoo

-Spasticity is a form of rigidity (still excelssive muscle tone). It
is rate-dependent. Generally involving UMN damage. Loss of inhibitory
control can cause an ongoing level of contraction, with decreased
ability to volitionally control the muscle contraction, and increased
resistance felt on passive stretch.
"continuous resistance to stretching by a muscle due to abnormally
increased tension"-
Describe the role(s) of the cerebellum.
coordination for speech and coordination for speech while doing other motor activities.
Describe the role(s) of the premotor area
planning motor movements
Describe the role(s) of the primary motor cortex
executing motor movements
Describe the role(s) of the basal ganglia
plans rate, speed, and range of movements
Describe the role(s) of the Cortico-bulbar tract-
info carried from the motor cortex to brainstem for speech (i.e., soft palate)
Describe the role(s) of the Cortico-spinal tract
info carried from the motor cortex to spinal cord if for respiration or limbs
Describe the role(s) of facial nerve
movement of the face (e.g., cheeks, lips) and production of saliva
Describe the role(s) of the vagus nerve
vocal folds and velopharyngeal mechanism control
Describe the role(s) of the accessory nerve
controls the sternocleidomastoid and trapezius muscles
Describe the role(s) of the hypoglossus nerve
tongue movement
Describe the role(s) of the thalamus
the relay station that takes info from the basal ganglia (i.e., rate/speed and range) and sends it to the motor cortex (i.e., motor execution)
What is the dysarthria intervention staging system?
The dysarthria intervention staging system is for speakers with a wide variety of etiologies. These stages are helpful in treatment planning. They are characterized in terms of severity, into five stages.
What are the 5 dysarthria intervention staging system stages?
Stage 1: No detectable speech disorders
Stage 2: Obvious speech disorder with intelligible speech
Stage 3: Reduction in speech intelligibility
Stage 4: Natural speech supplemented by augmentative techniques
Stage 5: No functional speech
What natural courses are commonly associated with neurological
disorders for improving?
-TBI
-Apraxia
*get them functional, keep them functional
What natural courses are commonly associated with neurological
disorders for stability?
-Cerebral Palsy
*preparing them to live with this condition
What natural courses are commonly associated with neurological
disorders for degeneration?
-Parkinson’s
-ALS
-MS
*speech gets worse
*intelligibility will drop
*our goal is to help them compensate and function
How do the differing natural courses change intervention strategy?
When working with someone on the degenerative course, you are working more on managing the course of the impairment, developing compensatory strategies for speech, and supplementing the speech with AAC. Whereas the people on the improving course are getting supplemental speech with AAC but also reestablishing the subsystems for speech.
*compensate verbal and with AAC.
What is speech intelligibility
*A measure of the understandability of the speech signal only.
*The listener is a listener (judge) only! (Needs to be unfamiliar with the text)
What is alphabet supplemented speech intelligibility?
* The speaker uses an alphabet supplementation board and points to the first letter of each word they are producing.
*End of the day our goal is to try to get to an acoustic signal that listeners can understand.
What is comprehension?
refers to how understandable the message as a whole is.
What is the difference among speech intelligibility, supplemented speech
intelligibility, and comprehension
-Intelligibility is how understandable the speech signal is at the SOUND or WORD level
-Supplemented speech intelligibility is using information independent from the speech signal to increase intelligibility. This is considered to be compensatory information (e.g. alphabet boards, semantic topic boards, word/phrase dictionary)
-Comprehension refers to how understandable the message is as a whole. By using supplemented speech it increases the intelligibility of the words and sounds, which in turn increases the listeners comprehension.
How would you assess Speech intelligibility for an adult who can read at a high school level?
Word & Sentence Intelligibility Test (Yorkston & Beukelman)
How would you assess Speech intelligibility for a child four years of age
Augmented Speech Comprehensibility in Children (Dowden)
(Pictures: apple, crayon, hotdog, etc.)
TOCS
How would you assess Communication effectiveness of an adult with acquired dysarthria
Communication Effectiveness- Participation (rating scale)
Never--1 2 3 4 5--Always

1. Conversing with familiar listeners
2. Conversing with strangers
3. Conversing with familiar listeners over the phone
4. Conversing with strangers over the phone
5. Conversing in noise
6. Conversing while traveling in a car
7. Conversing at a distance
8. Speaking in front of a group
9. Speaking in special circumstances
how would you assess listener load?
Attention Allocation
Minimal-- 1 2 3 4 5 6 7-- Full Attention
What is the impact on intelligibility measures of judge familiarity with the passage or message?
• Familiarity increases the intelligibility.
• It is important for the listener to be a naive, unfamiliar judge to show accurate intelligibility.
How can judge familiarity be controlled in a clinical setting?
• Since it is important for the listener to be unfamiliar, computerized assessments such as the Assessment of Intelligibility of Dysarthric Speech help with randomization
• There is a large pool of words and sentences that the computer draws from
Why do parents apparently routinely over-estimate the intelligibility of their children’s speech?
• Parents are around their child more often than SLP’s or caregivers
• The topic of which the child and parent are talking about is already known
• Parents adjust down questions so the child does not have to be as intelligible when answering
What can a clinician do to help parents understand that their child’s
speech may be more difficult to understand than they assume?
• An SLP could record the child’s speech with single word utterances and sentences. They could then share the unknown words and topic with the parent and allow them to determine what their child is saying. Usually the parent will not be able to identify most of the single word utterances or phrases because it is out of context.
What is the relationship between information from the speech signal and
signal-independent information
Speakers and their communication partners achieve mutuality using two types of information: (a) information exclusively from the speech signal and (b) information about context that is independent of the speech signal (*signal-independent information). When the speech signal information is rich and speech intelligibility is high, messages are comprehensible even in the face of limited contextual information. However when the speech signal is degraded because of reduced intelligibility due to severe-motor speech disorder, contextual information that is independent of the speech signal becomes critical for the maintenance of message comprehensibility. Supplemented intelligibility in combination with speech naturalness is associated with communication effectiveness.
*Signal- independent information is supplemental and helps the listener (e.g., semantic context, syntactic context, alphabet, gestures).
Summarize some speaker strategies as well as some listener strategies that might improve communication interaction effectiveness.
Preparing Your Partner- Make sure partner is paying attention. Say their name to let them know they need to listen.
Setting the Topic- Identify the topic before you begin. This can be done in a variety of ways.
Using Grammar to Enhance the Message- Talk in complete sentences because this is predictable.
Use of Gestures- Use gestures that support communicative intent.
Use of Turn Maintenance Signal- Develop a signal with the listener to show that you have something to say. Also, signal when you are finished.
Timing of Important Communication Exchanges- Try to keep important communication interactions earlier in the day or when you have more energy. This will increase the likelihood of intelligible senteces.
Selecting a Conducive Environment- Pick a quiet area with good lighting and little noise or distractions.
Listener strategies:
Maintain Topic Identity- The listener is equally responsible for being on the appropriate topic. Check to make sure.
Pay Attention to the Speaker- Sit directly in front of speaker and eliminate other auditory and visual distractions.
Piece Together Clues- Take fragmented cues and piece together to complete your partner’s idea. Maintain awareness of all clues. Check to make sure you are piecing correctly.
For what type of dysarthric speaker would you use alphabet supplementation?
• The type of dysarthria is not critical in determining who should use alphabet supplementation, but the severity of the dysarthria is. Generally, the best candidates are those with severe or profound dysarthria. Speakers with intelligibility over 80% may receive some minor benefits, however the accompanying reduction in speaking rate or naturalness is often considered unacceptable by the speakers.
What is the tx effect for alphabet supplementation?
-alphabet supplementation for words intelligibility: consistent 11.3%
-alphabet supplementation for sentence intelligibility: 25.5% (variability in tx effects for moderate to severe dysarthria) (less severity= more consistent tx effect) (variability in tx effect for severe individuals because of the slowed rate of speech with the use of alphabet supplementation. Some individuals have greatly increased intelligibility as they slow their rate while others already speak with a slow rate so their intelligibility does not improve as much)
What is topic supplementation?
use of a communication board that provides topics such as small talk, personal, weather, sports, health, etc. The person points to these topics before speaking to give the listener more background knowledge on the conversation piece.
What is the “treatment effect” of topic
supplementation on single word? AND sentence intelligibility?
-single-word: consistent treatment effect intelligibility for habitual speech (28% across severity)
-very little gain (10.7%) for sentence intelligibility
what is knowledge of results?
Feedback whether the motor sequence was performed correctly (word produced correctly) i.e. “that was correct” or “opps, that was wrong”
What is knowledge of performance?
Feedback about how a movement was performed (tongue, lips, jaw) i.e. “you put your tongue between your teeth instead of on the top of your mouth” or “ great, you put your tongue to the top of your mouth”
what is more effective for motor learning: knowledge of results OR performance?
knowledge of results
what is massed practice?
when the target is drilled over a particular amount of time
What is distributed practice?
when the target skill is drilled in a short amount of time, throughout a period of time
Which is better for generalization of learning massed or distributed practice?
distributed practice
what intervention strategy goes with impairment level?
Reduce Muscle Tone
what intervention strategy goes with activity limitation level?
*Reduce Speaking Rate
*Speak louder
*Speech amplifier
what intervention strategy goes with participation restriction impairment?
Alphabet supplementation
*Listener training
*Topic Supplementation
what intervention strategy goes with environmental factors level?
reduce noise
what is restoration in terms of intervention?
reduce the impairment—(use residual speech a bit better) work towards normalization
What is compensation in terms of intervention?
reduce activity imitation through behavioral and prosthetic intervention (e.g., palatal lift), electronic intervention.
supplementation?
provide information in addition to speech signal; another avenue towards communication.
True or false: Sometimes we become so focused on restoration that you forget about communication today.
true: Need to mix compensation and restoration
what is instruction in motor learning?
the SLP is teaching the client how to do the motor task. Make sure the client understands the task and why it is being taught. This stage includes instruction, modeling, and some practice. Goal is to be at 80% accuracy before moving on.
what is practice in motor learning?
Once the child has reached 70-80% (usually 80%) accuracy, move to practice. During practice, the SLP is NOT the primary facilitator. Parents, caregivers, or possibly computers take over. It is important to be at 80% accuracy before moving on - the goal is to have errorless learning so that the client is not practicing incorrect sounds/motor movements.
describe when to begin generalization for motor learning.
occurs when the client uses the correct motor movements outside of practice/instruction in other contexts.
describe the cerebellar and basal ganglia loops and their roles in speech motor control.
?????????????????
What is an neurological etiology (medical condition) that might cause each
type of dysarthria
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