CDIS Exam 1 1. Normal Communication and Communication Disorders a. Normal Communication- Process of sharing information between 2 or more persons (sender, receiver). Includes: talking, writing, gesturing. -Speech, language, and hearing are all uniquely human. b. Processes of Normal Communication: FTRC - Formulation: Coordinating thoughts/ideas - Transmission: Conveying ideas. Modes include writing, speech, and gestures (WSG) - Reception: Receiving information. Modes include listening, reading, watching - Comprehension: Makes sense of the message c. General categories of communication: - Language: Shared code used to represent concepts or ideas. -Language vs. Speech is different. Speech is physical, language is symbolic code -Syntax: Rules for internal organization of sentences -Morpheme: Part of word that holds meaning -Phoneme: Speech sound -Semantics: Rules of language for meaning and word combinations -Pragmatics: Social rules of language -Content (Semantics), Form (Syntax), Use (Morphology, Pragmatics) - Speech: Physical production of sounds of shared code -Articulation -Voice -Fluency - Hearing: Audition, perception of sound/speech -Language turned into speech - Cognitive Communication skills: Reasoning, problem solving, memory, planning/goals - Non-Verbal Communication and Pragmatics: Practical use of language in social interaction d. Communication Disorder- Significant difficulty in the ability to formulate, transmit, receive and/or comprehend information when compared to others sharing the same language, dialect, and culture. If not efficient in own code it is a communication disorder. -1 in 6 have a Communication Disorder -Incidence: Rate of occurrence of new cases -Most common Communication Disorder: Hearing loss e. Prevalence and types of Communication Disorders -Numbers are not increasing: Factors make it seem like more people are affected -Population growth -Increased survival rate of at-risk babies -Increase in scope of practice -Types: Voice Disorders, Speech Sound Disorders, Stuttering, Language, Autism. -Language: Developmental Disorders (children), Aphasia (adults), cognitive-communicative disorders (dimentia) -Speech: Fluency, voice, articulation, phonology, and motor speech -Hearing: Sensorineural (Inner Ear), conductive (middle/outer ear), Auditory processing disorder (central nervous system and brain) f. Communication Disorder = not understood in own code 2. Professions of Speech and Audiology a. Audiologist and SLP -Audiologist: Professional involved in the prevention, diagnosis and treatment of hearing and balance disorders. -Speech-Language Pathologist: Professional involved in prevention, diagnosis and treatment of disorders of speech, language and swallowing. b. Certification = nationally recognized professional credential Licensure = Legal requirement to practice c. Allied Professions: Special educators/teachers, psychologists. 3. Neuroanatomy and Human Communication a. Definitions Anatomy = Body Structures Physiology = Functions Neuroscience = A and P of nervous system b. Why is Neuroscience important to communication? - Better understand the neurological causes of communication disorders - Improved interventions for children and adults - Recognize signs/symptoms associated with specific neurological pathologies c. Hemispheres Lobes of Brain: - Frontal: Largest Lobe. Fine complex motor activities such as control of speech output. - Parietal: Perceiving/integrating sensory/perceptual information. Comprehension. - Ocipital: Receives/Processes visual information - Temperol: Auditory Complex d. Areas: - Broca?s Area: Left Hemisphere, Frontal Lobe -Speech output - Wernicke?s Area: Left Hemisphere, Temperol Lobe -Comprehension - Heschl?s Gyrus: Left Hemisphere, Temperol Lobe -Analysis of sound e. Organizational Principles of the brain: Interconnectedness - Specialization: unique functions of each part - Left Brain = Language Right Brain = Big Picture - Plasticity: Ability to learn - Contralaterality: Crossed/opposite brain -receive sensory information from opposite side, muscles controlled opposite side f. CNS: Brain and Spinal Chord. Motor, Sensory, and Cognitive information. PNS: Nerves emerging from brain/spinal chord -Cranial Nerves: 12 pairs of nerves form brain -Spinal Nerves: 31 pairs of nerves Afferent Sensory: carried to brain Efferent Motor: carried from the brain 4. Anatomy and Physiology of Speech a. Systems of Speech Mechanism: - Respiratory System: Primary purpose = support life Secondary = support speech -speak on exhalation - Phonatory System: Convert air flow/energy into sound -voice production (vocal fold vibration) - Articulatory System: Shapes airflow from the phonatory system into precise speech sounds -Fixed: Hard palate -Mobile: Tongue b. Associated Structures: - Larynx: Vocal Folds - Pharynx: - Trachea: Wind Pipe - Vocal Folds: 2 thin sheets of tissue connected to thyroid cartilage c. Passive Respiration = for breathing, inhale less air than Speech Respiration 5. Anatomy and Physiology of Hearing a. Outer Ear: Pinna and External Auditory Canal (EAC) - Pinna: Protects/channels acoustic information into EAC. Sound Localization - EAC: Directs sound to Tympanic Membrane - Tympanic Membrane: ?Ear Drum? located at end of EAC. Vibrates sound waves -Rarefaction: separation of molecules -Condensation: molecules come together -Intensity: amount of TM vibration. Loundess -Frequency: speed of TM vibration. Pitch/Tone Middle Ear: ?Air Filled Space?. Ossicular Chain, Eustachian Tube, Windows - Eustachian Tube: Equalizes pressure on both sides of Tympanic Membrane - Flying: Ascent = TM pushed out Descent = TM pushed in - Impedance: resistance to the flow of energy - Acoustical Energy = transformed into Mechanical Energy Inner Ear: Cochlea, Vestibule, Semicircular Canals - 2 Functional Systems: -Vestibular System = Balance -Auditory System = Hearing - Cochlea: Fluid filled, snail shaped. -Contains Organ of Cordy = long row of hairs cells that form the hearing organ - Physiology: Stapes footplate moves in and out of oval window -movement causes movement of cochlear fluids creating Hydraulic Energy b. Auditory Nerve: Transmits electrical sound signal from cochlea to brainstem c. Central Auditory System: Processing of speech information in temperol lobe. 6. The Nature of Sound a. What is Sound? - Vibratory energy transmitted by pressure waves in the air -Hearing = perception of sound - Physical Properties: Frequency and Intensity - Perceptual Properties: Pitch and Loudness b. Compression vs. Rarefaction: - Waves occur from a compression of a medium followed by a an expansion (rarefaction) of the medium - Energy moves through space, not molecules c. Simple Harmonic Motion: Sine waves d. Frequency: The number of cycles per second. Ex. 100 cycles per second = 100 Hz -Cycle: one completion of compression and rarefaction -High Frequency = shorter time - Period: Amount of time to complete 1 cycle e. Range of Hearing: 20-20,000 Hz f. Amplitude vs. Intensity - Amplitude: How much one molecule moves (amt. of vibratory displacement) - Intensity: Expressed as ratio of a measured pressure to a reference pressure. -0 decibels does not mean no sound. It means the db level is equal to the reference value g. decibel = measures sound intensity (loudness) h. Simple vs. Complex Sounds -Complex contains Periodic and Aperiodic -Periodic: Repeat over time, Speech and Music -Aperiodic: Random over time, Noise 7. Auditory Assessment a. Equipment: Audiometer, otoscope b. Audibility Curve - Sound pressure levels measured in decibels - Shaded area = average range of human hearing c. Threshold: The lowest level of sound at which it can be heard by an individual 50% of the time. d. Audiogram: Visual representation of a person?s threshold at a given frequency and intensity e. Behavioral vs. Objective Tests - Behavioral: Person actively involved in process -Air conduction: Outer, middle, inner ear fucntionality -Bone conduction: Cochlea function -Speech Audiometry: Measure threshold for speech - Objective: Person is not actively involved - Tympanometry: Mobility of Eardrum -Acoustic Reflexes: Ears response to land sounds -Otoacoustic Emissions: ?OAE? Function of cochlea -Electrophysiology: Function of auditory nerve to brain f. Types and Degrees of hearing loss - Conductive: Problems with outer and middle ear - Sensorineural: Cochlea - Retrocochlear: Beyond Cochlea, auditory nerve Degrees: - Normal: 0-25 dB - Mild: 26-40 dB - Severe: 71-90 dB g. Normal Hearing - Adults: 0-25 dB - Children: 0-15 dB (need pristine hearing for language development) - Adults over 65 yrs: 40 dB 8. Articulation and Phonological Disorders a. Fixed vs. Mobile articulators - Fixed: Hard palate, upper incisors, Aveolar Ridge - Mobile: Tongue, lips, velum, mandible Vowels = Voiced and break up the syllables in words b. Classification for Consonants: - Place: Area that remains motionless - Manner: How airflow is manipulated - Voicing: Presence or absence of vibration in vocal folds c. Speech Disorder: Inability to produce sound correctly or fluently, voice problem - Phonological Disorder: Impairment of phonological system d. Etiology/subtypes of articulation/phonological disorders - More often in males than females - Otitis Media with Effusion: Ear infection Effusion = liquid in middle ear -Distorted input = distorted output e. Coarticulation: overlapping speech; ?real world speech? f. Phonology: Rules for combining and using sounds in order for the sounds to convey meaning -Assimilation: Sound change according to context g. Dialect vs. Accent - Accent: phonetic traits of one?s native language carried over into a 2nd language - Dialect: specific form of pronunciation and vocabulary used in a specific geographic area, culture, or education class 9. Developmental Language Disorders a. Language: Shared code, symbolic, rule governed, modalities (speech, reading, etc), arbitrary (no absolute relationship between symbol and referent) - 5 Domains: Phonology, Morphology, Syntax, Semantics, Pragmatics b. Theories of Language Development: - Nature: Humans are wired for language at birth - Nurture: Only develop language in rich linguistic environments c. Language Learning - Birth to 12 months -Expressive: Babbles, uses speech/crying to get attention, 1-2 real words -Receptive: ?Peek a boo?, words for common items -12 to 24 months -Expressive: More words every month, 2 words together -Receptive: Points to body parts, follow simple commands, understand simple q?s d. Language Disorder: Impairment in comprehension and/or expression of symbol system e. Primary Disorder: occurs in absence of any other disorder - Secondary: Language disorder = consequence of another disorder - Developmental: Present at birth f. Language Impairments - Specific Language Impairments (SLI): Normal in other aspects - Intellectual Disability: Impairment of skills, which occur during developmental period g. 2nd Language Learning - BICS: social/conversational abilities, 2 years exposure to language - CALP: Language skills required for academic success, 5-7 years exposure to language 10. Developmental Trends: Infancy to Adolescence a. Hearing Milestones: - Birth to 3 months: startled by loud noises, recognizes voice and quiets - 3 to 6 months: turns eyes towards interesting sound, awakes easily to sounds - 6 to 12 months: turns head towards sound, understands ?no? and ?bye-bye?, imitate c. Early Hearing detection and Intervention - In order to increase likelihood of normal development - Detection: Auditory brainstem response, otoacoustic emissions Screenings: 85% of newborns screened d. Etiologies of Hearing Loss - Congenital: Present at birth -Genetic: more than 50% of all hearing loss -Other: present at birth, not hereditary - Complications with RH factor in blood f. Otitis Media - 75% have otitis media by age 3 - More common in males g. Children are more at risk for Otitis Media because the Eustachian Tube is smaller in children - 35 to 40 degree angle in adults - Poor fluid drainage from middle ear - Easier for bacteria to move to middle ear h. Signs of Otitis Media - Inattentiveness, louder volumes on television, misunderstanding directions i. Impact on Communication - Interference with speech and language development - CAPD and learning disabilities j. CAPD Etiologies - Head Trauma - Lead Poisoning - Chronic Otitis Media - Unknown Reasons
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