Lectures 11-16

Question 1

~The Nervous System~
Consists of:

Neuron:

Nerve:

Electrochemical impulses:

Answer 1

Consists of: the brain, spinal cord, and all associated nerves and sense organs

Neuron:
* Basic unit of the nervous system
* Contains: Cell body, axon, dendrites

Nerve:
* A collection of neurons

Electrochemical impulses: generally pass between the axon of one neuron to the dendrites of another across the synapse

Question 2

~Central Nervous System~
Brain and Spinal Cord:
Made up of-
Lobes-
Left hemisphere-

Cerebrum:

Answer 2

Brain and spinal cord: Communicates with the rest of the body through nerves

Made up of- Cerebrum, cerebellum, brainstem

Four lobes:
* Frontal, temporal, parietal, occipital

• Generalized areas of the brain for particular operations
• Left hemisphere is dominant for most aspects of language and motor speech
  production in 98% of people

Cerebrum: has left and right hemispheres
* Sensory and motor functions are mostly contralateral
* Each hemisphere consists of white fibrous connective tracts running below the surface and
covered by a gray cortex of cell bodies
* The cortex is wrinkled due to presence of gyri and fissures

Question 3

~Central Nervous System~
Cerebellum:

Answer 3

Cerebellum:
* Consists of right and left hemispheres and a central vermis
* Coordinates control of fine, complex motor activities, maintains muscle tone, and participates in motor learning
* Influences language processing and higher level cognitive and affective functions

Question 4

~Language Processing~
-Processed in ____ hemisphere for most people

In the right hemisphere:

Broca’s area:

Wernicke’s area:

Motor Cortex:

Answer 4

-Language is processed in the left hemisphere in most people

-Nonlinguistic and paralinguistic information are primarily processed in the right hemisphere

Broca’s area: Incoming auditory information is held in working memory in Broca’s area

Wernicke’s area: Most incoming linguistic processing occurs in Wernicke’s area, concepts are formed and supported by the angular gyrus (for words) and supramarginal gyrus (for grammar)

Motor Cortex: Broca’s area sends programming information to the motor cortex, which sends signals to motor neurons for speech

Question 6

~Aphasia~
# of Americans that have aphasia=

Problems in=

Impaired=

Aphasia may affect=

Answer 6

-Over 1 million Americans have aphasia

-Problems in auditory comprehension and word retrieval are common to all aphasias to some degree

-Memory may also be impaired

Aphasia may affect:
◦ Listening
◦ Speaking
◦ Reading
◦ Writing
◦ Specific language functions such as naming

Question 7

~Aphasia~
Severity=

Severity related to=

Other neurogenic disorders=

Common mental health issue=

Answer 7

-Severity can range from few intelligible words and little comprehension to those with subtle deficits

-Severity is related to the cause, location, extent, and age of brain injury
◦ Also the age and general health of the individual

-Patterns of behavior exist that allow categorization of aphasia syndromes

-Other neurogenic disorders often exist with aphasia

-Depression is common

Question 8

~Types of Aphasia~
Fluent Aphasia:

Wernicke’s aphasia:

Answer 8

Fluent Aphasias:
◦ Characterized by word substitutions, neologisms, and often verbose verbal output
◦ Lesions tend to be in posterior portions of the left hemisphere

◦ Wernicke’s aphasia
◦ Rapid-fire strings of sentences with little pause for acknowledgement or turn taking
◦ Often unaware of difficulties
◦ Content may be jumbled, incoherent, or incomprehensible but fluent and well articulated

Question 9

~Anomic Aphasia~

Answer 9

-Most aspects of speech are normal with the exception of word retrieval

Question 10

~Types of Aphasia~
Nonfluent Aphasias:

Broca’s Aphasia:

Transcortical motor aphasia (nonfluent):

Answer 10

NonFluent Aphasias:
◦ Characterized by slow, labored speech and struggle to retrieve words/form sentences
◦ Site of lesion is in or near the frontal lobe

Broca’s aphasia:
◦ Short sentences with agrammatism
◦ Slow, labored speech and writing
◦ Articulation and phonological errors

Transcortical motor aphasia (nonfluent):
◦ Difficulty initiating speech or writing
◦ Severely impaired speech (damage to motor cortex

Question 11

~Global Aphasia~

Answer 11

-Profound language impairment in all modalities

Question 12

~Causes of Aphasia~
Most common cause=

Types of stroke=

Answer 12

Most common cause= stroke/cerebrovascular accident (CVA)

◦Strokes affect half a million Americans annually
◦Onset is rapid

Types of stroke=
◦ Ischemic
◦ Hemorrhagic

Question 13

Other conditions that may have aphasia symptoms:

Answer 13

◦ Head injury
◦ Neural infections
◦Degenerative neurological disorders
◦Tumors

Question 14

~Primary Progressive Aphasia~

Answer 14

◦Degenerative disorder of language with preservation of other mental functions and of activities of daily living
◦Progresses to a near-total inability to speak

Question 15

Risks of Aphasia:

Answer 15

-Smoking
-Alcohol use
-Poor diet
-Lack of exercise
-High blood pressure
-High cholesterol
-Diabetes
-Obesity
-TIAs

Question 16

Signs of Occurrence in Aphasia

Answer 16

-Loss of consciousness
-Sudden numbness weakness on one side of body
-Difficulty understanding speech
-Loss of balance/coordination
-Trouble seeing in one or both eyes
-Weak/immobile limbs
-Slurred speech

Question 17

~Spontaneous Recovery~

Answer 17

◦A natural restorative process
◦Maximum spontaneous recovery for language occurs in the
first 3 months
◦Assessment and intervention begin as soon as the client’s
condition permits
◦The earlier the treatment, the better the rate of recovery

Question 18

What to expect

Answer 18

◦ Following acute care, the individual may require rehabilitative hospitalization, outpatient rehabilitation, or nursing home care
◦ Most individuals receive services for at least the first several months
◦ Course and extent of recovery is difficult to predict
◦ Loss of language ability changes social roles and can lead to isolation
◦ Families are frightened and confused
◦ Individual with aphasia may become dependent on others for daily tasks
◦ Economic burden can be enormous
◦ Individual may focus on physical and language complications, leading to frustration and depression

Question 19

Procedures (assessment)

Answer 19

-Occurs in several stages as the client stabilizes

-Observations inform nature and extent of the disorder

Formal testing is postponed until the patient is stable; informal testing allows treatment to begin as soon as possible

-Medical history, interview with client and family, oral peripheral exam, hearing testing, direct speech and language testing
◦ Should address overall communication skills, as well as receptive and expressive language in all modalities
◦ Standardized tests are available

-May exhibit perseveration, disinhibition, and emotional problems
◦ Note client behavior during testing

Question 20

Evidence- Based Practice:

Overall goal:

Answer 20

-Intervention methods vary; must be determined individually
-Failure to participate in intervention has an adverse effect on recovery

Overall goal= is to aid in the recovery of language and provide strategies to compensate for persistent language deficits
◦ Goals are determined by assessment results and the desires of the client and family
◦ Decide whether to work on underlying skills or skill deficits
◦ Cross-modality generalization
◦ Skills trained in one modality generalize to another
◦ Using semantic associations increases naming accuracy in patients with anomic aphasia
◦ Conversational techniques provide language therapy and therapeutic support

Question 21

Assessment of RHBD

Answer 21

◦ Special Areas
◦ Visual scanning/tracking
◦ Auditory/visual comprehension of words and sentences
◦ Direction following
◦ Response to emotion
◦ Naming/describing pictures
◦ Writing
◦ Sampling and observation are essential for pragmatics
◦ Portions of aphasia batteries, standardized tests for RHBD, and non- standardized procedures can be used

Question 22

Intervention for RHBD

Answer 22

-Often begins with visual and auditory recognition

◦ Expressive aprosodia (a deficit in comprehending or expressing variations in tone of voice)
◦ Imitate a sentence in unison with the SLP or used cognitive-linguistic treatment in which there are cues to modify prosody

◦ Interpretation of nonliteral or figurative meaning
◦ Word meaning and connotations can be mapped and diagrammed

◦ Intervention for activating meanings and suppression of non-contextual meanings
◦ Contextual pre-stimulation often begins with visual and auditory recognition

Question 23

Brain Damage:

May result from:

Answer 23

-Closed head injuries that include swelling of the brain result in diffuse injury
-Open head injury may accommodate swelling, resulting in less damage that is more focused

Brain damage may result from:
◦ Bruising and laceration of the brain from coming into contact with the rough inner surface of the skull
◦ Secondary edema, which can lead to increased pressure
◦ Infection
◦ Hypoxia
◦ Intracranial pressure from tissue swelling
◦ Infarction: Death of tissue deprived of oxygen supply
◦ Hematoma: Focal bleeding

Question 24

TBI Characteristics:

Answer 24

-May have sensory, motor, behavioral, and affective disabilities
-Seizures, hemisensory impairment, and hemiparesis or hemiplegia may occur
-Inability to resume interests and daily living tasks to the level that existed before the injury
-Affects orientation, memory, attention, reasoning/problem solving, and executive function
-Language may be affected in 3 out of 4 individuals with TBI
-Most disturbed language area is pragmatics

Pragmatic deficits include
◦ Inability to inhibit behavior
◦ Inappropriate laughter and swearing

-Psychosocial and personality changes

Question 25

CI- Umbrella Term

Irreversible cognitive impairment:

Answer 25

A group of pathological conditions and syndromes that result in declining memory and at least one other cognitive ability
◦ Significant enough to interfere with daily life
◦ Acquired
◦ Characterized by intellectual decline due to neurogenic causes
-Fewer than 15% of the elderly experience dementia or cognitive impairment
-Up to 20% respond to treatment

Irreversible cognitive impairment:
◦ Alzheimer’s disease (AD), vascular cognitive impairment (VCI), multi-infarct dementia, or mixed causes

Question 26

~Subdivided into cortical and subcortical types~

Cortical cognitive impairments:

Subcortical cognitive impairments:

Answer 26

Cortical cognitive impairments:
◦ Include Alzheimer’s and Pick’s diseases (Frontotemporal dementia (FTD) symptoms include personality & behavior changes)
◦Resemble focal impairments such as aphasia and RHBD

Subcortical cognitive impairments:
◦ May accompany Multiple Sclerosis (MS), A I D S-related encephalopathy, and Parkinson’s and Huntington’s diseases
◦ Slow, progressive deterioration of cognitive functioning

Question 27

Frontal Lobes house the primary motor cortex:

Direct activation pathway, or pyramidal tract:

Indirect activation pathway, or extrapyramidal tract:

Answer 27

Frontal lobes house the primary motor cortex:
-Descending pathways from primary motor cortex are important for initiating voluntary motor movements

Direct activation pathway, or pyramidal tract:
* Originates in the primary motor cortex
* Rapid, discrete, volitional movement of
limbs and articulators

Indirect activation pathway, or extrapyramidal tract:
* Regulates reflexes and maintains posture and muscle tone
* Provides the necessary framework to facilitate movement

Question 28

Parts of the brain diagram: LABEL

Answer 28

Look up picture from google docs

Question 29

Cranial nerves diagram:

Answer 29

Look up picture from google docs

Question 30

~Cranial Nerves~
Peripheral nervous system:

Cranial Nerves:

Spinal Nerves:

Brain stem:

Answer 30

Peripheral nervous system:
-12 pairs of cranial nerves
-31 pairs od spinal nerves

Cranial Nerves:
-especially important for speech production

Spinal Nerves:
-important for breathing purposes of speech production

Brain stem:
-control centers in brainstem, govern breathing for life

Question 31

~Apraxia-Neurology~
Speech disorder that…..

Damace to:

Usually occurs after:

Answer 31

-Speech disorder that impairs the ability to plan or program the sensory and motor commands needed for speech production

-Damage to the left cerebral hemisphere, particularly motor and premotor areas

-Usually occurs after a left hemisphere stroke in Broca’s area

Question 32

~Dysarthria Definition~
Group of:

Affect:

Motor Movements:

Answer 32

Group of: neuromotor impairments resulting from disturbances in the CNS and PNS that control the muscles of speech production

Affect: speed, range, direction, strength, and timing of motor movement
* Result of weakness, spasticity, discoordination, or involuntary movement

• Respiration, phonation,
  resonation, and articulation may all be affected
• Motor movements may be lost or modified in some way

Question 33

~Spastic Dysarthria~
Typically results from:

Weakness and loss of:

Reflexes:

Spasticity in the larynx=

Answer 33

Typically results from: bilateral upper motor neuron lesions in the cerebral hemispheres or a single lesion in the brainstem

-Weakness and loss of inhibitory motor control

• Reflexes are hyperactive, muscle tone is increased at rest, and individuals exhibit spasticity (increased resistance to passive stretch)
• Movements of the articulators are slow and reduced in force and range of motion
• Spasticity in the larynx results in a strain-strangled voice quality

Question 34

~Flaccid Dysarthria~
Usually results from:

Answer 34

Usually results from lesions in the cranial and spinal nerves (lower motor neurons) or the motor unit

Question 35

~Hypotonia~

Answer 35

Weak, soft, low muscle tone

• Reduced respiratory drive for speech breathing, continuously breathy voice, reduced pitch and loudness levels, monopitch, hypernasality, and imprecise
  articulation

-Flaccid Dysarthria

Question 36

~Bell’s palsy~

Answer 36

• Idiopathic condition that results in unilateral damage to the facial nerve
• Occurs suddenly and resolves in most cases
• Mild articulatory imprecision

-Flaccid Dysarthria

Question 37

~Progressive Bulbar Palsy~

Answer 37

-Degeneration of lower motor neurons

• Flaccid paralysis and eventual muscle atrophy
• Fasciculations
  • Visible, isolated twitches in resting muscle
  • Due to spontaneous firing of nerve impulses in response to nerve degeneration
  • Speech sounds weak, hypernasal, monopitched, and articulation is imprecise

-Flaccid Dysarthria

Question 38

~Myasthenia Gravis~

Answer 38

-Autoimmune disease that affects the neuromuscular junction

• Rapid weakening due to inadequate transmission of nerve impulses to the muscles
• Muscles become progressively weak with repeated use but regain strength with a short rest
• Imprecise articulation and hypernasality
  
  • Gets worse with prolonged speaking
  • Dramatically improves with 1-2 minutes’ rest

-Flaccid Dysarthria

Question 39

~Hypokinetic Dysarthrias~

Movements are:

Reduced:

Speech rate:

Loudness levels:

Answer 39

-Degeneration of dopaminergic neurons in the brainstem prevents proper function of the Basal Ganglia

• Movements are slow and reduced in range due to rigidity
• Individuals with hypokinesia feel stiff and find it hard to get movement started
• Once started, they struggle to stop
• Reduced ROM is a hallmark feature
• Speech rate becomes very fast, and disfluencies are common
• Loudness levels gradually diminish

Question 40

~Parkinson Disease~

Answer 40

• Idiopathic degenerative neurological
  disease
• Affect 1-2% of individuals over age 50
• Genetic and environmental factors play a role
• Hypokinetic dysarthria is eventually present in 90% of cases
• Reduced loudness, accelerated rate of speech, disfluencies, imprecise articulation
• Voice quality may be breathy and harsh or hoarse
• Pitch and loudness variability is significantly reduced, resulting in monopitch and monoloudness

-Hypokinetic Dysarthrias

Question 41

~Hyperkinetic Dysarthrias~
Production of:

Tremor:

Tics:

Answer 41

Indirect pathway or structures of the Basal Ganglia that help inhibit unwanted movements are damaged

• Production of motorically normal speech that is interrupted by abnormal involuntary movements
• Tremor: Rhythmic movement of a body part
• Tics: Rapid, patterned movements that are not completely involuntary and can be briefly suppressed

Question 42

~Hyperkinetic Dysarthrias~
Dystonia:

Chorea:

Answer 42

• Dystonia: Slow hyperkinesia that may involve the entire body or may be localized.
  
  • Excessive pitch and loudness variations, irregular articulatory breakdowns, variable rate, inappropriate silences
• Chorea: Rapid and unpredictable movements of the limbs, face, and tongue
  
  • Variable speech rate, irregular articulatory breakdowns, significant prosodic abnormalities

Question 43

~Ataxic Dysarthria~
Results in:

Irregular breakdowns in:

Movements are:

Answer 43

-Damage to the cerebellum or cerebellar control circuitry

• Results in incoordination and reduced muscle tone (ataxia)
• Irregular breakdowns in articulation and abnormalities of prosody
  
  • Due to incoordination and improper timing
• Movements are inaccurate, jerky, and lacking smoothness

Question 44

~Mixed Dysarthrias~

Answer 44

-When two or more Dysarthrias are present

-Can occur in neurodegenerative diseases that cause damage to multiple areas of the CNS

Question 45

Amyotrophic lateral sclerosis (ALS):

Traumatic Brain Injury (TBI):

Answer 45

Amyotrophic lateral sclerosis (ALS):
* Both upper and lower motor neurons degenerate
* Causes both spastic and flaccid paralysis
* 75% are unable to speak at the time of death

Traumatic Brain Injury (TBI):
* causes mixed dysarthria, usually spastic-ataxic
* Axonal shearing in TBI causes diffuse damage

-Mixed Dysarthrias

Question 46

~Cerebral Palsy~
CP in prediatric population:

Causes:

Type of CP:

Answer 46

-CP is the most common etiology of chronic physical disability in the pediatric population

-Causes abnormal muscle tone, loss of selective motor control, muscles weakness, and impaired balance

-Type of CP varies with the areas of the CNS that are damaged

Question 47

~Spastic Cerebral Palsy~
Damaged….

60% of individuals with CP:

Limbs may be:

Answer 47

-Damaged upper motor neurons are unable to inhibit signals that increase muscle tone

-60% of individuals with C P have characteristics of spasticity and increased muscle tone

-Exaggerated stretch reflex
-Movement is jerky, stiff, labored, and slow

Limbs may be rotated inward, with arms drawn upward and head turned to the side

Question 48

~Athetoid Cerebral Palsy~
Damage to:

30% of individuals with CP:

Feet may:

Answer 48

-Damage to Basal Ganglia structures and pathways that inhibit involuntary movements

-30% of individuals with CP have athetosis – slow, involuntary writhing

-Movement is disorganized and uncoordinated
-Speech breathing problems are more severe than in other types

-Feet may turn inward, back and neck arch, and arms and hands overextend above the head

-Severity varies

Question 49

~Ataxic Cerebral Palsy~
Injury to:
Impairs:

In extreme cases:

Answer 49

Injury to the cerebellum
* Impairs monitoring of information about balance from the inner ears and proprioceptive information from the muscles

-Uncoordinated movement
-Disturbed balance

-In extreme cases, walking is characterized by a wide stance with the head pushed forward and arms back

Question 50

~Procedures for Dysarthria Evaluation~

-Oral Peripheral mechanism evaluation-

Answer 50

• Thorough case history is necessary
• SLP evaluates structure and function of the oral mechanism, connected speech, and speech in special tasks

-Oral peripheral mechanism evaluation-
* Symmetry, configuration, color, and general appearance of the face, jaw, lips, tongue, teeth, and hard and soft palate at rest
* Movement of the jaw, tongue, lips, and soft palate
* Range, force, speed, and direction of the jaw, lips, and tongue during movement
* Lung capacity, respiratory driving pressure, control during speech production
* Phonatory initiation, maintenance, and cessation
* Pitch and pitch variability
* Loudness and loudness variability
* Volitional pitch-loudness variations
* Velopharyngeal function

Question 51

~Basic principles of treatment Dysarthrias~

Answer 51

• Must address respiration, phonation, resonation, articulation, and prosody
• Increasing respiratory drive might be accomplished via pausing/phrasing
• If respiratory muscle weakness is too great, an abdominal binder can be used
• Voice amplifiers can be used

Question 52

~Basic principles of treatment Dysarthrias~
~Evidence based practice~

LSVT:

CPAP:

Intensive:

EPG:

Augmentative and alternate communication:

Answer 52

• LSVT can be used to increase phonatory competence in adults with Parkinson disease and for respiratory and phonatory deficits in children with spastic CP
• Continuous positive airway pressure (CPAP) and palatal lift can be used for velopharyngeal function
• Intensive, repetitive speech production drill practice with meaningful words and phrases can increase articulatory accuracy
• Slowing speech rate is effective
• Electropalatography (EPG) may be helpful
• Augmentative and alternative communication

Question 53

~Basic Principles of Treatment Apraxia~
-Evidence based practice-

Integral Stimulation:

Melodic Intonation Therapy:

Answer 53

Integral stimulation:
* “Watch me, listen to me, do what I do”
* Involve an 8-step continuum for cueing that is used to help a client retrain motor
planning/programming
* Core set of functional vocabulary words or phrases
*Incorporates principles of motor learning

Melodic Intonation Therapy:
* Focuses on prosody, emphasizing the melody, rhythm, and stress patterns of the utterances
* Believed to facilitate motor planning/programming for speech by accessing the right
hemisphere
* Most effective for clients with mild-moderate apraxia of speech who have prosodic abnormalities but otherwise adequate articulation

Question 54

~SYMBOLS ARE CENTRAL TO THE PROCESS OF CLASSIFYING AAC SYSTEMS~

Unaided systems:

Aided systems:

Answer 54

Unaided systems do not involve external equipment

Aided systems involve the use of equipment
-Can be No-tech, low-tech, mid-tech, and high-tech

Question 55

~Unaided AAC~
Gestures and Vocalizations:

Iconic:

Transparent:

Opaque:

Fingerspelling:

Answer 55

Gestures and Vocalizations:
* Use of gesture, body movement, or observable signal with a partner
* (manual sign systems) ASL, Signed English, Signing Exact English, Tactile Signing, Amer-Ind

• Iconic: signs look like what they represent
• Transparent: signs are easily guessable, explainable, and memorable
• Opaque: signs are difficult to interpret
• Finger spelling: refers to the manual alphabet

Question 56

~Aided ACC, Symbol types~
Tangible:
Pictorial:
Orthographic:

Answer 56

Tangible:
* Visual schedules can use tangible symbols
* Organized according to daily activities

Pictorial:
-Pictures, drawings, or other representations
-Some are designed specifically for A A C use
-Relatively rule-governed and generative

Orthographic:
* Braille
* Fingerspelling
* Writing

Question 57

~Selection Types~
Direct:

Indirect:
Scanning-
Auditory Scanning-

Answer 57

Direct:
* Select an item directly by pointing with a finger, hand, head pointer, optical head pointer, joystick, or eye gaze
* Can be difficult for those with severe motor problems

Indirect:
▪ Scanning and partner-assisted selection/scanning
▪ Scanning involves assembling a message through a series of switch activations in which choices are presented sequentially
▪ In partner-assisted scanning, options are presented by another person
▪In auditory scanning, auditory cues are present
▪Scanning can be slow and laborious
▪Efficiency can be enhanced by placing the most
frequently used symbols in locations where they are scanned more often, or by changing scanning method

Question 58

~Voice Output on AAC Devices~

Answer 58

-Intelligibility can be increased through training

-Voice output communication (VO C) can be recorded or digitized, synthesized, or both

-Comprehension of synthesized speech requires increased focused attention by the communication partner

-Partners tend to respond more slowly to synthesized speech

Question 59

~Considerations with AAC~
Linguistic Competence:
Operational Competence:
Social Competence:
Strategic Competence:

Answer 59

Linguistic Competence: Individual’s language ability across all dimensions of language

Operational Competence: How a person uses an AAC system

Social Competence: How well a person manages the social aspects of communication
Turn taking, topic maintenance, reciprocal interactions

Strategic Competence: ability to solve problems

Question 60

~Intervention, Symbol Selection~

Answer 60

-Select vocabulary that reflects the user’s needs, desires, likes, and preferences

-Functional or useful

-Several lists of potential vocabulary are available

-Order of teaching signs or symbols must be guided by a client’s immediate need

Question 61

~Intervention Considerations~

Answer 61

-Intervention will be most effective if caregivers also use AAC with speech (augmented input)

-Establish a positive AAC culture

-Understand AAC as critical to literacy development

-Individualize the content

-Teach partners to modify their interaction style

-Classroom integration requires collaboration between the teacher and SLP

-AAC training for the educational team is a key element in success

-Abandonment of AAC is usually related to loss of facilitator/partner support

Question 62

~AAC evidence based practice~

Answer 62

-AAC does not impede speech production

-Many individuals who use AAC produce shorter utterances when they use graphic symbol-based AAC systems

-Few studies have investigated the effectiveness of AAC-specific aspects of intervention in a family context

-Improved speech intelligibility coming from high- tech systems doesn’t necessarily lead to a persons’ social participation

Question 63

~Incidence, prevalence, and classification of hearing loss~

% of Americans with hearing loss:

Worldwide # of people with hearing loss:

of people older than 65 with hearing loss:

Hearing loss undetected in more than:

Answer 63

~20% of Americans report some degree of hearing loss

-Worldwide 360 million people have disabling hearing loss

~1/3 Hearing Loss 5 of individuals older than 65 year os age have

Hearing loss goes undetected or untreated in more than 75% of adults with hearing loss

Question 64

~How with hearing loss~
Sound travels from:

Hearing loss results from:

Conductive hearing loss:

Sensorineural loss:

Answer 64

 Sound travels from:
outer ear–> middle ear –> inner –> auditory nerve –> brain

A hearing loss results from a change somewhere in this path.

Disorder that affects the outer or middle ear = conductive disorder

Outer or inner hair cell damage in the cochlea or damage to the auditory nerve, which travels from

Question 65

Conductive system made up of:

Sensorineural system made up of:

Conductive Hearing loss (results from, usually prevents, impacts):

Sensorineural Hearing loss:

Answer 65

The outer and middle ears comprise the conductive system

The cochlea and auditory nerve make up the sensorineural system

Conductive Hearing Loss:
-Results from deformation, malfunction, or obstruction of the outer or middle ear
-Usually prevents low- to moderate-intensity sounds from being heard at all and higher-intensity sounds being
perceived as softer
-Impacts audibility
-Most are not permanent

Sensorineural Hearing Loss:
-Absence, malformation, or damage to structures of the inner ear
-may be present at brith or develop over time
-usually permanent
-hearing loss is predominantly in the higher frequency range
-sounds that are audible are perceives as being distorted

Question 66

Causes and risk factors for conductive and sensorineural loss:

SENSORINEURAL LOSS Noise exposure due to
* The intensity of the noise
* The length of exposure
* No hearing protection

Answer 66

• Cerumen blockage, particularly due to the use of cotton swabs.
• Foreign objects inappropriately
  put into the ear canals or
  inflammation of canals
• Otosclerosis, abnormal bone growth which develops around
  the ossicles compromising the transmission of sound. * Otitis media, although it occurs
  far less frequently than it does
  with children (due to structural
  changes in the ear mechanism-
  lengthening and curving of the
  Eustachian tube & an improved
  immune system)

SENSORINEURAL LOSS Noise exposure due to:
* The intensity of the noise
* The length of exposure
* No hearing protection
* recovery time between exposures

Ototoxicity
Ototoxicity Another common cause of inner-ear damage and sensorineural hearing loss

Labyrinthitis
-a short-term infection that is treated medically

Meniere’s Disease:
-a long term disorder caused by an overproduction or under absorption of endolymph, a fluid that circulated in the inner ear, resulting in a progressive hearing loss

Acoustic Neuromas:
-tumors can be hard to identify and are usually noticed by a decrease in hearing in one ear, followed by a feeling of fullness or pressure

Question 67

~Hearing loss Procedures~
Screening:
Referral and case history:
Otoscopic exam:

Answer 67

Screening:
Can be initiated with an audiometric screening, but it more often begins
with a complete hearing evaluation

Referral and case history:
-Why the client has come in for an evaluation
-Has he/she been exposed to noise
-Is there a history of ear
infections or surgery
-How is communication difficult

Otoscopic Exam:
-Conducted with an otoscope
-Allows visual inspection of the canal and eardrum
-A video otoscope projects the image of the ear on a monitor

Question 68

Range for hearing loss:

Answer 68

-expressed in decibels (dB)
-the greater the dB value required to reach a person’s threshold, the greater the hearing loss
-the severity of hearing loss ranges from mild to profound and is typically defined using decibels
-range of normal is different for children and adults

Question 69

Helping people who have hearing loss:
Amplification Hearing Aids:

Cochlear Implants:

Answer 69

AMPLIFICATION HEARING AIDS
* Every hearing aid contains a microphone, amplifier, receiver, and some type of computer processor
* Most incorporate sophisticated digital signal processing
* Signal can be manipulated to improve audibility while maintaining comfort, reducing unwanted background noise, and eliminating feedback
* Primary goal is to make speech audible to improve intelligibility
* Will not return hearing to normal
* Must be counseled so expectations are realistic

COCHLEAR IMPLANTS
* Prosthesis that bypasses damaged hair cells in the cochlea
* Directly stimulates the surviving auditory nerve fibers with electrical energy
* External components
* Microphone, speech processor, external transmitter
* Internal components
* Receiver-stimulatorthatissurgicallyattached to the skull, and the electrode array that is inserted into the cochlea
* Bilateral implantation is becoming more common
* Signal is transmitted across the skin via F M waves to the internal receiver-stimulator and finally to the electrodes in the cochlea

Question 70

~Cochlear Implant~
Auditory Training and Auditory Communication Modality
Auditory Verbal Therapy (AVT)

Answer 70

Goal of auditory training is to maximize a person’s use of residual hearing

Neural plasticity:
Physiological and functional changes within the central nervous system in response to auditory stimulation

By providing certain types of auditory input, hope is to change the way the central auditory system works and improve effective use of speech and language information

Question 71

~Fundamentals of Sound~

Answer 71

• There must be an energy source, an object capable of vibrating, a medium, and a receptor
• Sound is a series of compressions and rarefactions that move outward from the vibrating source
• Amplitude is the distance the vibrating object travels in either direction
  *Determines intensity, measured in decibels (dB)
• Frequency refers to the number of cycles of vibration per
  second
• MeasuredinHertz(Hz)

Question 72

~Anatomy and physiology of the auditory system~
The outer ear

Answer 72

The Outer Ear
*Consists of the pinna and the external auditory meatus
* Pinna enhances sound and facilitates localization
*External auditory meatus is an elliptical tube lined with skin that extends from the concha to the tympanic membrane
* Outer external auditory meatus has hair follicles and glands that produce cerumen
*External auditory meatus can enhance high frequency sounds

Question 73

~Anatomy and physiology of the auditory system~
The middle ear

Answer 73

• Tympanic membrane vibrates in response to sound waves
• Tympanic membrane is composed of three layers of tissue and is a semitransparent pearl gray in color
• The middle ear space is air-filled, lined with mucous membranes,
  and includes the opening to the Eustachian tube 7
• The Eustachian tube connects the middle ear with the nasopharynx
• It is normally closed but opens to provide ventilation and equalize pressure
• The malleus, incus, and stapes are the bones (ossicles) of the ossicular chain
• The malleus is embedded in the fibrous layer of the eardrum
• The footplate of the stapes rests against the oval window

Question 74

~Anatomy & Physiology of
the auditory system~
The inner ear

Answer 74

The cochlea is responsible for providing auditory input to the central auditory system
* The vestibular system is responsible for supplying information about balance
* The cochlea contains auditory sensory receptor cells that respond to auditory stimuli
* Composed of two labyrinths
* Outer labyrinth is composed of bone and is filled
with perilymph
* Inner labyrinth is composed of membranous material and contains endolymph

Question 75

~Hearing loss severity~

Answer 75

-Hearing loss is classified according to its severity, using the decibel (dB) system.

Decibels
* Standard unit of sound intensity – how loud it is

Threshold
* represent the differences in loudness available to human hearing, from the threshold of sound at 0 dB (the drop of a pin) to the threshold of pain between 120 dB and 140 dB (a fire alarm close to your ear).

Audiogram
* The graphic representation of what a person can hear

Question 76

Infant Screening (ABR)

Answer 76

AUDITORY BRAINSTEM RESPONSE (ABR)
* Measures neuroelectric activity of the auditory nerve and structures of the lower brainstem
* Can be used to identify neurological issues such as tumor or cranial nerve VIII or auditory neuropathy/dys- synchrony disorder

Question 77

Comprehensive Audiological Evaluation

Answer 77

Behavioral Testing

Audiometer
*Equipment used for selection, manipulation, and presentation of stimuli during hearing assessment
*Testing is usually carried out in a specifically treated sound booth

Behavioral Observation Audiometry (BOA)
*Audiologist presents a stimulus through a loud speaker and observes a child’s reaction
*Reliability and validity has been questioned
*Electroacoustic and electrophysiological measures are
preferred when assessing children younger than 5 months

Question 78

Bimodal Hearing:

Answer 78

Cochlear implant on one ear and a hearing aid on the other

• Hybrid device that houses both hearing aid and cochlear implant technology in the same unit
• Children as young as 12 months can undergo cochlear implant surgery
• Post-lingually deafened adults tend to benefit extensively
• Children implanted at an early age who receive intensive auditory therapy demonstrate significant gains in speech perception, language acquisition, speech production, and literacy development

Question 79

Central Auditory Processing Disorders

Answer 79

-Interfere with the ability to efficiently and effectively use and interpret acoustic information
-May have difficulty hearing subtle differences between similar sounding words and misunderstanding of speech when presented in noise
-Normal peripheral hearing