CMD 160 Final Part 2 2024

smallest meaningful unit of sound - ANS-- phoneme phoneme - ANS-- phonemes are combined in specific ways to form words by changing a phoneme you can change the meaning of a word--> rot-lot, cat-hat, hip-lip articulation - ANS-- the ability to produce sounds in sequence by moving the articulators What are the articulators? - ANS-- tongue lips jaw hard palate soft palate (velum) How common are articulation disorders? - ANS-- 4% of children have an articulation disorder 60% are of unknown causes 40% associated with middle ear infections, developmental disorders-ex: MR, downs syndrome, Cerebral Palsy Which gender is affected more by articulation disorders? - ANS-- Boys International Phonetic Alphabet (IPA) - ANS-- describes and classifies each sound by how and where it is produced in the speech mechanisms classifies both vowels and consonants each sound is represented by a symbol transcription is usually between / / What are the 4 ways articulation disorders are characterized? - ANS-- 1. Substitutions: when one standard phoneme is substituted for another ex: wabbit instead of rabbit 2. Omissions: when a phoneme is deleted ex: abbit for rabbit 3. Distortions: when a non-standard phoneme is used-non-recognizable sound 4. Additions: when a phoneme is added to a word ex: chuair for chair speech intelligibility - ANS-- how easy it is to understand the individual somewhat subjective may be depend on: how well you know the speaker, number and types of sound errors, environmental factors (background noise) hearing impairments - ANS-- hearing loss not only limits the ability to hear others, but limits the ability to hear themselves and monitor their own speech production children with hearing loss will also have difficulty with: -pitch -rate -rhythm Cleft Palate - ANS-- 4th most frequent birth defect approximately 1/750 live births -50% both lip and palate -25% palate only -25% lip only (either 1 or both sides) 1 side affected=unilateral both sides affected=bilateral most speech difficulties with sounds requiring a build-up of pressure in the oral cavity ex: p, b, t, d, s, sh consonants can result in audible air escaping through the nose-nasal emissions, which can almost sound like a snort Other symptoms of a cleft palate - ANS-- misaligned teeth changes on the shape of the nose feeding/sucking problems flow of liquids/solids through nasal passages failure to gain weight/poor growth recurrent ear infections Surgical care for a cleft palate - ANS-- cleft lip usually repaired within the first 3 months of life cleft palate usually repaired at approximately 12 months of age 80-90% of repairs will be successful 10-20% may need additional surgery Neurogenic speech disorders - ANS-- muscles of speech production which includes the face, lips, jaw, tongue, soft palate, vocal cords, respiratory system, are moved by nerves arising from the base of the brain (cranial nerves) Etiology: damage to the central nervous system can cause disruption of the motor symptoms involved in speech production What are 2 commonly recognized speech disorders resulting from damage to the neuromuscular systems? - ANS-- Apraxia of speech Dysarthria In adults these are acquired disorders, meaning they result from some sort of damage or trauma to the neuromuscular system In children, both acquired and developmental forms of apraxia and dysarthria occur Apraxia - ANS-- also called verbal apraxia a disorder in which the patient has trouble speaking because of a cerebral lesion that prevents the execution of voluntary and on command movements of the complex motor movements involved in speaking movements are affected despite the fact that muscle strength is not affected may not be able to execute a movement on an involuntary basis, but able to perform on a voluntary basis (ask a patient to stick out their tongue and they can't do it but a few minutes later you see them licking their lips unconsciously) What are the 2 types of apraxia? - ANS-- 1. Oral apraxia 2. Verbal Apraxia/Apraxia of speech Oral apraxia - ANS-- difficulty in the voluntary execution of the orofacial muscles in the presence of preserved ability to perform automatic movements with the same muscles ex: patient may not be able to stick out their tongue when you ask them to but you'll see them licking their lips Verbal apraxia or apraxia of speech - ANS-- impairment in the ability to position the musculature and to sequence the muscle movements for volitional production of phonemes and sequences of phonemes, not accompanied by a significant weakness, slowness, or incoordination impairment in the ability to position the articulators for the production of speech sounds Testing for oral and verbal apraxia - ANS-- Oral apraxia: stick out your tongue blow show me your teeth bite your lip clear your throat smile puff up your cheeks Verbal apraxia: (have the patient say...) snowman gingerbread impossible statical analysis methodist episcopal zip-zipper-zippering Dysarthria - ANS-- a group of related motor speech disorders resulting from disturbed muscular control of the speech mechanisms can have devastating effects on intelligibility manifested by: paralysis weakness abnormal timing of the speech mechanisms incoordination of the speech muscles Flaccid Dysarthria - ANS-- muscles are weak affected side of the mouth will sag drooling may be present tongue may show tremors tongue may atrophy over time=shrink and become flabby speech characteristics: imprecise consonants voice may be breathy no variation of pitch or loudness Spastic dysarthria - ANS-- increased tone of muscles, although muscles are weak range of movement is limited rate of movement is slow tongue will deviate to weak side face may droop on the affected side speech characteristics: may be described as harsh strained, strangled quality pitch may be low fluency - ANS-- fluent speech is the consistent ability to move the speech production apparatus in an effortless, smooth and rapid manner resulting in a continuous, uninterrupted forward flow of speech stuttering - ANS-- the most common fluency disorder greatest medical mystery with no known cause or no known cure affects the ability to produce fluent speech a disturbance in the normal fluency and timing patterns of speech that is inappropriate for the person's age characterized by: involuntary repetitions, prolongations and broken words repetitions=buh-buh-buh-ball prolongations=mmm-mommy broken words (blocks)=b-oy secondary features/behaviors of stuttering - ANS-- result from excessive mental and physical efforts to promote fluent speech common secondary features: eye blinking facial grimacing facial tension head jerks pauses word changes (avoid the sounds that make you stutter) filler words-ex: um, uh a negative attitude towards speaking worry about speaking believe other people don't like the way they speak Charles VanRiper - ANS-- distinguished professor of speech pathology at Western Michigan University pioneer in the treatment of stuttering-many of his treatment techniques are still used today was a stutterer himself spent most of his life looking for a cure Incidence of stuttering - ANS-- 5% of adults report stuttering at some point in their life 65-75% of children who stutter will recover within the first 2 years after it's onset 85% will recover within the next few years 1% of those who reported stuttering will remain throughout adulthood high familial incidence-50% affects males 3:1 ratio Theories of stuttering (3 types) - ANS-- organic behavioral psychological organic theories - ANS-- believe there is an actual physical cause behavioral theories - ANS-- believe stuttering is a learned behavior psychological theories - ANS-- believes that stuttering is a neurotic symptom with ties to unconscious needs and internal conflicts and treated appropriately with psychotherapy developmental disfluencies - ANS-- children normally exhibit many hesitations, revisions and interruptions in their utterances children at around 25 months of age are more fluent than they will be at 37 months of age no secondary symptoms fluency improves following the 3rd birthday normal dysfluencies= 2 years-typically whole word repetitions-I want, I want, milk interjections=can we go um now? revisions=he can't-he won't play baseball Onset of stuttering - ANS-- typically occurs between 2 and 5 years of age stuttering is gradual for most children stuttering severity increases as the child grows older Bloodstein's Phases of developmental stuttering phase 1 - ANS-- Phase 1 -corresponds to the pre-school years, roughly between 2 and 6 years of age tends to be episodic; periods of stuttering followed by periods of relative fluency sounds and syllable repetitions are the dominant feature most children are unaware of the interruptions in their speech child will usually stutter when excited or upset about something usually occurs at the beginning of words or phrases occurs on both content words (nouns/verbs) and function words (articles/prepositions) Bloodstein's Phases of developmental stuttering phase 2 - ANS-- represents a progression of the disorder associated with children of elementary school age essentially chronic, or habitual, with few intervals of fluent speech has developed a concept of himself as a person who stutters-will refer to himself as a stutterer, but typically does not express concern about stuttering occurs primarily on content words stuttering more widely dispersed throughout the child's utterances Bloodstein's Phases of developmental stuttering Phase 3 - ANS-- Age 8 to young adulthood in response to specific speaking situations, such as telephone, speaking in groups, strangers certain words become regarded as more difficult and will avoid feared words or substitute with a similar word Bloodstein's Phases of developmental stuttering phase 4 - ANS-- the "apex" of stuttering stuttering at it's most advanced form vivid and fearful anticipation of stuttering certain words, sounds, or situations are feared and avoided evidence of embarrassment very advanced secondary symptoms secondary symptoms kind of progress (eye twitches, filler words, head nods, embarrassment that goes along with it) voice through the lifespan - ANS-- voice changes throughout a person's lifespan infant uses voice to express pain, hunger, or displeasure as the child matures he uses voice for production of speech sounds, and to express ideas and moods adult voice is achieved by age 18 at age 60 the voice begins to decline ability to control pitch and loudness declines females pitch lowers with age, males pitch increases pitch - ANS-- the highs and lows of voice determined by the speed of the vocal folds speed at which the vocal folds move is called fundamental frequency measured in hertz (Hz) or the number of vibrations per second each of us has an average fundamental frequency called habitual pitch adult male=130 Hz (vocal cords open/close 130 times per second) adult female=250 Hz average child=500 Hz if the vocal cords are tight you get a higher pitch, but if they're relaxed and looser you get a lower pitch vocal intensity (loudness) - ANS-- measured in decibels (dB) normal conversation is approximately 60 dB changes in loudness come from air pressure coming up from the lungs voice - ANS-- normal voice requires: voice quality pitch loudness flexibility ^all of which must be pleasing and audible to the listener Disordered voice involves: deviations of any or all of the above that may signify illness and/or interfere with communication most voice disorders in children are the result of misuse and abuse of the vocal cords and are often temporary. In adults the cause can vary edema - ANS-- swollen vocal cords, mostly due to laryngitis aphonia - ANS-- complete loss of voice (phonia=voice, a=without) harsh voice - ANS-- too much tension breathy voice - ANS-- voice produced like a partial whisper can be caused by paralysis of one of the vocal cords hoarse - ANS-- both harsh and breathy acute and chronic laryngitis - ANS-- inflammation of the vocal cords-temporary swelling of the vocal cords caused by: tobacco alcohol smoking allergies vocal abuse (screaming at a sporting event) vocal nodules - ANS-- sometimes called screamers nodules mainly caused by abuse to the vocal cords: screaming, shouting throat clearing coughing tend to develop over time when first develop may be soft, but become hard, much like a callous vocal polyps - ANS-- usually caused by trauma-mostly a one-time event develop when blood vessels in the vocal cords swell and rupture fluid filled much like a blister (can pop) prone to hemorrhage (bleeding) contact ulcers - ANS-- reddened ulcers that develop on the back of the vocal cords can be painful with pain radiating to the ear caused by: frequent coughing frequent throat clearing reflux disease trauma from intubation vocal fold cancer - ANS-- laryngectomy=surgical removal of the vocal cords typically due to cancer occasionally due to trauma breathe through a hole in their throat called a stoma trachea - ANS-- goes down to the lungs esophagus - ANS-- goes down to the stomach dysphagia - ANS-- swallowing disorders the impaired movement of material from the mouth through the pharynx (back of the throat) and into the stomach the normal swallow - ANS-- four phases of swallowing two are volitional (you have to control them) 1. oral preparatory phase 2. oral phase two are reflexive (automatic) 3. pharyngeal phase 4. esophageal phase Recent literature cites a 5th phase 5. anticipatory phase the 4 phases of swallowing are: - ANS-- interdependent=rely on one another dynamic=constant movement overlap=appear simultaneously anticipatory phase - ANS-- the 5th phase getting ready to eat includes: the sights the sounds the smells of food often diminished in the elderly they don't smell as much not cooking as much social aspect-everything revolves around food and family, children are grown, loss of spouse oral preparatory phase - ANS-- first the person has to grab food off the fork/spoon; close lips around utensils, cup food is manipulated and chewed (masticated) food mixes with saliva to form a bolus at the end of the oral predatory phase the bolus is compressed and held against the hard palate stroke patients have a weakness on one side, can't close their lips tightly Oral phase - ANS-- tongue cups the bolus and pushes the food backward through the oral cavity bolus starts to get squeezed itself and the soft palate groove becomes evident in the tongue pressure pulls the bolus back as the bolus reaches the faucial arches the swallow reflex is triggered pharyngeal phase - ANS-- complex set of muscular activities occur soft palate raises and closes off the nasal cavity vocal folds close-momentarily hold breath muscles under the neck pull the area surrounding the vocal folds upward epiglottis folds over and forms a chute to deflect the food into the esophagus muscles of the throat squeeze the food down to the upper esophageal sphincter muscle, which relaxes combination of oral and pharyngeal phases=1-1.5 seconds esophageal phase - ANS-- once in the esophagus the bolus slows down a series of waves move the bolus down the esophagus into the stomach takes 8-20 seconds Causes of dysphagia - ANS-- neurological causes: stroke parkinson's disease ALS multiple sclerosis huntington's disease cerebral palsy structural/anatomical changes: oral cancer head/neck trauma reflux disease hiatal hernia long periods of intubation pediatric population: premature babies oral/facial deformities MR/downs syndrome genetic syndromes aspiration - ANS-- occurs when the food enters the respiratory system below the level of the vocal cords penetration - ANS-- when the food enters the airway above the level of the vocal cords modified Barium Swallow study - ANS-- Videofluoroscopy or Modified Barium swallow (MBS) moving radiographic image recorded on a tape/DVD both a diagnostic and therapeutic tool to assess swallowing function trying to see what textures and consistencies patients can eat alter the diet based on diseases the test is done under x-ray in conjunction with a radiologist alternative and augmentative communication - ANS-- used with individuals who have severe impairments in speech involves supplementing or replacing natural speech and or writing with aids such as pictures, symbols, drawings, signing, gestures, finger spelling augmentative communication - ANS-- the process of augmenting or supplementing existing speech abilities alternative communication - ANS-- some method that becomes a substitute or replacement for speech (you have no speech) Who benefits from AAC? - ANS-- approximately 12 out of every 1000 people are unable to meet their daily communication needs through speech individuals who may benefit from AAC: deafness MR autism cerebral palsy glossectomy (tongue removal) layrngectomy dysarthria and apraxia 2 types of AAC - ANS-- aided and unaided aided AAC - ANS-- uses some type of equipment or device range from simple such as picture boards to extremely sophisticated devices such as electronic devices (ex: electro larynx) unaided AAC - ANS-- do not use any external devices, but relies on the individuals body sign language finger spelling gestures pointing Aided AAC (no-tech, low-tech, high-tech) - ANS-- No-tech: do not use any technology paper/pencil writing low-tech: communication picture boards alphabet boards eye gaze systems high-tech electronic devices many use computer technology many use synthesized voice