Remaining Lectures

Question 1

The Swallowing Phases

Answer 1

Oral - Food/liquid is contained and broken down
Pharyngeal - Bolus moves through the pharynx to the esophagus
Esophageal - Bolus moves from esophagus to stomach

Question 2

Airway Protection

Answer 2

-The epiglottis is inverted to cover the larynx
-Vocal folds close
-Larynx elevates and moves forwards

Question 3

Dysphagia

Answer 3

Any issue with chewing or the passage of food through the mouth or throat that makes oral intake difficult or unsafe

(includes swallowing disorders)

Question 4

Oral Dysphagia

Answer 4

-Difficulty or prolonged chewing
-Accumulation of food residue in the oral cavity
-Drooling or dry mouth
-Reduced sensation
-Anterior labial spillage of food/liquid

Question 5

Pharyngeal Dysphagia

Answer 5

Delayed initiation of the swallow, results in accumulation of bolus in the pharynx and a decreased/delayed airway closure reducing sensation

Question 6

Esophageal Dysphagia

Answer 6

-Reflux
-Regurgitation
-Anatomical issues (i.e. esophageal stricture/narrowing)

Question 7

Anatomical Causes of Dysphagia

Answer 7

-Cervical osteophytes (Bony spurs/ growths from cervical spine)
-Congenital Abnormalities (i.e. cleft lip/palate)
-Head and/or neck cancer

Question 8

Physiological Causes of Dysphagia

Answer 8

-Neurodegenerative conditions (i.e. Parkinson’s, Dementias)
-Acquired brain injury (i.e. stroke)
-Respiratory conditions
-Autoimmune disease
-Laryngeal pathology

Question 9

Implications of Dysphagia

Answer 9

-Malnutrition and/or dehydration
-Respiratory complications (choking, aspiration, pneumonia)
-Social isolation/depression

Question 10

Assessing Dysphagia

Answer 10

-Screening (identify patients at risk)
-Clinical assessment (provides limited diagnostic information as to reasons for Dysphagia [hypothesis])
-Diagnostic assessment (Provides physiological explanation for dysphagia and informs effective treatment

Question 11

Treatment Strategies for Dysphagia

Answer 11

Behavioural - Tongue strengthening, biofeedback
Alternative feeding - i.e. a feeding tube
Surgical - Reconstructive post-head neck cancer
Pharmacological - For an underlying cause (medical condition)

Question 12

Health Literacy

Answer 12

Degree to which people have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

Question 13

Landmark Supreme Court Case (Eldridge vs British Columbia)

Answer 13

-Case where it was determined hospitals were required to provide interpreters for deaf patients
-Demonstrates how effective communication is integral to healthcare and not doing so violates the charter

Question 14

Providing Equitable Access in Healthcare

Answer 14

Must acknowledge that the population is culturally and linguistically diverse where language proficiency is a determent of health and varies

Question 15

Impact of Language Barriers: Health Incomes

Answer 15

-Less likely to receive effective, evidence-based, and timely care
-More visits and longer stays at hospitals
-Poorer management of acute and chronic conditions (lack of access)
-Reduced mental health and counselling
-Misunderstanding of medication and condition
-Increased chance of adverse outcomes/wrongful consent
-More likely it have inappropriate diagnostic testing

Question 16

Impact of Language Barriers: Patient and Staff Experience

Answer 16

Patients
Lower healthcare satisfaction, lower compliance/adherence, problems with access and coordination of care an follow ups
Staff
Frequent difficulties communicating, relying more on ad hoc interpreters, increased chance of confidentiality breaches, increased risk of invalid consent
Indirect
Minorities underrepresented in clinical research, results aren’t generalizable, know less about risk factors, prevalence, and treatment

Question 17

Benefits of Professional Interpretation

Answer 17

Lower rate of ED use, less inappropriate testing, improved clinical outcomes and understanding care/treatment, high level of satisfaction, more efficient use of time, cost effective

Question 18

Approaches to improving access of healthcare through language

Answer 18

Increase the number of same language encounters
-Increase number of bilinguals or multilingual health care professionals (instead of i.e. pulling a nurse away to fill in)
-Increase the number of minority language speakers who speak official languages
Provide professional interpretation services
-Enable communication between individuals who do not speak each other’s languages

Question 19

Interpretation vs Translation

Answer 19

Interpretation is focused on accurately re-expressing speech between two languages while translation is focused on text

Question 20

Simultaneous Interpretation

Answer 20

Interpreted message is delivered nearly instantaneously while the speaker or signer continues to speak/sign

Question 21

Consecutive interpretation

Answer 21

When interpretation occurs after a section of the source language is produced, during a pause

Question 22

Limited English Proficiency (LEP)

Answer 22

Legal concept referring to an insufficient proficiency in English to ensure equal access to public services without an interpreter

Question 23

Ad Hoc Interpreter

Answer 23

Person who is asked to interpret but does not have professional interpretation training

Question 24

Cultural Broker

Answer 24

Person knowledgeable about the culture and/or speech-language community and passes that information between client and clinician in addition to language interpretation

Question 25

When to use an Interpreter

Answer 25

-If the health care provider and patient don't speak the same language or the patient has a limited english proficiency -A good measure is if the patient is only answering with yes and no

Question 25

Linguistic Broker

Answer 25

Person knowledgeable about speech community/communication environment and can provide information about language and sociolinguistic norms (i.e. pragmatics, patters, etc.)

Question 26

Modalities of Interpretation

Answer 26

Telephone, Video Call, In-Person

Question 27

Issues with Family and Ad Hoc Interpreters

Answer 27

**Family** -Cannot remain unbiased, uncomfortable, hard conversations (especially with providing diagnosis) -Very dangerous when involving minors **Ad Hoc Interpreters** -Often bilingual staff, might know the patient, lack of context or insufficient vocab, pulling staff away from their job, high error

Question 28

Aphasia

Answer 28

-Acquired communication disorder caused by brain damage -Characterized by an impairment of language modalities

Question 29

Causes of Aphasia

Answer 29

-Stroke (most common, about ~30% of stroke survivors experience aphasia) -Neurodegeneration -Head Trauma -Tumour -Infection

Question 30

Types of Aphasia

Answer 30

**Broca's Aphasia** (Most Common) Nonfluent, impairment of expressive ability and repetition but comprehension stays relatively intact **Wernicke's Aphasia** Impaired repetition, auditory and reading comprehension **Neurodegenerative language disorders** Deterioration of speech and language, associated with Alzheimer's

Question 31

Phonological Component Analysis

Answer 31

-Targeting verbal expressions and naming -Prompts person to analyze sound components of a target word to facilitate verbal expression

Question 32

Better Conversations with Aphasia

Answer 32

(AKA Conversation Therapy) Weekly communication training program for people with aphasia, uses video recorded conversations

Question 33

Augmentative and Alternative Communication (AAC)

Answer 33

Refers to any techniques or tools used to compensate for and/or supplement spoken communication

Question 34

Listener Bias

Answer 34

Studies show that perceived intelligibility of a speaker drops when seeing a minority in comparison to a white person

Question 35

Motor Speech Neuroanatomy

Answer 35

Speech disorders that come from neurologic impairments

Question 36

Motor Speech Neuroanatomy: Etiologies

Answer 36

Cerebral vascular accidents, tumours, traumatic brain injuries, neurodegenerative diseases, inflammatory, toxic-metabolic

Question 37

Apraxia of Speech

Answer 37

-Motor planning/programming issue -Can co-occur with aphasia and/or dysarthria -The localization is controversial (has been associated with Broca's area but a range of other places have been proposed)

Question 38

Dysarthria

Answer 38

Motor control and/or execution issue **motor control** -Ataxia: Poor coordination/timing -Hypokinesia: Too little movement Hyperkinesia: Too much movement **Execution** -Spasicity: Problems with discrete, voluntary movement and supporting movements -Flaccidity: Problems with stimulating muscle contraction

Question 39

Assessing Motor Speech Disorders

Answer 39

Chart review, case history and collateral, oral mechanism exam, speech tasks, patient perspective, compare to baseline, intelligibility

Question 40

What can't be measured using a standardized test

Answer 40

-Limited for testing languages other than English -Reliance on informal tools -consider the patient/client/resident/family values and goals -Consider dialectal differences

Question 41

Fluency

Answer 41

-Refers to the continuity, smoothness, rate, and effort in speech production -Also about the temporal sequencing

Question 42

Fluency Disorder

Answer 42

Interruption to the typical flow of speech (i.e. atypical rate or rhythm, or disfluencies accompanied by secondary behaviours)

Question 43

Disfluencies

Answer 43

-Fillers (i.e. um, uh) -Repetition of sounds or syllables (like stuttering) -Prolongations (i.e. eat the sssssandwich) -Blocks (The inability to initiate a sound) *All speakers/signers are disfluent sometimes

Question 44

Stuttering and Statistics

Answer 44

-The most common fluency disorder -Incidence: about 5-8% of the population is diagnosed every year -Prevalence: 1% or less of the total population stutter at a particular point in time Note: Prevalence is lower than incidence because 80% of children diagnosed as toddlers recover without therapy

Question 45

Stages of Stuttering

Answer 45

(AKA "Natural History") -Stage 1: Typical Disfluencies -Stage 2: Borderline Stuttering -Stage 3: Beginning Stuttering -Stage 4: Intermediate Stuttering -Stage 5: Advanced Stuttering

Question 46

Causes of Stuttering: Biological

Answer 46

-Genetic evidence: does not guarantee stuttering but people who stutter are likely to have a first degree relative who also stutters -if an identical twin stutters the other is 70% likely to as well, where 25% if not identical twin

Question 47

Causes of Stuttering: Speech Motor Control

Answer 47

-Hypothesized that stuttering may be a failure to form stable underlying motor programs for speech -Would explain differences in articulatory movement -Quality of any motor control task suffers in the face of stress and anxiety

Question 48

Neurogenic Stuttering

Answer 48

Can be the result of neurological damage after a brain injury or stroke

Question 49

Treatment: Stuttering

Answer 49

Behaviour treatment is generally considered effective at reducing stuttering