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Primer On Communication And Communicative Disorders, A, 1st Edition Test Bank

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    Contents Chapter 1 Communication and Communicative Disorders 1 Chapter 2 Anatomy and Physiology of Speech, Language, and Voice Production $ Chapter 3 Speech Sounds, Articulation, and Phonological Disorders 13 Chapter 4 Language Development in Children 24 Chapter 5 Language Disorders in Children 34 Chapter 6 Communication in a Multicultural Society 44 5 Chapter 7 Neurological Impairment: Speech and Language Disorders in Adults 52 2 Chapter 8 Voice Disorders 61 15 Chapter 9 Swallowing Disorders 69 Chapter 10 Fluency Disorders 79 Chapter 11 Anatomy and Physiology of Hearing and Hearing Disorders 88 Chapter 12 Hearing Testing and Management of Hearing Disorders 96 Test Bank 106 Answer Key 192 iii

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    Chapter 1 COMMUNICATION AND COMMUNICATIVE DISORDERS Content Outline * COMMUNICATION © Definition: an exchange of information (thoughts, feelings, or ideas) between at least two individuals through symbols, signs, or behavior © Majority of population communicate primarily through verbal expression * Other forms of communication involve reading, writing, understanding facial expressions, using gestures, and touch 2 * Reading: Knowing where to go or what to do is understood ~ through reading i= * Writing: We try to improve our writing skills to avoid a ambiguity when sharing information JL * Facial expressions: Most facial expressions are involuntary and they show our internal emotion. Six universal expressions include: ‘oo Disgust, sadness, happiness, fear, anger, and surprise * Gestures: Manual communication, sign language, and finger spelling are the primary gestures © American Sign Language (ASL): natural language of the Deaf community in the United States and it does not follow typical English grammar * Defined as: a conceptual language with its own structure and rules o Itis important to understand that some gestures used in the United States might mean something very different (and even offensive) in a different country * Touch: Touch can be used to comfort or reassure, used as a handshake when greeting, or used to show love or affection © All these forms show that communication goes further than simply talking to an individual to convey information * COMMUNICATIVE DISORDERS o When an individual has a communicative disorder, a communication breakdown exists between the speaker and listeners o Four concepts that identify the nature of communicative breakdowns include: 1

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    * Formulating: the ability to put thoughts and ideas into words, signs, or symbols * Transmitting: organizing and coordinating speech muscles or limbs (signing) with thoughts and ideas * Receiving: ability to use our sensory systems to transmit information to the brain * Comprehending: decoding and understanding the message that was sent o EXAMPLES OF COMMUNICATIVE DISORDERS ’ = Articulation disorder: when an individual encounters a problem = producing a specific sound 2 * e.g, saying “wabbit” for “rabbit” JL * Dysarthria: weakness of speech muscles due to brain damage = Language disorder: an array of problems which could affect expressive and/or receptive language * e.g. unable to name common objects, unable to follow multi-step tasks, misuse of pronouns, and unable to maintain a conversation * Stuttering (fluency disorder): an individual producing sound and/or syllable repetitions or prolongations that disrupt the flow of speech * Voice disorder: voice disorders are perceptual events that are identified by speech-language pathologists or otolaryngologists. They can occur from misusing and overusing the vocal mechanism, neurological disorders, and organic diseases * Professions such as teaching or singing can result in voice disorders due to continuous abuse or misuse of the voice * Hearing loss: depending on the severity of loss, individuals may find it difficult to understand speech. Individuals born with a hearing loss may have a hard time acquiring speech * PROFESSIONALS WHO WORK WiTH DISORDERED COMMUNICATION © Speech-Language Pathologists (SLPs): trained to identify, diagnose, treat, and help to prevent communicative disorders * The profession works with individuals who have articulation, language, fluency, voice, hearing problems, and swallowing disorders 2

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    * In order to become an SLP, an individual must obtain a master’s degree from a graduate program accredited by the American Speech-Language-Hearing Association (ASHA) * After obtaining 36 hours of graduate work and 400 hours of client contact, an SLP must complete a clinical fellowship: * 36 weeks of mentored practice * After the clinical fellowship, an SLP must pass a national exam * Once everything is complete, the person is awarded the Certificate of Clinical Competence in SLP (CCC-SLP): * Qualifies the individual to provide services in any work setting: educational, hospital, nursing homes, long-term % care facilities, private clinics, not-for-profit clinics, home 2 health care, university clinics, or consultants 2 © Audiologists: trained in the nonmedical treatment of hearing, balance, and v other related problems i * Audiologists work with individuals to determine their level of hearing and to recommend amplification devices (e.g., hearing aids or cochlear implants) * They also work alongside otolaryngologist (ENT — Ear, Nose, and Throat physician) to determine the best amplification device * To become a trained audiologist, majority of graduate programs will offer a clinical doctorate in audiology (AuD). * Students must complete 75 hours of coursework and 52 work weeks under supervised clinician practicum experience within a 3 — 4 year period * Students must also pass the national exam to receive the Certificate of Clinical Competence in Audiology (CCC-A) * Certification and licensure is required in order to dispense hearing aids to patients * Possible places of employment include: * Hospitals, ENT offices, outpatient care facilities, university clinics, hearing aid manufacturers, and on rare occasions serve as expert witnesses in legal cases regarding hearing losses in the workplace, etc. * PROFESSIONAL ORGANIZATIONS © American Speech-Language-Hearing Association (ASHA) * Professional organization representing and credentialing SLPs, audiologists, and speech-language and hearing scientists 3

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    * The organization has created a code of ethics to maintain the welfare of clients being treated, maintain professional competency, provide accurate and honest information to the public, and to monitor the professional standards of colleagues o Additional Professional Organizations * Other organizations exist that specialize in different areas of the speech and hearing field such as: + International Fluency Association * American Academy of Audiology * Academy of Doctors of Audiology * Academy of Neurologic Communication Disorders % = CONCLUSION 2 o Communication goes beyond speaking to another individual; it involves 3 writing, reading, facial expression, gestures, and touch v © A communication disorder may cause a communication breakdown when i formulating, transmitting, receiving, or comprehending is impaired o Speech-language pathologists and audiologists are trained professionals who practice in the field of communicative disorders and hearing loss, respectively © ASHA is the professional organization for SLPs and audiologists * RESOURCES o Academy of Neurologic Communication Disorders and Sciences * http//www.ancds.org © American Speech-Language-Hearing Association website * http://www.asha.org o American Board of Audiology * http://www.americanboardofaudiology org o International Fluency Association * http://www.theifa.org 4

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    Chapter 2 ANATOMY AND PHYSIOLOGY OF SPEECH, LANGUAGE, AND VOICE PRODUCTION Content Outline * CENTRAL NERVOUS SYSTEM o Definition: a system for receiving sensory information, integrating these signals with thoughts and memories, and organizing these thought to complete an action o Comprised of the: * Brain: protected by the skull * Spinal Cord: protected by the spinal column > © Meninges: three membranous layers that protects the brain and spinal 3 cord. The three layers are: i= ® Dura mater: outermost layer, tough and fibrous a * Arachnoid mater: second layer, web-like AL * Pia mater: inner layer, delicate fibrous o BRAIN = Cerebrum: topmost portion ® The brain is divided into left and right cerebral hemispheres * Corpus callosum: allows the two hemispheres to communicate with each other through a connection of fibers * Longitudinal fissure: a deep indentation that divides the cerebral hemispheres * Right and left hemispheres are furthered divided up into four lobes. The lobes are identified and separated through: * Gyri: hills or ridges * Sulci: indentations * Fissures: deeper indentations = The Four Lobes * Frontal Lobe: primary motor area (motor cortex). Also plays a role in motor planning, emotional control, judgment, problem solving, and socialization o If the motor strip is electrically stimulated on the left side of the brain, it controls the right side of the body o Efferent signal: a motor signal that exits the brain to move a body part © Areas of the body that need greater muscular coordination are represented by larger areas of the motor strip. This is called a motor homunculus 5

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    = For example: the mouth and tongue take up a large area on the motor strip because of the complex motor control needed for these structures o Broca’s area: speech motor planning area * Parietal Lobe: primary sensory area (sensory cortex) o If pain, temperature, or touch is felt on the left side of the body, the right side of the parietal lobe receives the information o Afferent signal: sensory signals arriving to the brain o Similar to the frontal lobe, the areas with greater % sensory receptors are represented by larger areas of 2 the sensory strip 2 Temporal Lobe: primary auditory cortex. Area responsible os for processing sound iE o Wernicke’s area: the brain’s language center * Occipital Lobe: primary visual cortex o Receives and interprets visual information * Structures below the cerebrum: * Cerebellum: involved with motor coordination, balance, and movement. Also plays a role in disorders such as stuttering and autism o Located below and to the back of the cerebrum * Brain stem: vital functions such as breathing and heart rate are controlled here. Efferent and afferent signals run through the brainstem. The brainstem consists of three structures: o Midbrain o Pons o Medulla: area where motor fibers cross to send information to the opposite side of the body o SpINAL CORD * The spinal cord extends from the brainstem and passes through an opening in the skull and continues down the bony spinal column. It is divided into five segments: Cervical, thoracic, lumbar, sacral, coccygeal ® PERIPHERAL NERVOUS SYSTEM o Definition: all neural tissue outside of the brain and the spinal cord. The most important are spinal and cranial nerves 6

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    o Spinal nerves: 31 pairs of nerves that originate in the spinal cord * Motor information is transmitted through these nerves = Sensory information is received and transmitted to the brain through these nerves o Cranial nerves * 12 nerves that originate in the brain stem * Two purposes: ¢ Transmit smell, vision, hearing, and taste information from bodily structures to brain * Transmit information from the brain to perform voluntary movements of the eyes, mouth, lips, tongue, and larynx ; 0) * AUTONOMIC NERVOUS SYSTEM 2 o Maintains our internal equilibrium v o Two branches: 15 * Sympathetic: protects and prepares our bodies for any situation by regulating our heart rate, breathing, and secretions * e.g, Our heart races and we may perspire more when frightened * Parasympathetic: returns our body to a state of equilibrium * ANATOMY AND PHYSIOLOGY OF SPEECH PRODUCTION oO RESPIRATORY SYSTEM * Two functions: * Breathing * Aides in the production of speech * Divided into two sections: * Upper respiratory system: airways found within the nose, mouth, and throat above the vocal folds * Lower respiratory system: begins just below the vocal folds in the trachea and continues into the lungs * Anatomy of Breathing * Thorax: airtight cavity formed by the ribcage, spinal column, clavicle, and scapula that link the lungs with the ribs through a membrane. This connection allows the lungs to move when the ribcage moves * Pulmonary System: includes the lungs and the airways leading to the lungs * Trachea: rigid but flexible tube. It is a series of 20 C- shaped cartilaginous rings 7

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    o Branches into >two bronchi, which divides into->bronchioles within the lungs and then turns into > alveolar ducts, and finally ends in > alveolar sacs: tiny elastic sacs where oxygen is exchanged for carbon dioxide * Diaphragm: dome-shaped muscle located at the bottom of the thoracic cavity. When contracted, the diaphragm flattens out and increases the size of the chest cavity. This initiates the process of breathing = Physiology of Breathing * Boyle’s Law > Energy = Pressure X Volume ; o This states that as volume increases, the pressure 2 decreases and vice versa 3 * Steps of breathing v o Contract and flatten the diaphragm (increases i volume and decreases pressure of thoracic cavity) o Air flows from high pressure to low pressure, filling up the lungs with air — inhalation o Pressure in the lungs increase, causing a decrease in the thoracic cavity pressure © Air then rushes out because the air pressure in the lungs is greater than the pressure outside of the body — exhalation * Lung Volume and Capacities o Quiet respiration: a breathing pattern that occurs when a person is quietly sitting o Tidal Volume (TV): a measurement of the amount of air entering and leaving the lungs © Forced respiration: a breathing pattern that requires greater volumes of air o Inspiratory Reserve Volume (IRV): taking larger breaths to get more air o Expiratory Reserve Volume (ERV): exhaling the IRV air o Vital Capacity(VC) = IRV + TV + ERV o Residual Volume (RV): air left in lungs after ERV o Total Lung Capacity(TLC) = VC + RV o Breathing for air is a different process than breathing for speech * Breathing for speech involves: 8

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    o Increasing the speed of air to build enough pressure to blow the vocal folds apart o Increasing the speed of air behind the structures in the mouth to create speech sounds o Greater volume of air is required o Shortening the inhalation process to about 10% of respiratory time, 90% of the time is spent exhaling o LARYNGEAL (PHONATORY) SYSTEM * The laryngeal system involves the larynx (voice box), which has important functions for speech: ; * Acts as a valve to control airflow, allowing the vocal folds 2 to open and close as air passes through 3 * Produces vocal fold vibration to produce sound. This is v known as phonation i * Anatomy of Sound Production * Cartilages of the larynx: o Thyroid cartilage: largest structure in the larynx and it protects the vocal folds o Cricoid cartilage: attaches underneath the thyroid cartilage o Arytenoid Cartilages: a pair of cartilages that sit on top of the cricoid cartilage and serves as an attachment for the vocal folds * Muscles of the larynx: © Muscles attach to the cartilages to abduct (open) or adduct (close) the vocal folds o Vocal folds: a paired muscle that attaches to the backside of the thyroid cartilage, crosses in the opening of the cricoids cartilage, and attaches to the arytenoids cartilages o Glottis: space between the vocal folds * Physiology of Sound Production * Myoelastic-Aerodynamic Theory of Sound Production: an explanation for our ability to produce sound o Myo- : muscles o -elastic: stretchable properties of the vocal folds o Aerodynamic: moving air * Process of sound production: o An individual closes the vocal folds 9

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    o Pressure builds up below the vocal folds: subglottic space 0 Subglottal air pressure overcomes the resistance of the vocal folds o Vocal folds are blown apart and air rushes through the glottis o Vocal folds come back together o This quick process is known as one cycle of vocal- fold vibration. In order to produce sound, the process begins again and again. * Bernoulli principle: as the speed of fluid (air) increases, the ; pressure decreases 2 o This explains why the vocal folds come back to 3 their resting position after the subglottal air is v released iE o The elastic properties of the vocal folds also bring the folds back together * Body-Cover Model: another proponent of vocal-fold vibration o This model explains that the vocal folds move from bottom to top because of the pressure differences within the larynx o Vocal folds are multilayered. Therefore, independent movement of the top and bottom occur * Vocal-Fold Vibration: o Males: occurs on average 125 times per second © Females: occurs on average 225-250 times per second o Children: can occur as fast as 400 times per second © These differences occur because of the length and thickness of the vocal folds © The independent vibration of the vocal folds create a buzzing noise © ARTICULATORY SYSTEM * Anatomy and Physiology of Shaping Sounds * Vocal tract: described as a long tube that starts just above the vocal folds and ends at the lips and nose. Responsible for producing speech sounds. Made up of three cavities in which the sound vibrates: 10

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    o Pharyngeal cavity: begins at the vocal folds and ends behind the mouth and nose o Oral cavity: begins at the lips and ends at the back of the mouth o Nasal cavity: begins at the opening of the nose and ends in the back at the pharyngeal cavity * Voiceless sounds: sounds produced by opened vocal folds * Voiced sounds: sounds produced by closed vocal folds. All English vowels are voiced, including half of the consonants * Articulation: movement * Articulators: structures that change the shape and length of ; the vocal tract to produce speech sounds. They include: 2 o Tongue, hard palate, soft palate (velum), mandible 3 (jaw). teeth, and lips v o Closing and tightening our lips help create pressure 15 to create certain sounds. e.g., /b/ and /p/ o Protruding or extending our lips creates a longer vocal tract to create sounds like “00” o Soft palate (velum): separates the nasal cavity from the oral cavity o Tongue: Plays a big role in producing speech sounds ¢ Coarticulation: allows us to produce sounds in an efficient manner by anticipating upcoming sounds and moving our articulators to prepare for those sounds ® SUMMARY AND REVIEW o Central nervous system is made up of the brain and spinal cord © The brain is separated into the frontal lobe (motor cortex), parietal lobe (sensory cortex), temporal lobe (auditory cortex), and occipital lobe (visual cortex) o The spinal cord transmits information from the central nervous system to the peripheral nervous system. The peripheral nervous system includes cranial and spinal nerves © Respiration plays a big role in the production of speech o There are voiced (adducted vocal folds) sounds and voiceless (abducted vocal folds) sounds. Speech sounds are shaped through movement of the articulators to change the size and shape of the vocal tract 11

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    ® RESOURCES o Brain Anatomy and Discussion of Traumatic Brain Injury * http://www.brainline.org/multimedia/interactive_brain/the_human _brain.html?gclid=COnV4Lex46 ACFRMNDQod-jl 71. w o Cross-Sectional Anatomy * hup://www.lumen.luc.edu/lumen/meded/grossanatomy/vhp/visible. htm o How Lungs Work = http://’www.lungusa.org/your-lungs/how-lungs- work/?gclid=CM2g47mw46ACFQOeDQodcDeBDw o Views of the Larynx ; * http://www.entusa.com/larynx_videos.htm 2 o Vocal Tract Visualization Lab F * http://speech.umaryland.edu/index.html os 12

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    Chapter 3 SPEECH SOUNDS, ARTICULATION, AND PHONOLOGICAL DISORDERS Content Outline ¢ LANGUAGE AND SPEECH o Difference between speech and language * Language: system of symbols used for communication and thought that can be spoken, written, or signed = Speech: the ability to relate meaning to human voice o Phoneme: a mental representation of specific speech sounds = If we change a phoneme within a word, it changes the meaning 2 = Phonemes are written with slashes - /p/, /b/, /t/, /k/ = o Phone: an individual production of the phoneme i= o Allophone: variations that occur from production to production a = For example, if we change a phoneme in a word then it changes the word JL meaning, but if we change the phone the meaning remains the same but sounds different ® SOUNDS IN ENGLISH o International Phonetic Alphabet (IPA): a set of symbols to represent human speech sounds = English uses about 40 of the phonemes represented in IPA * This system helps to avoid confusion across languages when multiple letter combinations are used to represent the sounds * e.g, the sound “f” in English is used in a variety of ways — tough, photo, and flute. If these words were written in IPA, each one would use /1/. = IPA is used to transcribe speech as it is heard o Classification of Speech Sounds = Vowels ® All vowels are voiced and they are made with a relatively open vocal tract o They are classified according to tongue height (high, mid, low) and tongue position (front, central, back) ¢ Diphthong: a combination of two vowels by changing the shape of the vocal tract when moving from one vowel to the next o e.g, when we say ‘buy’ we use the vowel /a/ and move to the second vowel /1/ = Consonants — consonants sounds have three classifications: ® Place: where the sound is produced in the vocal tract by the articulators. Place is identified by the eight places of production: o Bilabial: sounds are made with two lips, e.g., /p/ 13

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    o Labiodental: sounds are made with the lips and teeth, e.g., /f/ o Linguadental (dental): sounds made with the tongue and teeth, e.g., “th” o Lingua-alveolar (alveolar): made with the tongue positioned at the alveolar ridge, e.g., /t/ o Linguapalatal (palatal): sounds made with the tongue against the roof of the mouth, e.g, “sh” o Linguavelar (velar): sounds made with the back of the tongue and soft palate, e.g., /g/ o Labiovelar: sounds made by the lips and soft palate, e.g., ; wl 2 o Glottal: sounds made in the space between your vocal 3 folds, e.g., /IV re * Manner: type of constriction and how the breath stream is i managed. There are seven categories of manner: o Stops (plosives): sounds made by completely blocking off the vocal tract, building up air pressure behind the constriction, and exploding the sound, e.g., /p/, /b/, /t/, /d/, /k/, and /g/ o Fricatives: sounds made by using the tongue to create a constriction within the vocal tract and forcing the breath stream through the constriction, e.g., /f/, /v/, /s/, and /z/ o Affricate: sounds made by combing a stop and a fricative. First the air is stopped behind a constriction and then the sound is released through the constriction, e.g., /tf/ as in ‘chew’ and /d3/ as in ‘jewel’ o Glide (semivowels): sounds made by gradually changing the shape of the vocal tract as is moves to the adjacent vowel, e.g., /w/ o Liquids: = (lateral): sounds made by the air traveling around the constriction within the vocal tract, e.g., /lI/ 14

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