Comm Disorders & Sciences
Comm Disorders & Sciences SPPA 2000
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Delayed and Disordered Language Development Helen Sharp PhD Western Michigan University Ob39ectives At the end of the next 2 sessions you will be able to o the role of language comprehension and production in education settings 0 the role of language skills as they relate to social role in school 0 the impact of language disorders in educational tasks 0 some advantages and disadvantages of servicedelivery models in the schools Ob39ectives At the end of the next 2 sessions you will be able to 0 Identify characteristics of delayed language acquisition 0 Identify characteristics of children on the autism spectrum 0 Identify characteristics of children with specific language impairment Ob39ectives At the end of the next 2 sessions you will be able to o ldentifythe link between preschool language skills and early literacy skills 0 Describe activities that promote literacy 0 Define metalinguistic awarenessskill 0 Identify risk factors for early literacy problems Language Disorders 0 Receptive 0 problems with language comprehension o Expressive 0 problems with language production 0 Mixed 0 problems with both comprehension and production 0 Pragmatic 0 problems with the social use of language Sharp 2009 Rapid Review of Language Development 0 46 months 0 1015 months 0 1624 months 0 2436 months Guidelines for Identifying Children at Riskfor Language Impairment o No babbling by 12 months 0 No gesturing eg wave bye by 12 months 0 No single words by 16 months 0 No twoword phrases by 24 months 0 Loss of any language skills talks and then stops talking Detection 0 Early delayed from birth 0 Toddler late talkers o PreSchool problems surface as need for complex interpretation and production increase Some Causes Etiologies o Prenatal factors 0 Prenatal nutrition drug use during pregnancy Perinatal factors 0 Difficult delivery prematurity 0 Meconium aspiration o Postnatal factors 0 Environment otitis media 9 Some More Causes Etiologies 0 Global developmental delay 0 Eg Down syndrome 0 Sensory deficits 0 Hearing vision 0 Spinal cord injury 0 Central Nervous System disorders 0 Cerebral palsy str 0 Drug amp alcohol exposure 0 Autism Penasive Developmental Disorder PDD 0 7777777 0 Speci c language impairment SLI Characteristics of Autism Spectrum Disorders 0 Impaired social interaction pragmatics 0 Decreased or absent eye contact 0 Poor turntaking topic maintenance 0 Impaired communication 0 Up to 2don t talk 0 Echolalia o Repetitive and stereotypic behaviors 0 Tantrums amp difficult behavior may related to social and communication impairments Sharp 2009 Video Medication for people with autism 0 Mainly1majaging symptoms eg attention but no drugs alter t e primary core disorder 0 Classes of medications that are used 0 Anllrde ressanlse Fluoxellne Prozac FluvoxamlneLuvox Serlrallne Zoloft C omlpramlne nalranll o Analegllcs Stimulants eg MelhylphenldaleRllalln Concerla o Anllr s chollc Dru we ChlorpromazlneThorazlne lorlaazlne Me an aloperldol HaldolRlsperldone o Anllrde ressanlse Fluoxellne Prozac FluvoxamlneLuvox 39Serlralne 20 of C omlpramlne nalranll o Obsessivercomgulslvedisorder OODOlomlpramlne NOTE None of thesedru s have been agaroved for the e US Food an treatment of autism by Drug Administration FDA Resources 0 National Autism Association 0 httpwwwnationalautismassociationorg Specific Language Impairment 0 Also called language learning disability LLD o Gap between nonlanguage skills and language skills 0 Enormous impact in school success Specific Language Impairment o Characterized by poor language skills 0 with no evident or major contribution from hearing sensory nervous system or developmental problems 0 Normal nonverbal intelligence 0 Unknown etiology 0 Possible genetic links Language in School Comprehension 0 Home language is predictable routine based 0 What do kids need to do at school that involves comprehension Language in School Comprehension 0 Follow directions verbal written both 0 Follow complex ideas 0 Notice subtle changes 0 Eg afterwe finish the story we will stay get stand in our places 0 Answer questions about a story interpret predict Sharp 2009 Language in School Expression 0 What do kids need to do at school that involves expressive language Language in School Expression 0 Intelligible speech 0 Create new words and novel sentences 0 Answer teacher s questions 0 Spelling phoneticphonological knowledge 0 Create stories with a beginning middle end sequence ideas 0 Sharing show and tell presentations Identifying Children in School 0 Known diagnosis SLI autism developmental delay 0 Teacher request parent request 0 Gap between language and nonlanguage function SLP school psychologist 0 Must be educationally significant to qualify for servnces Samples What s the Impact Literal interpretation of wordsdescriptive language Idioms metaphors Under or overgeneralization of words Scissors haircut Failure to grasp humor recall Asperger eg Read the narrative samples in your book Link between Oral Language amp Literacy 0 Language skills predict literacy 0 Not necessarily cause effect 0 Phonological awareness 0 Link between sounds and letters 0 Identify beginning sounds Mom map Michigan 0 Rhyming o Narratives stories Sharp 2009 Risk Factors 0 Speech or language delay or disorder 0 Deafness or significant hearing loss 0 Socioeconomic factors 0 New learners of English 0 Focus on literacy at home 0 History of language impairment Promoting PreLiteracy Skills 0 Exposure 0 Read books together 0 Read everything Signs cereal boxes 0 Link sounds to letters of the alphabet 0 Kids should see adults reading 0 Tell stories recap events in order first then what happened 0 Drawing scribbling writing letters numbers shapes What is the Role of the SLP Models of ServiceDelivery Pull Out Student goes to speech therapy out ofthe classroom 1 1 1 394 Consultation SLP consults with teacher teacher provides the service within curriculum Collaboration SLP in the classroom works with teacher and within curriculum Sharp 2009 Main Message 0 A lot of school success rides on language capacity and literacy o A lot of language and literacy skills are established before Kindergarten 0 Parents grandparents preschool teachers have a critical role in establishing language and preliteracy before school begins 0 Early identification and treatment of language delay or disorder is important Hanley 2008 THE CONTROVERCY v5 I People have and will continue to argue about the definition of stuttering The argument centers around the various types of disfluencies whether feelings and emotional responses should be included and whether the speaker or the listener is the appropriate identifier This has led to difficulty in researchdiagnosistreatment areas FLUENCY Van Riper I Fluency is the aspect of speech production which refers to the continuity smoothness rhythm rate andor effort with which I Stuttering occurs when the forward flow of speech is interrupted by a motorically disrupted sound sylable or word or by the phonologic lexical morphologic andor listener s reaction thereto syntactical units are spoken If any or all of 39 v these are effeCted dlS uency occurs39 I Later Van Riper included av01dance and struggle behaviors in his definition I Task Force on Terminology SID IV i Core Behaviors SECONDARY BEHAVIORS I REPETITIONS I Sounds syllables or single syllable words repeated several times I ESCAPES It Terminate or end the stuttering it AVOIDANCES W Prevent the stuttering from occurring I Of voiced or voiceless sounds Sound or air ow continues but articulator movement is stopped Hanley 2008 j EJOHNSON S DISFLUENCY Secondary contd TYPES It Repetition BEHAVIORAL EXAMPLES I sound eye blinks I ppppppeople are funny head movement 39Syllable tension and struggle PalPaIPm Ufa WOId B Word hes1tat10n or stalling V V I He he he he Wants to go substitution of synonyms for feared Phrase WOT S IIwill Iwill Iwill 1 will go home now x 1quot n F t M r if H n Types contd Types contd I Tense Pause Block I a silent period accompanied by excessive I Prolongation um I Revision B Irittus1on of Sound Sound I p t put it in the jalin I Syllable I Wirwarwish you were here I Word He came arrived last mightquot I Phrase I wasiI amI will be going I be hecause he s myhi brohuther f iPREVALENCEINCIDENCE 3 EPREVALENCE CONTD I PREVALENCE The number of cases that exist I TREATED PREVALENCE The number Of within a population at a given time divided by the cases in treatment divided by the toal total number in the population number of the population I 1 I INCIDENCE The number of new cases arising in a population during a given time period usually over a year although a full lifetime is sometimes used I 45 Hanley 2008 i PROBLEMS DEFINING i ONSET Behaviors at onset I 1 Definition of Stuttering I Wholeword repetition I 2 Method of Gathering Data I Sentence Initiation I 3 Effects of memory loss and time lapse I Normal tempo I 4 Lack of confirmation or input by the I Lack of awareness or concern affecmd Child I Evidence of langl Formulation stress I Episodic 3 ONSET OF STUTTERING 3 Conditions Contd I Average age is 3 years two months with a I The incidence of stuttering is higher in twin range of 2 to 4 years populations I Onset is higher in Males 31 to 51 ratio I Concordance The likelihood that if one I Onset is higher in MIL Populations twm Stuns the Other Will too I Onset is lower in deaf populations I Concordance in fraternal twins 2310 1 Speech Behaviors at Onset I Concordance in identical twins 910 I 1 Fluid relaxed repetition I 2 Prolongation 1 CHARACTERISTIC STAGES OF STUTTERING GUITAR CONDITIONS SURROUNDING NSET I CHILDREN WERE Stage lNormal Dis uency I COMPETETIVE I No greater than 10 dis uencieslOO words I SLOWER IN SPEECH DEVELOPMENT I Typically one unit repetitions I Thinking of the right lexical item I Most common dis uencies k Fatigued I lmerjections I Perfectionistic 39 Remiom I Sensitive I Word repeutrons I Scolded or Punished Hanley 2008 g 1 STAGE 2 BORDERLINE 1 I STUTTERING Stage III Beginning Stuttering It More than 10 dis uenciesl 00 words i Signs Of muSde tenSiOH and hurrying appear It Often more than two units of repetition K Repentions are rapid magma and abrupt R More repetitions arid prolongations than i Push use may appear revisions or incomplete phrases R Fixed articulatory postures may be evident R Dis uencies are loose and relaxed at OHSEt as a result Of tens B Child rarely reacts to his dis uencies R Escape behaViors are sometimes present B Awareness and feelings of frustration are present Stage IV Intermediate Stuttering 71 E Phase V Advanced Stuttering i V Tquot 39 1 ost requent e aViors B Most frequent behaViors 1 k I Longer tense blocks and sometimes tremor B t I 06 S ense Pauses I Repetitions and prolongations R titi I ape mils I Extensive avoidance behaViors and suppressed I Prolongations stuttering I Escape behaviors are used to terminate blocks I Avoidance and escape behaviors become I Blocks are anticipated and sometimes habituated so the person is unaware they are postponed or avoided using them I Fear before stuttering embarrassment during I Emotions of fear embarrassment and shame are stuttering and shame after stuttering strong Negative feelings of helplessness and poor selfimage evolve CEREBRAL DOMINANCE 3 DIAGNOSOGENIC THEORY 3 1937 WENDELL JOHNSON It Hypothesis Persons who stutter have not established a strong dominance in a cerebral hemisphere It All children have a period of normal non uency B A parent suspects that the child is stuttering parental diagnosis and reacts inappropriately to these normal I Therapy focused on drills and activities 1111115110155 which would strengthen dominance ll Lack of dominance causes mistimings in the speech motor control system It The child because of the parent s reactions thinks heshe is doing something wrong It The frequency intensity and duration of Hanley 2008 Disturbed Feedback I quotThe Closed Feedback Loopquot n Delayed Auditory Feedback Lee 1951 Black 1951 m Normal A delay lmposed on a person s speedn slgnal 200 ms causes a breakdown usually characterlzed by vowel prolongauon slower mte females adapt rnore readrly younger chlldren more vulnerable but longer latencles are needed EAPPROACH AVOIDANCE ECONFLICT SHEEHAN It The degree of an approach drive and the degree of an avoidance drive reach a level that introduces con ict I As applied to stuttering by Sheehan the drive to speak gregarious and the drive to be silent because of dis uency cause con ict emotional leading to struggle I Persons who stutter I Fluency increases I in reading I in spontaneous speech I Kolk 1985 Adaptation theory agrarrlmatic Covert Repair aphasia I Window for processing reduces I adaptesimplify syntactic planning I corrective atmmpts to repair poor programming B Covert Repair Hypothesis CRH of stuttering Postrna amp Kolk 1993 I Stutterers have more errors in phonological encoding 3 PARAMETERS FOR MEASUREMENT Frequency of Stuttering Intensity of Stuttering TensionStruggle Duration of Stuttering I ESITUATIONAL ASSESSMENT Fear and avoidance will vary across different speech situations Thus a hierarchy of difficult situations must be established and the therapy activities will follow that hierarchy Hanley 2008 3 PHYSIOLOGICAL TARGETS 3 OF MEASUREMENT SPEECH SAMPLES It Air owAir Pressure It SPONTANEOUS SPEECH SAMPLE It Voicing R Rate of Speech R READING PASSAGE B Muscle Tension I Movement stoppage choppiness I ADAPTATION reduced stuttering over 3 Effort repeated readings I CONSISTENCY MEASUREMENT ATTITUDE MEASUREMENT Brown s Factors I LOCI OF STUTTERING The measurement of attitudes and attitude I Vowels vs Consonants change are essential parts of successful I Polysyllabic vs monosyllabic treatment I Content words vs Functional Words I First Words I Streesed Syllables vs Unstressed Syllables Browns Factors contd DISFLUENCY TYPES It The observation by Brown that stuttering 1 SOUND SYLLABLE WORD PHRASE occurs more on consonants than vowels REPETlTION needs to be interpreted with caution ll While the repetition or prolongation may be on a consonant the difficulty may be with the transition to the subsequent vowel 2 INTERJECTION 3 PROLONGATION 4 TENSE PAUSE BLOCK Hanley 2008 3 THERAPY TARGETS AND 3 g 3 ACTIVITIES I j 3 VOICE ONSET Hurried vs Unhurried 1i Onset of voicing is the most commonly observed difficulty The most typical pattern involves an Inltlatlons adducted tense vocal fold p0stuIeThe child may Excited and emotional onsets of speech are Rpm quotgetting Stink Excesswe subglonal 31 pressure is often involved The therapy target is usually hurned 133mm acceleratlon Of initiation with vocal folds abducted Easy movement Quick inhalations are often Eddie Hard Harry are good Fluency notede Pitch elevation is not unusuale Friends to be used during therapy activities Exaggerated head and neck movements are often observed AIRVOICE COMBOS VOICE ONSET CONTD 335823 aggiivsglu le nStart with vowel initiated words phoneme Is it voiced Voiceless gradually eXtending the compleXity ItOftentiInes a voiceless repetition is of the utterance t0 phrases clauses evidence of difficulty With voice onset sentences and combinations of related to a subsequent sound sentences y 1 f 5 VOICED VS VOICELESS 3 THE h AID f PHONEMES i l lf the child is having difficulty 7quot y VOICELFSS PHONEMES EG MELKl initiating V0106 from an abduaed D i1fa15335253312335 ii 7 i9 ecifli3 i ieg ai open fold position initiation of Tf gf u if i g f f Sus bemdmny m 5d air ow with an h sound insures an AIR VOICE open airway Then the vibration for voicing can be initiated gradually nLater the audible h phoneme can he chanced to an inaudible This is the control targetJ Cleft Lip amp Palate Helen Sharp PhD Western Michigan University Ob39ectives At the end of this session you will be able to posterior pharyngeal wall adenOI 0 Identify the incidence of of new cleft conditions 0 Describe the known causes of clefting 0 Distinguish between voice and resonance 0 Describe what the soft palate velopharynx does In speec 0 Describe speech difficulties associated with VPI 0 Role of interdisciplinary team care 0 Identify the structures of the velopharynx velum ds What is a cleft 0 An opening in the lip alveolar ridge hard palate andor soft palate 0 Failure of the tissues to fuse during early fetal development Cleft Types 0 Cleftlip only 0 Unilateral cleft lip and palate 0 Bilateral cleft lip and palate 0 Isolated cleft palate 0 Submucous cleft palate 0 Various facial cleft patterns rare Terms 0 Congenital present at birth may or may not be genetic 0 Genetic condition something present within the person s genotype may or may not be evident at birth Unilateral Cleft Lip amp Palate wk Post Operative Result Hospital For Sick Children Toronto Canada rttpmwwwstemtts cacleltlipsection asp7sPhotoGallery8tslDG2G7 Sharp 2010 How otten do otet39ts occur Ctettxoccmtnabomt m 700 mm ammatte detect dtxovden dnteveme vexent at bt h Ctett ttpand patate 0mm move otten m mte Ctett hp and unttatemtctett patate moveottenont EFT e Ctett patate atong 000m move otten m ternate occuv Why do detts occur ongtn Cerempredwcsnun o Envtmnmentat tam Sndvorne amctamn 5W Mom mated wnh symmme What is a syndrome Move tmnone cmmctenxtn pvexent m the wne tndmdmt Same undevtytngcauae Can otet39ts be prevented Vex 40 mme extent Fotnactd uppternentxave ettecWe at reducmgthe envtvonrnematdetary nxhx my ctettcondnnn Fotnactdatxo vedmexothevbtnhdetect mm m a ptna Ontywovk n takean eavty m pvegmmy Generat Medtoat Management Ltp vepawmogmomm Patate vepatvgto t2 month Pm ec Feedtng modttnatton but me tattuve to thwe untemothevamrnate pvexent Pnrnary veaxontov patate cmuet peech trnpact on Speech The Vetopharynx Scott pahte veturn Phawngeatwatt d2nudt m Sharp 2010 The Velopharynx Medial Nasal Wall Septum Terminology Resonance o Hypernasality overly nasal 0 Hyponasality not nasal enough Resonance a Voice Samples httpwwwacpa cpfordEducMeetinqsspeechSamplesind exhtm Screening Assessment Cleft Palate Team 0 Language development 0 Speech sound production 0 Voice 0 Resonance 0 Oralnasal fistula 0 Cognition amp development 0 Feeding 0 Otherteam members roles lnterdnscnpllnary Team Care Physicians 0 Pediatrician 0 Geneticist 0 Plasticamp reconstructive surgery 0 Ear nose and throat Otolaryngology 0 Neurosurgeon Dentists 0 Pediatricdentist 0 Orthodontist 0 Oral amp maxillofacial surgery 0 Prosthodontist Speech Language Pathologist Audiologist Social worker Nurse Psychologist Genetic counselor 0 0 000000 Management of Disordered Resonance 0 Speech therapy for adequate VP closure that is inconsistent 0 Physical management for inadequate VP closure 0 Surgery 0 Prosthodontic management Sharp 2010 Resources hupch e hm ovg Sharp 2010 Genetics Genetics 0 Branch of biology that studies inheritance and o the relationship of genes to biological functions Human Genome o Contained in 46 chromosomes 0 22 pairs of autosomes o 1 pair of sex chromosomes 0 XX female absence of male hormone XY male Genetics Genes 0 Sequence of genetic material DNA that codes for cell activities 0 Human Cells eg nerve cells muscle cells s in cells Genes predict or predispose a person to certain cell functions Q Genes are expressed differently so the genetic sequence identifies risk but not 100 certainty Patterns of Inheritance Autosomal dominant Single gene transmitted directly from parent to 50 of their offspring Examples brown eyes or Huntington disease Autosomal recessive Single gene disorder not evident in a carrier If both parents have the same recessive trait 25 of their offspring will exhibit the trait 50 will be carriers of the trait Examples blue eyes cystic fibrosis sicklecell anemia Recessive inheritance c O 0 m1quot DD minim N 9 Nn I quot NN Nquot Nquot nn 6 Ml 9 Dominant inheritance rage1 18 immmmu 3 Hr m Mnlher d 9 d ill in L w an d U lllllEllllll Mnuui unmm mum Numnx Genetics Syndrome o A recognizable pattern of symptoms or abnormalities related by an underlying disease or condition 0 Any time a childadult has a group of things going on should suspect that they might be related eg ocleft palate cardiac heart problems osmall jaw hearing loss Genetics Genotype o The gene sequence Phenotype o Whatthe person actually looksbehaves like Sharp 2010 Congem a Anomahes Congenna wmmamm himaway mthgemn mum 2a Mm but Sharp 2010 Iquot 3 WESTERN MIEHIGAN UNlVER39SlTY39quot y 39 9 y I I n39epartm entorSpeechPathologvt5 By the end of this class meeting you should be able to I ldentify23tructures and thefunction of Hear39ng Part I those structures in the outer middle and A Tour of the Ear inner ear Describe the pathway for sound from the environment to the brain 0 Identify the purpose of audiometry and tympanometry in assessing hearing and the function of the ear What is sound What is sound 113 aquot 3quot i39 HF l3939 3939 39 21 1 f5 fu39ttquot o Sound moves away 231 fgiiz hit from the source in all 3di vv f 39 quot39i39 363 dleCi39Ons o Cyclical movement of air particles o Greater displacement 9 increased intensity Measured in decibels dB o Faster repetitions 9 increased frequency Measured in Hertz Hz Any sound can be divided into a set of sine waves eeeeeeeeeeeeeeeeeeeeeeeeeeeee al A pure tone Speech and music are complex sounds that carry meaning Music clip Dido Amplitude Information is conveyed by the change in frequency content with time 5 W0 Spectrogram of music clip 3 Frequency kHz Time seconds The ear codes the acoustic information into neural impulses Inner ear Cochlea Outer ear Airborne sound Auditory Middle ear nerve Anatomy of the ear O r Semlcimular canals P I n y gt IT Vestibular quotl 1 I 7 57 nirvax wchlear E Fin 1 1 4 a 32 name Middle ear x A Ossicles 5533 canal quotI iii Raw 74 245 Eustachian Tube gmmhm Inner ear mm 1 I quot Cochlea Mm 5 Sim T39 quot Auditory nerve quot m5 The outer ear Everything up to the eardrum Aids in localization of sound sources 5353 Amplifies sounds at m some frequencies mm quot11 more than others The middle ear last middle ear bone Transfers sound into fluids in the cochlea x via mechanical movement 32 Bones are I wanna 35 3mm surrounded by air 117341quot quotquotquot l Air supplied through aim has the Eustachian Tube Earinfections happen here Theinnerear Converts mechanical energy into nerve impulses at the hair fl7 i r nerve Electrochemical Cuchlea energy is conducted via the auditory nerve to the brain In most cases the cochlea is the site of permanent hearing loss Sick Kids Hospital Toronto Theinnerear Tubes in the skull s Theinnerear The Organ of Corti contains the sensory cells and supporting cells The Basilar Membrane V V vibrates 5 139s 239s differently for each frequency DISPLACEMN ET Amplitude of sine waves Any sound can be divided into a set The tone complex as a periodic signal I 05 7 D5 The cochlea does this division Mapping hearing The Audiogram Frequency 391 Intensity 10 Threshold 2 3 30 Measured by g 40 audiometry 50 IE 60 CD 70 Average Vocal Effort 8 80 Loud Vocal Effort I Soft Vocal Effort 90 Thresholds 100 lt36 9 90 600 00 Frequency Hz Audiometry 3910 Compares listener O thresholds with EH10 normal hearing lt1 Tones are 6 presented at g different E frequencies Sound levels are 398 adjusted to find I the softest sound that can be heard so 36 0 Measuring hearing gt 20 30 390 40 a 50 l 60 on E 70 Average Vocal Effort a 80 Loud Vocal Effort Soft Vocal Effort 90 x Thresholds 100 7 a c 7 0 0 O 7 0 o 0 00 00 6 000 Frequency Hz 9 e 0 0000 Measuring hearing Otoacoustic Emissions OAEs Detect the operation of the cochlear hair cells if the middle ear is healthy Often used with newborns Otoacoustic emissions DP OAE Left Riuht 3U EU 10 a a D 0 D U in to D s a m 20 15 2 3 4 5 15 2 3 A 5 kHz Get OAE kHz Auditory Transduction By Brandon Pletsch Measuring hearing T mpanomet o Tym panometry y W 25 Le 25 Helps detect problems in the middle ear 2 2 Ear infections 5 15 Problems with the e 1 1 middle ear bones n5 05 Lines should peak in f J the normal range g 5 4 U BSD 80 D 11 230 4 D 360 daPa Tymp summary L R Range Equiv Volume ml 104 109 Static Compliance ml 052 050 02 to 12 Peak Pressure daFa 25 21 325 to 30 C Gradient 016 013 01m 05 0quot 3 Tymp Width 133 146 34 to 94 mi Q J Iowa Hearing Loss Prevention 7 7 AAA IHeLP Database Iowa Hearing Loss Prevention l HeLP Project Teslerl G Fiamme PureB torn RtldIFESthIdS Tympanometry Subiecl lD A7iT306 PlolA VVVV ye ue e y e 9 un es 9 l w 25 Li 25 Rim 1 Teleate 92403 2 2 School Sigourney 15 15 I Otoscopy 1 Left mm Ob PL n mu 2mm 741 sun i Mimic normal v s membrane Fluid invisible V 4n anti 72m Ann ml 036 053 011 05 Prequencyi iz 11 39 34mm Otoacoustic emissions DP OAE 3D Left 3D Ricihl ZEI ZEI in in a right a m u in 4D ZEI ZEI i 5 2 3 A 5 B i 5 2 3 A 5 E kHz Ge OAE kHz Comments 0 Otoscopy and tympanometry WNL bilaterally Ann n d5 5 dapa Get Tymp Tymp summary L R Range Volume ml 112 113 399 11 Cnmpllan ml 086 094 02to12 39 P kPre 11 Pa 21 3 325 so cam Sllgh wax 39 Tympanic m S No complaints re hearing membrane Bilateral tinnitus approximately Pure tone thresholds and otoacoustic emissions abnormal on left normal on A Evidence of early hearing damage in left ear P Retest in 1 year mm mm incus inVisibie Fluid invisible v lnCUS invisible v Clear Hearing Loss Rehabilitation and Prevention Greg Flamme PhD Audiologist Department of Speech Pathology and Audiology Western Michigan University 9232009 Hearing loss is an epidemic Very common 50 o of adult men more in rural areas Somewhat less in women Linked to multiple negative psychosocial outcomes Depression Selfefficacy Mastery Social functioning Interventions for hearing loss Technological Hearing aids Cochlear implants Area amplification systems Behavioral Auditory training How many people would benefit from hearing aids gt 50 chance of benefit for speech in noise when average threshold exceeds 30 dB 15 of rural females 30 of rural males ll Dams international Journal of Audiolog 2003 Prevalence of Hearing Aid Use gt 50 probability of hearing aid use only for those with 1000 100 thresholds gt 50 dB UI HL 3 30quot 015 a m 600 3 050 3 400 v E 025 g 200 7 I 000 0 20 40 60 80 100 Bilateral 4frequency average earing level Proportion using hearing aids What are hearing aids anyway 1 Miniature sound systems Microphone Amplifier LoudspeakerReceiver Specific characteristics Compensate for hearing loss Audibility Comfort m a llUlnEM I 0000 in m The role of each hearing aid part Microphone Converts airborne sound energy into electrical energy Amplifier Amplifies electrical energy in a controlled way Receiver Converts electrical energy into airborne sound energy released into the ear canal 9232009 How hearing aids sound Hearing Loss Simulator Cochlear Implants Ear with mm implant wwwnidcdnihgov AWAY nirtllvn I VAHH IIIIiA Ann I an um MerlinI Am TlPOOR L Electrode array Receiverstimulator Processor Transmitter Microphone Cochlear implant parts often merged into one unit Frequency How do cochlear implants sound Speech increasing channels MUSiCi increasing Channels My 393 Frequency llil illii J Lli in r Ti me Simulations by Shannon et at House Ear Institute Iwww hpi om Area amplification systems Sound signals transmitted to an amplifier via radio or infrared waves Amplified signals are sent to loudspeakers throughout the room Can also be sent to a personal hearing aid 9232009 BehaVIoral Interventions Strategies for improving communication LIstenIng practlce Risk factors for hearing De raded s eech 9 p damage Auditory memory Noise Heavy metals Organic solvents Asphyxiants Pesticidesherbicides Synergy and potentiation Norse Exposure Measurements Time Trends Exposure Key exposure criteria Age effects occur late ghhrggrgggggdfemg intensity time Exposures over 364 Noise causes 25 Pascal s uared PaZS per day WI 3 20 q 2 cause a small amount permanent thr39eSIhOld f seconds Pa 3 of hearing loss over Shifts PTS Within a E is A weighting time few years 39 3640 Pazs er da is a E 0 For continuous p Y 55 of maXImum In 5 sounds it doesn t 100 no39se dose re ears E 5 NIOSH 1998 V a matter how the 39 85 dBA for 8 hours 74 Of maleum in 10 0 20 25 so 35 40 45 50 exposure OCCUl S 82 dBA for 16 hours years Years Less intensity more 39 80 dB for 24 hours time 140 dB SPL peak More intensity less ANSI 344 1996 ANSI 344 1996 2Noise Elleci 38400 Pa s per Day tor 20 years A99 Ellec s 95 dBA Leq tor 8 hours 7 o Typical Noise Exposures to r 639 l 5 20 g 30 e People often have high on we g to E non occupational notse Everyday noise exposures g so exposure levels m 94 m D 60 Average 24hour Leq IS 78 5 91 400 oi 700 2 dBA 83 dBA 8 hrs 88 200 I Frequencvi HZ Combined Age and Noise Elleots Frequency KHZ QE 0 I o 3 85 lOO 8 lt E to E 82 50 a co 2 I h e v a t6 20 F 7g 25 a 30 g 5 a g e 5 76 PTS onset l25 g 340 g Equot 73 a Z I so 2 g E i a 7005 l 2 a A e h H l I F m n w ANSI 344 19 lt k r r r no svrh mm m R r 9232009 Impulse Noise Exposures Noise Countermeasures Principles Avoid exposure Reduce exposure time x Barrier methods Exposure Spending Heavy metals Lead 10to 40 of rural children have blood levels exceeding 10 u Reduce blood flow through the stria vascularis Triggers generation of d reactive oxygen Iowa Health Fact Book 2001 Heavy Metal Countermeasures Gloves and respirators Keep kids away from peeling paint and teething toys Especially sub sub sub subcontracted toys from China species Also cause central Platinum cisplatin nerVOUS System Mercury damage Organic solvents Organic Solvent Countermeasures Aromatic hydrocarbons Toluene Avoid V96 Inhalat39on and Xylene pesticidesherbicides cleaners degreasers skin absorption Styrene Create reactive oxygen T m th I polyurethane foam adhestve removers spray Species quotc oroe eyne paint nail polish removers cigarette smoke o pesticidesherbicides cleaners degreasers polyurethane foam adhesive removers spray paint nail polish removers cigarette smoke Barrier methods Gloves Respirators Handwashing 9232009 Asphyxiants Asphyxiam Countermeasures manure Carbun Nurwmz 39 Ventuamn 9mmquot U MW 7 5mm my 7 53mm m smequ wmnmem an mac m mama 0mmw aww mms mammde mm 7 m cm was mime meanm m rwwmsma tunQM mugan screma new team PeaioidesHerbioides PeaioidesHerbioides v Pamth v Banevmetmd rcemaesmw Elm92H 9023 mmw gm v ngampmxpmte 7 Lung 5mg Dans Saks 7c hrssmra mnhnun eambmum cm W Mums my ae bmbne r Fae she s rbboksreummnuhvtmnsm un v Handwaxmng Amman m m an Synergy and potentiation v Rmk actov my not ope me me pe we my erMUVEVwEmcsum swa an esum Questions ENE NECEan HE39S 7 Mia and co mmma un suns at 200 ppm iNu ard Hyumgencyamummmamn G39egF amme PhD smst Dom Gveg Hamme wmmh edu Language and Speech Deve opment Hebnsmm P D Byme end of Ms dass meenng you shou d be ab e o Dmvbe e mumerme communan m devebpmemuwrer mega ms Dmvbe e wow quthrguge mmmemmm m n 2 2vaars Paca expvexmn Bodyponme Dem tame mum babbhrg EWNNE Axioum mlv Wmsymmnmcnmweawm Dem Soeech PatmtgyampAmutgy Damm mmaxmg andpragmams WmmMnhgan LinnMSW DEE quotamasamnsean amen mm mm mm manage m Commumcauon Language mm mm Movmotcommunnamn Gum Somanymvedxetommbok pm togethev mg sgn m an be a mm 0 Me mwk m Mmealvanytmng bm m we We eqmnwsmwurds mmm v 02 m m Samewurdcanbeanmm We mqu TUNE Smbomo mama s mum noun 5 Pamerme vevb mm vevb NW U Language Fovm Symax ward my mum Mm pnummymm Cement 51mm dug dcgs myquot Semmps mm mm wg as Pygmtpsmcal mbsm bnguag nun mv name mums Sharp 2010 Geneva Commumcauon M eslones 03 weeks Cmng Wm me 320 weeks Cuumg wees my unmeme mow Laugmng Wm 1926m lt aka678 mars Vma DEV Prebahbhrg Rabanes Squad Bevma budmss Geneva Commumcauon M eslones 7 m month Canun abahbhrg hababahahaha SWtb sums 3 2 month Jargcm 0 m month Fvslraamvds Language Deve opment Vdeo 0 m 30 momhs Geneva Commumcauon M eslones AgeA Zmommr word Age 2 24 month 0wurdvmabu Age 37 mn mmenoe Sowovdx NZIIJGIIJWUM wcahuhry Hon 7 Zwovd Mme Age 47 equence new N150071800 WM wcahuhry SaeTzHe zewmmzsw n Wrm Specwa Languagechumslances Emngmhxm Cmdven Tani tube smvm wcahuiaryawusmun Tani tube m man wards m2an 3 we phrases any mmrg u Emmns symax memamna Agopuon We arguage devehonem Sharp 2010 Anatomy amp Physiology of Speech Production ll Helen Sharp PhD Associate Professor Dept Speech Pathology amp Audiology Western Michigan University By the end of this class meeting you should be able to 9 Describe the relationship between the sound source and the vocal tract filter 0 Describe how vowels and consonants are formed using the sourcefilter model Define and give an example of a phoneme vowel and consonant 0 Define place voice and manner of articulation as major classifications for consonants By the end of this class meeting you should be able to 0 Identify the majorstructures in the CNS 0 Identify the frontal and temporal lobes of the brain 0 Describe the general location of the speechlanguage centers in the brain 0 Demonstrate a basic understanding of contralateral innervation Identify the following structures amp what they do 9 Cerebral cortex Memory language reasoning 0 Coordination of movement 0 Cerebellum 0 Essential life functions breathing swallowing Brain stem Inspection of Larynx Views during Inspiration and Phonation o Sharp 2010 Review of Structures and Spaces 707 Elem SouroerFMer Theory Units of Speech w rorna ound ouvce awnx m modmed bya mommy xyxtern omhev o Phonemer smaHes mm 01 speech mama m5 m Eng sn Anhu a ovxomnge the Wm 00 the pmrene mneharge 02 meean m remmtmgmbe vow mm mm 99 anged a1 mat smpecmngeme vexomme pvopeme mm mm The Shape and mm oHne tube detevrnme the hequenmexo mong re mmnoe Consonant C assi oation Two major kinds of phonemes P aoe 01 amou auon mo 34quotme Vowe s E b bbah k uwm m w 0 Mannev 01 annu anon o Consonams 4wa quotd n vma tmtwns1lbsatmm mwm2g v 29 Vme WW quot 9quot a Vmomg VuwdnmvmaHutlsvbra39E k739 Vuwh ntmydunY P aoe of Anion a on Consonant C assi oation Evenoonso m o assmed Bmamb p m on meevea mes p aoe vmoe mannenvmoe o Lwnguargah a r lump onquot ow 5m Lngua avtn 9 no Y39mrmwm h o Ghma w s abnabiah vowed slop o w s a bnabwah vowe ess smp oApauovconsonamsma m even any vmoe ave oaHed oogna e pans Snarp 2010 Manner of Articulation 0 Stop also plosive stop amp release p t k 0 Fricative narrow turbulent f s sh o Affricate stop fricative ch j o Nasals nasal resonance opening between soft palate and pharynx mnng o Glides amp Liquids also approximants vowel like 0 Glides yquot you WVquot 0 Liquids I r Special symbols for the phonemes o Alphabet letters do not completely correspond to speech phonemes o Eg the e eh sound can be written as neighbor or way or ace 0 Similarly consonant sound sh is spelled ell na on sure f in sh or mone Sounds in words not letters 0 You could do this in elementary school 0 Flute oot Central Nervous System CNS 0 Brain Spinal cord 0 Brain housed within the skull 0 Spinal cord housed within spinal column Sharp 2010 Planning foresight Motor speech Skull Lateral View Dcnipiul I m Parielal hone Fronla bane 39 Peripheral Nervous System PNS The Brain Speech amp Language 0 Muscles glands sensory receptors Lateralization that are connected to the CNS 0 Functions tend to dominate on one side of the brain Most people s language centers are on the left side 0 Localization o Specific functions map to an area of the brain 0 Contralateral innervation 0 Left brain controls right side Right brain controls left side Sharp 2010 Hearing Loss Greg Flamme PhD Audiologist Department of Speech Pathology and Audiology WMU Hearing Loss signiticantahmvmh 90 Statistics 3 1 E S f39 2 3 out of 1000 births g so 7 quot have hearing loss 2 7 9 out of 10 have hearing 2 j AK parents w 4 4 k Over 50 of adults in the o m 2 so on so so 70 an 90 US have some degree of Age Yea HL x V 90 Males fr 40 50 of adults over 75 a f have enough HL to make 7 rquot s conversation difficult g 5 wi w 1 out of 5 people who a 2 ff have HL wear hearing aids 2 f m r Ajaxquot gt 4 10 20 30 M 50 SO 70 80 Age yeavs Flamme et al 2005 Hearing Loss Statistics n 39 I I v 39 It v 39 i n t u 39 39 39 I n n I 39 I I i v V v I C etti amp Flamme 2008 Types of Hearing Loss Conductive Outer or middle ear Sensorineural Inner ear or nerve Mixed Part conductive and part sensorineural Conductive Hearing Loss DeformedAbsent Pinna Blockage of outer ear Otitis Media Otosclerosis Syndromes Treacher Collins Down Syndrome Cleft Palate etc Frequency Hz 10 250 sou 2000 4000 8000 Hearing threshold level in decibes SPEECH TESTS AudiogmmKey Righxlu Uniaagked O X M ifid A D a Unm gke lt gt s Masfed 1 a rowhim 1 r Masked rzsrs 5p Rerepvmn Threshold 5m 30 d5 5p Distrr39rn Shares 35 dB Sl httpivenigo net http NW unchwxwmycamn achhdshdsl htm r v Down Syndrome MyWIwvmrmWmlsllmrmmm monks Deformed Pinna microtia WWW Wmmmmc mi 11 Cleft LipPalate megMW mywmml gnudef 1m Otitis Media OM Medical costs estimated at 5 billionyear 17 of children under 2 have recurrent OM 7 National Institute on Deafness and other Communication Disorders National Institutes of Health 1999 Fluctuating hearing loss 0 Irritability Otitis Media 5 million days per year missed due to OM 200 days of reduced hearing in a year possible with chronic OM 30 of students with learning disabilities have histories of chronic middle ear problems httpwww msu edu humnazs Otitis Media 0 Treatment Antibiotics Pressure Equalization tubes 0 httpwwwentusacomeartube727wmvhtm Alternative Chiropractic httpwwwentusac Sensorineural Hearing Loss Noise exposure Ototoxicity Chemicals Smoking Medicines Age Presbyacusis Disease Genetic disorders Noise Induced Hearing Loss Single exposure or repeated exposure Notch at 4 kHz 3 dB increase half exposure time Keep volume control low Do not listen if ambient noise is too loud Frequency Hz 250 500 1000 2000 4000 8000 Audiogram Key Riglll le Unrc gked O Mggkced A UmEnagked lt Mlifuu 1 X D gt 1 r Hearing lhreshold level in decibels SPEECH TESTS TESTS 3 5p Reception Threshold 51m 25 dB m 39 5p Dmnm Sam 35 dB 5L httpivenigo net Conductive and sensorineural Mixed Hearing Loss Frequenw Hz Hearing Ihreshold level in decibels Degrees of Hearing Loss 2 zmu 4000 m mm m Ei liom 21 3 MILD m rmrglms so 5 murmm mm 7 humus an 90 e Lounnessn xumm a Sound levels on an Audiogram 7 60 6 a seq 5 Frequency Hz Effects of Hearing Loss 0 Environmental Awareness 0 Speechmanguage Psychological 0 Educational Needs Umlateral or Mmlma Lox MHzm Sumdm xpdxd nh Heanng Mlld Heanng Lox Moderate Hearing Lox SWIMW levnmmmalxpmh mm A Psydnlogul n1 evereto Profound Hearing Lox Mm What Can You Do Getpenou name before pezkmg Speak may and clearly Rephme mm ofrepezmng 39 Don toowr I mu Make me your m I well In Encourage them we seek help 9 Articulation and Phonological Disorders Helen Sharp PhD Associate Professor Dept Speech Pathology amp Audiology Western Michigan University By the end of this class meeting you should be able to 0 Descr be the basic steps of a speech language evaluation 0 Recognize why it is important to differentiate organic speech sound disorders from functional or behavioral causes 0 Define terms phonology intelligibility stimulability Speech Production 0 What do you want to say 0 Neurologic representation 0 Output 0 Neuromotor control of lungs larynx articulators 0 Input 0 feedback auditory amp sensory Speech Assessment 0 Goal is to figure out whether there is a speech production problem 0 Rule out accent dialect difference 0 Rule out normal simplification processes 0 Examine language skills amp general development 0 If there is a problem 0 Is it structural physiologic 0 Is it hearing 0 Is it mislearning Components of a Speech Assessment 0 History 0 Conversation 0 Oral structure and function 0 Hearing screening full assessment 0 Standardized tests 0 Names pictures that give a sample of each speech sound eg th in every word position eg mumb bamtub bam Sharp 2010 Standardized Assessments 39I RUC39I L R El HOTOGRAPHIC R39I ICULATION b5 Ul NSIZKRY Snmu abwh y Fac Mo Ova Suucmve and Funcuon Up teem jaw tongue havd and mu ate m ymmew Verne m 0 each lmcmve Mw m rm bammg rechth reme barn an weed my Sm mg cansrevmmerewimm g cansresmmumfmmemm Sm mummww wmww ch sacardda e uvweecmhevaR mama Wm ream msunmwn Pemepuon vevsus Pmduamn Phono ogwca Leammg hnkedto emu may pemewe the dmevence but not be able to ayn Lawns pmmmn M whim are duynuwanh 02 redure SI EWWWH mm m mew Ream am mam Dmrdeved pmno ogna eammg m hnkedto acmsm nethHm m Speechdmrdersrd cmadbrguag ump Demdmg AbomThevapy When Happens m Speech ThevapW we o Behavmmhangemmug nteHgany Op nunnemmavmodewagamhwy 81mm Dwect teachmg Leve o mxlmuon Muhwpb vepempn by the pevxon wnh am meme 9 max mothawn ma Waugh phy Ve otcomem M mma pm Remmemem Coma peech thempy be mvmw Sharp 2010 Sharp 2010 Wha Happens m Speech Thevapw Sound m xo a on x Wodmma 4mm 4 medwahchmev P me Wha Happens m Speech Thevapw Pmmbgna appvoach Teeamrg 02 we Dnms mmmmmaxanpumn msun Se ma wum quot em vam Dav Eg mu m Bevan Convevxamn 9e mmhzamn EHdVgS msz umde the thempycomexl camoven We p s an Vdeochp Piease oompieie SPPA 2000 immduaionm Human Communicauon Laslpage oithe mm soigeno Sciences t Disovdevs kmwyoui Hm siami Ph D Ame Pmimlv Dem Sosech Pentiuth Mummy Wmm Mnhgan UVWEVSW Focus oi ihis course ovene i Course Overview w 0 mvmaidevebpmemandiummnsoi Lemme Mbmdiscusmn peecm ianguage heaving and in Ciassdemonstmmns WWW aw sewn dates imedi syiiabus commndimvdevs oi mean iangmge heaving s swaiiowing n Homewovkassgnmemsave compieied independemiy iangmge pa miogv Madam quizzes and exam 0 stvongiy veco mmend mm compieteassgned wading s mmewovk Assignments Whatis Communication Navmiive HearingAssessmem Emmpiexv Wlib2 HEaIirg Ciinn was n yum Leamirg isl One wpmmmem Duiny Canoeikmrs dm tn iiiress 2 HiNi am Mr ike iiiress Duinymus1be wmmunwed m advan in By Km atammia bmwwug Sharp 2010 Communication 0 Exchange of information or ideas 0 Sender amp receiver 0 May be oneway eg TV 0 May exchange roles eg conversation 0 Speech verbal communication is most common method 0 Other modes of communication as if i g l 5 4399 When you say something what happens Sharp 2010 A few facts 0 Communication disorders occur in 1 of every 8 people or more 0 Audiologists are professionals who prevent assess and manage hearing loss 0 Speechlanguage pathologists are professionals who prevent assess and manage speech language and swallowing disorders V DEO Wham anamwo ogwx Who Wha17When7Why v w ampWovd ReponJanuanS 200s Audm ogwsm SpeechrLanguagePa ho ogwsms We may aw AHied Heahh Professions WovkmdependenWasan amonomouspmvessmnax Wovkc ve a ed esswonsmmanagmg he who pevson oHabovauveN Wm o hev mm mm Career p aoemem WhevedoAudmmgwsls i Speech LanguagePa ho ogwslswovk Variay of Peop e Served Muhs Mommiven a MmeChemo o SeHrwmpmvemem eg awem modmcauon Some meresung mmgs 0 conswder Wham mrmaW Whendoexa dmevence become a dmmmw Doe Wenemery wow E g 723mg an we pvo emom Sharp 2010 For next time mm mm Read 0am mam 2m Mmr emmkqusnms snug w cums hdzss m may Suzymmmdwe Sharp 2010 tntroductton toAphasta and TraumattoEratn tnjury Apmm and Tmumam Emtn tmmy Hetensmvp Mutttmeda 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Outcome of Brain Injury 0 Memory 0 Attention 0 Organization of ideas 0 Language word finding comprehension o Pragmatics 0 Motor TEFtheoLmk v MgNMWbbccoukmdnAmenoecam may 2002mm MmPma Gage new v oodmnnorymobWoodvmv weDax Com w a ABC New Aphasia Dmmpmn m angmge ammated wnh munto the mm mm 7 mum Bmca39we MDWE 4mm arm Munmme v Wemnke mghama v Wevmcke We Evoca A m w Em We G oba apmm Bum EmmssNE am VEDth Steme Speech and Language Recovery Emngmhxm Fm arguag M351 m7 Pemdo agnamn mmer H 6mm depvexm mm mums AphamarTmmpy Comprehenmnoecepm anguage qubalEneme Da gao w Warbaligmumiwvmn Remmeexpveme modamy Verbal axlum wrmen AphamarTmmpy mprovememwnhume megmte commummmnwnh goamov my my AphamarTmmpy Mummodamycommunnamn Pmunng Aehaxa Tmuemom move we on Nnmnbox my Right Hemisphere Strokes Other effects of stroke brain injury Visuospatial disturbance neglect 6 Vision hemianopsia disruption of optic Pragmatics tract or occipital lobe Prosody Comprehension facial expression others prosody Literal interpretation of idioms Selfawareness Differences vs Disorders Byme end of Ms dass meenng you shou d be ab e o Dexcvbe why we houbdmevemme h ngmmc dMeveme quotom Speech angmge dmovdev Gwe mme exampme myma vavam 0V Hebnsmm P D Wm Axioms Pm mv Dem Soaech Pava Mmumy Wmm Mnhgan Linn275w Language Amemvs Dwa ea Fovm Dies b Hg d Maxwmm u s y quota mmsaw umam Nurpmtgy ward 51mm nmgs meow a e a WWW mm Phumtgy mm sStsm Cement Semmps mm mm wg The way me pawn may we mum Mam mom smr gmemby and Um weal cham39evsms Prgmtnsmcral mbsmbrguag nun O engmgmhna mv kname gmngs mmm by my arguages can have BOTH an awemand a dhlecl onsody Accems m E bemmMamWwBUgQZ aturzww Sharp 2010 Amerquot vs Dwa ec Ahwcan Ameucan Vemacu av Eng hsh Dwa ems and SM dwa ec s WM mg mm mm mmmmwmmwne WL W W mm0m1mz WW m u pm u WWW Emube mmMamWwWW b B amp O aamredehed WWW my Mww mugggmammgnmag Dabct Seemrvdzs quotWm Ro eo he s eech Lan m Patmb m code SW a mteachempvexoume gaffe cngnx Nmnnammmnpeecm anguage Betammywn ectandac 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thwmwou hhcw apempeech phoaucmh wmtwou dvouexpectna peach m So hhhhevma may ersssuvsbmng pure mmm amoume Sharp Mote Speech Dmrdev Caumxo dyanmm can be congem39a ov snmnswmmmdmgerEg cerebral paw oerebe hvsmke Mom Speech Dwsovdevs Uppevmmomemon mum ltgt mum Ibravsrem he s1mke bram mum tumurs pnmary mew some gm gm mnm mg Amwtmohn Lemurst sham mm ngggmmwguwm Pam Dam sh m P9 WHEN WE Lowevmotomeuvon amwtmpm BEVE EEVESB awed nerve 5W mm MEErEg mmwempny 9 a D W MW Both uppevand bwev motomeuvon g Alvwvnpm hiya scbmsg Mo o39speeoh D so39de39s MotovP anmng Dmovdev Dmnma lerwal Pa m y MEuth mphy motovp anmng Mac News My md mm Mmdz mm D mmgame mprmmmncmn unanmaymuepmucm mm mm bywhvm ammumm e WW Was mtmzs hewm m y Egagxz Iv Treatmenuov Mom Speech Dmovder Behamm mam Cumr rmtun Nunnunrg caldeagmmm efexv Emeedback Suvgerypmlhem Tveatmemompmxa 0 Speech Behamm therapy Tawb ems Rwemun m age uvevand quv Sharp 2010 Why do t heed to cite other peopte s work t ewe cvednto them who an the wovk 2 Lead the 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Aunts We 0 twevcaxe tommtov bmkmmegetxcapxtoveachmw wovd rEg Smnh AS 9003 A mym 5mm Dreteremes my me am fawurs Can J dSIIIWReseatch 5mm ttsts v Boo cmptev houtd be cned wnh the amhovxot the chaptevmotthe edttov ottheboo thtexlandthehohthe veteveme 01 703m R mm H 9007 Embatan Egat momma ms Stetara ems rum 5 TreatmentPtanmhgm Dentvstry Battvmre Mushy p 151470 Sharp 2010 What about e eotrohio references v Avon ve evehcmg mn pee Newede omhe web amcmnnx Webxne a a xouvce 0V othev ve eve me my pecmc sandman v w kwpedwa m Ma veoogmzed wee 0V movmauoh my aeademe pvoject v hvoudoumawebxneyoumuxt ve eveme mm mm the authov Citing a website v we me mm m text Vanna but you may We be mme 0 me macawquot ov okuauon mead Mheverysm We bWs wewa menamem Amman 2007 v On the veteveme hxnhe ammv m me owuauon mnhe we bxne 7mm cm Famed mm 2mg wmunhmmmzw What happens if doh t cite appropriate y v Dwectoopymgovmwmma cmngexm phmmg wnmm qmtamh ov wnmm cnamn m caHed plagiarismand a xenon acade me eneme v Teachevxave obhgated e vepon phgahxmto the omoe 0 Student Comm WW How wiH you know if doh t cite appropriate y v Facuhy ave wed to eemg vetevememo uppon latemem dehnmon many hevmauon m oommohh kmwn rwe mm m omown i a 5 wrmng v We ve am pvelly good a mtmng change m wmmg Me By We end oHnws cLass rneeung you snouLd be abLe 0 Dawnsm Langmp um Fawn 6mm m Lu mammals Remmw 1mgng LCmesm mm LWSM Emmw Language and Speech M magnum 2mm 3m L Deve opment H um muncucmmwmwwmwmmm am 7 am guru mam mnrmnm mm m Language 2 Habnsrarp PnD Wmmdmdngdmemscmmsdw SEEM Wm De m m madmasmmdmmufm DeotSoeecnPatmtgvampAM1utgy MN am my w L quotmm Wm WW WWW 33m 5mm mm mm m mdmnd a tram mmtm and mm pars Geneva Commumcauon Mueslones Language Language Expvessmn up BismHEMEmes Awards mnannmdvmhlzrym scevmzbwunsmezsnmnwm Language DeveLoprnent Gend evdMevences7 ovueocnps Language DeveLoprnen Aduhs Can Sharp 2010 Speech Sounds revwew Speech Termino ogy B ends ov C us evs combhemons 01 consona Eg gen 1nnq meaxe dium mmmne Lumwlmnny M M Counnen Che eaetc Coamcu auon Eg bude ovbunev Mmengandxock Speech Deve opmeht Vowe Speech Deve opmeht Vawe Name 1 Sequence 73533 9511105 ltgtgb25 mm 9mm a matts Speech Deve opmeht Vowe nnevSequenoe rasab 951E059gmeslmmmzs man a ma39ts Phce Sequenee amasuuuuasuveasuanmumen aHpnsEhmbl pama Speech Deve opmeht Vwe Name 1 Sequence 75533 9511105 9g ms lmmmmzs gtme 9a mat2s Phce Sequence Gmtab9b hbab9v hrs9ahmbhmem aHpns1aNmaI o pama Conmmnt mend dune 1 Word pompquot MEL hmh neqm Sharp 2010 Speech Sound Development cognate Pa39rs AGE LEVEL 0 Same place and manner different in 0 b and p 0 t and d 0 s and z i y YACHT r r HOT i quot s 5m 1h AzunE Phonological Processes Coarticulation o Normal ways to simplify speech production 0 The influence of nearby speech sounds on 0 Examples sounds before 0 Final consonant deletion leave off final sound ten versus Ted nasaiization is anticipated 0 ball becomes ba 0 Consonant cluster reduction two consonants together just produce one of them 0 swing becomes wing or after 0 Assimilation substitute one sound throughout the word Knot versus tot nasaiization continues 0 dog becomes 909 0 Stopping fricatives become stops 0 Sing becomes ting 0 soup versus sip lip rounding on s Special Language Circumstances Blts and Pleces 0 Bilingualism Children 0 Tend to be slower in vocabulary acquisition Exam 1 0 Tend to be later in combining words in 2 and LOWGSt 61 3 word phrases o Highest 975 0 Early mixing of semantics syntax 0 Mean 83 0 International Adoption o Median 84 0 Arrested language development Sharp 2010 Various Bits of Information 0 Tonsils r Head and Neck Cancer Helen Sharp PhD Western Michigan University Obiectives At the end of this session you will be able to 0 Identify primary causes of cancer in the larynx and vocal tract 0 Identify symptoms of laryngeal cancer 0 Define the terms laryngectomy glossectomy and stoma 0 Describe the major change in speech and voice after total laryngectomy or glossectomy 0 Identify major sideeffects of radiation chemotherapy and surgery related to speech voice and swallowing 0 Discuss common approaches to restoring oral communication after total laryngectomy Laryngeal Cancer Incidence Rates 39 Mkrv w r g n 39v E m quotkquot v HH 3 ix y 0 00060009 co co 0000006 OM httpseercancergovfaststats Etiology of Oral Pharyngeal Laryngeal Cancers 0 Smoking 0 Alcohol 0 Smoking Alcohol 0 Smoking Chemical Exposure 0 Viral HPV 0 Reflux 0 Genetic Signs amp Symptoms of Laryngeal Cancer 0 Voice change hoarseness 0 Chronic cough throat clearing 0 Pain on swallowing 0 Weight loss 0 Ear pain 0 Difficulty breathing or stridor 0 Neck swelling or lump Sharp 2010 Oral Cancer 0 30000 new cases year 0 Signs amp Symptoms of Oral Cancer 0 Intraoral lesion 0 Intraoral pain 0 Dysphagia 0 Mass in neck 0 Weight loss 0 Persistent sore throat Erythroleukoplakia Leukoplakia Jar Smoker Precancerous leukoplakia Buccal Squamous Cell Carcinoma Smoker s Palate Sharp 2010 Advanced Laryngeal Carcinoma Advanced Laryngeal Carcinoma Treatment Options 0 Surgery 0 Radiation therapy 0 Chemotherapy 0 Combined therapy approaches SideEffects of Treatment 0 Surgery 0 Absent structures 0 Sensory motor changes 0 Radiation therapy 0 Tissue stiffening decreased mobility 0 Fatigue 0 Chemotherapy 0 Loss of sensation 0 Combined therapy approaches Role of Speech Language Pathologist o PreTreatment 0 Immediate PostTreatment 0 PostTreatment Normal Anatomy Sufm39c Lam ngccinmy Sharp 2010 Post Laryngectomy Alter Lu 39 gummy Post Laryngectomy Treatment Options 0 Electrolarynx You don t always die from tobaccoflv 0 Esophageal speech 0 Tracheoesophagealspeech httpwwwwebwhispersorgindexasp Esophageal Speech Traoheoesophageal Speech Tt39ztc hugtcsrgtphngeui Voice Prosthesis Role of Speech Language Pathologist o httpwwwwebwhispersorgindexasp Sharp 2010