Diagnostics Flashcards
including speech and language, articulation and phonology, language and cognition, fluency and stuttering, voice and resonance, motor speech, neurogenic disorders, dysphagia and swallowing, etiologies, and functional vs. organic
1
Q
types of diagnostics
A
- articulation and phonology
- language and cognition
- fluency and stuttering
- voice and resonance
- motor speech
- neurogenic disorders
- dysphagia and swallowing disorders
2
Q
case history
A
medical and personal background history used to analyze and diagnose diseases, disorders, etc.
3
Q
case history: what do we want to know?
A
- onset and development
- medical history
- family history
- speech-language disorders and concerns
- educational and social history
- prior level of function
- signs and symptoms
4
Q
case history: onset and development
A
- age of onset
- other conditions during onset
- length since onset
- variations since onset
- awareness and reactions of onset
5
Q
case history: medical history
A
- history of hospitalizations
- history of surgeries
- medication list
- vision, hearing, and motor abilities
6
Q
case history: family history
A
blood relatives history of any related SLP conditions
7
Q
case history: speech-language disorders and concerns
A
- previous speech/language therapy and outcomes
- reason for SLP referral
8
Q
case history: educational and social history
A
- highest level of education
- job and/or hobbies
- primary, secondary languages spoken
9
Q
case history: prior level of function
A
- if new (e.g., acute CVA) or not new onset
- changes in function from baseline
- who patient lives with ADLs, daily communication needs, etc.
10
Q
case history: identify signs and symptoms such as…
A
- difficulty chewing and/or swallowing
- difficulty expressing self and/or understanding language
- problems with memory and/or problem solving/reasoning
- problems with attention and/or concentration
- problems with reading and/or writing
- difficulty with word retrieval and word finding
- difficulty with topic maintenance and following directions
11
Q
articulation and phonology
A
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
12
Q
articulation and phonology: formal assessments
A
- standardized
- Goldman-Fristoe Test of Articulation (GFTA-3)
- Khan-Lewis Phonological Analysis (KLPA)
13
Q
articulation and phonology: informal assessments
A
- identify strengths and weaknesses
- speech-language sample
- evaluate etiology of articulation and phonological disorders
14
Q
articulation and phonology: speech-language sample
A
- phonetic inventory
- speech intelligibility
- rate and prosody
- number, type, and consistency of errors (classify based on most appropriate system)
15
Q
phonetic inventory
A
- explain which position/s sound was seen during testing
- assess and identify stimulable sounds
16
Q
speech intelligibility
A
24 months: 50%
36 months: 75%
48 months: 100%
17
Q
articulation and phonology: number, type, and consistency of errors
A
- traditional SODA errors
- features
- phonological processes
18
Q
speech-language sample: traditional SODA errors
A
- substitutions
- omissions
- distortions
- additions
19
Q
speech-language sample: features
A
- voice
- place
- manner
20
Q
speech-language sample: phonological processes
A
- typical vs. atypical
- typical vs. typical but no longer age-appropriate
21
Q
evaluate etiology of articulation and phonological disorders
A
- organic/known physical cause: cleft lip/palate, cerebral palsy
- functional/no known physical cause
- unknown etiology
22
Q
language and cognition
A
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
23
Q
language and cognition: formal assessment
A
expressive and receptive formal assessments
24
Q
language and cognition: informal cognitive assessment
A
- Piaget’s stages of cognitive development
- effective communicator profiles
25
language and cognition: informal language assessment
will depend based on communication level
26
prelingual/nonverbal communication level: expressive language
- communication attempts
- frequency and type of gestures
- phonetic inventory
- stimulability
27
prelingual/nonverbal communication level: receptive language
- nonverbal responses to verbal stim
- attention to speech/orientation
- early pragmatic development
- pointing to objects when asked
28
single-word user communication level: expressive language
- grammatical morphemes and MLU
- naming of familiar objects
- use of syntactic devices
- simple pragmatics
29
single-word user communication level: receptive language
- comprehension of words
- simple phrases
- 1 vs. 2-step commands
30
multi-word user communication level: expressive language
- advanced grammatical morphemes
- semantic relations
- syntactic structures
- advanced pragmatics
31
multi-word user communication level: receptive language
- response to 1, 2, or multi-step commands and/or directions
- comprehension and understanding of conversational speech
32
language and cognition: speech and language sampling
- analyze sample
- calculate mean length of utterance (MLU)
- calculate rate of speech (count number of words per minute)
33
speech and language sampling: analyze sample
- number, types, and consistency or errors
- correct sound production
- intelligibility
- speech rate
- prosody
- language errors
- atypical patterns
34
speech and language sampling: calculate mean length of utterance (MLU)
- number of morphemes/number of utterances = MLU
- Brown's morphological markers
35
speech and language sampling: calculate rate of speech
- count number of words per minute
- average adult: ~270 WPM
- average 1st grader: ~125 WPM
36
speech and language sampling
provides and diagnostic information and guides treatment plan
37
articulation and phonology: analyze the sample
- articulation errors and distortions
- rate of speech
38
language and cognition: analyze the sample
- language errors and patterns of errors
- speech intelligibility
39
expressive language: elicit morphology, semantics, and syntax by asking the child to...
- point to more than 1 of an objects (plurals)
- follow oral directions (varying number of steps)
- verbalize/gesture serial tasks (e.g., counting)
- name objects, pictures, etc.
40
expressive language: elicit semantics/syntax by asking the child to...
identify spatial concepts (e.g., over/under)
41
receptive language: elicit morphology, semantics, and syntax by asking the child to...
- describe pictures
- describe and tell stories
- describe objects by features or relationships
- explain sequence of events for daily tasks
- role play scenarios
- describe solutions to problems or situations
42
kindergarten-1st grade: elicit language sample in conversational language user...
delve deeper into language pyramid
- phonology, morphology, semantics, syntax in expressive and receptive language
- analysis used for younger children still applies except for MLU (not valid after age 5)
- C-unit analysis
- T-unit analysis
43
C-unit analysis
conversational analysis for school aged
44
T-unit analysis
monologue analysis for school aged
45
older children: elicit language sample in conversational language user...
analyze more global measures
- receptive/general comprehension (listening and reading), expressive (pragmatics)
- evaluation of pragmatics
- evaluation of narratives
46
evaluation of pragmatics
- appropriate attention and prosody
- topic initiation and maintenance
- conversational repairs and turn taking
47
evaluation of narratives
personal narratives, retelling stories, appropriate sequencing and details, etc.
48
fluency and stuttering
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
49
fluency: formal assessment
- severity scale: assess degree of impairment
- covert scale: assess degree of emotional component
- the Overall Assessment of the Speaker's Experience of Stuttering (OASES)
50
informal assessment for fluency
assessment of typical disfluencies vs. fluency disorder
51
2 main types of fluency disorders
1. stuttering
2. cluttering
52
stuttering
- irregular repetitions, prolongations, blocks, secondary behaviors
- individual is usually aware
53
cluttering
- rapid/regular rate of speech, abnormal disfluencies, reduced intelligibility
- individual is usually unaware
54
assessment of young child (2-6 years old): purpose
to determine if the child will need speech-language treatment
- identify normal vs. abnormal fluencies
- identify likelihood of recovery without therapy
55
assessment of young child (2-6 years old): comprehensive assessment
case history, speech sample, observation, and other speech-language comorbidities
56
assessment of young child (2-6 years old): speech and language sample
- type/frequency of disfluencies
- duration of disfluencies
- rhythm and rate of speech
- secondary behaviors
- parent interactions and reactions
- awareness to stuttering/disfluencies
57
older child/adult (7+ years old): purpose
to gather comprehensive information (i.e., nature/impact) of the disorder
- identify readiness
- identify desire for therapy
58
older child/adult (7+ years old): comprehensive assessment
case history, speech sample, observation, and other speech-language comorbidities
59
older child/adult (7+ years old): speech and language sample
- type/frequency of disfluencies
- duration of disfluencies
- rhythm and rate of speech
- overt features (core vs. secondary)
- core behaviors (involuntary)
- secondary behaviors (voluntary)
60
voice and resonance
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
61
voice and resonance: informal assessment
- determine etiology
- analyze conversation
62
voice and resonance: determine etiology
team approach (refer to ENT for structure and SLP treats function)
- organic: problem with structure (e.g., cancer)
- neurogenic: innervation to structure impaired/damaged (e.g., vf paralysis)
- functional: non biological, behavioral/psychogenic (e.g., muscle tension)
63
voice and resonance: analyze conversation
- characteristics based on acoustic and perceptual factors
- pitch, loudness, quality
64
acoustic evaluation: pitch
- determine pitch
- fundamental frequency
65
perceptual evaluation: pitch
- mono pitch, restricted range
- excessive pitch variability
- diplophonia, pitch breaks
66
acoustic evaluation: loudness
measure intensity level
67
perceptual evaluation: loudness
- lack of voice, range of loudness
- inappropriate (soft/loud/monotone)
- phonation breaks
68
acoustic evaluation: quality
- jitter (frequency)
- shimmer (amplitude)
- s/z ratio
69
perceptual evaluation: quality
- breathy
- harsh
- hoarse
70
acoustic and perceptual evaluation: resonance
- hypernasal
- nasal emission
- hyponasal
71
hypernasal
too much air going through nasal cavity
72
nasal emission
look for pressure consonants
73
hyponasal
not enough air going through (i.e., sounds like a cold)
74
acoustic and perceptual evaluation: respiration
- type of breathing patterns
- stridor
- number of words per minute (6 or less may indicate a problem)
- maximum phonation time
- rate
75
respiration: type of breathing patterns
diaphragmatic, clavicular
76
respiration: stridor
vf paralysis may be present
77
respiration: maximum phonation time
sustained vowel
78
respiration: rate
words per minute, perceptual judgement of rate
79
motor speech
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
80
motor speech: OFSME
- movement and strength: cranial nerve (CN) function
- diadochokinesis
81
motor speech OFSME: movement and strength
distinguish between different dysarthria types
82
motor speech OFSME: diadochokinesis
- distinguish between different dysarthria types
- differential diagnosis of dysarthria vs. apraxia of speech
83
motor speech: informal assessment
- motor speech assessment
- reading passage and speech sample (assess articulation error types)
- informal assessments of voice and resonance
- repetition tasks
- cognition
- motor
84
2 types of motor speech disorders
1. dysarthria
2. apraxia of speech (AOS)
85
informal assessments of voice and resonance
perceptual judgement
86
motor speech: repetition tasks
- dysarthria: will always struggle with repetition tasks
- apraxia: will struggle with repetition as complexity increases
87
motor speech: cognition
- orientation
- planning and problem solving
- memory
88
motor speech: motor
- repetition: simple vs. complex, mono- vs. poly-syllabic
- reading
- conversational level
89
dysarthria: articulation error types
- distortions
- consistent errors
90
apraxia of speech: articulation error types
- substitutions, omissions, additions
- inconsistent errors
91
neurogenic disorders
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
92
neurogenic disorders: OFSME
especially important for differential diagnosis of neurogenic disorders
93
neurogenic disorders: informal assessments
- language sample
- cognition
- receptive language
- expressive language
94
neurogenic disorders: language sample
- analyze for contextual accuracy
- topic maintenance
- length of utterance
- syntactic variety
- word finding
- fluency
95
neurogenic disorders: cognition
- orientation
- memory
- reasoning
- story telling
- verbal explanations
- perception
96
neurogenic disorders: receptive language
comprehension and reading
97
neurogenic disorders: expressive language
verbal output and writing
98
aphasia
- language disorder
- deficits in expressive and receptive language
99
dysarthria
- speech execution disorder
- muscle weakness, slowness, and/or reduced coordination
100
apraxia
- motor planning and programming disorder
- inconsistent speech errors, normal speech musculature
101
cognitive communication
- disorder of cognitive systems, impacts communication
- cognitive deficits (e.g., attention) impacts communication
102
dysphagia and swallowing disorders
- case history
- hearing screening
- oral facial sensory motor exam (OFSME)
- formal assessment
- informal assessment
103
dysphagia and swallowing disorders: OFSME
imperative information
- lips, tongue, mandible, velopharyngeal movement
- ROM, strength, sensation of tongue/lips, oral cavity
104
dysphagia and swallowing disorders: formal assessment
- Modified Barium Swallow Study (MBSS)
- Flexible Endoscopic Evaluation of Swallowing (FEES)
105
dysphagia and swallowing disorders: informal assessment
bedside examination
106
dysphagia and swallowing disorders: bedside examination
- patient complaints
- evaluate cognitive status
- evaluate respiratory status
- evaluate dry swallow
- food and/or liquid trials
107
bedside examination: patient complaints
difficulty/pain when swallowing, difficulty chewing, etc.
108
bedside examination: evaluate cognitive status
alertness, orientation, ability to follow directions
109
bedside examination: evaluate respiratory status
- if present tracheostomy and/or respiratory distress
- shallow, gurgly, and/or wet quality breathing
- rapid breathing
- ability to hold breath
- oxygen saturation level (ask nursing/MD for patient specific norms)
110
bedside examination: evaluate dry swallow
hyoloaryngeal elevation (HLE)
111
bedside examination: food and/or liquid trials
- reposition to 90 degrees or as upright as patient can tolerate
- know current diet orders (textures/consistency) and feeding method
- identify signs/symptoms of aspiration and/or penetration (overt): coughing, wet vocal quality, poor HLE, frequent throat clearing, shortness of breath, expelling food, pocketing/food remaining on tongue after swallow, etc.)
- identify need for instrumental assessment (i.e., MBSS, FEES)
112
potential etiologies for speech, language, and swallowing disorders
- prenatal and neonatal
- hearing loss
- developmental disorder or disability
- psychiatric disorders
- genetic disorders
- physical impairment
- vocal abuse and misuse
113
prenatal and neonatal
- before or during birth
- e.g., premature
114
hearing loss
- may contribute to speech and/or language deficits
- e.g., chronic ear infections
115
developmental disorder or disability
- chronic long-term disabilities
- e.g., Autism Spectrum Disorder
116
psychiatric disorders
- related to psychosis or some psych event
- e.g., Schizophrenia
117
genetic disorders
- occurs as a result of a DNA abnormality
- e.g., Fragile X Syndrome
118
neurological disease
- disease of central and peripheral nervous system
- e.g., Alzheimer's disease, Traumatic Brain Injury
119
physical impairment
- physical impairments related to speech
- e.g., cleft lip/palate
120
vocal abuse and misuse
- prolonged abuse/misuse of voice
- e.g., rough, breathy, etc.
121
functional
unknown cause
122
organic
known underlying cause
123
types of functional etiologies
- mislearning
- articulation
- phonology
124
types of organic etiologies
- structural
- sensory
- motor
125
functional: mislearning
- mislearning of specific sounds
- mislearning of whole class of sounds
126
functional: articulation
- motor aspects
- errors in production of specific speech sounds (e.g., distortions, omissions, etc.)
127
functional: phonology
- linguistic aspects
- consistent, rule-based errors in place of multiple speech sounds (e.g., stopping, final consonant deletion, etc.)
128
organic: structural
- structural etiology (e.g., cleft palate)
- obligatory errors: correct placement, abnormal structures
- compensatory errors: incorrect placement compensates for structure
129
organic: sensory
- traditional errors: typically distortions and omissions
- may use amplification for speech therapy
- phonemic and phonetic treatments may be used
130
organic: motor
apraxia of speech:
- deficit in motor planning/programming
- hallmark signs: inconsistent and prosody errors, groping
dysarthria:
- deficit in motor execution, may impact all speech systems
- respiration, phonation, resonation, articulation
