Adult Com Exam 1

Front 1

What is cognition?

Back 1

The act or process of knowing
The basis of communication

Front 2

What's communication?

Back 2

Exchange of info, ideas, feelings
Sender and receiver
Various modes
Control our environment
Can communicate through language

Front 3

What is language?

Back 3

Set of symbols used to communicate
Has rules
Several outputs and inputs
Components include: phon, morph, syntax, seman, prag

Front 4

What is speech?

Back 4

The acoustical representation of language

Other modes: writing, sign lang

Front 5

What is speech production?

Back 5

1) Neural "control"
2) Muscular "force"
3) Structural "movement"
4) Aeromechanical "energize

All 4 stages "private"

Front 6

Public speech production stages

Back 6

5) Acoustical (speech) "transmission" (fq, intensity, time)

6) Perceptual "psychological interpretation"
-hearing
-auditory perception
-auditory comprehension

Front 7

What is a communication disorder?
Where is the breakdown?

Back 7

Neural
Muscular
Structural
Aeromechanical
Acoustical
Perceptual

Front 8

CNS
PNS

Back 8

12 pairs cranial nerves
31 pairs spinal nerves

Front 9

Plan/program

Back 9

Motor cortex
Basal nuclei (ganglia)
cerebellum

Front 10

Perceptual correlate
Pressure=
Volume=
Shape=

Back 10

Pressure= loudness
Volume= breath group length
Shape= inspiratory duration (and stress)

Front 11

Culture

Back 11

“A learned set of shared interpretations about beliefs,
values, and norms that affect the behaviors of a relatively
large group of people.”

Front 12

Dysarthria is a ______ disorder

Back 12

SPEECH

Front 13

Dysarthria is caused by

Back 13

Impairment to PNS and/or CNS
Stroke, trauma, tumor, disease
Can involve all speech subsystems

Front 14

Flaccid Dysarthria

Signs of lesions

Back 14

Flaccid= LOWER motor neurons

Signs:
Paresis/paralysis
reduced/absent reflexes
atrophy
flaccidity
fasciculations

Front 15

Spastic dysarthria

Signs of lesions

Back 15

Spastic=UPPER

Weakness (paresis or paralysis)
NO atrophy
Hyperactive (normal) reflexes
Pathologic reflexes
Spasticity
Reduction in skilled movement

Front 16

Flaccid vs Spastic

Back 16

Flaccid
-normal artic rate
indiv nerves may be impaired

Spastic
Slow artic rate
movement patterns impaired
Pseudobular affect

Front 17

Ataxic Dysarthria

Back 17

Lesion of the CEREBELLUM

Dyscoordination- difficulty controlling force, speed, range, timing, direction of movements
Low muscle tone

Front 18

HypOkinetic dysarthria

Back 18

Parkinsons (reduction of dopamine in substantia nigra)

Resting tremor
Rigidity
Bradykinesia (slow/small movements)
Postural problems
Masked face and micrographia

Front 19

HypERkinetic dysarthria

Back 19

Speed/rate of involuntary movements
tics
ballism
tremor
myoclonus
chorea
athetosis
dystonia

Front 20

Mixed dysarthria

Back 20

Amyotrophic lateral sclerosis (flaccid+spastic)

Multiple sclerosis (ataxic+spastic)

Front 21

Evaluation of dysarthria

Back 21

Looking
Listening (pitch, loudness, quality, artic precision, artic rate, pauses, variability of all...)
Instrumental (acoustic, physiologic)
Referrals

Front 22

Management of clients with dysarthria

Back 22

Medical-surgical

Prosthetic

Behavioral: artic practice, sph rate modificaiton, AAC

Front 23

Core features of Apraxia of Speech

Back 23

Mixture of SODA, distorted substitutions, in spontaneous and imitative speech
Awareness and dissatisfaction with errors
Groping, struggling attempts to correct errors
Difficulty initiating speech

Front 24

Other common characteristics of Apraxia

Back 24

Slow rate (prolonged vowels+interword intervals)
Tendency to equalize stress
False starts, restarts, self-corrections
Automatic better than volitional speech
Consonant singletons better than clusters

Front 25

In Apraxia there is NO

Back 25

slowness
weakness
incoordination
paralysis
alteration of tone in muscles

Front 26

Evaluation of Apraxia

Back 26

automatic vs volitional sph
papapa vs pataka
utterances of increasing length and complexity

Front 27

Management of apraxia

Back 27

Practice!
Feedback: reduced over time, delayed better than immediate

Front 28

Deglutition

Back 28

Entire process of eating/drinking, from placement of food or liquid in oral cavity until material enters stomach, includes volitional and involuntary portions

Front 29

Oral Preparatory Phase (1)

Back 29

Food placed in mouth and Prepared for transport to stomach
Food masticated
Position bolus against roof of mouth

Front 30

Oral Transit Phase (2)

Back 30

Bolus is Transported from mouth to pharynx
Central groove forms in middle of tongue to act as a shoot
Quick- less than 1 sec

Front 31

Pharyngeal Phase (3)

Back 31

Bolus is moved through pharynx into esophagus
Reflexive and complex:
-velum elevates
-larynx elevates
-epiglottis flips down
-VF close
-pharynx muscles contract sequentially
-upper esophageal sphincter relaxes to allow food into the esophagus
Quick- less than 1 sec

Front 32

Esophageal Phase (4)

Back 32

Bolus is transported through esophagus to stomach
involuntary
Peristalsis- successive contractions in esophagus
8-20 seconds

Front 33

Dysphagia=

Back 33

Any impairment in swallowing

Front 34

Causes of dysphagia

Back 34

Age-related dysphagia
congenital abnormalities (cleft palate)
dementia
head/neck cancer
immature development
progressive neurologic diseases (parkinsons, ALS)
severe reflux
stroke
surgery/radiation
TBI
Tracheostomy

Front 35

The major concern of dysphagia

Back 35

Aspiration

can lead to choking, pneumonia

Front 36

Other consequences of dysphagia

Back 36

Malnutrition
Dehydration
Reduced food enjoyment
Reduced socialization

*quality of life

Front 37

Dysphagia assessment

Back 37

Bedside evaluation
Modified barium swallow study
Flexible Endoscopic evaluation of swallowing
Assessment

Front 38

Bedside evaluation

Back 38

Med chart review
patient/family interview
Oral mech exam
voice/respiratory assessment
oral trials
cognition

Front 39

Chart review

Back 39

Med diagnosis
med history
respiratory status
GI status
Lab work
chest x-rays
current diet
reason for evaluation
nutritional status

Front 40

Interview : Build ________

Back 40

Rapport
Address patient first, intro yourself, explain OME & BSE, then ask the family
Prior Level of Funct: baseline diet, patient complaint, assist level, appetite, prior sph therapy?
Duration of prob
Compensatory strategies
Additional medical history

Front 41

Oral Mech Exam

Back 41

Say 'ah' - 10, 9
gag reflex- 9, 10
Stick out tongue- 12
smile and pucker- 7
push tongue against tongue blade-12
close lips tight against resistance-7
raise eyebrows, close eyes tight-7
check sensation-5
taste- 9, 7

Front 42

Voice Respiratory assessment

Back 42

volitional cough
volitional clear throat
voice quality
vocal ampliture
pitch
O2 needs and saturation
breath groups
respiratory rate
lung sounds

Front 43

Oral trials
consistency presentation

Back 43

consistency presentation
-thin
-nectar
-puree
-solid

Front 44

Oral trials
Observations

Back 44

duration of mastication
lip seal
rotary chewing
prompt swallow initiation
oral residue

Front 45

Clinical indications of aspiration

Back 45

coughing
throat clearing
wet vocal quality
watering eyes/runny nose
choking

cervical susculation &lung auscultation before, during, after swallow

Laryngeal palpation

Front 46

Cognition

Back 46

orientation
general level of confusiton
impulsivity
short-term memory
reasoning
safety awareness
sequencing
initiation

Front 47

Modified barium swallow study MBS

Back 47

AKA Videofluoroscopic swallow study
Procedure: start in lateral view
given foods/liquids with barium

Purposes:
view all phases of swallow
objectively assess dysphagia
assess coordination of swallow phases
view aspiration

Front 48

Flexible Endoscopic Evaluation of Swallow FEES

Back 48

aka fiberoptic EES

Procedure: endoscope passes transnasally into hypopharynx
patient given food/liquid (dyed green)

Purpose: direct visualization of pharynx and larynx
view laryngeal funct
assess airway protection

Front 49

Assessment- swallowing

Back 49

synthesize info:
history
patient complaint
observations with oral trials
signs/symptoms of aspiration
results of objective measures
dietary limitations
hydration/nutritional needs
immune function
respiratory status
endurance/fatigue
overall medical status/fragility

Front 50

Assessment
Clinical impression:

Back 50

severity of dysphagia
aspiration risk
aspiration risk factors
chronicity of dysphagia
primary impairments
prognosis

Front 51

Plan of care & treatment

Back 51

Goals:
prevent aspiration, malnutrition/dehydration

Decisions/POC
oral v non-oral (feeding tube) nutrition
medical v behavioral management
direct v indirect treatment
referrals

Front 52

Direct treatment

Back 52

Texture modifications
thin or thick liquids, soft, hard, pureed foods
Positioning/postures: sit upright, chin tuck, head turn
Compensatory maneuvers: effortful swallow, mendelsohn, supraglottic
Volume/rate control: liquid by spoon, small sips/bites, slow pace

Front 53

Indirect treatment

Back 53

Exercises
Biofeedback: surface EMG, FEES
Swallow stimulation: temperature, taste, e-stim
Counseling/edu: quality of life