CSD 212 Exam 3 Study - Lecture notes 1-26 PDF

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Exam 3 Study Guide Neurogenic Disorders of Language and Speech – Cognitive-Communication Disorders 1. What are cognitive communication disorders? What kind of brain damage causes them? What cognitive processes are affected? a. Caused by widespread damage to the brain b. Damage affects multiple cognitive processes: memory, reasoning, control of behavior c. Communication is affected because of these cognitive deficits d. Usual etiologies (causes): hemisphere stroke (R CVA), dementia (e.g. Alzheimer’s disease), traumatic brain injury (TBI) 2. What are the right hemisphere functions discussed in class? a. Music, emotion, art, geometry, visual processing, spatial processing, integrative skills 3. What are some of the perceptual deficits that result from Right Hemisphere damage? a. Visual agnosia i. Difficulty recognizing objects b. Left neglect i. Lack of attention to the left side of space; very common in the early stages of recovery. ii. Reading only the right-side of printed materials iii. Finding only objects on right side of room iv. Bumping into walls or doorways on left 4. What are some of the cognitive deficits that result from Right Hemisphere damage (RHD)? a. Attention, awareness i. Staying on task; ignoring distractions; inhibiting impulsive reactions ii. Anosognosia: denial of deficits b. Short term memory i. Recalling three items after five minute delay ii. Remembering appointments c. Judgment and problem solving i. Solving hypothetical problems, choosing a solution from among alternatives d. Organization i. Sequencing or organizing items; organizing discourse e. Reasoning and abstract thinking i. Deductive reasoning puzzles ii. Understanding figurative language 5. What are some implications of the cognitive deficits for communication? a. Comprehension and production of discourse: i. Difficulty attending to important information &integrating details to form a coherent story ii. Tendency to go off on tangents iii. Difficulty understanding non-literal language iv. Misunderstanding of implied meaning (humor, sarcasm)

v. Difficulty producing/understanding emotion cues b. Reading & writing: i. As above, difficulty attending to important information, and integrating details ii. Visuospatial problems may result in missing information on left side of page c. Language is better than communication 6. What is traumatic brain injury (TBI)? What are the two types of TBI? a. Damage to the brain caused by physical trauma or external force. b. Two Types: i. Open head injury: Skull is penetrated (Gun shot wound) ii. Closed head injury: Skull is not penetrated; blunt force trauma causes more widespread damage. (Concussion) 7. Be able to name some of the most frequent causes of TBI a. Motor vehicle accidents (MVAs) b. Falls c. Sports/recreation d. Homicide attempts e. Firearms incidents 8. What are some of the risk factors for TBI? a. Age and gender b. Substance Abuse 9. What is the mechanism for TBI? a. Damage at site of impact i. Frontal lobe damage (Coup) ii. Occipital lobe damage (Contre-Coup) b. Damage throughout brain i. Acceleration forces cause movement of brain within skull ii. Axons stretch, tear, break iii. Common around brainstem where the brain is anchored, results in a coma. c. Bruising and swelling of the brain/ Increased intracranial pressure 10. What are the common cognitive problems in TBI? a. Attentional deficits i. From diffuse damage b. Memory impairment i. From damage to medial frontal and temporal structures c. Executive dysfunction i. Personality change from damage to frontal lobe 11. Know basic memory system definitions: a. Prospective memory i. Ability to store new memories b. Declarative memory i. Conscious c. Procedural memory i. Sub-conscious

d. Episodic memory i. Memory for events 12. What are some of the frontal lobe functions that are impaired as a result of TBI? a. Initiation of action, organization & planning b. Allocating attention to coordinate multiple tasks (“multi-tasking”) c. Problem-solving; making judgments d. Making social judgments e. Self-monitoring behavior f. Inhibiting inappropriate behavior 13. What are some of the cognitive deficits associated with dementia? a. Short-term and long-term memory b. At least one other cognitive area (e.g. abstract reasoning, visual processing, personality, language) c. Significant FUNCTIONAL consequences: i. E.g. with employment, social situations, or relationships d. Evolution of disease characterized by: i. Acquisition in adulthood ii. Insidious onset iii. Persistence (e.g., delirium, drug-induced states) 14. How does age affect the incidence of dementia? a. Increases rapidly with age b. 2% of 65 year olds and 20% of 80 year olds are likely to be affected 15. What are signs and symptoms of dementia? a. Forgetfulness (Losing things, missing appointments) b. Disorientation (Getting lost, unsure of day/month) c. Poor judgment and reasoning (Difficulty handling money or operating appliances) d. Poor visuospatial processing (Misrecognizing people or things) 16. What memory system is impaired in dementia? a. Affects all systems 17. What are some implications of dementia for communication? a. Comprehension: i. Losing track of conversations; forgetting information previously mentioned ii. Difficulty understanding figurative speech iii. Increasing difficulty understanding complex grammar iv. Lack of sensitivity to listener b. Production: i. Poor topic maintenance; tangential (off topic) speech; perseveration ii. Empty language, word-finding problems, word errors iii. More passive, less likely to initiate Neurogenic Disorders of Language and Speech – Motor Speech Disorders 1. What is apraxia? a. Difficulty carrying out volitional movement sequences in the absence of sensory loss or paralysis sufficient to explain the difficulty b. Often accompanies aphasia

2. What is dysarthria? a. A group of motor speech disorders associated with disturbed neuromuscular control of speech b. Due to CNS (brain, spinal cord) or PNS (nerves, muscles) damage c. May affect speed, strength, timing, range, and/or accuracy of movements d. May affect one or many motor speech processes 3. What speech processes are affected in motor speech disorders? a. Respiration (Respiration system serves as the “Power Source” for production b. Phonation (laryngeal system converts respiratory energy into sound energy) c. Articulation & Resonance (tongue, lips, jaw and soft palate determine the shape of the vocal tract and the flow of sound energy) 4. What motor neurons “talk” directly to muscles? a. Efferent Neurons 5. What are the Basal Ganglia? What is their role in movement control? a. Facilitate wanted movements and inhibit unwanted movements 6. What is the Cerebellum’s role in movement control? a. Send & receive information from motor cortex b. Coordinate voluntary movements 7. What are some speech characteristics of people who have motor speech disorders? a. Respiratory i. Reduced volume ii. Short phrases iii. Disrupted prosody iv. Monopitch b. Phonation i. Hoarse breathy voice ii. Harsh rasping voice c. Articulatory i. Imprecise consonants ii. Slow, labored articulation iii. Prolongation of vowels d. Resonance i. Hypernasality e. Coordination i. “Blurred” articulation ii. Involuntary noises iii. Accelerated, variable rate iv. Equal & excess stress 8. What are some therapeutic goals for motor speech disorders? a. Restore lost function i. Improve strength, range, accuracy of speech movements; respiratory capacity, speech volume through intensive practice b. Promote residual function & compensate for deficits by: i. Exaggerating articulation, reducing rate of speech, speaking loudly ii. Modifying the environment to enhance intelligibility

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iii. Using a prosthetic device (e.g. to amplify voice, lift soft palate) to make speech more intelligible iv. Using alternative communication system (e.g. computer program to speak for the client) c. Reduce impact of lost function i. Adjust life-style (e.g. change jobs) ii. Counsel patient & family to help them accept limitations Fluency Disorders What is stuttering? How is it defined? a. As an observable behavior and as a disorder of communication b. Disfluency: Between-word disfluencies Types of disfluencies (be able to give example of each) a. Interjections b. Revisions c. Phrase repetitions Which disfluencies are considered abnormal or stuttered? a. Listeners more often judge within-word disfluencies to be “Stuttering,” or “Atypical,” as compared to between-word disfluencies. What are core stuttering behaviors? a. Basic speech behaviors; Repetitions, Prolongations, Silent blocks b. They are involuntary and are out of the PWS’s control What are secondary stuttering behaviors? a. Escape i. Speaker is stuttering and attempts to terminate the stutter and finish the word ii. Includes head nods and eye blinks iii. Initially, escape behaviors are random but can turned into learned patterns b. Avoidance i. Produced in anticipation of stuttering ii. Used to avoid stuttering iii. Same behaviors used to Escape moments of stuttering could be used as avoidance iv. Example: changing a word you were going to say v. Initially Avoidance behaviors may prevent stuttering but they soon become strong habits that are resistant to change

6. What role do feelings and attitudes play in the development and maintenance of stuttering? a. A settled way of thinking or feeling about someone or something, typically one that is reflected in a person's behavior. b. Initially when excited a child may stutter more c. When a child stutters often, he/she may become frustrated, ashamed d. Those feelings may impede fluency 7. What is developmental stuttering? How it is different from acquired stuttering? a. Developmental Stuttering

i. Accounts for vast majority of stuttering cases ii. Onset typically before 4 years of age, can be as late as 12 (rare cases) iii. In 70% of cases, onset is gradual, with NO known psychic and/or physical trauma associated with 90% or more of cases. b. Acquired Stuttering i. Accounts for small percentage of stuttering cases ii. Onset typically in later life, usually following some psychological or physical (usually the latter) trauma iii. Sudden onset, typically 8. What are the criteria for stuttering diagnosis? a. Produces THREE or more WITHIN-WORD speech disfluencies per 100 words of conversational speech (i.e., sound/syllable repetitions and/or sound prolongations) b. Parents and/or other people in the child’s environment express concern that the child stutters. 9. Know the facts about the onset of stuttering: a. Age of onset: i. 2-4 years of age b. Lifetime incidence i. 4-5% of USA population c. Prevalence in children vs. adults i. 1% and higher among children d. Sex ratio i. It is pretty equal (1:1) until school age which is when females recover quicker making the ratio about (3:1) 10. What is spontaneous recovery from stuttering? How many children recover? a. Recovery from stuttering without treatment b. Estimates of unassisted recovery or remission range is about 75% 11. What are recovery predictors? (More than these 3) a. Onset before age 3 b. Female c. No family history 12. Know four basic phenomena of stuttering: a. Consistency: Tendency to stutter on the same words or sounds during successive readings or repetitions of the same material. b. Locus/Loci: The characteristics of sounds, syllables, and words that are consistently stuttered on c. Adaptation: Progressive decrease in the number of disfluencies during successive readings of the same material 13. How do linguistic properties of the utterance influence the amount of disfluency? a. PWS may differ from PWNS their ability to quickly, efficiently and accurately “handle” syntactic, semantic and phonological properties of speech-language production 14. What conditions is fluency inducing? a. Singing, Talking in unison with another person, whispering, using an accent

Anatomy and Physiology of Hearing 1. What is sound? a. Sound is a propagation of a pressure wave in space and time 2. What is a pressure wave? a. Relays energy through a medium without significantly moving its molecules from one place to another. 3. Know the difference between transverse and longitudinal pressure waves. Which type is a sound wave? a. Transverse: Ex: A spring b. Longitudinal: Ex: A pendulum c. Sound waves are Longitudinal Waves 4. What is pitch? What is loudness? a. Pitch: Perceptual interpretation of frequency b. Loudness: Perceptual interpretation of intensity 5. What is a threshold of hearing? a. The faintest sound that a human can detect 6. What are parts of the auditory system? a. Outer Ear: Gathers acoustic pressure waves b. Middle Ear: Converts acoustic energy to mechanical energy c. Inner Ear: Converts mechanical energy to neural signals 7. Know the following anatomical structures and their purpose: a. Pinna: Composed of skin over cartilage b. External auditory meatus (Ear canal): Canal leading up to the ear drum; produces ear wax c. Tympanic membrane (Ear drum): Laterally, continuous with skin of canal. Medially, continuous with mucosal lining of middle ear. Two layers are joined by connective tissue. Cone of light d. Osscicles (malleus, incus, stapes (3 tiny bones)): i. Malleus (Hammer): Comes in contact with the TM, point of attachment is the Umbo ii. Incus (Anvil): Middle Osscicles iii. Stapes (Stirrup): Base of the stapes sits in the oval window and sends energy into the inner ear e. Eustachian tube: Mucosal lined tube running from the nasopharynx to the base of the middle ear, opens via yawning, coughing, etc. Allows air to enter through the ME and also allows fluid to drain. f. Cochlea: 2 ¾ turn snail-shaped cut out in the temporal bone i. “Tube” within the cochlea progresses from basal to apical end ii. Scala tympani iii. Tube is divided into three sections 1. Scala Vestibuli 2. Scala Media 3. Houses the Basilar Membrane g. Vestibule

h. Semicircular canals 8. Know the following structures of the inner ear: a. Oval window b. Round window c. Basilar membrane d. Organ of Corti (Hair cells) 9. What is traveling wave? How does it travel along the basilar membrane? a. “Traveling wave” progresses through cochlea and is relieved at the round window. b. Traveling wave will fall on the basilar membrane at a place consistent with the frequency of the signal 10. What is tonotopic organization? How does basilar membrane respond to different frequencies of sound? a. The basilar membrane responds to higher frequencies at the base and lower frequencies at the apex. 11. What energy transformations are happening within each part of the auditory system? a. Acoustic – mechanical – hydraulic – electrical i. Acoustic 1. Sound energy in canal ii. Mechanical 1. Physical movement of ossicles iii. Hydraulic 1. Traveling wave within cochlea iv. Electrical 1. Firing of hair cells at 8th nerve Hearing Measurement 1. What is otoscopy? What part of the auditory system does it evaluate? a. Examination of the external ear, using an instrument with lighting and magnifying systems. Visual examination of the tympanic membrane and the ear canal i. Tympanostomy tubes ii. Perforation of the ear drum iii. Middle ear infection 2. What is tympanometry? What part of the auditory system does it evaluate? a. Allows checking how well the TM moves. Provides information about status of the middle ear b. Flat vs. normal tympanogram i. Flat: No Peak identified ii. Normal: Peak identified near 0 3. What kind of tympanogram is associated with middle ear infection? a. Flat tympanogram 4. What is audiometry? What part of the auditory system does it evaluate? a. Check how well the middle ear and the cochlea work 5. What is an audiogram? Be able to read an audiogram. a. Graph used by audiologists to plot hearing sensitivity 6. What is air vs. bone conduction testing?

a. If bone conduction responses are better than air conduction responses then the loss is due to a problem with outer / middle ear. If bone conduction responses are equal to air conduction responses then the loss is due to a problem in the inner ear or deeper...