00 - CSD 110 - MAKE UP AT END OF SEMESTER
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CSD 110
End of the Semester Make-up assignment
Due: Friday, May 11 (11:00 AM)--- no late assignments accepted
CH 6 – ADULT LANGUAGE IMPAIRMENTS
1.
Describe how language use changes through adulthood.
Compared to children, adults aree very efffective communicators and skilled conversationalists
who have a variety of styles of talking, from formal to causual. Styles require modification not
only in the manner of talking but also in the topics introduced and the vocabulary used.
Competent adult communicators quickly sense their role in an interaction and adjust their
lanuage and speech accordingly.
The number of communicative intentions increase grasully so
that adults are able to hypothesize, to cajole, to inspire, to entice, to pun, and so on.
2.
Describe how language content changes through adulthood.
Adults contunue to add to their personal vocabularies, and most use between 30,000 to 60,000
words expressively. Receptive vocabularies are even larger. Specialized vocabularies develop for
work, religion, hobbies, and social and interest groups. Some words fade form the laguage and
are used less frequently. Typical seniors experience some deficits in the accuracy and speed of
words retrieval and naming. When compared to younger adults, seniors use more indefinite
words, such as “thing” and “one” in place of specific names. These deficits relect accompanying
deficits in working memory and, in turn, they affect ability to produce grammatically complex
sentences.
3.
Describe how language form changes through adulthood.
Within language form, adults continue to acquire prefixes, more phophonemic contrasts, and
infrequently used irregular verbs. Conversations become more cohesive through more effective
use of lingusitc devices, such as pronouns, articles, verb tenses, and aspect. In general, the form
of written language is more complex than the form of spoken language. The length and syntactic
complexiety of oral sentences increase into early adulthood and stabilized in middle age. Older
seniors experience a decline in complex sentence production that seems related to word retrieval
problems. There is also a decline in oral and written language comprehension, understanding of
syntactically complex sentences, and infrencing.
4.
What are the three parts of a neuron?
Dendrites
Cell body
Axon
5.
What are the four lobes of the brain?
Frontal Lobe
Parietal Lobe
Temporal lobe
Occipital lobe
6.
Name five concomitant or accompanying deficits associated with aphasia and provide definitions.
Agnosia: A sensory deficit accompanying some aphasias that make is difficult for the client to
understand incoming sensory information. The disorder may be specififc to auditory or visual
visual information.
Agrammatism: Omission of grammatical elements. Individuals with apahsia may omit short,
unstressed words, such as articles or propositions.
Agraphia: Diffuclty writing, may be full of mistakes and pooly formed. Clients may be unable to
write what they are able say.
Alexia: Reading problems, clients may be unable to recognize even common words they use in
their speech and writing.
Anomia: Difficulting naming entities, clients may struggule greatly. Knew what they wanted to
say but could not locate the appropriate word.
Jargon: Meaningless or irrelevant speech with typical intotational patterns. Responses are often
long and syntatically correct although containing nonsese.
Neologism: Some indivdulas with apahsia may create novel words that do not exist in their
language, using those words confidently.
Paraphasia: Word substituions in clients who may talk fluently and grmatically. Associations to
the intdended word may be based on meaning.
Verbal Sterotype: An expression repeated over and over. Sometimes the expression is an obscene
word or expletive or a neoglogism.
7.
Name the types of fluent aphasia
Wernicke’s Apahsia
Anomic Aphasia
Conduction Aphasia
Transcortical Sensory Aphasia
8.
Name the types of nonfluent aphasia.
Brocas’s Aphasia
Transcortical Motor Aphasia
Global or Mixerd Aphasia
9.
Name and define the additional types of aphasia that may affect only one modality and cannot be
categorized into specific syndromes.
Alexia with agraphia: Reading and writing impariment
Alexia without agraphia: Reading impairment with no accompanying writing difficulty
Pure agraphia: Severe writing disorder
Pure word deafness: Lack of auditory comprehension with error-fre spontaneous speech
Crossed aphasia: aphasia accompanying right hemisphere brain damage.
10. Name and describe the types/factors related to ischemic stroke.
Ischemic stroke, which is the more common type of stroke, resulting from a complete or partial
blockage (occlusion) of the arteries transporting blood to the brain, as in cerebral arteriosclerosis,
embolisms, and thrombois. Cerebral arterioscleroisis ia thinking of the walls of cerebral arteries
in which elasticity is lost or reduced, the walls become weakend, and blood flow is restricted.
The reuling ichemia, or reduction of oxygen, may be temporary or may cause permananet
damage through the death of brain tissue. An emboilism is an obstruction to blood flow caused
by a blood clot, fatty materical, or an air bubble. The obstruction may travel through the
circulatory system until it blocks the flow of blood in a small artery. For example, a clot may
form in the heart or the large arteries of the chest, break off, and become an embolus. AS in
cerebral arteriosclerosis, blockage results in a lack of oxygen-carrying blood, deprivign brain
cells of needed oxygen. Similarly, a thrombosis also blocks blood flow. In this case, plaque
buildup or a blood clot is formed on site and does not travel. The result is the same.
A transient
ichemic attack (TIA) is sometimes calleed a ministroke, it is a temporary condition whose
symptoms mirror those of a stroke. A TIA occus when blood flow to some protion of the brain is
blocked or reduced. After a short interval, the symtoms decrease as blood flow return. TIA’s
should be taken seriously because they can be a warning sign of increased likelihood of a stroke
occuring in the future.
11. Name and describe the types/factors related to hemorrhagic stroke
A hemorrhagic stroke is one in which the weakened arterial walls burst under pressure, as occurs
with an aneurysm or arteriovenous malformation. An aneurysm is a saclike bulging in a
weakened artery wall. The thin wall may rupture, causing a cerebral hemorrhage. Most
aneurysms occure in the meninges, the layered membranes surrounding the brain, and blood
flowing into this space can damage the brain or, in serious cases, cause death. Arteriovenous
malformation is rare and consists of poorly formed tangle of arteries and veins that may occur in
a highly viscous organ such as the brain. Manformed arterial walls may be weak and give way
under pressure.
12. How do the patterns of recovery vary with the type of stroke?
Patterns of recovery differ with the type of stroke. Often with ischemic stroke, there is a
noticable improvement within the first weeks after the injury. Recovery slows after 3 months. In
contrast, the results of hemorrhagic strokes are usually more severe after injury. The period of
most rapid recovery is at the end of the first month and into the second, as swelling lessens and
injured neurons regain functioning. Damage from stroke may occur in any part of the brain. In all
right-handed indidivuals and in some left-handed ones, injury to left hemisphere language areas
produces apahsia. Injury
to the right hemisphere results in aphasia in only a small percentage of
cases, usually left-handed indidvuals whose right hemisphere is more important for lanaguge.
13. What is the overall goal of treatment for aphasia?
The overal goal of intervention is to aid in the recovery of language and to provide strategies to
compensate for persistent language deficits. Indivdual intervention goals are determined by the
results of the assessment and by the desires of both the client and family. Goals will be
individualized according to the type and severeity of the aphasia an dupon the indivial eneds of
each client. It cannot be stressed enough that intervention that is effective for one client may be
less so for another who differs in the type of aphasia and the severity. Ideally, the goals are
mutually acceptable to the client, family, and SLP. All members of the team coordinate their
efforts to strengthen treatment received from others.
14. Name the common characteristics of RHBD.
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Neglect of all information from the left side
Unrealistic denial of illness or limb involment
Impariment judgment and self monitoring
Lack of motivation
Inattention
15. Explain the following terms: edema, hypoxia, infarction, and hematoma.
Edema: swelling due to increased fluid, which can lead to increased pressure
Hypoxia: oxygen deprivation
Infarction: deth of tissue deprived of blood supply
Hematoma: focal bleeding
16. What are the two most commonly reported symptoms in TBI?
Anomia
Impairent comprehension
17. What is the most disturbed language area in TBI? Describe the related deficits.
The most diturbed lanuage area and that with the most pervasive problems is pragmatics.
Pragmatic impairments result from the inability to inhibit behavior and from errors of judgment.
The result may be rambling speech and incoherence, as manifested by off-topic and irrelevant
comments and inability to mainatain a topic, as well as by poor turn-taking skills, such as requent
interruption of others. In addition, communication may be marked by poor affective or emotional
language abilities and inappropirate laughter and swearing.
18. Describe lifespan issues related to TBI recovery from injury to later stages of recovery.
Most individuals will not reach full recovery, and some residual deficits will most likely remain.
Initially, the indivudal may be nonresponsive to stimuli and may need assistance in a hospital
setting. When the indivual does begin to respond, his or her beahvior may not reflect the varying
nature of the stimuli. Gradually, the individual begins to respond differently to different stimuli
and to recognize familiar individuals. Response to commands is still often inconsistent. As the
client becomes more alert, he or she may seem confused or agitated. Short-term memory and
goal-directed behaviors may be poor. Although the client is able to sit and walk, these behaviors
are performed without purpose. The client may be subject to mood swings and may have
incoherent, inappropriate, or emotional language. Although the individual still needs
rehabilitatative hospital care, he or she has recovered enough to move from intensive care. As
agitation fades and language continues to return, the individual can remain alrt for short periods
of time and hold brief conversations if strong external cues, such as pictures or objects, are used.
There are still periods of nonpurposeful behavior. Short term memory is still severely impaired.
With structure, the patient can perform learned tasks but is still unable to learn new behaviors. As
the inidivudal continues to improve, he or she needs less assistance. Able to attend for up to 30
minutes with redirection, the indiviual is aware of the appropriate responses to self, family,, and
basic needs, which become more goal directed. Relearned tasks exhibit some carryover to other
situations, although new learning does not. Language is used appropraitely only in highly
familiar contexts.
Gradutally, the inidivual becomes oriented to persons and place. Time is still
confusing, and the individual demonstartes only superficial undestanding of his or her condition.
Usually in outpatient status, the individual is able to learn and carry over his learning to other
tasks and to monitor his or her own behavior with minimal assistance. Still unable to recognize
inappropriate social behavior, the client is often uncooperative, unrealistic in his or her
expectations, and unaware of the needs and feelings of others. As the individual gains more of an
understadning of his or her condition and is able to plan and initate routine tasks, frustration may
build, and he or she may become depressed, argumentative, irritable, or overly dependent or
independent. Living at home and possibly having reutrned to work, the indidivual may be able to
concentrate for an hour even with distractions, to recall past and present events, and to learn new
tasks with only minimal assistance. Increasing abilities may not reduce the individual’s low
tolerance for frustration, alhough behavioral responses may be less. In the later stages of
recovery, the inidivual can shift between tasks for up to 2 hours and initate and carry out familiar
tasks. Able to acknowledge his or her impairment, the client is able to consider the consequences
of his or her actions and to recognize the needs and feelings of others. Finally, the individual may
be able to consistently act in a socially appropriate manner, to respond appropriately to others,
and to plan, initiate, and complete both familiar and unfamiliar tasks. Periodic depression may
occur, and irritability may reappear with illness, inability to perform a task, and in emotional
situations. An individual with TBI may face a long period of rehabilitarion. Even those who have
made a nearly
full recovery will have some lingering deficits, especially in pragmaatics.
19. Describe cognitive rehabilitation and its two approaches.
Cognitive Rehabilitation is a treatment regimen designes to increase functional abilities for
everyday life by improving the capacity to process incoming information. The two primary
approaches are restorative and compensatory. The reestorative approach attempts to rebuild
neural circuitry and funtion through repettitive activities, while the compenstory approach
concedes that some functions will not be recovered and delops alternatives. Restorative
techniques might include classification tasks and word associations. In contrast, compensatory
strategies to improve memory might include focused attending and rehersal of new information.
20. What are the lifespan issues associated with Alzheimer’s disease?
Alzheimer’s disease (AD) is a genetic fisorder that lies in hiding, although eary screening is
possible in some cases. Often the person who will be afflicted with the diseease is unaware
and/or ignores early signs. At present there are no cures, but some early drug therapies drrm to
lessen the effects. In the early stages of AD, the indidivual experiences memory loss, especially
of wnew information. The individual experiences word retrieval problems and some difficulty
with higher language functions, such as humor and analogies. The individual may seem
indifferent and may initiate littler communication. Able to live at home, the inidividual can
become an increasing burden on an elderly spouse or on adult children who may have families of
their own. As the disease progresses, memory loss increases, with the effect that vocabulary
decreases. Comprehension is reduced. Language production ay be reduced or ritualistic or high-
usuage phrases accompanies by poor topic maintenance and repair of errors, frequent repetition
and word retrieval problems, and insensitivity to conversational partners. Irritability and
restlessness may increase. The individual may be able to live at home with visiting nurse care to
help with daily living routines. In the most advances stages of the disease, all intelectual
functions including memory are severely impaired, and almost all individuals reside in nursing
homes. Language may be meaningless, or the inidivual may be mute or echolalic. Most clients
cannot recall the names of loves ones and may undergo radical personality changes. Motor
function is also severely impaired, and the individual needs total care.
21. What is the SLP’s role in assessment of dementia?
An SLP usually helps identify changes in language performance that may signal intellectual
deterioration and aspects of behavior amenable to change. The results of this assessment may
help differenciate AD from other neuropathologies.
22. What is the focus of intervention for communication in dementia?
In cognitive rehabilitation, the client, health profressionals, and families develop individualized
goals and implement strategies bzsed on those goals. Cognitive training, is used to denote
structured and practice to improve specific cognitive functions, such as attention, memory, and
executive functions. Cognitive stimulation is less direct. Usually conducted in groups, cognitive
stiulation is concerened with general emhancement of cognitive and social functioning and might
involve relaxation exercises or music therapy.
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CH 10 – MOTOR SPEECH DISORDERS
1.
How do the basal ganglia modulate motor activity?
The Basal Ganglia are large subcortical nuclei that regulate motor functioning and maintain
posture and muscle tone. Thus, they are a part of the Brain’s extrapyrmidial system. The basal
ganglia modulate the acitivty of the primary motor conrtext and indirectly influence movement,
while the indirect pathway serves to decrease or inhibit movement. Depending on which pathway
is involved, damage to basal ganglia will either result in reduced and/or slowed movement, as
seen in Parkison disease, or will result in abnormal, involuntary movements as in Huntington’s
chorea.
2.
Describe the motor speech production process beginning with the motor plan.
In the process of motor speech production, first the movement plan/program, which I an
organized set of motor commands that specifies all of the necessary parameters of movement, is
retrived from memory. Next, it is sent to the motor control areas (motor cortex), then it is
transmitted with precise timing along the nerves to muscles and structures of the speech
mechanism, resulting in sequences of acoustic signals that are recognized as speech sounds.
Along the way, these nerve impulses are modified to ensure precise, smooth muscle movement.
3.
What is muscular dystrophy and how does it affect speech?
Muscular dystrophies are a group of genetic disease that cause progressive degeneration of the
muscles themselves. The muscles are unable to contract and relax normally, and all aspects of
speech production may eventually be affected.
4.
What are the speech characteristics associated with spastic dysarthria?
Spastic paralysis od muscles reflects the combined effects of weakness and loss of inhibitory
motor control. As a result, reflexes become hyperactive, muscle tone is increased at rest, and
inidivuals exhibit spasticity or increased resistance to passive stretch. Spasticity of the speech
mechanism is the hallmark of spastic dysarthria, causing movements of the articulators to
become slowed and reduced in force and range of motion. Spasticity as the level of the larynx
causes the vocal folds in inappropriately adduct (close) during speech production, resulting in a
strain-strangles voice quality. Spastic dysarthria typicall results from bilateral upper motor
nueron lesions (due to strokes) in the cerebral hemispheres or a single lesion in the brain stem,
where direct and indirect activation pathways are in close proximity.
5.
What are the speech and motor characteristics of ataxic dysarthria?
Damage to the cerebellum or cerebellar control circuitry results in incoordination and reduced
muscle tone, called ataxia. Ataxic dysarthria reflects the effects of incoordination and the
improper timing of movements, causing irregular break downs in articulation and abnormalities
of prosody. Ataxia and ataxic dysarthria are not caused by weakness. Muscles are not reduced in
strength; rather, they are poorly timed and improperly coordinated during movement.
Movements are inaccurate, jerky, and lacking smoothness. Too much alcohol consummption can
result in temperary ataxia. In fact, indidivuals who have had a stroke in the cerebellum, or who
have a neurological disease that causes degeneration of the cerebellum, often complain that they
look and sound drunk.
6.
What are the speech and movement characteristics of hypokinetic dysarthria?
Hyokinetic movements are slow and reduced in range of motion due to the effects of rigidity, or
inccreased resistance to passice stretch in all directions. Indidivuals with hypokinesia (reduced
movement) feel stiff and find it difficult to get movements started. Once started, they then
struggle to stop. The most common cause of hypokinesia is Parkinson disease where a
degeneration of dopaminergic neurons in the brain stem prevents proper functioning of the basal
ganglia. Reduced range of motion is the hallmark of hypokinetic dysarthria. The articulators
appear to be balery moving during speech production, and as a result, speech rate becomes very
fast. Disfluencies are common, and loudness levels gradually diminish such that is often difficult
to hear a person with Parkinson disease where he or she is talking.
7.
What are the speech characteristics of hyperkinetic dysarthria?
Hyperkinietic dysarthrias are also due to damage to the basal ganglia control circuitry; however,
in this case, the indirect pathway and/or structures of basal ganglia that help to inhibit unwanted
movements are damaged. As a result hyperkinesia (increased movement) occurs. Hyerkientic
dysarthria is esentially the production of motorically normal speech that is interrupted in some
fashion by abnormal involuntary movements.
Tremor: the most common involuntary movement disorde, involves rythmic movement
of a body part, such as the limbs, head, or voice. The best way to determine whether an
individual has voice tremor is to ask him or her to sustain the vowel /a/ for as long as
possible. Voice tremor may go unoticed during conversational speech but is quite
evident during vowel prolongation
Tics: are rapid, patterned movements that are not completely involuntary and can be
suppressed for brief period with effort. Tics are commmonly associated with Tourette’s
syndrome, which affects more males than females (3:1 ratio) with onset prior to 18.
Vocal tics are the hallmark of hyperkinetic dysarthria in indidivuals with Tourette’s
syndrome, with rapid production of these noises, sounds or words causign significant
interruption to the normal flow of speech.
Dystonia: is a slow hyperkinesia that may involve the entire body or ay be localized to
just one body part. Involunrary movements are characterized by slow, sustained
abnormal posturing, with possible twisting of body parts. Hyperkentic dysarthria in
individuals with dystonia may include excessife pitch and loudness variations, irregular
breakdowns in articulation, variable rate, and inappropriate silences.
Chorea: is a rapid and unpredictable movements of trhe limbs, face, and tongue.
Hyperkinetic dysarthria in individuals who exhibit chorea is characterized by variable
speech rate, irregular articulatory breakdowns and significant prosodict abnormalities.
8.
What is Huntington’s chorea? Describe the speech and motor characteristics, as well as effects on mood and
personality.
Huntington’s chorea, also known as huntington’s disease, is an inherited progressive disease that
results in degeneration of structures in basal ganglia. Initial symptoms, which appear between the
ages of 30 and 50, include involuntary choreatic movements and changes in behavior. As the
disease progresses, involuntary movements worsen and become more genralized. Significant
changes in mood and personality become eveident, with subsequent development iof depression
and dementia. Average survival rate is about 20 years; however, individuals diagnosed with
huntington’s chorea have a higher risk of sucide than do those with other neurodegenerative
diseases, although the mechanisms for this are poorly understood.
9.
How might acquiring dysarthria change an adult’s life?
The impact of acquired apraxia of speech on an indidivual’s life depends on the etiology of the
disorder, as ell as the severeity. Most individuals who acquire apraxia of speech do so following
a stroke in the left hemisphere, specifically Broca’s area in the left frontal lobe. Dpending on the
severeity of the stroke, indidivuals can make a full reocveryy and speech may return to normal.
In other cases, speech may recover to some extent, but mild prosodic abnormalities such as slow
rate and incorrect stress patterns may persist. For an indidivual who has apraxia of speech
secondary to a progressive neurological diease, an SLP should get the client to think about AAC
early as such indidivuals are likely to lose most or even all ability to
speak. It is important for an
SLP to always encourage clients to continually practice speaking when they can and to utilize
their AAC deveice as often as possible to promotoe communicative participation. It’s also
important to promote a positive attitude in clients with apraxia of speech, as well as all other
types of motor speech disorders, as helping to maintain a satisfactory quality of life throughout
the course of a degenerative disease in an essential role of an SLPz.
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10. What are options for education and employment for those with cerebral palsy?
Variables such as severeity, concomitant disorders, parental involvement, and school system
flexibility are important in determening the appropriate educational environment for a child with
CP. In general, children with average or higher than aversgr intelligence with mild CP are more
likely than other children with CP to have a typical educational experience. It is extremely
important to assess the cognitive abilities of indidivuals with severe motor disabilities
approproately because a physical disability may obscure deficits in intellectual functioning.
Many individuals, especially those with mild physical and cognitive difficulties, obtain higher
education and/or go into competitive employment. Often physical adaptation are made to
improve performace in the educational and workplace settings. Other individuals may work and
learn in centers run by agencies or the state. Day treatment programs are avilable to provide
trraining in daily living and vocational skills for individuals with severe motor deficits/ and or
cognitive impairment.
11. Many individuals, particularly those with mild physical and cognitive difficulties, obtain higher education
and/or go into competitive
employment
12. What are the purposes of the motor speech evaluation?
To correctly identify motor speech disorders, ou must obtain a thorough case history from the
client or client’s caregive, as motor speech disorders are often accompanied by predictable
complaints and symptoms. In addition, it is important to have a client attempt various speech
production tasks specifically designed for purposed of differential diagnosis, along with
perceptual and objective measures of the speech production subsystems. Such measures will
alow you to determine the msot effective treatment approach for the client. As an SLP, you will
likely serve on a diagnostic team with medical professionals, particalarly when your client is
exhibiting generalized meurological impariments. By correctly identifying different speech
patterns consistent with a particular type of motor speech disorder, you as an SLP provide
valuable information to other members of the team responsible for differential diagnosis of
underlying neurological conditions.
13. What speech tasks might be used for differential diagnosis of apraxia of speech?
For adults who may have acquired apraxia of speech, the following spoeech production tasks
will help in differential diagnosis:
Imitation of single words of varying lengths
Sentence imitation
Reading aloud
Spontaneous speech
Rapid repetition of “puh”, “tuh”, “kuh”, and “puh-tuh-kuh” (or “buttercup)
CH 12 - AUDIOLOGY AND HEARING LOSS
1.
Define the classifications of impairment, disability, and handicap.
Impairment: a loss of structure or function
Disability: the functional consequences associated with a particular impairment as activity
limitation
Handicap: the ability of a person to participate in life situations.
2.
What are the major components of the auditory system?
Anatomically, the auditory system can be divided into several general areas. They include the
outer ear, the middle ear, the inner ear, the vestibulocochlear nerve, the auditory brain stem, and
the auditory cortex of the brain.
3.
What is the external auditory meatus and and what is its function?
External auditory canal
4.
Describe the anatomy of the basilar membrane and how it responds to sound.
The basilar membrane is narrower, thinner, and stiffer at the base and wider, thicker, and more
flaccid at the appex.
5.
How does information get from the cochlea to the vestibulocochlear nerve?
As the stapes rocks in and out of the oval windo, fluid is displaced in the membranous labyrinth.
As the sstereocilia are bent through the movement of the tectorial and basilar membranes,
chemical trabnsnutters are released at the base of the hair cells, and neuroelectric energy is
generated and transmitted to auditory nerve fivers that form the acoustic brance of the
vestibulocochlear.
6.
What anatomical structures make up the central auditory system and what is its job?
The central auditory system, which consitsts of nuclei, nerve fibers, and nerve tracts, includes
pathways that carry auditory information to the branch (ascending pathway) and pathways that
receive information from the brain (descending pathways). Although it may appear that the
anatomical structures leading to the brain simply send neural impulses, they actually play a key
role in ensuring that information about the frequency, intensity, and duration of the auditory
stimuli remains intact until it reaches the auditory cortex for interpretation.
7.
Describe a conductive hearing loss.
A conductive hearing loss occurs as a result of deformation, a malfunction, or an obstruction of
the outer or middle ear. Not all disorders of the outer and middle ear result in a loss of hearing. In
many cases, however, problems in these areas reduce or eliminate the ear’s natural conduction of
sound as it travels to the cochlea. As a result, the intensity of sound arriving at the inner ear is
reduced. This usually prevents low- to moderate- intensity sounds from being heard at all and
higher intensity sounds being perceived as much softer than normal.
8.
Describe sensorineural hearing loss and factors that influence the effects of the loss on speech, language,
and cognition.
Sensorineural hearing loss results form the absence or malformation of, or damage to the
structures of, the inner ear, including the hair cells within the cochlea. Sensorineural hearing loss
may be present at birth or may develop over the course of one’s life. It may be sudden in onset,
occuring over a matter of hours, or gradual, occuring over a period of years. Some forms of
sensorineural hearing loss have a genetic basis; other forms are acquired. Some cases of
sensorineural hearing losses may remain stable, some become worse, and some fluctate. Unlike
conductive hearing losses, which are most commonly temporary, sensorineural losses are usually
permanent. Although sensorinural hearing loss may affect hearing sesnitivity for any range of
frequencies, in most cases,
the higher frequencies are affected. Unlike conductive hearing loss,
where the problem stems from sound not being loud enough, sensorineural hearing loss can
involved both a lack of loudness and a lack of clarity. Not only are certain sounds inaudible or
difficult to hear, but sounds that are audible are often percieved as being distorted. Sensorineural
hearing loss can have a negative impact on speech, language, and cognitive development. Factors
that influence the effects of the loss on these aspects of development includethe degress of the
loss, the age of the person when the loss occurred, referred to as age of onset, the age of the
person when the loss was identified, and the age of the person when appropriate intervention was
begun.
9.
What is auditory neuropathy spectrum disorder, what are the effects on hearing, and what are effective
treatments?
Auditory neuropathy spectrum disorder (ANSD), is characterized by normal outer hair cell
function and abnormal responses from the inner hair cells or auditory nerve fibers. A lack of
synchrony in the firing of auditory nerve fibers in response to sound appears to be underlying
problem in these cases. Individuals who have ANSD may exhibit pure tone hearing that is
anywhere from within normal limits to profoundly impaired, and pure tone hearing does not
typically correlate well with their real- world difficulties or their potential to develop language.
These individuals also usually have considerable difficulty understand speech, even where their
pure tone loss is not significant. Hearing aids are helpful to only a small number of these
individuals; cochlear implants have been shown to be helpful to greater numbers of these clients.
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Some of the challenges in working with induvial who have ANS is that the diagnosis is often not
made in a timely manner, which means the resulting treatment plan does not provide the needed
supports. Also, once the diagnosis is made, there is some disagreement regarding the best
treatment approach to use. When working with children who have this disorder, many
audiologist start by fitting the child’s auditory behaviors and skills. Lack of progress may lead to
a discussion with parents about possible use of cochlear implant.
10. What are the characteristics of individuals with central auditory processing disorder?
The function of the peripheral auditory stem is routinely assessed during a comprehensive
audiological evaluation, Because what we hear needs to be processed in order to be useful,
audiologists must consider the entire auditory system including problems that affect the central
auditory system. This can generally be thought of as the auditory structures, pathways, and
neural synapses that span from the level of the brain stem to the cortex of the brain. Problems
associated with the central auditory system do not typically cause hearing loss; instead they are
characterized by an inability to efficiently in problems such difficulty hearing subtle difference
between similar sounding words and misunderstanding of speech when presented in a
background of noise. These types of difficulties in an individual who has normal peripheral
hearing may be an indication of a auditory processing disorder.
11. What are otoacoustic emissions and why are they important?
Otoacoustic emissions (OAEs) are a second type of electroacoustic measure that has received
considerable attention during the past two decades. Otoacoustic emissions are low intensity
sounds, commonly referred to as “echoes”, that are generated within the cochlea as a result of
movement of the outer hair cells. These tiny emissions move outward from the cochlea, through
the middle ear, to the external auditory canal, where they can be recorded by a microphone
places in the ear canal. For clinical use, otoacousic emissions are produced by presenting a
moderate- intensity acoustic stimulus to the ear canal. The same probe that generate these stimuli
contains a miniature microphone that records emissions returning from the cochlea. Generally,
when OAEs are present, hearing sensitivity is presumed to be normal or no worse than a mild
loss. In contrast, reduced or absent OAEs can result from outer hair cell dysfunction or the
presence of conductive pathology. Perhaps the most important use of OAE testing is in newborn
hearing screeening programs. This noninvaisve and quick test had provided an inexpensive and
efficent ways to test millions of newborns each year.
12. What is the auditory brain stem response and why is it important?
A type of AEP that audiologists commonly use is the auditory brain stem response (ABR. This
test measures the neuroelectric activity of the auditory nerve and structures in the lower brain
stem. In normal ear, this response is characterized by five to seven distinct peaks in the
waveform that occur within the first 5 to 6 milliseconds following stimulation. ABR testing can
be used to identify neurological issues, such as a tumor on the eighth cranial nerve. In addition, it
can be used to estimate the auditory thresholds in individuals who are unable or unwilling to be
evaluated using conventional behavioral techniques, such as infants, young children, and
individuals who have developmental delays. Because this testing can often be conducted while a
child sleep, it is often used as part of newborn hearing screening programs.
13. Describe air conduction and bone conduction and what the comparison of the measures can tell us about
hearing loss.
Airconduction testing is administered while a client wears either traditional earphones or insert
earphones. Insert earphones contain pliable, foam like recievers that are placed within the
external auditory meatus; traditional or supra-aural earphones are attached to a headset and
placed over each pinnal. Presenting stiulis by air conduction results in sound traveling to the
cochlea via the outer and middle ear. This is the typical way that we hear. Hearing loss resulting
from disorders in any of the tree main sections of the peripheral auditory system will be
identified with air conduction testing. Once air conduction testing is completed, the process is
repeated using a bone oscillator, a small vibrating devide that is positioned against the skill,
behind the pinna. When a stimulus is presented through the oscillator, the boens of the skull are
set into vibration, and this vibration direcly stimulates the cochlea. So, with bone conduction, the
person is able to hear the stimulus even though it has bypassed the outer and middle ear. By
comparing the results of air conduction testing to thosre obtained from bone conduction testing,
it is possible to identify the type of hearing loss.
14. Describe the types of speech audiometry (SRT and WRT).
The Speech Recognition Threshold (SRT) is a measure of the lowest (softest) intensity where a
person can recognized approximately 50% of the spondee words presented. A Word Recognition
Test (WRT) is different from other procedures discussed so far in that it is not a threshold
measure. Instead, the WRT assesses how well a client is able to identify one-syllable words
presented at some level above the threshold. The intensity level at which the WRT is
administered varies depending on the type of information the audiologist wants to collect.
15. Describe the processes of informational counseling and personal adjustment counseling.
Counseling is usually though of as the process of giving a client information, sometimes referred
to as information counseliing. Some examples of this include examining the results of inidiviual
tests, providing technical information on the anatomy of the ear, or explaining how hearing loss
occurs so the client can bettrer understand the nature of his or her problem. Although important,
informational counseling is only one part of the counseling process. A second broad category of
counseling is personal djustment counseling, which involves providing assistance to the client
and damily in dealing with the emotional consequence of hearing loss.
CH 13- AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
1.
Why are unaided systems not appropriate for every individual who needs to enhance or replace their current
communication method?
Unaided systems are not appropriate for every individual who needs either to enhance or replace
his or her current method of communicating. AN indivual with severe motor involvement in the
limbs, as in some forms of CP may be unable to make the fine motor adjustments necessary for
many signs. Another problem with gestural communication systems has to do with the number
od communication partners who undersrand the system. Unfortunately, many individuals in the
community are not familiar with sign and may not be able to understand what a signer is trying
to communicate.
2.
How can efficiency be enhanced for scanning techniques?
Scanning is very effective option for individuals with significant motor limitations, however it
can be extremely slow and laborious process. The majority of an individual’s time is spent
waiting while extraneous things are presented. Scanning requires extended concentration has the
potential to be very frustrating, especially when symbols are missed and the process must be
repeated.
3.
What is social competence?
Social competence relates to how well a person is able to manage the social aspects of
communication, such as turn taking, topic maintenance, and using balanced and reciprocal
interaction with a partner.
4.
Discuss factors related to AAC system
selection
.
In decing on an appropriate AAC system or method, an SLP considers a client’s motor and
cognitivew abilities, the potential size of the client’s vocanulary, the ease in learning and using
the syste, the acceptability of the system to the user and potential communication partners, and
the flexibility and intelligeibility of the system.
5.
Discuss considerations related to choosing an aided symbol system.
Decisions related to the appropriate type of AAC for a specific person typically include a feature
matching process that may need to be reviused as the user’s abilities or needs change. People
using AAC may also employ mutliple types of systems for successful communication that
require others in their enviornment
to learn about ways to faciliate maximum efficiancy.
Involvement of everyday communication partners in the assessment and intervention
planningprocess cannot be overstated. An SLP, in coordination with a client’s family members
and other professionals, uses the date from an assessment to make decisions about the
appropriate AAC method, AAC symbold system, and potential vocabulary. In planning
interventions to address both the short rage and long range communication needs of a client, an
SLP must be concerned with the linguistic, operation, social, and strategic competencies of
person using AAC and his or her partners.
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