In a case of bilateral vocal fold paralysis in the open position, it would be appropriate to state "the client is unable to phonate because the folds cannot abduct"
A neural impulse traveling from sensory receptors in the skin toward the spinal cord would be classed as an "efferent" impulse.
The Central Nervous System is composed only of the brain and spinal cord; the cranial nerves are not included in the CNS.
Dendrites differ from axons in that they are afferent extensions of neurons.
The brain sits atop the spinal cord and is composed of the cerebrum, cerebellum, and brain stem.
The five parts of the brain stem mediate and route signals between the Peripheral Nervous System and the spinal cord.
The establishment of the right and left hemisphere preferences for different functions is an example of the principle of "localization"
The left cerebral hemisphere is dominant for all language functions.
Broca's area, located in the left temporal lobe, is primarily associated with language comprehension.
The Fissure of Sylvius delineates the left and right hemispheres of the brain.
Among other functions, the parietal lobe perceives and integrates perceptual information.
Projection fibers connect the spinal cord and brainstem with cortical sensory and motor areas.
The Peripheral Nervous System is bidirectional, carrying information both to and away from the Central Nervous System.
The Autonomic Nervous System is divided into "sympathetic" and "parasympathetic" branches.
The spinal nerves are part of the Central Nervous System.
Damage or dysfunction of cranial nerve VIII can produce vertigo, dysequilibrium, nystagmus, and hearing loss.
Apraxia of speech is a group of speech disorders that are directly related to paralysis or weakness of speech musculature.
Spastic dysarthria results from bilateral damage to the upper motor neurons of the pyramidal tract (the motor cortex)
Compensatory alterations of prosody including pauses, slow speech rate and inappropriate equalization of stress are primary characteristics of apraxia of speech.
Prosodic abnormalities are secondary characteristics of apraxia of speech thought to be compensatory attempts to avoid articulatory errors.
Perceptual assessments have a number of inherent inadequacies that limit their value in diagnosis and in determining treatment priorities.
Advantages of acoustic assessment of motor speech disorders include their ready arability and ease of implementation and interpretation as well as the fact that they can be implemented with little or no specialized equipment.
Physiological assessment of motor speech disorders differs from perceptual and acoustic assessments in its use of a wide range of objective, physiological measures.
After a stroke causes a neurogenic speech disorder, it is essential to wait for the central nervous system to recover physiologically before beginning rehabilitation.
Rehabilitation during the acute phase of recovery for motor speech disorders initially may consist of feeding and dysphagia treatment for both children and adults.
Surgical and prosthetic approaches are the most common treatments for neurogenic motor speech disorders followed by behavioral treatment to teach the patient to use the prosthetics and accommodate to the surgical alterations.
Stroke is the most common cause of adult aphasia and many of the risk factors for stroke now are controllable.
The terms "hemiplegia" and "hemiparesis" are synonymous and are generally used interchangeably.
Language function is located in the left cerebral hemisphere and it is therefore considered the brain's dominant hemisphere.
"Nonfluent" aphasias typically are associated with damage located in the anterior portion of the brain, classically in "Broca's area"
Common symptoms of Wernicke's aphasia include effortful articulation, telegraphic speech, impaired prosody, and apraxia of speech.
Nonfluent aphasia syndrome include transcortical sensory aphasia, anomic aphasia, and conduction aphasia.
Paraphasias involve word substitutions which may be sound-based (phonemic) or meaning-based (verbal)
In thrombotic strokes, arterial walls before weakened by the effects of high blood pressure or loss of elasticity in aging and burst, damaging brain tissue causing intense inflammation and swelling.
People with aphasia often experience "catastrophic" reactions to frustration and this is especially true to those with severe global aphasia who are acutely aware of their limitations.
For some months immediately after a stroke a patient's whole presenting syndrome may evolve into another, usually milder, form of aphasia.
The first goal of evaluation in cases of aphasia is to determine if clinical intervention is feasible.
The formality of the initial assessment in cases of aphasia is governed primarily by the gender, ethnicity and attitude of the patient.
Melodic Intonation Therapy for aphasia attmenpts to recruit the undamaged hemisphere to take over functions normally performed by the damaged hemisphere. This is an example of a restorative treatment approach.
A person is said to have “dementia” if any of the following conditions exist: memory impairment, cognitive impairment, problems in processing language, producing speech, or recognizing objects.
A diagram showing the structure of the peripheral nervous system illustrates:
The physiology of speech.
Elements of PNS anatomy.
How the peripheral nervous system functions in speech production.
The cause of neurologically-based motor speech disorders.
None of the above.
As you read the neurologist’s report on a geriatric patient referred to you for voice problems associated with unilateral, right side vocal fold paralysis, you come across the phrase “PET scan results suggest dysfunction of spinal nerves innervating the dorsal side of the larynx.” This statement directly indicates:
The spinal nerves affected originate in the lumbar region.
It is likely that the problem lies in the Central Nervous System.
That damage is in the left cerebral hemisphere due to the principle of contralateral innervation.
It is the nerves controlling movement of structures on the rear side of the larynx that are affected
All of the above.
An otolaryngologist tells you that a client being referred to you cannot abduct her vocal folds. This means:
a. Her vocal folds are paralyzed.
b. She has laryngeal carcinoma.
c. She will have difficulty with voiced vs. voiceless consonant sound production.
Both answers a and c
None of the above
A neural impulse that travels from the motor cortex of the brain to activate muscle fibers used in speech is:
An afferent impulse
An abducted impulse
An adducted impulse
An efferent impulse
Part of a "sensory response feedback loop"
The Central Nervous System:
Is composed of the brain and spinal cord.
Includes the brain, spinal cord, and the cranial and spinal nerves.
Contains the Peripheral Nervous System as a subcomponent.
Is made up of 31 cranial and 12 spinal nerves.
This diagram depicts.
A neuron
Myelination
A synaptic cleft
An axon
The shaded area is:
a. The Medulla Oblongata
b. The Cerebellum
c. The Peripheral Nervous System
d. The Brain Stem
both b and c
The brain stem includes:
The basal ganglia
The cranial nerves
The cerebellum
The spinal cord
The reticular formation
A person with damage to the left brain hemisphere may suffer right side, unilateral vocal fold dysfunction. This illustrates the principle of:
Lateralization.
Functional redundancy.
Hemispheric dominance.
Contralateral innervation
Localization
For left-handed persons, the left cerebral hemisphere:
May or may not be dominant for processing of language tasks
Is almost never the dominant hemisphere for language comprehension and expression.
Is always dominant for speech and language related processing tasks.
Has no function in processing language.
After a car accident in which she sustained a significant blow to the left, frontal area of her head, an adult patient complains of problems producing speech sounds accurately.
a. She may well be malingering since a blow to that part of the brain would be more likely to cause problems with comprehension of language rather than with speech.
b. It is likely that Wernicke’s area has been damaged and you recommend a CT scan to confirm your diagnosis.
c. Diffuse damage to the parietal lobe is indicated.
d. You suspect Broca’s area may have sustained damage as a direct result of the impact.
e. Both answers b and c.
The Fissure of Rolando
Delineates the left are right cerebral hemispheres.
Defines the upper border of the temporal lobe.
Demarcates the occipital lobe.
Separates the frontal lobe from the parietal lobe
Separates the brain stem from the cerebellum.
Broca’s area
Is located in the left temporal lobe.
Is associated with coordination of speech movements
Perceives and integrates perceptual information.
In involved in comprehension of both oral and written language and in calculation for mathematics.
The lobe of the brain most closely associated with both oral and written language comprehension is:
a. Occipital lobe
b. Parietal lobe.
c. Frontal lobe.
d. Temporal lobe
e. Both b and c.
Association fibers act to:
Connect corresponding areas in left and right hemispheres.
Connect the spinal cord and brain stem with cortical sensory and motor areas.
Connect cranial and spinal nerves.
Connect areas within a hemisphere
Connect the central and peripheral nervous systems.
Peripheral Nervous System nerves are composed of:
Cranial nerves
Dendrite clusters
Spinal nerves
Axon bundles
Projection fibers
The Autonomic Nervous System:
a. Directly controls speech, voice and fluency due to its function in regulating the motor cortex and Broca's area
b. Is composed of 31 spinal and 12 cranial nerves
c. Is subdivided into "sympathetic' and "parasympathetic" branches
all of the above
both answers a and c
The ventral root of spinal nerves
a. Is efferent, sending motor information from the Central Nervous System to the muscles
b. Conducts sensory information to the Central Nervous System from the muscles.
c. Is an afferent root.
d. Directly controls the laryngeal muscles and is essential to the regulation of phonation.
e. Answers b, c and d.
Bilateral trigeminal lesions may leave the elevators of the mandible too weak to approximate the mandible and maxilla. This is likely to profoundly effect:
a. The ability to produce labial and lingual consonants and vowels.
b. Overall speech intelligibility.
c. Control of laryngeal musculature and phonation.
d. All the above.
e. Both answers a and b.
A client who has flaccid dysarthria is likely to display:
Awareness of articulatory mistakes with attempts at self-correction.
No muscular weakness or paralysis.
Inconsistent speech errors.
Weakness in the speech and/or respiratory musculature
All of the above
A condition frequently associated with Parkinson’s Disease is:
Spastic dysarthria.
Flaccid dysarthria.
Developmental apraxia.
Hypokinetic dysarthria.
Apraxia of speech.
Primary features of apraxia of speech include:
Hypotonia of affected muscles.
Breathy, harsh voice quality, impaired breath support with reduction in phonation time and difficulty in initiating speech.
Compensatory alterations of prosody.
Slowing of speech rate with an abnormal evenness in stress and spacing of syllables and words in order to avoid or prevent articulatory errors.
Visible and audible groping to achieve correct articulatory postures and sequences of postures needed to produce sounds and words.
Secondary features of apraxia of speech include:
a. Compensatory alterations of prosody.
b. Visible and audible groping to achieve correct articulatory postures and sequences of postures needed to produce sounds and words.
c. Slowing of speech rate with an abnormal evenness in stress and spacing of syllables and words in order to avoid or prevent articulatory errors.
Answers a and c only.
Major advantage(s) of perceptual assessment of dysarthric speech include:
Perceptual assessments assess the individual motor subsystems of the speech mechanism and define the underlying speech motor pathophysiology enabling development of optimal treatment programs.
Perceptual assessments highlight and quantify aspects of the speech signal that contribute to the perception of deviant speech.
Perceptual assessments provide objective documentation of the effects of treatment.
Perceptual assessments are readily available and do not require expensive equipment to implement
Perceptual assessments provide a three-dimensional display of voice frequency and amplitude as a function of time.
For the purpose of making an acoustic assessment of speech for a client with a motor speech disorder, spectrographic displays of data might be preferred over oscilloscopic displays because:
Spectrographic instrumentation is less expensive.
Oscilloscopic displays show only amplitude as a function of time while spectrographic displays show both frequency and amplitude
Spectrographic displays are more easily interpreted.
Data from spectrographic displays are objective while that from oscilloscopic displays are subjective.
Potential advantage(s) of physiological assessment in comparison with perceptual assessment for motor speech disorders include:
a. Improved objectivity of measurement.
b. Greater power for determining and measuring the specific affected subsystems of the speech motor system.
c. The relative inexpensiveness of equipment needed to implement physiological assessment methods.
Answers a and b only
Answers b and c only
The overall goal of treatment programs for people with neurogenic speech disorders is:
To accurately measure the specific affected subsystems of the speech motor system.
To improve intelligibility
To begin treatment as early as possible.
To motivate the client.
To allow a period of mutism in the early recovery period.
When selecting a nonspeech communication system for use during the early phase of recovery for motor speech disorders, it’s most important to consider:
The client’s gender.
The type of medical insurance the client has.
The patient’s cognitive, perceptual, and motor ability level
How long its been since the precipitating event.
Preexisting bilingual background.
The most widely used treatment approach(es) for neurogenic motor speech disorders is (are):
Compensatory approach.
Pragmatic approach.
Biofeedback/instrumental approach.
Surgical and prosthetic approaches.
Behavioral approach.
Uncontrollable risk factor(s) for stroke, the most common cause of adult aphasia, include:
a. Ethnicity
b. Diabetes
c. Hypertension
answers b and c only
A 54-year-old male client is referred to you for speech and language assessment. He was previously hospitalized after a sudden onset of total right-side paralysis and loss of speech. As you read the client’s file, you are NOT surprised to see:
a. Reference to a stroke in the right cerebral hemisphere.
b. A notation that the client has “hemiparesis.”
c. A neurologist’s report detailing “thromboembolic stroke involving the left middle cerebral artery.
Answers b and c only.
The right cerebral hemisphere:
When damaged, is commonly associated with aphasia.
Appears to be involved in language processing and function to a greater extent than was previously thought
Is the dominant hemisphere for language processing and function.
Is the nondominant cerebral hemisphere.
Has a subservient role and cognition and language processing compared to the left hemisphere.
Damage in the frontal lobe is most likely to produce:
a. Problems in articulation and motor programming.
b. Speech that is slow and labored.
c. Abnormalities in normal speech flow and intonation.
Answers a and c only
“Fluent” aphasias include:
a. Broca’s aphasia.
b. Transcortical motor aphasia.
c. Wernicke’s aphasia.
Both b and c
Transcortical motor aphasia differs from Broca’s aphasia in that
People with Broca’s aphasia have normal prosody and speech with relatively good language comprehension unlike transcortical motor aphasia.
Those with transcortical motor aphasia have better speech imitation skills than those of people with Broca’s aphasia but otherwise display similar symptoms
All language and speech functions are affected in transcortical motor aphasia, which is the most severe form of aphasia, unlike Broca’s aphasia which is the mildest form.
Transcortical motor aphasia is characterized by word-finding difficulties (anomia) and fair to good language comprehension, while those with Broca’s aphasia display fluent but meaningless speech, impaired comprehension, and jargon.
Verbal agnosia would be most likely to be associated with:
Occipital lobe dysfunction.
Damage or dysfunction in Broca’s area.
Motor speech disorders.
Disorders caused by traumatic injury to the Motor Cortex.
Damage or dysfunction in Wernicke’s area
Thrombotic strokes:
Result from bursting of arterial walls due to high blood pressure or loss of elasticity due to aging.
Cause fluent aphasias while embolic strokes cause nonfluent types.
Are the result of plaque buildup which restricts vessels and produces clots that block them entirely, cutting off blood to the area served
Are caused by rupture of sacular aneurysms which are blisterlike balloonings of arteries occurring at vessel branch points.
Are more common than any other type.
When a person experiences a stroke and associated aphasia:
a. Major problems for the nonaphasic spouse include lack of time alone, money, and dealing with the spouse’s dependency.
b. Communication difficulties are the most important problem other family members are likely to experience.
c. The nonaphasic spouse often begins to exhibit more concrete thinking, lose initiative, and becomes less inhibited.
During the period of spontaneous recovery, the presenting type of aphasia often evolves into a milder form. Such evolution into a milder form is most likely in cases of:
Conduction aphasia.
Global aphasia
Transcortical motor aphasia.
Broca’s aphasia.
Anomic aphasia.
The first goal of evaluation in cases of aphasia is to:
Determine if clinical intervention is feasible
Identify preexisting conditions that may have brought on the stroke.
Determine the type of aphasia.
Ascertain the likely period of spontaneous recovery.
Measure the severity of the condition.
Assessments made shortly after an aphasic patient’s stroke:
Are in-depth evaluations employing a variety of formal assessment measures.
Are less structured and reliant on bedside observations of the patient
Rely on a combination of informal and formal tests of language ability.
Are more likely to be valid measures than those made several months post-stroke.
Are not recommended.
You observe a therapy session in which an aphasic adult works together with his wife in simulated everyday requesting situations. The therapist encourages the client to use a variety of communication strategies including gestures and writing. The client is considered to have “succeeded” if his wife understands the message regardless of its form. This is an example of:
Promoting Aphasic Communication Effectiveness
Copying and Recalling Therapy.
Complexity Account of Treatment Efficacy.
Melodic Intonation Therapy.
Visual Action Therapy.
In order to meet the American Psychiatric Association’s definition of “dementia:”
a. Both short and long-term memory must be impaired.
b. Cognitive impairments affecting abstract thought, judgment, and executive function should be present.
c. The patient displays symptoms of aphasia, apraxia, or agnosia.
All the above.
Symptom(s) consistent with the presence of Broca’s aphasia include:
Effortful articulation, telegraphic speech, impaired prosody, apraxia of speech
All language and speech functions affected, verbal stereotypes, severe deficits in comprehension and production, most severe form of aphasia.
Word-finding difficulties (anomia), fair to good language comprehension.
Difficulty imitating modeled speech, normal prosody and speech, relatively good comprehension.
Fluent but meaningless speech, impaired comprehension, jargon, word-finding difficulty (anomia) good articulation and intonation.
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