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Speech Pathology

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nad ash

on 20 September 2016

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Transcript of Speech Pathology

Speech-Language Pathology In-Service
Speech-Language pathologist scope of practice
Speech-Language pathologist Role in tertiary care hospital
Neural Control of Speech-Language and Swallowing and it’s Impact
Language Assessment and Management
Dysphagia Assessment and Management
When to refer for Speech-Language/Swallowing assessment.
SLP Professional Role
1. Language (comprehension & expression): syntax, sematnics, pragmatics, literacy
2. Speech: articulation, apraxia of speech, dysarthria, ataxia, dyskinesia
3. Voice: phonation quality, pitch, loudness, and respiration
4. Cognition: attention, memory, sequencing, problem solving, and executive functioning
5. Feeding and Swallowing: Oral, Pharyngeal, Laryngeal, and Esophageal Dysphagia. In addition to Oral Motor functions
Role of SLP's in Feeding and Swallowing
1. Clinical swallowing and feeding evaluation

2. Instrumental assessment of swallowing function

3. Identifying signs of disorders in the upper Aerodigestive tract

5. Determining appropriate dismissal criteria

6. Serving as an integral part of a team as appropriate

7. Counseling patients and their families
Roles of SLP's in Communication Disorders
1. Screening individuals who present with language and communication difficulties

2. Determining the need for further assessment and/or referral for other services


Neural Control of the swallow
3.Diagnosing the presence or absence of language/speech deficits

4.Developing treatment plans, providing treatment, documenting progress, and determining appropriate dismissal criteria
Cortical areas of control for swallowing include:
Primary motor cortex
Supplementary motor area
Anterior cingulated cortex. (Ludlow 2005)


Studies showed that swallowing is represented in both cortical hemispheres with people having a dominant swallowing hemisphere ( not necessarily the same as handedness)
The brain communicates with muscles via upper motor neurons (UMN) and lower motor neurons (LMN)
UMN communicate signals from the brain to the LMN (Cranial Nerves whose axons leave from the brainstem) which are the final neurons connecting to muscle fibers
Swallowing is controlled by both cortical and brainstem regions
Impact of Neurological Deficits on the swallow
Left Hemisphere:

Swallow Apraxia
Pharyngeal Swallow may be motorically normal
Right Hemisphere

Increased duration of oral phase
Greater delay in pharyngeal trigger
Pharyngeal dysmotility
Subcortex

Mild delay in pharyngeal trigger
Impairment in timing of pharyngeal component
Cerebellum

Uncoordinated swallow
Poor bolus control
Impaired sequencing timing
Brainstem Deficits

Delayed pharyngeal swallow
Reduced hyolaryngeal excursion with cricopharyngeal dysfunction
Medulla
Absent pharyngeal swallow
Reduced hyolaryngeal excursion
Unilateral vocal fold paresis/paralysis
Pons:
Neural Control of Speech and Language
Located in the left hemisphere
Associated with speech production and articulation
Ability to articulate ideas, use words accurately in spoken and written language
Broca’s Area
Wernicke’s Area
In the Posterior Superior Temporal Lobe connects to Broca’s area via a neural pathway
Primarily involved in the comprehension of speech and language
Associated with language processing, whether it is written or spoken
Angular Gyrus
Allows us to associate multiple types of language-related information (Auditory, Visual or Sensory)
Located in close proximity to other critical brain regions

(the Parietal lobe: processes tactile sensation, the Occipital lobe: involved in visual analyses and the Temporal lobe: processes sounds)

Allows us to associate a perceived word with different images, sensations and ideas.
Use of spontaneous speech and motor speech control
Words uttered very slowly and poorly articulated
Speech may consist primarily of nouns, verbs or important adjectives.
Difficulty with repetition and a severe impairment in writing.
In some patients, the understanding of spoken and written language may be preserved
Affect speech comprehension (information is heard through the auditory cortex but when it arrives at the posterior association areas, the information cannot be sufficiently “translated.” )
Marked By:
Fluent, grammatically correct speech with little meaning
Poor comprehension
Paraphasic errors:
semantic (calling a spoon a fork)
literal (calling a spoon a spood)
Neologisms (or nonsense words)

Leads to Logopenic progressive aphasia (LPA)/Anomic Aphasia.
Typical symptoms include:
Slowed speech with normal articulation
Impaired comprehension of sentence syntax
Impaired naming of things
We will Discuss
Speech Pathologist Role in Tertiary Care Hospital

Statistics:
Top 5 primary medical diagnoses of acute care patients CVA: 35%, Respiratory diseases: 13%, Head injury: 6% Hemorrhage/Injury: 5%, CNS diseases: 4%
neurological disease/dysfunction (e.g., traumatic brain injury, cerebral palsy, cerebral vascular accident, dementia, Parkinson's disease, amyotrophic lateral sclerosis)
Top 5 Functional Communication Measures scored by SLPs working in acute care hospitals Swallowing: 77% , Spoken Language Comprehension: 24%, Spoken Language Expression: 23%, Motor Speech: 19%, Memory: 13%


Dysphagia
Definition
Swallowing Phases
Systems Involved: Nervous System, Respiratory System, GI System

Dysphagia Assessment
Case History
Feeding/swallowing History
Patient/caregiver interview
Assessment:
Patient’s status: Alertness, orientation, posture in bed, communication abilities.
Oral Mechanism Examination: Cranial Nerve Testing
Bed Side Swallowing Assessment:
Oral Phase
Pharyngeal Phase
Trached patients: Evan’s Modified Blue Dye Test
Objective measures:
MBSS

Dysphagia Management
Oral Vs. Non-oral: NGT, PEG, GT
Diet Modification:
Compensatory Strategies:
Therapy:
Oral-Motor Exercises: strengthen oral musculature
Sensory Exercises: Improve sensory functions
Swallowing Exercises: Improve the swallow mechanism (work on multiple muscles simultaneously)
Recommendation:
Referral: GI, ENT, OT, Dietician, Psychologist

Language Assessment
Screening: assess oral motor functions, comprehension and production of spoken and written language, and cognitive aspects of communication
Comprehensive Assessment:
Case History
Review of auditory, visual, motor, cognitive, and emotional status
Standardized/ Non-standardized assessment of the Patient's verbal expression, written expression, auditory comprehension, reading comprehension.
Functional assessment: evaluate impact of impairment on everday functioning.
Assessment of motor speech function
Identification of effective compensatory techniques and strategies (AAC)
Language Management
Restoring language abilities by addressing impaired communication modalities and focusing on training in those areas
Strengthening intact modalities and behaviors to support and augment communication
Teaching strategies that compensate for language impairments
Training family and caregivers to communicate with the patient
Facilitating generalization of skills and strategies in all communicative contexts

When to Refer to SLP Services
Diagnosis of:

Stroke (Cerebral, Brainstem, Cortical, and Subcortical)
Neurodegenerative Diseases
Neurosurgical procedures affecting the Brain

When to Refer to SLP Services
Symptoms that indicate the need of a Swallowing Referral:
Recent history of reduced LOC, alertness, orientation
Drooling and/or pooling of saliva
Sudden weight loss
Recurrent chest infections, constant copious chest secretions in absence of diagnosed lung disease
Coughing or choking during eating and/or drinking
Tracheostomy, Hx of prolonged intubation, mechanical ventilation

THANK YOU !
Amber Hassan, SLP-M.Sc.,CCC
Maha Al-Delaigan, SLP-M.Sc., CFY
Nadia Ashour, ASLP, B.S
Speech-Language Pathology Team
Brainstem control of swallowing include:

Nucleus Tractus Solitarius (NTS): sensory neurons of the involuntary swallow process

Nucleus Ambiguus: motor neurons of the involuntary swallow process

Cognitive contribution to the process of eating (from cortex)
When to Refer to SLP Services
Symptoms that indicate a Speech/Language Referral:
Unresponsiveness to all external stimuli
No purposeful speech
Impaired attention and memory with impulsivity
Limited communication (social behaviors, paying attention, responding appropriately, understanding abstract information)
Limited memory
Difficulty expressing basic needs and managing emotions
Difficulty following directions
Full transcript