CD 5671 Neurogenic Disorders

Introduction Packet

Course Syllabus & Overview

COURSE DESCRIPTION

The differential diagnosis and management of speech, language, cognition, and swallowing disorders which result from neurological dysfunction.  Special consideration will be given to age-, gender-, and culture-related differences, as well as to common diagnoses such as stroke, head injury, dementia, and degenerative diseases (Meets ASHA II-B).

TEXTS

• Brookshire, R. H. (1997). Introduction to neurogenic communication disorders (5th Edition). St. Louis: Mosby.
• Logemann, J. A. (1998). Evaluation and treatment of swallowing disorders (2nd Edition). Austin: Pro-Ed.
• Yorkston, K. M., Miller, R. M., & Strand, E. A. (1995). Management of speech and swallowing disorders in degenerative diseases. Tucson: Communication Skill Builders
• Yorkston, K. M., Beukelman, D. R., Bell, & Strand, E. A. (1999) Management of motor speech disorders in children & adults. Austin: Pro-Ed.

COURSE OBJECTIVES

Students completing the course will

1. understand the anatomical and neurological support system for communication and deglutition
2. identify characteristics of normal communication and deglutition with appreciation for diversity in communicative and eating behaviors
3. identify and characterize
   1. pathophysiology and impairments contributing to communicative and swallowing disabilities,
   2. functional limitations in communication and deglutition, and
   3. social limitations resulting from communication and swallowing disorders
4. gain skill in selecting and utilizing clinical tools for the assessment of communication and deglutition
5. gain skill in identifying and implementing strategies for managing communication and swallowing impairments, disabilities, and resulting handicaps
6. understand the impact of a variety of common neurological disorders on communication and deglutition
7. appreciate the role of the speech language pathologist across health care settings including
   1. participation in and facilitation of patient and family centered service provision teams
   2. health promotion and wellness

COURSE REQUIREMENTS

Exams.  Four midterms and a final exam will be administered.  Each midterm exam will be worth 100 points and will be administered during scheduled class meetings.  "Cheat sheets" of designated lengths may be used during the midterms (see below).  The final exam, worth 200 points, will be "take home," due on the last day of class.

Portfolio.  Each student will submit a portfolio documenting that s/he has met the course objectives. The portfolio may take several forms depending on individual student goals.  Students may choose to develop a clinical portfolio to serve as a handbook for future clinical experiences, or a professional portfolio to provide evidence of competence to potential employers.  Regardless of format, the portfolio should be meaningful in content, organized in structure, and professional in appearance. The portfolio will be worth 100 points, and will be scored based on the following criteria:

• table of contents (5 points)
• statement of purpose (10 points)
• quality of materials for supporting purpose of the portfolio (70 points)
• organization, style, and professionalism (15 points)

Competencies. Each student will demonstrate competence in the administration and interpretation of various assessment tools, and in the use of several treatment techniques:

• Modified barium swallow (10 points)
• Differential diagnosis of speech and language disorders based on case history and assessment findings (10 points)
• Administration and scoring of one standardized language test (10 points)
• Administration and scoring of one standardized speech test (10 points)
• Development of an assessment report (10 points)
• Demonstration of three swallowing techniques: supraglottic swallow, Mendelsohn, thickened liquids (10 points)
• Demonstration and explanation of one language treatment technique (10 points)
• Demonstration and explanation of one speech treatment technique (10 points)

Class participation.  Because of the intense nature of this class, attendance and participation in class activities is critical to the learning process.  Each student may earn up to 20 points for consistent attendance and active participation in in-class and internet based activities.

Extra credit.  A list of extra credit opportunities are available on the class website.  Each student may earn up to a maximum of 20 extra credit points.
 

GRADING SCALE 760 + 745-759 730-744

A A- B+

B B- C+ C F

715-729 700-714 685-699 670-684 Below 670

 

COURSE SCHEDULE
Date	Topic	Readings
6/5	Introduction & Course Overview	Concept map Murphy’s Inner World of Aphasia (Reserve)
6/6, 6/7	Support System	Brookshire Ch 1 Groher Ch 2 (reserve) Packet 1
6/9	Diversity in normal adult communication	Packet 2
6/12	Exam I: Obj 1 & 2	Cheat Sheet: 3 single pages
6/13	Cognitive disorders	Brookshire Ch 7, 8, 9 Packet 3
6/14, 6/15	Aphasia	Brookshire Ch 4 pg 127-156 Packet 4
6/19, 6/20	Speech Disorders	Yorkston 99 Ch 1, 3, 4 Brookshire  Ch 10 Packet 5
6/21,6/22	Patholophysiology/Etiologies	Logemann pg 307-318, 332-336 Yorkston 99 pg 65-114, 156-157, 188-139 Yorkston 95 Ch 1, 2 Packet 6
6/26	Exam II: Obj 3 & 6	Cheat Sheet: 5 single pages
6/26-6/29	Assessment of Neurogenic Disorders	Brookshire Ch 2, 3, 4 Yorkston 99 Ch 5, 6 Packet 7
7/6, 7/7, 7/12	Treatment of Neurogenic Disorders	Brookshire 5, 6 Yorkston 99 Ch 7 -13 Packet 8
7/13	Exam III: Obj 4 & 5	Cheat Sheet: 5 single pages
7/13 - 7/19	Swallowing Disorders	Logemann Ch 2, 3, 4, 5, 6, 9, 10 Packet 9
7/20	Exam IV: Obj 1- 6	Cheat Sheet: 3 single pages
7/24, 7/25, 7/26	Management across care settings Case Studies	Johnson (reserve) Logemann Ch 13 Packet 10 Portfolios Due 7/24
7/27	Course Wrap-up	Final Exams Due: Obj 1 - 7

CONCEPTUAL FOUNDATIONS

Definitions

Aphasia:    a multimodality disruption of language performance resulting from neurological insult. While some basic underlying cognitive processes such as attention may be impaired in aphasia, higher order processes such as intellect and personality are generally intact.

Amnesia: Disruption of memory processing.  It may be manifest by inability to store new memories or to retrieve previously stored memories.

Apraxia of speech: neurogenic speech disorder resulting from impairment of the capacity to program sensorimotor commands for the positioning and movement of muscles for the volitional production of speech.  It can occur without significant weakness or neuromuscular slowness, and in the absence of disturbances of conscious thought or language.

Dementia: chronic, progressive deterioration of intellect, personality, memory, and communicative function resulting from nervous system dysfunction.

Dysarthria: a collective name for a group of speech disorders resulting from disturbances in muscular control over the speech mechanism due to damage of the central or peripheral nervous system.  It designates problems in oral communication due to paralysis, weakness, or incoordination of the speech musculature (Darley, Aronson, & Brown). Dysarthria is defined perceptually (heard, seen or felt), NOT instrumentally (McNeil, 1998)

Dysphagia: symptom: difficulty swallowing.

Motor Speech Disorders: disorders of speech resulting from neurologic impairment affecting the motor programming or neuromuscular execution of speech (Duffy, 1995)

Sign: disruption of function or abnormal condition observed by a diagnostician as indicative of disease

Symptom: disruption of function or experience of discomfort as described by the affected individual
 
 

Characterization of Chronic Conditions	The WHO system of impairment, disability, and handicap is the most widely used and recognized.  It is in the process of being revised to use the terms impairment, activity, and participation.  The following system was adopted from Yorkston et al. (1999) as an elaboration of the WHO system.
Definition	How it is observed or identified	Examples for Language	Examples for Speech	Examples for Cognition	Examples for Swallowing
Pathophysiology	Laboratory tests, imaging studies	Stroke	Degeneration of motor neurons	TBI	carcinoma
Impairment	Detailed inspection of specific physiological systems	Impaired phonological processing	muscle weakness	impaired ability to disengage attention	reduced strength and ROM of vocal cords
Functional limitation	Observation of performance	Impaired auditory comprehension	imprecise articulation	perseveration	reduced vocal cord adduction
Disability	Observation of performance across specific conditions	Inability to participate in large group conversations	reduced comprehensibility	unable to complete tasks requiring sequential or parallel steps	aspiration of thin liquids
Societal limitation	Self-report, observation of change in lifestyle or acquired limitations	No longer attends church social events	Has to resign from job as radio announcer	Drops out of college	None, individual continues normal activities with compensatory strategies

 

Methods of Observation
Level	Definition	Methods	Examples	Features
Perceptual	characterized by perceptual judgments unmediated by significant instrumentation	auditory visual tactile	slurred speech semantic paraphasias inability to follow commands	may be best indicator of disability some disorders are defined by perceptual characteristics
Acoustic	analysis of the acoustic energy of a speech sample	speech spectrogram visipitch computerized speech analyzers	fundamental frequency voice onset time formant transitions	particularly useful for analyses of phonatory features may be more sensitive to subtle variations in the acoustic signal becoming more common in the clinical setting
Kinematic	analysis of the movements of articulators	strain gauges palatography	displacement velocity acceleration interarticulatory timing	useful in examination of the upper articulators may be more sensitive to subtle motor impairments
Physiologic	instrumental measures of physiologic characteristics	EMG Spirometry EGG Nasometry PET	muscle activity vital capacity blood flow	almost always measures at level of impairment or pathophysiology

It is not possible to perfectly predict from one level to another.  While prolonged segment durations in an acoustic signal may be related to prolonged movement times, it is not necessarily so.  Individuals with reduced articulatory displacements and velocities may have perceptually normal speech, and normal EMG patterns.  Each level of description can be useful.

REFERENCES