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SPAUD 101 Exam #2
| Question | Answer |
|---|---|
| Primary Causes of Voice Disorders | Abuse - Screaming, untrained singing, etc. Medical - Nervous system damage, virus, cancer Psychogenic - Emotional stress |
| Edema | Swelling of the vocal folds |
| Atrophy | Reduction of tissue |
| Hyperfunction | Increased muscle activity (too much tension) |
| Hypofunction | Decreased muscle activity (not enough tension) |
| Aphonia | Loss of voice |
| Harsh voice | Excessive muscle tension |
| Breathy voice | Partial wisper |
| Hoarse | Both breathy and harsh |
| Dysphonia | Psychogenic problem Normal phonation in vegetative functions |
| Puberphonia | High pitch voice by post pubertal male Easily corrected Michael Jackson |
| Muscle Tension Dysphonia | Simultaneous contractions of adductors and abductors Type A personalities |
| Vocal fold paralysis | When one side or both don't move like they should. Possible solution is moving affected side closer to the midline |
| Spasmodic Dysphonia | Basal ganglia is affected Adductor SD - strain-strangle voice quality BOTOX |
| Contact Ulcers | Ulcers on the vocal processes of the arytenoids Excessive slamming during low pitch, non productive throat clearing/coughing, reflux |
| Author of the text book | Ronald B. Gillam and Thomas P. Marquardt |
| Nodules | Callous-like growths Form in pairs |
| Polyps | Blister-like growths Unilateral |
| Papillomas | Wart-like growths Usually go away without treatment Caused by HPV |
| Carcinoma | Cancer caused by HPV, excessive drinking or smoking 15-20% require a laryngectomy |
| Laryngectomy | Complete removal of the larynx due to cancer Trachea redirected to stoma Treatment: Esophageal speech - air released near Electrolarynx - Hand held battery operated device that provides vibrations |
| Tracheoesophageal Puncture | now you can potentially communicate, because if you close your stoma out, the one way valve with the flap of skin may allow for voice production eating/drinking: no more aspiration unless flap gets corroded |
| Lip Development | 7-8 weeks: Tissue grows downward from the nose area to meet tissue coming in from each side to form the upper lip If the three sections of tissue never touch or join up, a cleft will occur |
| Palate Development | 6-9 weeks: The premaxilla (housing for 4 front teeth) joins with the palantine processes, which then fuse with each other front to-back to form the palate If process disrupted at any time, a cleft will occur |
| Cleft Lip | Partial - No alveolar ridge involvement Complete - Alveolar ridge involved Union of the lip occurs after palate formation begins It’s possible for a child to be born with an intact palate but a cleft of the lip |
| Cleft Palate | Complete - Open mouth and they obviously have a cleft palate Submucous cleft - notch in the hard palate, split uvula, thin blue velum Occult cleft - Malformation of palatal musculature, hard to see causes speech problems Typically surgerically repaired |
| Chelioplasty | Surgery for cleft lip usually done within first 3 months of life |
| Palatoplasty | Surgery for cleft palate typically done around 12 months |
| Effect of clefts on speech production | Problems with velopharyngeal closure Compensatory articulations - glottal stops, pharyngeal stops and fricatives Changes to nasal structure |
| Velopharyngeal Insufficiency | there is a persistent opening between the velum and pharynx |
| Pharyngeal flap surgery | Flap of tissue from back of throat is raised and inserted into the velum (adding more bulk) Provides a “veil” over the velopharyngeal port |
| Superior sphincter pharyngoplasty | Posterior faucial pillars cut free and swung up, then sutured together to form a “purse string” Consistent hyponasality Added bulk ensures that reduced lateral wall movement is adequate for closure |
| Prosthetic Management | Speech bulb or pharyngeal extension appliance - Inadequate soft palate length. work like retainer, blocks space not covered by velum, hyponasal Palate lift appliance - Adequate soft palate length, but lack of muscle control lifts the velum up |
| Fluency vs. Disfluency | Fluency - Speech is effortless in nature easy, rapid, rhythmical, even- flowing Disfluency - Marked by word or phrase repetitions, interjections, pauses, and revisions - Normal speakers produce disfluencies some of the time |
| Stuttering | Unusually, tense disfluencies that interfere with communication Most common form of fluency impairment acquired/neurogenic/psychogenic stuttering - adulthood, brain damage or emotional trauma Negative self talk, low confidence |
| Cluttering | Rapid bursts of dysrhythmic, unintelligible speech |
| Part-word repetitions | Syllables (with or without schwa vowel) Interjections (“uh”/ “um”) Phonemes (“baseb,b,b,ball”) |
| Prolongations | vvvvvvvvvvvvan |
| Blocks | Silent prolongations (get's stuck/silent struggle) |
| Secondary stuttering behaviors | Counterproductive behaviors as people try to avoid primary stuttering behaviors Become more automatic Are more distracting than primary behaviors |
| variability in stuttering behaviors | Peaks and valleys of fluency - frustration Pressure to be fluent - greater disfluencies May be fluent when: Singing, Using pretend voices, Talking to babies or animals |
| Neurological differences between those who stutter and those who don't | More activation in right hemisphere speech and language areas More activation in the cerebellum Less activation in left hemisphere speech and language areas |
| Chronic Stuttering | Continues from childhood into adolescence and adulthood |
| Frequency of stuttering | words stuttered on / total words = percentage |
| Percentage of each disfluency type | words with specific disfluency / words stuttered on = percentage of specific disfluency |
| Treatment: Stuttering Modification | MIDVAS - Motivation, Identification, Desensitization, Variation, Approximation, Stabilization |
| Treatment: Fluency Shaping | Change the way people talk - aim for stutter-free speech Control rate, onset, transitions, paraphrasing Airflow therapy Gradual increase in length and complexity of utterances (FILCU) Aim to integrate stuttering modification and fluency shaping |
| Acquired Apraxia of Speech | Damage occurs near Broca's area Causes slow, disfluent speech and flat, monotonous intonation Disorder in the planning and programing of motor speech movements caused by damage to the left, frontal lobe Often after a neurological event |
| Acquired Apraxia of Speech cont. | Can happen without language issues, but usually not In most cases, occurs alongside Broca’s aphasia Speech sound errors Based on imprecise consonants, subtitle simple sounds for complex sounds Prosodic Impairment |
| Prosodic Impairment | Slow rate, prolonged consonants and vowels, pauses between words, even stress on syllables |
| Childhood Apraxia of Speech | Area of damage unknown still Delays in speech development, but other motor skills develop normally Severe speech delays Words dominated by simple syllable shapes and early developing sounds Vowel errors Inconsistent sound production/air Groping |
| Groping | when you try to get the motor plan, and your mouth isn’t cooperating |
| Dysarthria | Speech disorders from damage to the central and/or peripheral nervous system pathways involve: Respiration, phonation, resonance, articulation Cerebral palsy causes congenital dysarthria severity relates to intelligibility in conversational context |
| Cerebral Palsy | A syndrome of deficits in resulting from injury to the nervous system at or shortly after birth Often before birth, during birth, or just after birth The child’s muscles are weak, paralyzed, and/or uncoordinated - including speech mechanism |
| Causes of CP | Prenatal - Anoxia (lack of oxygen), disease, metabolic problems Perinatal - Anoxia from umbilical cord problems, Premature placenta separation, Brain trauma Post natal - Brain trauma |
| Orthopedic Classification | Monoplegia - one limb Paraplegia - 2 limbs Triplegia - 3 limbs Quadriplegia - 4 limbs |
| Spastic CP | Damage to pyramidal/extrapyramidal tracts Spasticity Abnormal resistance to muscle lengthening Muscles resist movement Hypertonicity Arms bent upward Legs positioned like scissors Muscle atrophy he can’t control his diaphragm - rushes of speech |
| Athetoid CP | Primary damage in basal ganglia (EP tract) Involuntary writhing and twisting movements (they happen from the trunk and progress outwards) Child appears to be in almost constant motion |
| Ataxic CP | Caused by damage to the cerebellum Disturbances in motor coordination (errors in speed, direction, accuracy of movement) Difficulty in motor tasks involving a target and precision and rhythm Often occurs with spastic (can be both, but primarily one) |
| Respiration with CP | Reduced vital capacity, inefficient valving at the glottis/velopharynx, and within oral cavity Cannot generate/maintain subglottal pressure well |
| Phonation with CP | Intermittent breathiness/strangled harshness of voice; compromised by changing tonicity of vocal muscles |
| Resonance with CP | Hypernasality and nasal emission Premature opening of velopharynx |
| Articulation with CP | Mandible may be hyperextended Difficulties rounding or protruding mouth Abnormal tongue position All prevent precise shaping of vocal tract and lead to articulation problems |
| Prosody with CP | Poor respiratory control - one or two utterances per breath Poor laryngeal tension control – hard to manipulate changes in pitch |
| Acquired Dysarthria | Occurs when an individual had developed speech and language skills before the onset of the disorder Flaccid, spastic, ataxic, hypokinetic, hyperkinetic, mixed |
| Flaccid Dysarthria | Lower Motor Neuron Audible Inspiration, hypernasality, nasal emission, breathiness |
| Spastic Dysarthria | Upper Motor Neuron Imprecise articulation, slow rate, harsh voice quality |
| Ataxic Dysarthria | Cerebellum Phoneme and syllable prolongation, slow rate, abnormal prosody (rhythm of speaking) |
| Hypokinetic Dysarthria | Parkinson’s disease - most common cause (there are other ones too) Extrapyramidal system Monoloudness, monopitch, reduced intensity, short rushes of speech |
| Hyperkinetic Dysarthria | Extrapyramidal system Imprecise articulation, prolonged pauses, variable rate, impaired prosody (rhythm of speaking) |
| Mixed Dysarthria | Multiple motor systems How speech production is affected depends on which systems are damaged/to what extent |
| Intervention for Dysarthria | Postural supports Speech therapy - Reductions in rate Diaphragm training surgical management Palatal lift or pharyngeal flap for velopharyngeal inadequacy Vocal fold relocation |
| AAC | Augmentative and Alternative Communication Augmentative = Supplementation Alternative = replacement |
| Augmentative Communication | Systems for speech Can take various forms: Gesture, Communication boards, Electronic devices Issues: Motor control, Cognitive and intellectual impairments, Is slower than oral speech |
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