Spa Exam #2 Flashcards
(141 cards)
1
Q
Is the cranial nerve responsible for opening and closing the true vocal fold is?
A
CN X
2
Q
In the area of voice, the term frequency to?
A
Pitch Production
3
Q
The true vocal folds are located where in the Larynx?
A
Within the Larynx
4
Q
The angle where the cartilage plates of this structure meet at the midline in the neck creates what called the “Adams apple”?
A
Thyroid Cartilage
5
Q
From the choices listed below, please select all the occupations that would be considered to require “professional voice use”?
- Salesperson
- Professional Singer
- Trial Attorney
- Elementary School Teacher
A
All the choices
6
Q
Which of the choices below are considered proper vocal hygiene measures?
- Do not Smoke
- Avoid Intake of Alcoholic Beverages
- Drink Plenty of Water
- Drink Plenty of Hot Coffee
A
Answers 1, 2, & 3
7
Q
Treatment for voice disorders by a voice care team includes which of these answers?
- Direct Therapy
- Indirect Therapy
- Medical Intervention
A
All the choices
8
Q
Surgical removal of the entire larynx is called?
A
A Total Laryngectomy
9
Q
The true vocal folds vibrate when air flows up through them from the trachea. This vibration occurs due to what?
A
The Bernoulli Principle
10
Q
The Larynx is made entirely of bones True or False
A
False
11
Q
A voice that is mildly hoarse is considered aphonic True or False
A
False
12
Q
Speaking at a pitch that is not optimal can lead to a voice disorder True or False
A
True
13
Q
Vocal folds that are closed are in an adducted position True or False
A
True
14
Q
When utilizing an electrolarynx a person’s voice sounds very natural and it’s very similar to the sound of their own voice True or False
A
False
15
Q
Spasmodic dysphonia is a neurological disorder that results in the impairment of vocal fold function True or False
A
True
16
Q
The angle where this structure’s cartilage plates meet at the neck’s midline creates what that is known as the “Adams apple”?
A
Thyroid Cartilage
17
Q
From the choices below identify which are a part of the Central Nervous System “CNS”?
- Brain
- Spinal Cord
- Brainstem
- Cerebellum
A
All Answer Choices
18
Q
From the choices identify which of the disorders/diseases may result in neurogenic communication disorders
- Traumatic Brain Injury
- Parkinson’s Disease
- Amyotrophic Lateral Sclerosis
- Cerebral Vascular Accident
A
All Answer Choices
19
Q
This type of cerebral vascular accident results to blockage of flow to brain tissue
- Ischemic
- Both
- Hemmorphage
A
- ischemic
20
Q
What lobe of the brain processes sensory information?
- Parietal
- Frontal
- Temporal
- Cerebullum
A
- Parietal
21
Q
Most neurogenic communication disorders are what?
- Developmental
- Genetic
- Acquired
A
- Acquired
22
Q
The primary auditory center is located in what lobe of the brain?
- temporal
- occipital
- parietal
- frontal
A
- temporal
23
Q
Symptoms of what can result in slurred speech, reduced speech rate, and strained speech output?
- apraxia
- aphasia
- dysarthria
- all of the above
A
- dysarthria
24
Q
The Lee Silverman Voice Therapy (LSVP) program is most frequently utilized for patients with apraxia of speech following a stroke. True or False
A
False
25
Gunshot wounds typically result in a closed head injury. True or False
False
26
Braco's area is located in the temporal lobe of the brain. True or False
False
27
The disorder dysarthria includes impairment of both speech and language function. True or False
False
28
Patients with apraxia of speech typically do not have weakness in the oral muscles.
True
29
Patients with speech difficulty related to Parkinson's' disease may demonstrate difficulty with speech production along with dysphonia. True or False
True
30
Wernicke's Area is typically located in what area of the brain?
1. right frontal
2. left temporal
3. right temporal
4. left frontal
left temporal
31
From the choices below identify the functional areas that can be negatively impacted by injury to the right hemisphere of the brain
1. short-term memory
2. attention
3. orientation
4. naming
1, 2, & 3
32
This lobe of the brain processes visual information
1. temporal
2. occipital
3. parietal
4. frontal
2. The occipital lobe
33
This lobe of the brain processes visual information
1. frontal
2. temporal
3. occipital
4. parietal
3. occipital
34
Voice disorders are likely to be found in people who depend on a healthy voice. True or False
True
35
Voice Disorders can be easily prevented. True or False
True
36
The key anatomical structures required for voice production can be found where?
In the framework of the Larynx
37
What is the key purpose of the Larynx?
It prevents food, and liquid foreign invaders from entering the lungs
38
What words are used to determine whether the thyroarytenoid muscle "vocal folds" are open or closed
abducted open
adducted closed
39
The physiological process of voice production is phonation. True or False
True
40
What are the 3 Processes of Phonation?
1. Respiration
2. Phonation
3. Resonance
41
The number of vocal fold vibrations per second determines what?
Pitch
42
What are the three voice registers?
1. pulse register low pitch
2. Modal register mid-pitch
3. Falsetto register loud pitch
43
Voiced sounds encompass all vowels and approximately 1/2 of the consonants. True or False
True
44
What is Dysphonation and what disorder is this associated with?
It is any kind of impaired voice and is associated with aphonia which is the inability to produce any kind of voice
45
What is Hyperfunctional Voice
Speaking with excessive muscle tension resulting in a tense high pitched voice
46
What is Hypofunctional Voice
when the muscle tone of the laryngeal mechanism during the production of voice is often weak, low-pitch, and breathy
47
What is an otolaryngologist?
A surgeon who treats disorders of the ear, nose, and throat "head and neck surgeon".
48
Voice Disorder Categories by Colton, Casper, Leonard
1. Vocal Misuse "phonotrauma"
2. Nervous System Involvement
3. Organic Disease and Trauma
49
Which of these disorders are a result of vocal misuse?
1. Laryngitis
2. Vocal Polyp
3. Spasmodic Dysphonia
4. Vocal Nodules
5. Puberphonia
Answer
1, 2, 4, 5
50
Laryngitis
What is Laryngitis: Swelling of vocal folds
What causes Laryngitis: Excessive voice use, bacterial infection, viral infection, irritants, or heartburn "backup of stomach acid in the throat".
Symptoms: Sore throat, swallowing difficulties, breathy or hoarseness.
Forms: Acute- lasting only a few days
Chronic-lasting weeks to months
Potential issues: Chronic laryngitis can result in more severe voice disorders, and children who experience severe forms of laryngitis may result in breathing difficulties.
51
Vocal Nodules
What are Vocal Nodules: Noncancerous callous-like bumps on the vocal folds.
What causes Vocal Nodules: Repeated pressure on the same area of the vocal folds
Symptoms: Slightly breathy, or hoarse voice. Abnormally low voice pitch, singers being unable to sing high notes. Delay in onset of sound when singing high notes with audible air escape.
52
Vocal Polyp
What is a Vocal Polyp: A noncancerous growth on one of both of the vocal folds, however instead of being hard and callous like the vocal nodules they are soft like blisters.
What causes Vocal Polyps: Usually caused by sudden vocal trauma, however, Reinke's Edema "smokers voice" caused by smoking can also create vocal polyps
Symptoms: abnormal voice quality, vocal fatigue, and sensation of a lump in the throat that requires clearing.
53
Puberphonia
What is Puberphonia: "Mutational Falsetto" when an adult usually a young male speaks in a high-pitched voice well after when his voice should have deepened. It may reflect a psychogenic disorder caused by a rare underlying psychological disturbance.
54
Which of these voice disorders are related to nervous system involvement?
1. Neurogenic Voice Disorder
2. Spasmodic Dysphonia
3. Papilloma
4. Carcinoma
Answer: 1, 2
55
What are the kinds of Neurogenic Voice Disorders?
Parkinson's Disease & Amyotrophic Lateral Sclerosis
56
Parkinson's Disease
A progressive neurological disorder affecting movements such as walking, talking, and writing. It generally affects people beyond the age of 40.
Symptoms: Tremors, Stiffness, Bradykinesia "slowness of movements".
Parkinson's can create voice problems in approximately 50%-80% of Parkinson's patients.
Voice tones created by Parkinson's include monotonic, low-pitched voice, and loudness variation
57
Amyotrophic Lateral Sclerosis
Motor Neuron Disease, is a progressive chronic disease of the nerves that supply the electrical stimuli to the muscles used for any and all movements. It creates muscle weakness and muscle wasting, and also effects people who are generally over age 40.
Symptoms: Hoarse voice, accompanied by vocal spasms
58
Spasmodic Dysphonia is the most mysterious of all voice disorders as we are unsure what causes it, and how best to treat it. True or False
True
59
What are the 2 types of Spasmodic Dysphonia
Adductor Type, and Abductor Type, both relate to the opening and closing of the vocal folds. They both occur in middle-aged adults and have no preference toward men or women.
60
Adductor type is more rare the Abductor type Spasmodic Dysphonia. True or False
False, Abductor type is more rare
61
What is an Organic Disease and Trauma related Voice Disorder
Those that affect the structure of the vocal mechanism as a result of an organic disease or physical trauma.
62
Papillomas
What are Papillomas: benign tumors caused by the infection of the papillomavirus. These develop anywhere in the body including the larynx. 60%-80% are found in children, usually before age 3.
Why are they dangerous: Although benign their rapid growth can result in airway obstruction which can then result in asphyxiation if not promptly treated.
Most obvious symptom a hoarse voice
63
Carcinoma
What is Carcinoma: Cancer of the larynx, without treatment, can become life-threatening.
Primary Cause: Smoking
64
Bilingualism and multilingualism should always be considered when completing an assessment of communication function. True or False
True
65
A swallowings disorder can result from what?
TBI, Traumatic Brain Injury
Head & Neck Cancer
Respiratory Illness/Dysfunction
Stroke CVA
66
Intervention and management for swallowing disorders include which of the following?
1. Positioning Recommendations
2. Diet Modifications
3. Swallowing Exercises
Answer: All of them
67
What word refers to food, liquid, or stomach acid reaching the airway and entering the lungs?
Aspiration
68
The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) can only be done by a physician. True or False
False
69
Dysphagia can result in both illness and death. True or False
True
70
Digestion begins in the mouth through saliva enzymes. True or False
True
71
The most rapid phase of swallowing is the esophageal phase
False
72
NPO = No food or Liquid by Mouth. True or False
True
73
It is easy for patients, families, and caregivers to understand, with little SLP instruction how to consider a recommended nonoral means of nutrition. True or False
False
74
Dysphagia is well understood and there is little research being done on the condition. True or False
False
75
Swallowing is a complex activity requiring 30-40 muscle pairs, and at least 6 nerve pairs. They also must be in sequence with breathing patterns to ensure that the food enters the stomach instead of the lungs. True or False
True
76
What is the swallowing breakdown for disabled students?
1. wakefulness and awareness
2. brain functioning
3. muscular strenght
77
Dysphagia is the medical term for difficulty swallowing and is not a communication disorder. True or False
True
78
The normal swallowing process is called maintenance. True or False
False: Degluttition
79
What are the 2 reasons we swallow
1. Maintenance- to remove excess saliva in the oral cavity
2. Ingestion- To consume food or water
80
After an individual experiences a stroke, they are 75% likely to experience a swallowing disorder, which can lead to aspiration. True or False
True
81
What is reflux?
A backward flow of food or liquid
82
What are the 3 stages of normal swallowing?
1. Oral
2. Pharyngeal
3. Esophageal
83
The Oral Stage
Prepares food to be swallowed, and brings it to the back of the mouth, while at the same time maintaining normal nasal breathing.
84
The Pharyngeal Stage
Begins once food or bolus reaches the back of the mouth. As the bolus moves down the pharynx the nasal cavity is closed off from the oral cavity, while the throat muscles shorten the pharynx and push the food toward the esophagus. The vocal folds close tightly and breathing stops to prevent food and liquid from entering the trachea
85
The Esophageal Phase
When the bolus is directed away from the trachea into the gullet or esophagus, which goes to the stomach, and once sphincter is tightly closed, normal breathing resumes
86
What are the 3 types of Dysphagia, and which 2 have known physiological and anatomical difficulties?
1. Oropharyngeal Dysphagia
2. Esophageal Dysphagia
3. Function Dysphagia
1, and 2 have known difficulties
87
Oropharyngeal
What it is: The most common dysphagia type, and it effects the transfer of liquids and foods from the mouth, pharynx, and esophagus
88
The space between the tongue and epiglottis is called the what?
The Valleculae
89
What phase of swallowing involves constriction of the throat muscles, inversion of the epiglottis, and elevation of the larynx
The Pharyngeal Stage
90
What uses X-rays to evaluate swallowing function?
The modified barium swallow study
91
Which of these structures are a part of the Central
Nervous System CNS?
1. Brain
2. Spinal Cord
3. Brainstem
4. Cerebullum
All of them
92
Which of these structures is a part of the Peripheral Nervous System PNS?
1. Brain
2. Spinal Nerves
3. Cranial Nerves
All of them
93
From the choices below which diseases may cause neurogenic communication disorders?
1. Parkinson's Disease
2. Amyotrophic Lateral Sclerosis
4. Cerebral Vascular Accident
5. TBI
All of them
94
Symptoms of Dysthrathria include slurred speech, slow rate of speech production, and strained speech. True or False
True
95
Groping behaviors of oral movements, inconsistent sound errors, and greater ease of production of automatic speech are symptoms of Apraxia. True or False
True
96
The larynx is made of muscle, bone, and cartilage. True or False
True
97
The thyroid cartilage is the largest laryngeal structure, the two plates of cartilage coming together form the laryngeal prominence or Adam's Apple. True or False
True
98
The Hyoid Bone
Is above the thyroid cartilage, is U shaped, not attached to any other bone, and is considered free floating.
99
The Cricoid Cartilage
Is under the thyroid cartilage, is ring-shaped, ant sits above the trachea or windpipe
100
Vocal cords, or folds
Housed within the larynx, and made of several tissue layers the core of which is muscle.
101
What are abducted vocal folds used for?
Breathing and Respiration
102
What are adducted vocal folds used for?
The beginning of a cough, phonation "talking", and breath holding
103
The space between the true vocal folds is called the what?
The glottis
104
Laryngeal Videostroboscopy
To evaluate vocal fold vibration, a strobe light is utilized which allows
us to visualize the vibration and to assess for any abnormalities.
105
Air that is flowing from the lungs, up through the trachea on
expiration creates subglottic pressure
(below the level of the true
vocal folds) which blows the vocal folds open and sets them into
vibration.
106
Bernoulli principle
Rather than just opening due to the force of air, vibration occurs.
* The opening of the vocal folds creates a negative pressure which then sucks
the vocal cords back together again – and then the subglottic air blows them
apart again – repeat!
* This vibration of the vocal folds creates the sound that we call audible
phonation.
107
Modal pitch
normal speaking
108
Vocal registers
The different pitches
109
What is vocal intensity measured in?
Decibels "dB"
110
Only physicians can diagnose vocal pathology. True or False
True
111
The Larynx Lowers with age. True or False
True
112
Vocal hygiene examples
Adequate hydration
* Avoid intake of caffeinated beverages (foods)
* Avoid intake of acidic foods/beverages
* Avoid alcohol intake
* Do not smoke/vape
* Avoid throat clearing
* Avoid speaking over background noise
* Avoid yelling/screaming
* Avoid whispering
113
The brain is called the cerebrum. True or False
True
114
Frontal Lobe
Responsible for planning of body
movement.
* The frontal lobe of the left
hemisphere contains Broca’s
area.
* An important area for speech
and language.
115
Parietal Lobe
Process Sensory Information
116
Temporal Lobe
Contain the primary auditory center
* Sound from the ears travels
through the nervous system to
the primary auditory center to
be interpreted.
* The temporal lobe of the left
hemisphere contains Wernicke’s
area
* An area responsible for
language comprehension.
117
Occipital
Process Visual Information
118
Individuals with TBI can experience deficits in the areas of:
speech, language, cognition & swallowing. True or False
True
119
PD Parkinson's Disease
A degenerative disease that typically occurs in individuals over the age of 60
years.
* Loss of nerve cell function in the basal ganglia of the brain which is
responsible for the control of muscle movements.
* Symptoms include:
* Tremulous movements of the limbs and the face
* Stiffness of the limbs and trunk
* Slowing of movements (bradykinesia)
* Impaired balance & coordination
* Individuals with PD may have deficits in speech, voice, cognition &
swallowing
120
Amyotrophic lateral sclerosis (ALS)
Disease of the motor neurons that leads to inability to control
muscles
* Typically diagnosed between the ages of 40 – 60 years of age
* A degenerative disease - survival after diagnosis is typically 3-5
years
* More common in men
* Individuals with ALS typically experience difficulty with speaking
and swallowing
* Motor impairment typically leads to immobility and respiratory
failure
121
Dysarthria
An impairment of motor control for speech production.
* Can be caused by impairment of the muscles necessary for speech
production which results in:
* Paralysis of muscle(s)
* Weakness of muscle(s)
* Reduced coordination of muscle movement
* Dysarthria is a speech disorder (not a language disorder)
* It can co-occur with other communication disorders, however.
Dysarthria
* There are different types of dysarthria (see Table 8-2)
* The type of dysarthria that occurs is based on the site of the lesion
within the nervous system.
* The most common type of dysarthria is “mixed dysarthria”
* Occurs when there is damage to more than one area within the
nervous system.
Characteristics of dysarthric speech can include:
* Slurring of speech
* Slow rate of speech production
* Strained speech
* Dysarthria can be seen in:
* Stroke (CVA)
* TBI
* Parkinson’s disease (PD)
* Amyotrophic lateral sclerosis (ALS)
* And several other diseases/disorders
122
Apraxia
* Impairment in motor planning to perform voluntary oral movements.
* This is not due to muscle weakness!
* Two types:
* Developmental (We discussed this already – Childhood Apraxia of
Speech (CAS))
* Acquired apraxia
* Stroke
Apraxia of Speech
* Characteristics:
* Misarticulations are variable
* Typically, shorter words are easier to produce than longer
words
* “Groping” behaviors of the speech structures can be
noted.
* Automatic speech production is preservedApraxia of Speech
* Characteristics:
* Misarticulations are variable
* Typically, shorter words are easier to produce than longer
words
* “Groping” behaviors of the speech structures can be
noted.
* Automatic speech production is preserved
Types of Apraxia
* Apraxia of speech (what we have discussed)
* Oral apraxia
* Impaired motor planning for volitional movements of the
speech structures
* Limb apraxiaTypes of Apraxia
* Apraxia of speech (what we have discussed)
* Oral apraxia
* Impaired motor planning for volitional movements of the
speech structures
* Limb apraxia
123
Neurological Diseases
Neurological diseases:
* Parkinson’s Disease (PD)
* Amyotrophic Lateral Sclerosis (ALS)
* Multiple Sclerosis (MS)
124
The same medical conditions/diseases that can result in neurogenic
speech disorders (dysarthria and apraxia) can typically also result in
neurogenic language disorders. True or False
True
125
Left Hemisphere Dysfunction
Language disorders
* Aphasia
* Most commonly caused by stroke (CVA)
* Impaired language function
* Severity and areas of language that are impacted vary from
individual to individual
126
Aphasia
Types of aphasia can be broken down into:
* 1. Fluent
* 2. Nonfluent
* Description of impairment can also be based on degree of
impairment in areas of language (expressive & receptive)
* For example:
* Mild expressive aphasia
* Moderate receptive aphasia
* Moderate-severe mixed aphasia (both expressive and receptive)
* Moderate expressive aphasia with mild receptive aphasia
127
Global vs Broca's Aphasia
Global Aphasia – Severe/profound non-fluent aphasia – impacts all
modalities of expressive and receptive language.
* Can be evolving
* Broca’s Aphasia – Nonfluent aphasia (Expressive language function is
more impaired than receptive language function – short phrases with
omission of function words like “the” “and” “is” ). E.g.: “Walk dog” for
“He is taking the dog for a walk”.
128
Wernickes vs Anomic Aphasia
Wernicke’s Aphasia – Fluent with absent content; comprehension is
reduced. E.g.: “You know that smoodle pinkered and that I want to
get him round and take care of him like you want before.”
(nidcd.nih.gov)
* Anomic Aphasia – Fluent, but experience difficulty with word finding
(which may negatively impact on fluency, at times). Typically have
better language comprehension than language expression.
129
Broca's area and Wernicke's area both affect the left hemisphere. True or False
True
130
Broca's Area
Broca’s area
* Discovered by Dr. Paul Broca in
1865.
* Impairment in this area, located in
the frontal lobe of the brain,
results in a language impairment
with nonfluent aphasia.
* In Broca’s aphasia, expressive
language function is more
impaired than receptive language
function.
https://www.biomedguide.com/anatomy-and-physiology/the-nervous-system/brocas-area-
and-wernickes-area/
131
Wernicke's Area
Wernicke’s area
* Discovered by Dr. Karl Wernicke in
1874.
* Impairment in this area, located in
the temporal lobe of the brain,
close to the auditory cortex,
results in fluent aphasia.
* Wernicke’s aphasia is
characterized by language that is
without meaning with significantly
impaired auditory comprehension.
* There are words present,
spoken fluently, that have no
meaning.
* “Word salad”
https://www.biomedguide.com/anatomy-and-physiology/the-nervous-system/brocas-area-
and-wernickes-area/
132
There are several other types of aphasia, not just Broca’s
Wernicke’s and Anomic, and Global aphasia. True or False
True
133
Not all aphasias can be completely identified as a “type”
due to brain organization differences and the potential for
more than one stroke.
True
134
Right Hemisphere Damage
Right hemisphere damage (not just the frontal lobe!)
* Impairment can result from a right CVA (stroke) or a TBI (traumatic brain
injury)
* Deficits occur in the areas of:
* Orientation
* Attention
* Auditory comprehension
* Immediate recall
* Short-term memory
* Reasoning / Judgment
* Executive function
* Planning
* Organizing
* Making decisions
135
Stroke Visual Deficits
Have a negative impact on a constellation of functions.
* Consider ambulation and activities of daily living (ADLs)
* Consider printed materials provided for patient education
* 1. Visual Neglect
* Not an issue with the eye itself or the visual cortex (occipital lobe).
* Left visual neglect
* Inattention to objects/people on the left
136
Dementia
An umbrella term that refers to a disorder (usually progressive) that result
in deficits in the areas of:
* Thinking
* Behavior
* Language function
* Ability to complete activities of daily living
* Results from a variety of diseases that impact on function of the cortex of
the brain or subcortical function.
* Alzheimer’s Disease (A type of cortical dementia - the most common cause of
dementia)
* Parkinson’s Disease (A type of subcortical dementia)
* Role of the speech-language pathologist
137
Baseline Communication Function Assessment
* What is the patient’s baseline function/communication function?
* Does the patient wear glasses?
* Where are they?
* Does the patient wear hearing aids?
* Where are they?
* Do they function?
* What is the patient’s education level?
* Is the patient bilingual or a polyglot?
* What is their preferred language?
* Is the patient right or left-handed?
138
Aphasia Assessment
Administer a standardized assessment (if appropriate based on the
patient’s medical condition).
* Evaluate:
* Expressive language
* Naming
* Real objects
* Pictures
* Sentence completion
* Writing function
* Receptive language
* Auditory Comprehension
* Ability to execute commands
* Yes/No responses
* Reading ability/comprehension
139
Aphasia Therapy Goal
Aphasia: The goal of therapy is to:
(1) Maximize recovery of impaired function
(2) Assist in the development of communication strategies
(3) Help the patient adjust to the residual deficits of the brain injury
(4) Provide education to the patient’s caregivers regarding strategies
to maximize communication function
140
Primary structures of swallowing
Oral Cavity
* Lips
* Tongue
* Teeth
* Mandible
* Saliva
* Nasal Cavity
* Velum
* Pharynx
* Muscles
* Epiglottis
* Valleculae
* Pyriform sinuses
* Upper esophageal sphincter (UES)
* Trachea
* Cartilage
* Below the true vocal folds
* Esophagus
* Muscular tube
141
Dysphagia
Dysphagia
* Disordered swallowing function
* A symptom – not a diagnosis
* Often results from a neurological disorder
* All those disorders we discussed (CVA, TBI) and neurological
diseases.
* Other causes include:
* Structural changes
* E.g.: Head and neck cancer
* Resulting from the presence of tumor and intervention for
the tumor
* Physiological changes/disorders
* E.g.: Respiratory dysfunction – COPD
