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53 Cards in this Set
- Front
- Back
What is cognition?
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The act or process of knowing
The basis of communication |
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What's communication?
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Exchange of info, ideas, feelings
Sender and receiver Various modes Control our environment Can communicate through language |
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What is language?
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Set of symbols used to communicate
Has rules Several outputs and inputs Components include: phon, morph, syntax, seman, prag |
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What is speech?
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The acoustical representation of language
Other modes: writing, sign lang |
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What is speech production?
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1) Neural "control"
2) Muscular "force" 3) Structural "movement" 4) Aeromechanical "energize All 4 stages "private" |
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Public speech production stages
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5) Acoustical (speech) "transmission" (fq, intensity, time)
6) Perceptual "psychological interpretation" -hearing -auditory perception -auditory comprehension |
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What is a communication disorder?
Where is the breakdown? |
Neural
Muscular Structural Aeromechanical Acoustical Perceptual |
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CNS
PNS |
12 pairs cranial nerves
31 pairs spinal nerves |
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Plan/program
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Motor cortex
Basal nuclei (ganglia) cerebellum |
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Perceptual correlate
Pressure= Volume= Shape= |
Pressure= loudness
Volume= breath group length Shape= inspiratory duration (and stress) |
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Culture
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“A learned set of shared interpretations about beliefs,
values, and norms that affect the behaviors of a relatively large group of people.” |
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Dysarthria is a ______ disorder
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SPEECH
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Dysarthria is caused by
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Impairment to PNS and/or CNS
Stroke, trauma, tumor, disease Can involve all speech subsystems |
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Flaccid Dysarthria
Signs of lesions |
Flaccid= LOWER motor neurons
Signs: Paresis/paralysis reduced/absent reflexes atrophy flaccidity fasciculations |
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Spastic dysarthria
Signs of lesions |
Spastic=UPPER
Weakness (paresis or paralysis) NO atrophy Hyperactive (normal) reflexes Pathologic reflexes Spasticity Reduction in skilled movement |
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Flaccid vs Spastic
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Flaccid
-normal artic rate indiv nerves may be impaired Spastic Slow artic rate movement patterns impaired Pseudobular affect |
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Ataxic Dysarthria
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Lesion of the CEREBELLUM
Dyscoordination- difficulty controlling force, speed, range, timing, direction of movements Low muscle tone |
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HypOkinetic dysarthria
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Parkinsons (reduction of dopamine in substantia nigra)
Resting tremor Rigidity Bradykinesia (slow/small movements) Postural problems Masked face and micrographia |
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HypERkinetic dysarthria
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Speed/rate of involuntary movements
tics ballism tremor myoclonus chorea athetosis dystonia |
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Mixed dysarthria
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Amyotrophic lateral sclerosis (flaccid+spastic)
Multiple sclerosis (ataxic+spastic) |
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Evaluation of dysarthria
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Looking
Listening (pitch, loudness, quality, artic precision, artic rate, pauses, variability of all...) Instrumental (acoustic, physiologic) Referrals |
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Management of clients with dysarthria
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Medical-surgical
Prosthetic Behavioral: artic practice, sph rate modificaiton, AAC |
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Core features of Apraxia of Speech
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Mixture of SODA, distorted substitutions, in spontaneous and imitative speech
Awareness and dissatisfaction with errors Groping, struggling attempts to correct errors Difficulty initiating speech |
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Other common characteristics of Apraxia
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Slow rate (prolonged vowels+interword intervals)
Tendency to equalize stress False starts, restarts, self-corrections Automatic better than volitional speech Consonant singletons better than clusters |
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In Apraxia there is NO
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slowness
weakness incoordination paralysis alteration of tone in muscles |
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Evaluation of Apraxia
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automatic vs volitional sph
papapa vs pataka utterances of increasing length and complexity |
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Management of apraxia
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Practice!
Feedback: reduced over time, delayed better than immediate |
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Deglutition
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Entire process of eating/drinking, from placement of food or liquid in oral cavity until material enters stomach, includes volitional and involuntary portions
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Oral Preparatory Phase (1)
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Food placed in mouth and Prepared for transport to stomach
Food masticated Position bolus against roof of mouth |
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Oral Transit Phase (2)
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Bolus is Transported from mouth to pharynx
Central groove forms in middle of tongue to act as a shoot Quick- less than 1 sec |
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Pharyngeal Phase (3)
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Bolus is moved through pharynx into esophagus
Reflexive and complex: -velum elevates -larynx elevates -epiglottis flips down -VF close -pharynx muscles contract sequentially -upper esophageal sphincter relaxes to allow food into the esophagus Quick- less than 1 sec |
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Esophageal Phase (4)
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Bolus is transported through esophagus to stomach
involuntary Peristalsis- successive contractions in esophagus 8-20 seconds |
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Dysphagia=
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Any impairment in swallowing
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Causes of dysphagia
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Age-related dysphagia
congenital abnormalities (cleft palate) dementia head/neck cancer immature development progressive neurologic diseases (parkinsons, ALS) severe reflux stroke surgery/radiation TBI Tracheostomy |
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The major concern of dysphagia
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Aspiration
can lead to choking, pneumonia |
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Other consequences of dysphagia
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Malnutrition
Dehydration Reduced food enjoyment Reduced socialization *quality of life |
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Dysphagia assessment
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Bedside evaluation
Modified barium swallow study Flexible Endoscopic evaluation of swallowing Assessment |
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Bedside evaluation
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Med chart review
patient/family interview Oral mech exam voice/respiratory assessment oral trials cognition |
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Chart review
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Med diagnosis
med history respiratory status GI status Lab work chest x-rays current diet reason for evaluation nutritional status |
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Interview : Build ________
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Rapport
Address patient first, intro yourself, explain OME & BSE, then ask the family Prior Level of Funct: baseline diet, patient complaint, assist level, appetite, prior sph therapy? Duration of prob Compensatory strategies Additional medical history |
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Oral Mech Exam
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Say 'ah' - 10, 9
gag reflex- 9, 10 Stick out tongue- 12 smile and pucker- 7 push tongue against tongue blade-12 close lips tight against resistance-7 raise eyebrows, close eyes tight-7 check sensation-5 taste- 9, 7 |
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Voice Respiratory assessment
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volitional cough
volitional clear throat voice quality vocal ampliture pitch O2 needs and saturation breath groups respiratory rate lung sounds |
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Oral trials
consistency presentation |
consistency presentation
-thin -nectar -puree -solid |
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Oral trials
Observations |
duration of mastication
lip seal rotary chewing prompt swallow initiation oral residue |
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Clinical indications of aspiration
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coughing
throat clearing wet vocal quality watering eyes/runny nose choking cervical susculation &lung auscultation before, during, after swallow Laryngeal palpation |
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Cognition
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orientation
general level of confusiton impulsivity short-term memory reasoning safety awareness sequencing initiation |
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Modified barium swallow study MBS
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AKA Videofluoroscopic swallow study
Procedure: start in lateral view given foods/liquids with barium Purposes: view all phases of swallow objectively assess dysphagia assess coordination of swallow phases view aspiration |
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Flexible Endoscopic Evaluation of Swallow FEES
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aka fiberoptic EES
Procedure: endoscope passes transnasally into hypopharynx patient given food/liquid (dyed green) Purpose: direct visualization of pharynx and larynx view laryngeal funct assess airway protection |
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Assessment- swallowing
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synthesize info:
history patient complaint observations with oral trials signs/symptoms of aspiration results of objective measures dietary limitations hydration/nutritional needs immune function respiratory status endurance/fatigue overall medical status/fragility |
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Assessment
Clinical impression: |
severity of dysphagia
aspiration risk aspiration risk factors chronicity of dysphagia primary impairments prognosis |
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Plan of care & treatment
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Goals:
prevent aspiration, malnutrition/dehydration Decisions/POC oral v non-oral (feeding tube) nutrition medical v behavioral management direct v indirect treatment referrals |
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Direct treatment
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Texture modifications
thin or thick liquids, soft, hard, pureed foods Positioning/postures: sit upright, chin tuck, head turn Compensatory maneuvers: effortful swallow, mendelsohn, supraglottic Volume/rate control: liquid by spoon, small sips/bites, slow pace |
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Indirect treatment
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Exercises
Biofeedback: surface EMG, FEES Swallow stimulation: temperature, taste, e-stim Counseling/edu: quality of life |