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What does dysarthria affect? (3)
-articulation, prosody, respiration, phonation, and/or resonance
-errors are usually consistent on repeated productions
-Predominant speech errors are distortions and substitutions
What does apraxia affect? (4)
-timing, rate, and sequence of articulation
-articulation and prosody
-errors are usually inconsistent on repeated productions
-predominant speech errors are substitutions and repetitions.
Hyperkinetic dysarthria characteristics and site of lesion
-Involuntary movements
-Basal ganglia or basal ganglia connection to CNS
Hypokinetic dysarthria characteristics and site of lesion
-Reduced range and speed of motion
-Basal ganglia or basal ganglia connection to CNS
Motor Speech Disorders (5)
Neurogenetically-based problems that affects speech production.
-Can be congenital or acquired.
-Can be static, improving, or progressive.
-Associated with pathology in multiple areas of the nervous system.
-Caused by a wide variety of diseases.
What are the 2 main types of motor speech disorders
Dysarthria and apraxia
Dysarthria (4)
-Problem with the execution of articulatory movements
-Lesions may be in CNS or PNS
-No deficits in speech motor planning and programming
-Muscle weakness and abnormal muscle tone may be present
Apraxia (3)
-Problem with planning and programming articulatory movements.
-Lesions in the CNS, associated with lesions in Broca's area in the left frontal lobe
-Absence of muscle weakness, or changes in muscle tone, steadiness and range of motion.
Flaccid dysarthria characteristics and site of lesion
-Weakness and low tone in muscles
-LMN (Lower motor neurons)
Spastic dysarthria characteristics and site of lesion
-Spasticity and increased tone in muscles
-Bilateral damage to UMN (Upper motor neurons)
Ataxic dysarthria characteristics and site of lesion
-Incoordination between muscle groups
-Cerebellum or cerebellum connections to the CNS
Mixed Type dysarthria characteristics and site of lesion
-Any combination of symptoms of any dysarthria types
-Multiple sites of lesion in the motor system
Causes and risk factors of motor speech disorders (3)
-Neurological conditions (Stroke, TBI, Parkinson's)
-Genetic factors
-Developmental issues (Cerebral palsy)
AAC (2)
Augmentative and Alternative Communication:
-Aided and unaided symbols, techniques, and strategies for receptive and expressive communication
-Depends on communication partner and environment
What are the 4 components of AAC systems?
-Symbols
-Aids
-Techniques
-Strategies
Symbols within AAC systems
Something visual, auditory, and /or tactile that represents something else.
Ex: Gestures, photos, sign language, drawings, objects, printed words, spoken words, Braille.
Aids within AAC systems
A physical object or device used to transmit or receive messages.
Ex: Communication book or board, chart, mechanical or electronic device, computer/iPad apps
Techniques within AAC systems
Method of transmitting a message
Ex: Direct select, scanning, encoding, signing, gesturing
Strategies within AAC systems
Specific ways to use symbols, aids, and techniques to enhance communication in specific situations
Ex: Message timing, message rate, grammatical formulation
Dementia
A group of symptoms caused by various diseases and conditions that affect the brain which lead to a progressive decline in cognition, language, and personality which interfere with independent functioning.
What causes dementia?
reduced neural communication
Swallowing characteristics of dementia (7)
-Overall slowing of the swallowing process:
-Reduced sensation (will hold food in mouth)
-Reduced tongue and mandibular strength (reduced oral manipulation/coordination),
-Food/liquid remain in mouth/throat (reduced bolus clearance)
-Cognitive deficits in knowing the time, location, remembering how to use utensils, highly distractible.
-Reduced self-feeding directly related to pneumonia
-Weight loss
Compensatory communication strategies for dementia (11)
-Use short, simple, one-idea sentences
-Reduce WH questions
-Speak with exaggerated intonation
-Eliminate distractions
-Avoid suddenly shifting topic
-Speak slowly
-Ask one question or give one instruction at a time
-Approach slowly from the side; establish eye contact
-Avoid interrupting; allow plenty of time for responding
-Encourage circumlocution during word-finding problems
-Repeat messages with the same wording
Spaced retrieval training for dementia
Repeated presentation of target information such as semantic memory, procedural memory, prospective memory, and episodic memory.
Additional treatment options for dementia
-Memory books/wallets
-Montessori-based programs: Enhances engagement and reduces behavioral symptoms.
Alzheimer's disease (3)
-60-70% of dementia cases
-Characterized by amyloid plaques and beta tangles
-Symptoms include impairments in memory, language, and visuospatial skills.
Common symptoms of dementia
memory loss, impaired judgements, personality changes, and an inability to perform daily activities.
Aphasia (4)
-Acquired impairment of language processes underlying receptive and expressive modalities (speaking, understanding, reading, and writing) caused by damage to areas of the brain.
-Acquired, not developmental
-Not a problem of intellect
-Damage to the brain
What causes aphasia? (6)
-Damage to the central or peripheral nervous system
-Stroke, cerebrovascular accident (CVA), brain attack
-Trauma
-Disease
-Idiopathic
Stroke (3)
Cerebrovascular attack (CVA):
-Sudden action/event that disrupts the brain's blood supply.
-3rd leading cause of death in the USA after heart disease and cancer
Stroke risk factors (6)
-heart disease
-diabetes
-tobacco use
-obesity
-high blood pressure
-physical inactivity
Stroke signs and symptoms (6)
BEFAST
-Loss of balance
-Trouble seeing
-Face drooping
-Arm or leg weakness
-Slurred speech
-Time to call 911
How to communicate with a person with aphasia (10)
-Do not yell
-KISS principle-direct information
-Speak slowly but naturally
-Pause
-Alert to topic
-Add stress to important words
-Use repetition and paraphrasing
-Check for understanding with nonverbal behaviors (eye contact, head nod)
-Summarize what they say
-PATIENCE: give them time- do not rush or interupt
What part of the brain is impacted by aphasia?
Usually the language-component half of the brain
Dysphasia (4)
-Disordered swallowing
-Affects all age groups
-Multiple sign and symptoms
-Numerous complications
Complications of dysphasia (3)
-Malnutrition
-Dehydration
-Aspiration
Mastication
Chewing
Bolus
Food that has been chewed and mixed with saliva and collected into a small ball
Aspiration
Food or drink entering the trachea below the level of the the vocal folds
NPO
nothing by mouth (nil per os)
What can lead to dysphasia in adults? (7)
-CVAs
-TBIs
-Dementia
-Neuromuscular disease
-Cancer
-Trauma
-Edema
What can lead to dysphasia in pediatrics? (9)
-Developmental disability
-Neurological disorders
-Structural abnormalities
-Genetic syndromes
-Sensory issues
-Complex medical conditions
-Medication side effects
-Behavioral factors
-Social, emotional, and environmental issues
What are the 4 phases of the normal swallow?
1. Oral preparatory phase
2. Oral transport/transit phase
3. Pharyngeal transport phase
4. Esophageal (transport) phase
Oral preparatory phase and abnormalities that would affect it (2)
-Chewing and manipulation of food into a bolus
-Cleft palate or dental issues
Oral transport phase and abnormalities that would affect it (4)
-Bolus begins to move posteriorly (back) in the oral cavity, toward oropharynx
-Soft palate elevates
-Posterior pharyngeal walls move to accept bolus
-Cleft palate and neurological problems
Pharyngeal transport phase
-directs the food from the pharynx to the esophagus
-airway protection
Esophageal transport phase and abnormalities that would affect it (3)
-Food travels to the stomach
-Peristalsis: wave-like motion that compresses bolus into stomach
-Esophageal cancer and paralysis of muscles
Direct therapy for dysphasia
Involves the presentation of food and/or liquid trials during therapeutic activities
Indirect therapy for dysphasia
Involves the use of instrumentation, training in the use of strategies or techniques and/or implementation of maneuvers and exercises without introduction of food or liquids
Impact of hearing loss on adults (15)
-Depression
-Social isolation
-Cognitive decline
-Income disparity
-Impaired memory
-Being misjudged or mischaracterized
-Forgetting what nature sounds like
-Safety concerns
-Greater chance of falling
-Missing someone flirting with you
-Missing a grandchild's first words
-Making a mistake at work
-Not hearing a cry for help
-Increased anxiety
-Lower quality of life
Impact of hearing loss on children (7)
-Delayed language development
-Academic under achievement
-Social isolation
-Higher risk of injuries
-Increased poverty
-Reduced speech perception
-Lowered self-esteem
What are the 4 aural rehabilitation interventions?
1. Devices
2. Counseling
3. Training
4. Strategies
Hearing aids
Electronic devices that fit inside or behind the ear and amplify sounds.
Outcomes with hearing aids for adults (3)
-Improved understanding in quiet and overall communication function
-still difficulties understanding speech in noise
-Overall positive satisfaction with HAs, but some still end up in the drawer
Outcomes with hearing aids for children
HAs support language development
Cochlear Implants (4)
-Electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing
-Bypasses a nonfunctional inner ear and stimulates nerve with electrical current
-Implant is surgically placed under the skin behind the ear
-External unit worn to pick up sound from environment
Aural rehabilitation counseling (2)
-Informational counseling: degree/type/impact of HL, untreated hearing loss
-Psychosocial adjustment counseling: Acceptance
Aural rehabilitation auditory training (4)
-Services designed to help train individuals to hear distinctions between sounds
-Performed by both SLPs and Audiologists
-Direct training, drill like activities with the purpose to hear differences among various sounds.
-Online auditory training or auditory training apps
Aural rehabilitation strategies (10)
-Make eye contact
-Get their attention before you start speaking
-Encourage hearing aid use
-Speak clearly, but don't yell
-In group settings, speak one at a time
-Have your mouth be fully visible
-Speak in a well-lit environment
-Remember if one ear is better than the other
-Give important information in writing, just to be sure
-Be patient
Traumatic brain injury
An acquired injury to the brain due to external force
How is the severity of TBI classified?
A scale based upon responsiveness at point of injury, Glasgow coma scale
What areas of the brain of most often injured in TBIs? (3)
-Frontal lobe! (most accidents happen facing forward)
-Temporal polls
-Occipital lobe (recoil)
What does an axonal injury cause?
A disconnection between brain areas
Medical complications of TBI (7)
-Sleep disturbance
-Headache and fatigue
-Bowel and bladder dysfunction
-Physical mobility changes
-Drug effects
-Complication of pre-existing medical conditions often get worse
-Might have a larger personality than before
What is primary injury with TBIs? (3)
-Contusions
-DAI (Diffuse axonal injury)
-Hemorrhage
What is secondary injury with TBIs?
Neuron death
What does post-acute assessment look at for TBIs? (4)
Success of community integration:
-Glasgow outcome scale
-Disability rating scale
-ASHA-FACS
-Community integration questionnaire
Executive function (8)
-Directed attention/resistance to distraction
-Planning and organization
-Goal-setting and implementation
-Incorporation of past experience into future behavior
-Problem-solving and strategy use
-Verbal reasoning
-Continuous thought stream
-Metacognition
Communication behaviors supported by executive functions (4)
-Conversational level
-Discourse level
-Utterance level
-Word level
Consequences of executive function impairment (5)
-Inertia
-Disinhibition/impulsiveness
-Reduced flexibility
-Lack of spontaneous strategy use
-Repeated errors
Social cognition and communication in TBIs (3)
TBI affecting the frontal lobes associated with impairments in functions such as:
-Detecting social cues
-Taking the listener's perspective
-Comprehension of nonliteral language
Working memory and communication in TBIs (5)
-Literal comprehension
-Comprehension of inference
-Inhibition of competing information
-Formulation of output
-Multi-tasking
Morals (3)
-The idea of right and wrong
-Based on personal beliefs
-Determined by a person's culture, religion, environment, or community
Ethics (4)
-The set of rules about acceptable and not acceptable behaviors
-Not based on personal beliefs
-Determined by an organization
-Action with the "best intention" can still be unacceptable
What are the 4 principles of ethics?
1. Responsibility for persons in treatment, research, academia, and animals in research.
2. Responsibility to advocate for professional competence and performance
3. Responsibility to advocate and provide accurate information to the public
4. Responsibility to uphold autonomy of professions and maintain collaborative relationships
ASHA code of ethics (2)
-Reflects what we value as professionals and establishes expectations for our scientific and clinical practice based on principles of duty, accountability, fairness, and responsibility.
-Intended to ensure the welfare if the consumer and to protect the reputation and integrity of the professions.
Interprofessional practice (IPP) and benefits
-Working together with experts from different fields, as well as with families and caregivers is important. IPP is a way to make this teamwork better.
What is research?
-Contributing new knowledge
-Solving problems that impact society
Evidence based practice (EBP)
-Combination of clinical expertise, client perspectives, and the most up to date scientific evidence
Why do research?
-Positively impact our patient's lives at local, state, national, and global levels
-Patient stories and experiences often drive our passion.
How do we judge credibility of an article?
For data to be considered scientific evidence, it must go through a peer review process before published
-Articles on blogs, newspaper site, etc. do not got through this process, thus they are not treated as credible evidence.
Steps of research (6)
1. Review of the literature
2. Development of a framework or theory
3. Design an experiment to test the theory
4. Conduct the experiment and analyze the data
5. Revise the theory
6. Repeat
Benefits of undergraduate research
-Contribute to the greater good
-Learn new skills
-Find your passion
-Build a competitive graduate school application
-Build working relationships with CSD faculty
-Network
T/F Apraxia is primarily characterized by muscle weakness or paralysis
False
Flaccid dysarthria is caused primarily by damage to which area?
Lower motor neurons
What two disorders are classified under the term "motor speech disorders"?
Apraxia and dysarthria
Which treatment activity would be appropriate for targeting resonance?
Speaking against resistance from a CPAP machine
Which type of dysarthria is predominantly characterized by involuntary movements?
hyperkinetic
T/F Visually impaired people cannot use AAC
False
T/F AAC always involves technology that is difficult to learn
False
How often should AAC be used, after it has been implemented as an intervention?
At least 80% of the time
T/F Speech-language pathologists should learn about AAC regardless of whether they work with clients with significant motor deficits
True
What is an symptom of Parkinson's disease?
a mask-like face
T/F Dementia and Alzheimer's disease refer to the same thing
False
How is dementia different from aphasia? (2)
-Dementia has more gradual onset
-Brain damage is more diffuse in dementia
What does it mean for a disease to be idiopathic?
The cause of the disease is unknown
T/F Aphasia is a disorder caused by motor impairment
False
T/F People with aphasia have difficulty with listening and understanding because of damage to their hearing
False
What is the more technical/medical term "stroke"?
Cerebrovascular accident (CVA)
When a person with aphasia says "lion" when they meant to say "tiger," this is known as a(n) _________________.
Paraphasia