5/15/2014 8:02:00 PM

Lecture 18
Wernickes Area
o Posterior brain
o Temporal lobe
o Senses to brain
o Language comprehension
Brocas Area
o Anterior part of brain
o Frontal lobe
o Production of speech

Aphasia
Wernickes Aphasia
o Fluent aphasia
o Person not aware b/c of comprehension problems
o No speech/swallowing problems
o No general movement problems
o Poor language comprehension
o Poor recognition/naming of objects, people
o Language often confused, filled with neologisms
o Little to no auditory comprehension
Brocas Aphasia
o Non-fluent aphasia
o Person is aware
o Good but not perfect auditory comprehension
o Agrammatic language (poor expressive language)
o Telegraphic language, leave out little words, struggle to find
correct one
o Speech slow, labored, lacks intonation
o May have speech or swallowing problems
May have hemiparesis or hemiparalysis (on RIGHT side
of body)
Global Aphasia
o Damage to both anterior and posterior areas of brain
o Poor auditory comprehension
o Poor expressive language
o May use only jargon or stereotypical responses

o May have speech deficits (depends on location)

o Depending on location, may have speech/swallowing
problems
****Aphasia is a language disorder (difficulty understanding speech)
whereas articulation, stuttering, are examples of speech disorders. ****
Lecture 19
Causes of Aphasia
o Most common cause = stroke

Hemorrhagic bleeding
Ischemic (blockage of artery)
o Brain tumors, loss of oxygen, disease
Stroke Facts
o Risk history of stroke, high blood pressure, smoking
o Prognostic factors: Age, severity of damage, family support
o Can undergo spontaneous recovery
Treatment of Aphasia
o Restorative
One part of brain takes over for another
o Compensatory
Working on alternative ways to communicate
Traumatic Brain Injury
o Generalized damage
o Mild = concussion
o Most commonly males 18-35
o Problems in attention, memory, learning new things,
decreased inhibition, poor pragmatic skills, organization
o

o
Right
o
o
o

problems
Recovery need ongoing evaluation, may have
speech/swallowing problems
Often dont have complete recovery
Hemisphere Disorders
NOT APHASIA
Problems similar to TBI memory, orientation, awareness
Visual neglect (if left arm paralyzed, wont notice it)

o Poor visual recognition and perception

o Confused language, problems with pragmatics
o Treat through working on visual problems (attention to left
side), teach pragmatics
Dementia
o Progressive, irreversible, generalized damage to all cognitive
skills
o Alzheimers type
o Earliest symptoms = memory and word finding problems
o End stage = losing all cognition, become mute
o Treat early on with memory strategies, counseling, evaluate
swallowing

Lecture 20
Speech
Four systems involved in speech and voice production and their
relevant structures
o Respiration
Trachea, bronchi, bronchioles, lungs, alveoli, bronchus,

thorax, diaphragm
o Phonation
Hyoid bone, Larynx (thyroid cartilage, cricoid cartilage,
arytenoid cartilages), epiglottis, glottis, vocal folds
**Vocal folds attach to backside of thyroid cartilage and
the arytenoid cartilages
o Articulation
o Resonance
Respiration
o Quiet breathing equal inhalation and exhalation
o Speech 90% exhalation, 10% inhalation
o Lungs are POWER source for Speech
o Lungs important for varying loudness for stress
Respiratory Disorders
o Less air held in lungs due to things such as emphysema. Poor
coordination of breath control and speech production (brain
stem)

Phonation
o Producing voice through rapid movement of VCs
Voice Characteristics
o More times VCs open/close, higher pitch
Male 100-125 vibrations/sec
Female 180-220 vibrations/sec
Some sounds made with voice, others not
Disorders of voice
o Caused by damage to VCs, removal of VCs, damage to nerves
that control VCs

Lecture 21
Articulation
o Movements used to shape sounds into speech sounds
Structures of Articulation
o Teeth, lips, nasal cavity, oral cavity, tongue, hard palate, soft
palate (velum), alveolar ridge, mandible, pharyngeal cavity
Disorders of Articulation
o Physical damage to brain, nerves that control articulators

o Hearing impairment
o Behavioral developmental delays most common types
Resonance
o Sound changes with shape of cavity; controlled by velum
o Velum either goes up to cover nasal cavity and produce
regular voice or stays down to produce nasal voice
Disorders of Resonance
o Damage to brain/nerves that control velum
o Opening b/t oral and nasal cavities (cleft palate)
o Hearing impairment
3 characteristics of sound articulation
o Place (where in mouth)
o Manner how air is modified through oral cavity
o Voice presence or absence of VC vibration

Lecture 22
Articulation Disorders

o Problems producing speech sounds wabbit for rabbit

o Substitutions (most common)
o Omissions leave out sounds
o Distortions
o Additions falower least common
Causes of Articulation Disorders
o Functional no known cause (most fall into this category)
o Organic
Hearing loss
Neurological Damage
Cleft lip and palate
Oral structure abnormalities
Ankyloglossia (tongue tie)
Glossectomy (removal due to cancer)
Phonology Disorders
o Part of LANGUAGE; has rules and patterns
o When children dont learn rules/patterns
Phonological Development
o All kids 2-5 yrs produce sound errors b/c they havent learned

the rules yet

Evaluation for Articulation and Phonology Disorders
o Articulation
Usually a formal test (goldman-fristoe test) see if
underlined sound is being produced when word is said
out loud.
o Phonological
Look at articulation test for patterns; # of errors is
important
Types of errors
Stopping (changing fricatives to stops) thumb to
tum
Fronting gun to dun
Sound Cluster Reduction squirrel to sirral
Articulation Therapy
o Teach individual sounds
o Teach established sound

o Generalize to all parts of words

o Maintain sound everywhere
o Use only for a few sound errors
Phonology Therapy
o Teach RULES not individual sounds
o Teach child the rule with ALL consonants
o Much more efficient use for many sound errors

Lecture 23
Stuttering
o All normal speakers dysfluent at times (interjections,
revisions, repetition of phrases, prolongations of sounds, etc)
o Developmental Dysfluency (normal as children develop) has
high spontaneous recovery rate (80%)
Factors influencing
Duration of symptoms (<12-18 months)
Boys >>>> Girls
Ages of onset (2-4 years)
Family history (genetic)

Development of true stuttering

o 2-4 years
o Boys >>>> Girls
o Genetic components
o Over time, speech behaviors complicated by non-speech
behaviors (head nodding, etc)
Stuttering ABCs
o A Affective (feelings)
Feelings, emotions, attitudes
o B (2) Behavioral (actions)
Speech
Repetitions
Audible sound prolongations
Nonaudible sound prolongations
Problems with rate, speaking naturalness, tricks
Non speech
Secondary behaviors (head nodding)

 Escape and avoidance

Eye blinks, jaw jutting, head nodding, clapping
o C cognitive (thinking)
Personal strategies, beliefs, interpretations
Lecture 24
What Causes Stuttering?
o WE DONT KNOW
o Unlikely causes
Psychological: stuttering is learned, results from
emotional trauma, diagnosogenic theory monster
study (cause stuttering by reacting negatively to
dysfluencies)
o Likely causes
Neurological basis
Partly a language problem but the act of stuttering is a
speech problem
Tends to run in families, males >>> females
o Conditions that reduce stuttering
Singing
Making noise
Delayed auditory feedback
Approaches to Fluency Therapy
o Young Children
Indirect
Work on environmental factors (reduce adult
speech rate)
Direct

Change speech behaviors and attitudes related to

stuttering
Parent Administered Programs (Lidcombe
Programme)

o Adults
Direct
Change speech behavior
Fluency shaping

o Speak more fluently by slowing rate,

continuous phonation, ease onset of
phonation
Stuttering Modification
o Stutter more fluently change
movements to be more forward
moving and fluent
Cancellations
Pull-outs
Change attitudes and emotions

Reduce avoidance, fear of speaking and

stuttering
Learn about normal voice and stuttering
voice
Desensitization

Lecture 25
Voice Disorders
o 3-6% school age children
6-9% entire population
Teachers double that %
Women > men
**24% of US population have jobs that critically require voice
use
o Phonotrauma (3) vocal abuse/misuse
Indicates relationship between problem and behavior
Caused by
Hard glottal attack
o
o
o
o

Vocal fry
Prolonged use
Excessive loudness
Using wrong pitch
Results in
Traumatic Laryngitis
Inflammation of VC tissue hoarse voice
Goes away with rest

Vocal
o
o
o
o
o
Vocal
o
o

Vocal

Smoking/alcohol make it worse

nodules
Chronic abuse/misuse
Changes wave movement of VC
Start out on one side, become bilateral
Hard, callus-like
Voice hoarse, breathy
No pain
Treatment either voice therapy early on or
surgery later followed by changing behavior

Vocal

polyps
Start out on one side, stay on one side
Like blisters soft, fluid-filled
Same place as vocal nodules
Voice hoarse, breathy
Excessive throat clearing, coughing
No pain
Treatment is either voice therapy or surgery
followed by therapy to change behavior

Pitch
Frequency of vibration
Pitch change change in VC length and thickness
Male 125 Hz
Female 225-250 Hz
Children 400 Hz
Loudness
Intensity (dB)
Increased intensity with increased subglottic pressure

Measure with sound level meter

Resonance
Vibration in oral, nasal, or pharyngeal cavities
Describe voice as
Hypernasal
hyponasal
Vocal Quality
o **Subjective
o
Vocal
o
o

o Refers to VC tension
o Clarity of vocal productions
o Ex: breathy, hoarse, harsh, strained
Lecture 26
Voice Disorders continued
o Neurological (3)
Movement of VCs controlled by vagus nerve
Damage if complication of unrelated surgery
VC Paralysis

Adduction = to close
Bilateral Adductor paralysis VCs open (no
voice)
Abduction = to open
Bilateral Abductor paralysis VCs closed
(cant breathe)
Unilateral VC Paralysis most common type, one
cord cant close, leaves opening a little bit (voice
sounds breathy)

Treatment: voice therapy or injection to make VC

fatter
Spasmodic Dysphonia
Cause unknown
Hyperadduction of VCs (closed a lot)
70% female
Linked to people who use their voice a lot
Treatment: sever nerve or use Botox injection to
relax muscles

Parkinsons Disease
Hypoadduction of VCs
o Organic (2)
Granuloma
Caused by irritations due to intubations during
surgery, prevents arytenoids from moving
Voice hoarse

Can also be caused by reflux of stomach acids,

sitting on cords (painful)
Laryngeal Papilloma
Viral
Wart-like growths
75% of people below age 6
Can limit airway, may go away at puberty
Surgical removal
May return; often have scar tissue
Voice Evaluation

o Medical Exam
o SLP does
Case history
Perceptual evaluation (listening)
Instrumental measurements
Establish therapeutic plan
Voice Therapy
o Treatment
Surgery

Behavioral voice therapy

Medical treatment (Botox)
Psychological counseling
o Intervention Goals
Restore healthy VC tissue, regain full VC function
Eliminate abusive habits/improve vocal hygiene
(especially in phonotrauma)
Good Vocal Habits
Dont smoke

Drink lots of water

Eliminate excessive throat clearing
Alcohol contributes to laryngeal cancer risk
Avoid vocally abusive behaviors
o Decrease overall volume
o No shouting/yelling
o Watch excessive phone talking
o Dont whisper

o Dont talk or sing when you have a bad cold

Avoid using lots of mouthwash
Have good posture
Exercise regularly
Get enough sleep
Always warm up your voice before prolonged speaking or singing

5/15/2014 8:02:00 PM

5/15/2014 8:02:00 PM