Review 1 Flashcards
(112 cards)
1
Q
Tongue protrusion forms part of any oral examination. Which muscles and nerves are responsible here?
A
Intrinsic tongue muscles innervated by CN XII, the hypoglossal nerve.
- specifically, styloglossus draws tongue tip back, hyoglossus retracts and depresses the tongue, chondroglossus depresses the tongue
2
Q
When a pt has parkison’s disease, what do you expect see at the tongue protrusion part of the OME?
A
Tremor at rest (in PD, the tremor may also affect the tongue)
3
Q
Hypokinetic dysarthria is most commonly associated with what condition?
A
Parkinson’s Disease
4
Q
What is a common feature of hypo kinetic dysarthria?
A
hurried spurts of speech are inter-twined with periods of slow labored speech.
5
Q
Typically a patient with dysphagia as a result of Parkinson’s Disease will demonstrate:
A
Reduced swallow frequency, delayed pharyngeal swallow, inadequate laryngeal elevation/closure and reduced laryngeal sensitivity to penetration
6
Q
flaccid dysarthria is most associated with what condition?
A
myasthenia gravis (LMN)
7
Q
Damage to the basal ganglia resulting in hyperkinetic dysarthria is associated with what condition?
A
Huntington’s disease
8
Q
Spastic dysarthria results from …
A
bilateral damage to upper motor neurons
9
Q
Ataxic dysarthria results from…
A
damage to the cerebellum
10
Q
What are the classic symptoms of Parkinson’s disease?
A
- tremor or shaking, bradykinesia and rigidity. This is a progressive disease that may also affect communication and swallowing ability
11
Q
Describe Multiple Sclerosis (MS)
A
tends to have periods of remission and no associated tremor
12
Q
Describe myasthenia gravis (MG)
A
typically presents as muscle fatigue causing intermittent weakness, especially after exercise.
13
Q
How do you calculate MLU?
A
MLU = number of morphemes (divided by) number of utterances
14
Q
What is the research on stuttering in families?
A
There have been reports in the literature that the likelihood of childhood stuttering is increased when a member of the family reports stuttering during childhood, however male children of mothers who stutter are more at risk.
15
Q
When asked to write a report, what assessment would you use and why?
A
A standardized assessment would be the best option. You will need quantitative data, showing the norm for this child’s age if you are to write a report. By Federal or State Law you may need to show this data if you were to request any special services for this child.
16
Q
Describe how you would use Minimal Pair Contrast approach in a child who is doing fronting /ti/ for ‘key’ and FCD (final consonant deletion) /tou/ for ‘goat’.
A
Minimal Pair Contrast approach would be used to target both final consonant deletion (fcd) and velar fronting (vf) by means of pictures and words showing both a toe -v- goat and then the letter T -v- key (this reinforces in a concrete manner the idea that the sounds we make represent different meanings).
17
Q
What is the purpose of Milieu Therapy?
A
MT uses functional communication techniques to train children in the correct use of verbal responses.
18
Q
What does the research suggest about targeting language vs articulation?
A
Hoffman and Norris (2002) suggest that with a child who has a language disorder and articulation/phonological difficulties that the clinician should target both areas simultaneously. This includes increasing more phonosyntactic skills (Rob has deficits in both speech and language).
19
Q
difference b/w articulation and phonological processes assessments?
A
Articulation assessments will only examine the production of phonemes in one phonetic context and will not focus on patterns of speech processes.
20
Q
Velar fronting and Final consonant deletion usually disappear by the age
A
3;0
21
Q
difference between dysarthria and dyspraxia
A
Speech errors are consistent. There are no episodes of clear speech observed when Dysarthria is present. Dysarthria affects all speech, automatic included. Errors of speech are predictable and it is muscle weakness that is responsible for poor intelligibility. Dysarthria only manifests as a speech disorder. vs Dyspraxia which is a motor programming disorder
22
Q
Describe CN VIII
A
is the Acoustic nerve, it is a sensory nerve and is linked with hearing and equilibrium
23
Q
Describe CN IX
A
IX - The Glossopharyngeal nerve is mixed and is linked with taste, gag, elevation of the palate and larynx.
24
Q
Describe CN XII
A
XII (Hypo-glossal nerve) is a motor nerve and is responsible for movement of the tongue.
25
A pt has unilateral facial weakness. Which CN is responsible?
VII (the Facial nerve). It is a mixed nerve carrying both sensory and motor signals and is linked with taste and movement of facial muscles
26
The medical records you receive from Mrs. Howley's neurologist detail damage to the areas that would confirm your diagnosis of Ataxic Dysarthria with mild to moderate non-fluent Aphasia. What areas are damaged?
damage to the cerebellar system (ataxic dysarthria) and Brodmanns areas 44 & 45 (Broca's aphasia)
27
If a pt had presented with Hypernasality, Imprecise Consonants, Breathiness, Monopitch and Nasal emissions you would diagnose which type of Dysarthria?
Flaccid
28
Flaccid dysarthria results from ____ and is associated with ______
Flaccid Dysarthria results from damage to the lower motor neurons and is associated with CVA, disease, palsies and tumor
29
A pt presents with Imprecise consonants, irregular articulatory breakdowns, distorted vowels, harsh voice, loudness control problems, variable nasality and equal and even stress patterns. What kind of dysarthria?
Ataxic Dysarthria is a result of damage to the cerebellar system and typical symptoms are: Imprecise consonants, Excess and equal stress patterns, a Harsh voice quality with Loudness control problems.
Variable nasality and Distorted vowels along with Irregular articulatory breakdowns. (You may find the acronym HI LIVED a useful way of remembering these ataxic features)
30
the most common form of TBI associated with road traffic accidents.
Acceleration-Deceleration injury
31
Non acceleration injury occurs when
the head is trapped and either crushed or impacted by a heavy object.
32
Type of head injuries refer to closed head injuries usually caused by a blow to the head (professional fighters usually suffer this type of injury).
Both coup and contre coup
33
what is xerostomia
abnormal dryness in mouth
34
What dysphagia treatments are most often recommended for patients diagnosed with Parkinson's disease?
Compensatory strategies
These strategies could include: increasing sensory awareness, changing posture, modifying food consistency, chin tucking, double swallow, effortful swallow and adaptive utensils.
35
How many components are typically included in an aural rehabilitation program?
There are typical components of an aural rehabilitation program. These include detection of sound, discrimination of sounds, identification, and comprehension, in that order. Each sequential component is more difficult than the one before it.
36
What are the basic principles of intervention with motor speech disorders?
Target the speech components that will yield the most functional benefits, reduce the severity of impairment, specific motor movements can be taught at any level, linguistic approaches. Both rate specific and linguistic approaches can be used together. Use AAC method if needed.
37
describe adverb development in children
While adverbs rarely occur in the speech of very young children, the earliest adverbial modifiers to be observed usually include "here" and "there". Even by 3 or 4 years of age, the proportion of adverb use compared to nouns, verbs, pronouns and adjectives is modest with the use of adverbs remaining fairly consistent at 7% of total words across all ages. Research shows that expressive and receptive knowledge of adverbial form and function may not be complete until late adolescence.
38
What is a quick preschool speech/language screening tool?
The Fluharty-2 is a quick screening tool for preschoolers that includes articulation, sentence repetition, direction following, and sequencing. It provides standardization and should pick up those children who will require a full speech/language evaluation.
39
Explain the difference between a hearing aid and cochlear implant
Hearing aids amplify sound so they can be heard, a cochlear implant sends signals to the brain through the auditory nerve. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn.
40
explain what cochlear implant is
It is a small and complex electronic device that can help provide a sense of sound. It does not restore hearing but gives a representation of sounds. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin
41
the speech banana is located between ___ and ____ dB
20 to 60 dB, depending on the sound
42
air conduction refers to sounds given through
headphones
43
in bone conduction, a black box (attached to a headband) is placed on the _____ bone
mastoid
44
bone conduction bypasses the outer ear and middle ear and goes straight to the __
cochlea
45
common causes of conductive hearing loss
was in middle ear
otosclerosis
otitis media
46
define presbycusis
hearing loss in the elderly
47
______ _____also called a vestibular schwannoma, is a benign primary intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve (CN VIII).
acoustic neuroma
48
what are the earliest symptoms of acoustic neuromas?
- unilateral sensorineural hearing loss/deafness
- disturbed sense of balance and altered gait
- vertigo with associated nausea and vomiting
- pressure in the ear
(all of which can be attributed to the disruption of normal vestibulocochlear nerve function)
- Additionally more than 80% of patients have reported tinnitus
49
tinnitus
high pitched ringing
50
acoustic neuromas can affect nearby cranial nerve VII (facial nerve) leading to...
Involvement of the nearby facial nerve (CN VII) may lead to unilateral facial weakness, sensory impairment, and impairment of glandular secretions
51
acoustic neuromas can affect nearby cranial nerve V (trigeminal nerve) leading too...
involvement of the trigeminal nerve (CN V) may lead to loss of taste and loss of sensation in the involved side's face and mouth
52
treatment options for acoustic neuromas are
surgery and radiation therapy
53
pros and cons for surgery vs radiation for acoustic neuromas
Microsurgery for acoustic neuroma is the only technique that removes the tumor. Radiation treatment does not remove the tumor, but has the potential to slow or stop its growth.
Surgery is the only treatment that will definitively treat balance symptoms associated with tumor growth, as the vestibular nerves are removed at surgery.
54
Risks of radiation tx for acoustic neuroma
Two risks of radiation treatment are carcinogenic progression of the acoustic neuroma (conversion from benign to malignant) or induction of other tumors (such as glioblastoma) in the nearby irradiated brain tissue.
55
levels of HL
```
0-20 dB HL - Normal range - Adults
21-25 dB HL - Slight
26-40dB HL - Mild
41-55dB HL - Moderate
56-70dB HL - Moderately Severe
71-90dB HL - Severe
91dB+ - Profound.
```
56
typical symptoms of Noise induced hearing loss
hearing loss
tinnitus
poor speech discrimination
57
When exposed to harmful sounds that are too loud or loud sounds that last a long time, what structures in the ear are damaged?
hair cells
58
When a client presents with a disability and needs to find work, where should you refer?
Rehabilitation Counseling is focused on helping people who have disabilities achieve their personal, career, and independent living goals through a counselling process
59
Maternal rubella causes hearing loss in babies during
during her first trimester
60
congenital rubella can cause the following
hearing loss, heart defects, eye problems; Intellectual Disability also often accompanies these defects.
61
If there is a 15 decibel or greater difference between two or more air conduction thresholds between the two ears, the loss is considered ___________
asymmetrical (disimilar)
62
The hearing loss is considered symmetrical (similar) when
the thresholds in both ears at each frequency are approximately equal.
63
A unilateral hearing loss is always, by definition, ________
asymmetrical
64
Meniere's disease is a disorder of the inner ear that can affect hearing and balance. What is thought to be a cause of Meniere's disease?
Excess fluid in the inner ear
65
Since there are other disorders which have symptoms similar to Meniere's disease, how is a diagnosis established?
There is no definitive test. It is diagnosed when other causes have been ruled out. Audiometry and head magnetic resonance imaging (MRI) scan should be performed to exclude a tumor of the cranial nerve VIII (vestibulocochlear nerve) which would cause similar symptoms.
66
How is Meniere's disease treated?
reatment for individual symptoms, salt-restriction and/or surgical intervention
67
Otosclerosis is
a hardening of the stapes (or stirrup) in the middle ear and causes conductive hearing loss.
68
_______ _________ is one of the autoimmune conditions that may precipitate hearing loss.
Wegener's granulomatosis
69
What is Word Recognition?
The percentage of one-syllable words a patient can identify at a comfortable hearing level
70
children with _______ hearing loss generally have poor speech discrimination
sensorineural
71
During a hearing evaluation, you ask Tommy to repeat familiar words as they are named. You make note of the weakest intensity that Tommy is able to recognize these familiar words. What are you evaluating?
Speech Reception Threshold
72
During a hearing evaluation, you say one-syllable words at a comfortable loudness for Tommy and calculate the percentage of those words that he can identify. What are you measuring?
Speech Discrimination Score or Word Recognition Score
73
Whenever there is an indication of family history of hearing loss, it is recommended that patients seek _____ counseling
genetic
74
A teacher has nodules. How will her fundamental frequency sound?
decreased
75
A teacher has nodules. How will her voice sound?
Breathy and hoarse
76
aphonia is
loss of voice
77
dysphonia is
abnormal voice (hoarse voice)
78
organic etiology means
there is an observable and measurable disease process, such as inflammation or tissue damage; there are detectable physical changes or biomarkers
79
functional voice disorders are
voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation
80
What is an organic cause found in patients with aphonia?
Bilateral disruption of the recurrent laryngeal nerve
81
What are some probable causes of bilateral disruption of the recurrent laryngeal nerve resulting in aphonia
A primary cause of aphonia is bilateral disruption of the recurrent laryngeal nerve, which supplies nearly all the muscles in the larynx. The nerve is best known for its importance in thyroid surgery, as it runs immediately posterior to this gland. If it is damaged during surgery, the patient will have a hoarse voice. Similar problems may also be due to invasion of the nerve by a tumor or after trauma to the neck.
82
If you have a patient with diagnosed damage to the recurrent laryngeal nerve who is experiencing breathing difficulties and aphonia, what would you suspect about the nature of the nerve damage
That there is bilateral nerve damage
83
If the damage to the recurrent laryngeal nerve is unilateral, the patient may present with
voice changes including hoarseness.
84
Bilateral damage to the recurrent laryngeal nerve can result in
breathing difficulties and aphonia
85
The ___________ is more susceptible to damage during thyroid surgery due to its relatively medial location.
right recurrent laryngeal nerve
86
If you have a patient who presents with bilateral vocal fold edema with a low-pitched, husky voice, what benign vocal lesion do you suspect?
Reinke's edema
87
Reinke's Edema, also known as polypoid degeneration, is
the swelling of the vocal folds due to fluid collection (edema).
88
Individuals with Reinke's Edema typically have what kind of voice?
low-pitched, husky voices.
89
Vocal Nodules are referred to as a benign vocal lesion. What are some other benign vocal lesions?
Reinke's edema, polyps, and cysts
90
Symptoms of vocal nodules
Symptoms include chronic or recurrent hoarseness, loss of ability to sing high notes softly, frequent voice breaks, increased breathiness, and vocal fatigue.
91
Vocal nodules usually result from
overuse, poor vocal technique
92
Factors that contribute to chronic irritation of the larynx with excessive throat clearing can include:
Chronic sinusitis (post-nasal drip), pulmonary disease (which may lead to poor breath support), and tobacco use/abuse (exposure to irritants)
93
Vocal nodules can occur as the result of chronic vocal use/misuse, acute vocal misuse or trauma resulting from infection. What is another cause of vocal nodules?
Trauma from gastric reflux-- Trauma resulting from infection, or trauma from gastric reflux (GERD) injuring the laryngeal mucosa (protective cover of the vocal folds).
94
What type of symptoms would you expect in a child diagnosed with Rett Syndrome?
Poor eye contact, lack of reciprocity, language impairment and cognitive impairment
95
Most individuals with Rett Syndrome are female or male?
female
96
If a child had been diagnosed with Klinefelter's Syndrome what kind of symptoms would you have expected?
Flat affect in combination with language impairment
97
If a child had Landau-Kleffner syndrome what kind of symptoms would you have expected?
Sudden or gradual loss of receptive and expressive skills
98
What language areas would you suspect a child with WIliams Syndrome would have difficulty with?
Problem-solving, perspective and inferencing (Because of the probable low cognitive scores and difficulty with Theory of Mind)
99
Williams Syndrome is sometimes called:
The cocktail-party syndrome (Persons with Williams generally possess very good social skills, )
100
Williams syndrome is characterized by
- a distinctive, "elfish" facial appearance, along with a low nasal bridge;
- an unusually cheerful demeanor and ease with strangers, coupled with unpredictably occurring negative outbursts;
- Intellectual Disability coupled with an unusual facility with language;
- a love for music;
- and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcaemia.
101
How will scarring on a vocal fold will affect the mucosal wave?
decreased
102
How will scarring on a vocal fold affect the amplitude of vibration?
decreased
103
The most prevalent cause of a missed diagnosis of laryngeal cancer is a belief that persistent hoarseness is due to
laryngitis
104
Should hoarseness last for more than 3 weeks, one should consult an
ENT (otolaryngologist)
105
Paula, a 46-year-old female was referred for videostroboscopy secondary to complaints of laryngitis and dysphonia. She is employed as a sales clerk and reports using her voice on a daily basis to communicate with customers. A flexible scope was used to view vocal fold vibratory behavior. The flexible scope revealed severe medial compression of the false vocal folds bilaterally. Why might it be difficult to study patterns of vocal fold vibration in this patient via a stroboscopic assessment?
Stroboscopic results will be inconclusive because of severe medial compression of the false vocal folds obstructing view of the glottis during voicing
106
You're examining a patient. The flexible scope revealed severe medial compression of the false vocal folds bilaterally. How will this affect the patient's fundamental frequency?
False vocal folds are coming together, causing fundamental frequency to be higher
107
what is a bifid uvula
cleft uvula (a uvula that is split in 2 or forked)
108
What are some neurogenic causes of velopharyngeal insufficiency
Dysarthria, tumors, stroke, traumatic injury or cranial nerve damage
109
A child has velopharyngeal insufficiency, what speech sounds would you expect to be affected?
Because of the velopharyngeal insufficiency you would likely see difficulties in the production of Fricatives and Affricates.
110
What is Velopharyngeal insufficiency
When the velum and the lateral/posterior pharyngeal walls fail to separate the oral cavity from the nasal cavity during speech..
Velopharyngeal insufficiency (VPI) is defined as the failure to close the velopharyngeal sphincter, resulting in an inability to adequately separate the nasal cavity from the oral cavity (Armour et al., 2005)
111
Describe Velopharyngeal insufficiency to a parent
When the back of the palate and the sides and back of the walls of the throat don't fully close, the sound and air pressure go through the nose instead of the mouth
112
VPI is most commonly caused by a cleft of the secondary palate, but other causes may include
submucous clefts, neuromuscular abnormalities, and congenital VPI of unknown cause (Sloan, 2000).
