Speech

Question 1

All behaviors used to perceive and transmit information and interact with others

Answer 1

communication

- speech, language, written

Question 2

what’s the difference between speech and language?

Answer 2

Speech: Verbal communication

• Articulation: How sounds are made
• Voice: Use of vocal folds and breathing to produce sound
• Fluency: Rhythm of speech

Language: Includes what words mean, how new words are made and put together, what words work best in which situations; much more of a cultural component

Question 3

understanding language

Answer 3

receptive language

Question 4

Sharing (Communicating) thoughts, ideas, and feelings

Answer 4

expressive language

Question 5

What are the functions fo speech organs?

Answer 5

1. Function primarily for breathing & swallowing

2. Function differently when used for speech production

Question 6

Acts as a barrier to prevent aspiration of food in to the lungs; acts as a valve to lock air in to the lungs (providing stability) when completing heavy work with the upper extremities

Answer 6

larynx

- ex: door opening

Question 7

create the sound of speech; controlled by interactions at the subcortical and cortical levels

Answer 7

vocal cords

Question 8

What are the receptive language skills from birth- 3 months?

Answer 8

1. Startles to sound
2. Quiets when spoken to
3. Recognizes voice of caregivers

Question 9

What are the receptive language skills from 4-6 months?

Answer 9

1. Moves eyes in response to sound
2. Responds to changes in tone of voice
3. Notices toys that make sound
4. Pays attention to music

Question 10

What are the receptive language skills from 7-12 months?

Answer 10

1. Enjoys songs or rhyming games
2. Attends to directions of sounds
3. Listens when spoken to
4. Recognizes common words
5. Begins to respond to requests

Question 11

What are the expressive language skills from birth- 3 months?

Answer 11

1. Makes pleasure sounds (cooing)
2. Cries to express needs
3. Smiles in response to faces

Question 12

What are the expressive language skills from 4-6 months?

Answer 12

1. Babbles with speech-like sounds (p, b and m)
2. Giggles
3. Vocalizes excitement and displeasure
4. Makes gurgling sounds when left alone or when playing

Question 13

What are the expressive language skills from 7-12 months?

Answer 13

1. Advanced babbling
2. Uses speech or non-crying to express needs
3. Uses gestures (or sign language) to communicate
   Imitates different speech sounds
4. Has 1-2 words

Question 14

What are the receptive language skills from 1-2 years?

Answer 14

1. Points to body parts
2. Follows simple commands
3. Understands simple questions
4. Listens to simple stories
5. Points to pictures in a book when named

Question 15

What are the receptive language skills from 2-3 years?

Answer 15

1. Understands opposites (go/stop)
2. Follows 2-step directions
3. Enjoys longer stories

Question 16

What are the receptive language skills from 3-4 years?

Answer 16

1. Hears when called from another room
2. Hears TV/radio at the same loudness as others
3. Understands words for some colors, shapes, and family members

Question 17

What are the receptive language skills from 4-5 years?

Answer 17

1. Understands “order” words (First, Last, etc)
2. Understands words for time (yesterday, tomorrow)
3. Follows multi-step directions
4. Hears and understands what is said at home and school

Question 18

What are the expressive language skills from 1-2 years?

Answer 18

1. Says more words every month
2. Uses 1-2-word questions
3. Strings two words
4. Uses a variety of consonants to begin words

Question 19

What are the expressive language skills from 2-3 years?

Answer 19

1. Has a word for almost everything
2. Uses 2-3 word sentences
3. Increased variety of consonant sounds used
4. Speech is intelligible by familiar listeners most of the time
5. Directs attention to an object by naming it
6. Asks why
7. May stutter

Question 20

What are the expressive language skills from 3-4 years?

Answer 20

1. Talks about daily activities
2. Uses about 4 sentences at a time
3. Unfamiliar people generally understand speech
4. Answers, “Who? What? Where?” Questions
5. Says rhyming words, pronouns, plurals
6. Generally talks without repeating syllables or words

Question 21

What are the expressive language skills from 4-5 years?

Answer 21

1. Says all speech sounds in words; may make mistakes
2. Responds to “What did you say?”
3. Uses sentences with >1 action word
4. Tells a short story
5. Maintains conversation
6. Talks in different ways depending on context/ environment

Question 22

Acquired communication disorder that manifests in people previously able to use language effectively for communication

Answer 22

aphasia

• types = fluent, non-fluent
• if there is damage, there is not a compensatory mechanism without rehabilitation

Question 23

Receptive Language Impairment, poor language comprehension; Expressive Language with typical rate and melody; Result of damage to the temporal gyrus of the left hemisphere; Characterized by difficulty with word finding; Motor function typically preserved

Answer 23

fluent aphasia

- types: wernicke’s, anomic

Question 24

Results from damage to the posterior portion of the first temporal gyrus of the left hemisphere; Impaired auditory comprehension; Word substitutions common; May produce neologisms (nonsensical words)

Answer 24

Wernicke’s

• AKA sensory or receptive aphasia
• most common type of fluent aphasia
• may evolve into anomic aphasia

Question 25

Characterized by significant word-finding difficulty, despite fluent, grammatically correct and well-formed speech; Impaired comprehension; Adaptation may include “circumlocutions” - A person answers a question vaguely to avoid notice of their impairments

Answer 25

anomic aphasia

Question 26

Characterized by - limited vocabulary, hesitant speech, awkward articulation, restricted use of grammar; Auditory comprehension is preserved; Lesion - Anterior Third frontal convolution of the left hemisphere; Often associated with right hemiparesis

Answer 26

nonfluent aphasia | Types: Broca's

Question 27

Characterized By- Awkward articulation, Restricted Vocabulary, Restricted grammatical forms, Preserved auditory comprehension, Limited to 1-2 words of expression; Lesion - Subcortical White Area of the third frontal convolution of the left hemisphere, extends to the inferior portion of the motor strip (Precentral Gyrus)

Answer 27

Broca's - AKA expressive, motor, verbal - less common in those with TBI

Question 28

Not a “type” of aphasia, but rather a designation of severity; Impaired receptive & expressive language; Lesion - Extensive damage in the CNS; Severe limitations

Answer 28

Global aphasia

Question 29

Occurs in children as a result of cerebral damage from brain injury, tumor, or stroke; Same manifestations as in the adult with aphasia; Prognosis is considered better in those children who are younger due to plasticity

Answer 29

acquired aphasia

Question 30

Initially presents with difficulty naming objects, will progress (in the most severe cases) to the inability to speak; Associated with dementia

Answer 30

Primary progressive aphasia (PPA) | - Outside the generally accepted scheme for classification elsewhere– not caused by CVA, trauma, tumor, or infection

Question 31

What are the means by which aphasia is assessed?

Answer 31

1. Naming tasks 2. Conversational speech assessment -Fluency, Effort, Articulation, Phrase length, prosody, substitutions, or omissions 3. Repetition 4. Comprehension 5. Word finding 6. Reading 7. Writing 8. Other standardized exams

Question 32

What is the best rehab potential of aphasia

Answer 32

early intervention: 2-3 months following onset - compete recovery typically occurs within hours or days - spontaneous recover can happen up to 1 month - recovery rates drop at 6-12 months

Question 33

What are the two recovery dimensions of aphasia?

Answer 33

1. Quantification of rehabilitation of language ability | 2. Recovery of functional communication

Question 34

What factors contribute to prognosis of aphasia?

Answer 34

1. Age - younger the better 2. Employed persons demonstrated more full recovery compared with those who were unemployed at the time of their stroke 3. Recovery from post-traumatic aphasia is better than aphasia occurring secondary to a vascular origin (CVA) 4. Global aphasia=poor prognosis 5. No differences in fluent vs. nonfluent aphasia 6. Comprehension recovers better than expression 7. Negative prognositic indicators: Depression, Anxiety Paranoia, Premorbid personality (extroverts fared better than introverts)

Question 35

What are the categories of rehab treatment?

Answer 35

1. Indirect stimulation-facilitation: Views language impairments as an “access” problem 2. Direct structure-pedagogic: Views Language impairments as a “loss” - intensive speech therapy = effective - pharmacologic intervention = effective

Question 36

An impairment of speech production resulting from damage to the CNS or PNS, which causes weakness, paralysis or incoordination of the motor-speech system

Answer 36

dysarthria - common in TBI or CVA - LMN damage - anarthria = unintelligible speech

Question 37

What are the types of dysarthria?

Answer 37

1. Spastic 2. Flaccid 3. Ataxic 4. Hypokinetic 5. Hyperkinetic 6. Mixed: 2+ types co-exist

Question 38

Results from damage to bilateral pyramidal system involve the corticobulbar tracts (UMN Lesion); Characteristics: imprecise articulation, slow and labored articulation, hypernasality, harsh or strained phonation, monotonous pitch; Respiration: weak inspiration and poor control of exhalation; High incidence in those with cerebral palsy

Answer 38

Spastic dysarthria | - PTs would work on breathing

Question 39

Results from muscle weakness or low tone; Characterized by: slow and labored articulation, hypernasality, hoarse/breathy phonation, short phrases; Respiration: Shallow inhalation, reduced control of exhalation

Answer 39

flaccid dysarthria

Question 40

Caused by lesions bilaterally of the deep midline nuclei and/or pathways of the cerebellum; Common in those with MS and TBI with cerebellar damage; Characterized by: disturbed timing, movement, range, control, and coordination of the muscles that control speech

Answer 40

ataxic dysarthria

Question 41

Caused by lesions in the substantia nigra; Most common amongst those with Parkinson disease and parkinsonian-type symptoms Characterized by: variable precision, slow rate, poor voice quality (harsh, hoarse), excessive pauses, reduced phonation

Answer 41

hypokinetic dysarthria

Question 42

Caused by lesions within the basal ganglia and/or extrapyramidal projections; Common in those with huntington’s chorea; Characterized by: variable precision, vocal harshness, prolonged sounds and intervals between words, monotonous pitch, loud

Answer 42

hyperkinetic dysarthria

Question 43

What factors the treatment of dysarthria?

Answer 43

1. Focus on functional speech– it won’t be “normal” 2. May emphasize compensatory speech skills, which result in decreased disability 3. Goal: Improve effectiveness of communication 4. LSVT/LOUD training for those with hypokinetic dysarthria secondary to Parkinson disease - Use of exercise to stimulate dopamine production and decrease symptomatic presentation 5. Drive neuroplastic changes through principles of exercise physiology (intensity, salience, timing of treatment) 6. Use of ACA/AAC Augmentative and alternative communication aids - Speech generating programs, iPads, etc.

Question 44

How can a PT support speech functions?

Answer 44

1. Posture 2. Respiration 3. Head control 4. Sitting balance 5. Set up of augmentative communication devices - need to be able to recognize the need for referral to SLP

Question 45

What are the do's and don'ts of working with pt with speech impairment?

Answer 45

Do: 1. Short and simple sentences 2. Give patient time to process 3. Make questions “yes” or “no” 4. Give physical assistive cues 5. Make directions simple Don't: 1. Switch topics too quickly 2. Speak too quickly 3. Background noise 4. Talk while patient is doing physical activity 5. Converse with more than one person at a time 6. Change the entire command after a pt doesn't understand the first time