CD 277 Final

Place, manner, and voicing

tongue height, tongue placement, tension

difficulty with physiological movements of articulators, coordination of air support, timing of phonation

child doesnt know which sounds are contrastive and which are not, kinds of positional constraints and sequential constraints placed on verious speech sounds

substitutions, omissions, distortion, additions,

• substitution
• error is in PLACE

• substitution
• error in VOICING

• substitution
• error in PLACE and MANNER

Syllable deletion

• substitution
• error in place

Structural, Genetic, Hearing Loss

• Describes the flow of speech in a conversation'
• Relates to the ease and smoothness of speech

• -Trouble finding words
• -Excessive pauses
• -Repetition of phrases to make time to think

• -Politicians
• -Being fluent and saying nothing
• -Fluent speakers of foreign language
• -Glib speakers (Robin Williams)

• -Speech behaviors that disrupt flow of speech
• -Pauses
• -Interjections
• -Revisions

When speech contains a high rate of stoppages that disrupt flow of communication must be severe enough to impact social communication

• -Most people know what stuttering is
• -Stuttering was the first disorder SLP's researched
• -More research on stuttering than any other disorder

Disorder offluency characterized by certain types of disfluencies, excessive amounts of dysfluency in general, of excessive durations of dysfluencies

Fluency problem that can affect intelligibility; it is characterized by breakdowns at the word or phrase level, poor cohension and coherence.

• Interjections
• Revisions

• Repetitions
• Prolongations
• Silent Pauses
• Broken Words

• Core- repetitions, prolongations, blocks
• Secondary- eye blinks, filler words, emotional reactions

1%

Boys

age 2-5

75

• -Occur on first few words of sentance
• -Occurs on major cord content
• -Predictability

5-10%

motor behavior, tightening muscles of speech aparattus,

slower speech, unnatural speech, disruption of speech by associated behaviors

interference with basic communication skills

Not getting called on in class, not being selected for a play, being hung up on.

• Developmental has no known cause.
• Other- predisposing + precipitating

• -Runs in the family
• - Boys>Girls
• -

predisposing factors must be present but precipitating factors determine whether or not predisposing factor is manifested, temperment, and stressors

• -% of disfluencies per 100 words
• - Rate of speech in syllables per minute
• -Duration of blocks
• - avoidance strategies

two different people see and hear the same thing

the same person makes the same observation at a different point in time

• -Wait, Watch, Re-evaluate
• -Enroll in therapy but not necess stutter ther.
• -Enroll in treatment with SLP

Enrol in therapy, ane make realistic expectations

• 1. speak normally without thinking about it
• 2.. Control and manage the problem

Stuttering Modification

Fluency Shaping

• -Pause and talk
• -Behavior Modification (punish disfluency)
• -Computer aided home practice

UNHS

• Audiologic Evaluation
• Follow-up to confirm Hearing Loss

Medical treatment, early services, and family support

90

• -Family History of HL
• -TORCH
• -Bacterial Meningitis

Toxoplasmosis, Other Agents, Rubella, Cytomegalovirus, Herpes

Auditory Brain Response Test

Electrodiagnostic test that requires application of elctrodes to skin and presentation of click like sounds through earphones. Used to assess inner ear and auditory pathways

Otoacoustic Emissions

Acoustic energy produced by cochlea and measured by ear canal, may be awake but better is asleep, moderate sensitivity.

Sounds are presented through loud speakers, assesses hearinf eaither aided or unaided, important to behaviorally confirm heraing loss, some tests can be done 3-6 months.

• tympanometry, acoustic reflex
• (measure mobility of eardrum and how well muscles in ear contracts to loud sound)

microphone, amplifier, receiver, battery

-Electronic devices inside or behind ear, Do not restore hearing, Medical clearance needed from Physician

• -Severe-Profound SNHL
• -12+ mo
• -Lack of progress of auditory skill

-Improved audibilidy, improved communication, reduced handicap, increased participation in activities

Noise, Fast Speech, Takes time to adapt

59

In the ear, fits deep in canal

in ear device, Small enough to fit almost entirely in canal (In The Canal)

(In the ear) made to fit in external ear

(behind the ear) fits snug behind the ear and is attacched to a custom earpiece

Ultra thin tubing is virtually invisible

(Receiver-in-the-canal) the smallest BTE instruments

• -Amplify sound wave after converting to an electrical signal
• -Less precise tuning
• -Less expensive

• -Amplify sound waves after they have been converted to a binary numerical code
• -Precise Tuning
• -More Expensive

5-7 years

• wax
• It may need to be adjusted

750-3000

Bypasses a nonfunctional inner ear and stimulates a nerve with electrical current

pick up sound

selects and arranges sounds

receives signals and converts them into electric impulses

collects impulses from the stimulator and sends them to the brain.

• -HA acoustically amplifies speech & relys on healthy inner hair cells
• -CI convert speech info into electric signal, bypass hair cells, stimulate hearing nerve (8th cranial nerve)

Services designed to help individuals with HL realize their optimal potential. (can be in individual of group setting)

HA operation, Assessment of self report, Psychological counseling, Communication strategies, Speechreading, assistive devices, auditory training

Reading disorders, mild dementia, cochlear implants/hearing aids, auditory processing disorders

-Tobacco, Alcohol, GERD (inflammation), Epstein-Barr, HPV

Hoarseness greater then 3 wks, lump in throat, persistent throat clearing, coughing, or sore throat, throat discomfort, difficulty breathing

Case history, indirect mirror laryngoscopy, flexible fiberoptic endoscopy, Biopsy, imaging studies

• T- tumpr size
• N- lymph node metastasis
• /m- presence of distand metastasis

Rediation, Chemo, Laryngeal surgery, combination, laryngectomy

air is no longer flitered, moisturized or warmed

smell impaired since can not breath through nose, which also affects taste

loss of sound generator, pulmonary source disconnected from oral cavity

Electro layrnx. When held against skin of jaw, converts vibration into electronic sound

Electronic Artifical Larynges

Cooper-Rand or P.O. Vox

Ultravoice custom built into upper denture

Memacon and Tokyo artificial Larynges (rarely used in US)

Easy to learn, Equal in intelligibility to esophogeal, more easity discriminated in noise than esophogeal, can be easy changed to intraoral

Robotic, costly, requires one hand for use, Mechanical Breakdown, Difficult to vary pitch and intensity

patient transports air into esopagus, air is forced back past PE to include resonance

• inhalation
• injection

No mechanical devices, both hands are free, more natural sounding

takes 4-6 mo to learn, low sucess rate, phonation can be sustain for a short period, low intensity and pitch, limited pitch modulation

TE fistula puncture created at time of Laryngectomy

TE fistula puncture created months after laryngectomy (less successful)

inserted into trachea held by strap or collar

Long phnation sustainablity, more natural breathing action, easy to acquire and learn, hands free

daily maintenance, semi-permanent, leakage, cost, requires additional surgery

aspects of movement that remain constant in different contexts

practice or experience leads to permanent changes in capability for movement

Process that defines and sequences articulatory goals prior to occurence

Process responsible for establishing the flow of motor information across speech production muscles

Process of activating relevant muscles during speech production

neromuscular defect, motor control system defect, or both

Motor planning/programming, Motor execution

Cogenital (Downs, Cerebral palsy), Acquired (CVA, TBI, Parkinsons)

modulates airflow, controls vocal folds, used for prosody

Inhale/Exhale, Airflow required for speech

Regulates airflow in oral/nasal cavitiy, nasality of speech, shape of VT impacts sound quality

regulate articulation, controls oral muscles

• Disorder of motot planning
• -inability to transform linguistic representation into appropriate movement of articulators
• -Affects ARTICULATORY system

Effortful slow speech, distortions of sounds, impaired prosody

groping articulatos, difficulty initiating speech, ex: hello is untomatic until on command

Neurobiological, Different lesion locations associated, may accompany aphasia

Dirorder of execution may affect any or all systems

learn of re-learn accurate speech production, retention, generalization

Posture changes, respiratory exercises, speak at onset of exhalation

exercise to increase vocal fold closure, use of easy onset voicing, increase volume

prosthetic device

oral motor exercise, sound production

rate control, stress training

Speech is an overlaid function,

30

Swallowing

Chewing

round, soft, mass of food

Malnutrition, dehydration, poor wound healing, pulmonary complications, aspiration risk, poor oral care

closed to protect the airway

space between tongue and eppiglottis

located beside larynx and formed by shape of muscle attachments to pharyngeal walls

UES (upper esophogeal Segment)

• FEES (Fiberoptic Endoscopic Evaluation of the Swallow)
• MBS (Modified Barium Swallow)

Oral Prep Phase, Oral Phase, Pharyngeal Phase, Esophageal phase

Bolus formed, Variable and voluntary stage

Voluntary but not prolonged, lasts one second, breathing inhibited at beginning of stage, food moved to back of mouth

Bolus moves from mouth down throat to esophagus, airway protection, reflex, 1 second

INVOLUNTARY bolus is moved down esophagus, 3-20 secs,

Repiration-->Phonation-->Resonance

Sphicteric Muscular Organ degined to protect airway. Speech is an overlaid function

Vocal Fold Microstructure

Vocal abuse, surgical trauma, chrinic illness,

cleft palate, velopharyngeal insufficiency, deafness, cerebral palsy, etc

environmental stress, psychological conversions, identity conflict,

Larygology evaluation, Voice pathology evaluation,

Patient interview, Voice assessment (CAPE-V, Equal appearing interval screen), Acoustic Voice Assessment, Laryngeal videostroboscopy

discover behavioral causes of voice disorder and modifies to improve vocal condition (throat clearing, shouting, speaking loudly)

• modification of deviant vocal symptoms (breathiness, pitch, loudness, hard glottal attacks)
• ex: tone focus, halthy shout

focus on emotional and psychological status of pt. that lead to voice disorder (muscle tention dysphonia, aphonia, falsetto)

improve balnce among voice resp. system , muscle strength, (vocal function exercise, lee silverman voice therapy)

Combination of any therpies

sensorineural hearing loss

auditory nerve

height, frontness, roundness, tension

place, manner, voicing

unknown

ear pain, bleeding ear, sudden or progressive HL, unequal hearing by ears, HL after injury of loud sound, slow speech dvmt, balance disturbance

disfluency

part and single syllable word repetitions

circumlocution

constitutional factors that make an individual susceptible to fluency disorder (genetics, or overly sensitive temperment)

developmental and environmental factors that can worsen stuttering such as age or stress

FS tries to eliminate disfluency SM modifies stutter and decreases fear and anxiety

when vocal folds are closed at midline

when vocal folds are open, rested, so one can breathe

• Length (longer=lower F)
• Mass (thick=lower F)
• Tension (Greater=higher F)

how well two vocal folds work during vibratory cycle

strained, broken, breathy quality

disordered voice

Lack of voice

vocal folds that are under functioning

vocal folds that are pressed too tight and strained

Vocal folds produce two pitches simultaneously

9000

inflamed ulcers around arytenoid cartilages

linked to emotional and psychological characteristics

male with abnormally high voice