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Contents
Preface xix
CI:iAPTER 1
Anatomy, Neuroanatomy, and Physiology of the Speech Mechanism 1
Respiration: Structures and Processes 1 Respiration Patterns During Speech Production 1
Framework of Respiration 2
Muscles of Respiration 6
Phonation: Structures and Processes 8 Larynx 8
Laryngeal Structures and Cartilages 9
Intrinsic Laryngeal Muscles 10
Extrinsic Laryngeal Muscles 12
Vocal Folds 12
Physiology of Phonation 13
Neuroanatomy of the Vocal Mechanism 14
Resonation and Articulation: Structures and Processes 15 Fundamentals of Resonation 15
Fundamentals ofArticulation 17
Neuroanatomy and Neurophysiology: The Nervous System 28
Neurons and Neural Transmission 28 Anatomy and Physiology ofNerve Cells 28
The Peripheral and Autonomic Nervous Systems 31 Peripheral Nervous System 31
Autonomic Nervous System 38
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vi • CON TEN T S
The Central Nervous System 40 Basic Principles 41 The Brainstem 41 Reticular Activating System 43
Diencephalon 43
Basal Ganglia 44 The Cerebellum 45 The Cerebrum 46
Pyramidal System 51
Extrapyramidal System 54 Connecting Fibers in the Brain 55 The Cerebral Ventricles 56 Protective Layers of the Brain 57
Cerebral Blood Supply 57
Chapter Highlights 61
Study and Review Questions 62
References and Recommended Readings 66
Study and Review Answers 66
CHAPTER 2
Physiological and Acoustic Phonetics: A Speech Science Foundation 69
Basic Principles and Definitions 69 Definitions 70
Anatomy and Physiology: A Brief Review 71
Phonetic Transcription 72 The International Phonetic Alphabet 72
Broad Phonetic Transcription 72 Narrow Phonetic Transcription 72
Production of Segmentals: Consonants and Vowels 7S Consonants and Vowels: The Syllable as a Unit 75 Classification Systems 76
Consonants 78
Vowels 84
The Effects of Context in Speech Sound Production 88 Dynamics of Speech Production 88
Suprasegmentals 88
Speech Science: Physiological Phonetics, Acoustic Phonetics, and Speech Perception 90 Acoustics: Basic Definitions 90
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CON TEN T S • vii
Introduction to the Study of Sound and Acoustic Analysis of Speech 92 Sound Wave Generation and Propagation 93
Frequency and Pitch 93
Amplitude and Loudness 94
Sound Pressure Level and Hearing Level 94
Introduction to the Acoustic Analysis ofSpeech 95
Chapter Highlights 97
Study and Review Questions 98
References and Recommended Readings 101
Study and Review Answers 102
CHAPTER 3
language Development in Children 105
Terms and Definitions 105 Morphology 106
Syntax 107
Semantics 108
Pragmatics 109
Normal Language Development: Developmental Milestones 111 Role of the Caregiver in Language Development 111
Birth to 1 Year 112
1-2 Years 114
2-3 Years 117
3-4 Years 118
4-5 Years 121
5-6 Years 123
6-7 Years 125
7-8 Years 126
Development ofLiteracy Milestones 127
Language Development and Education in the School-Age Years 127
Theories of Language Development 128 Behavioral Theory 129
Nativist Theory 130
Cognitive Theory 132
Information -Processing Theory 134
Social Interactionism Theory 136
Chapter Highlights 138
Study and Review Questions 139
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viii • CON TEN T S
References and Recommended Readings 145
Study and Review Answers 147
CHAPTER 4
Language Disorders in Children 149
Introduction to Children with language Disorders 149 Description of Language Disorders in Children 150
Risk Factors for Language Disorders in Children 150
Children with Specific language Impairment 151 Characteristics of Children with Specific Language Impairment 151
Children with language Problems Associated with Physical and Sensory Disabilities 153 Intellectual Disabilities 154
Autism Spectrum Disorders 155
Brain Injury 157
Children with language Problems Related to Physical and Social-Environmental Factors 160 Language Problems Related to Poverty 160
Language Problems Related to Neglect or Abuse 161
Language Problems Related to Parental Drug and Alcohol Abuse 162
Language Problems Related to Attention-Deficit/Hyperactivity Disorder 164
Assessment Principles and Procedures 166 Language Assessment: General Principles and Procedures 166
Assessment of Infants and Toddlers 169
Assessment of Preschool and Elementary-Age Children 172
Assessment of Adolescents 176
Treatment Principles and Procedures 182 General Principles 183
Specific Techniques and Programs 184
Augmentative and Alternative Communication 190
Chapter Highlights 194
Study and Review Questions 195
References and Recommended Readings 199
Study and Review Answers 205
CHAPTER 5
Articulatory-Phonological Development and Speech Sound Disorders 207
Foundations of Articulation and Phonology 207 Basic Definitions 208
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CON TEN T S • ix
Distinctive Features Paradigm 209
Place-Voice-Manner Paradigm 209
Acquisition of Articulatory and Phonological Skills: Typical Development 211 Theories of Development 211
Infant Development: Perception and Production 214
Typical Articulation Development in Children 215
Typical Phonological Development in Children 217
Speech Sound Disorders 219 General Factors Related to Speech Sound Disorders 219
Description ofArticulatory Errors 220
Organically Based Disorders 221
Assessment of Speech Sound Disorders 225 Screening 226
General Assessment Objectives 226
Related Assessment Objectives 226
Assessment Procedures 227
Specific Components of an Assessment 228
Scoring and Analysis ofAssessment Data 230
Treatment of Speech Sound Disorders 232 General Considerations in Treatment 232
Motor-Based Approaches 233
Linguistic Approaches 235
Phonological Awareness Treatment 238
Adults Who Speak English as a Foreign language 239 Principles ofAssessment 239
Principles ofAccent Training 240
Chapter Highlights 242
Study and Review Questions 243
References and Recommended Readings 247
Study and Review Answers 252
CHAPTER 6
Fluency and Its Disorders 253
Fluency and Stuttering: An Overview 253 Definition and Description of Fluency 254
Definition and Description of Stuttering 254
Forms of Dysfluencies 257
Theoretical and Clinical Significance of Dysfluencies 258
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x • CONTENTS
Incidence and Prevalence of Stuttering 258
Onset and Development of Stuttering 261
Associated Motor Behaviors 262
Associated Breathing Abnormalities 262
Negative Emotions and Avoidance Behaviors 263
The Loci of Stuttering 263
Stimulus Control in Stuttering 264
People Who Stutter and Their Families 266
Theories of Stuttering 267
Assessment and Treatment of Stuttering 272 Assessment of Stuttering 272
Treatment of Stuttering 274
Neurogenic Stuttering 279 Definition and Etiology of Neurogenic Stuttering 279
Description of Neurogenic Stuttering 280
Assessment and Treatment of Neurogenic Stuttering 280
Cluttering 281 Definition and Description of Cluttering 281
Assessment and Treatment of Cluttering 282
Chapter Highlights 283
Study and Review Questions 284
References and Recommended Readings 288
Study and Review Answers 290
CHAPTER 7
Voice and Its Disorders 291
Vocal Anatomy and Physiology 291 The Larynx 291
Voice Changes Through the Life Span 296
Vocal Pitch, Volume, and Quality 297 Pitch 298
Volume 298
Quality 298
Evaluation of Voice Disorders 300 Case History: Purposes and Goals 301
A Team-Oriented Approach 301
Instrumental Evaluation 301
Perceptual Evaluation 306
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CON TEN T S • xi
Disorders of Resonance and Their Treatment 309 Hypernasality 310
Hyponasality 310 Assimilative Nasality 311
Cul-de-Sac Resonance 311
Treatment Principles 312
Disorders of Phonation and Their Treatment 313 Carcinoma and Laryngectomy 313 Physically and Neurologically Based Disorders of Phonation 317
Abuse-Based Disorders of Phonation 326
Disorders of Loudness and Pitch 332
Psychogenic Voice Disorders 334
Gender Issues and the Voice 335
Chapter Highlights 337
Study and Review Questions 338
References and Recommended Readings 343
Study and Review Answers 344
CHAPTER 8
Neurologically Based Communicative Disorders and Dysphagia 347
Aphasia 347 Foundational Concepts 348
Definition and Classification ofAphasia 348
Nonfluent Aphasias 349
Fluent Aphasias 351
Subcortical Aphasia 354 Aphasia in Bilingual Populations 355
Aphasia in Left-Handed Individuals 356
Assessment of Aphasia 356 Treatment ofAphasia 360
Alexia, Agraphia, and Agnosia 363
Apraxia of Speech 364 Definition and Distinctions 365
Neuropathology ofAOS 365
General Symptoms ofAOS 365
Communication Deficits in AOS 366
Assessment ofAOS 367
Treatment ofAOS 368
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xii • CON TEN T S
The Dysarthrias 369 Definition of the Dysarthrias 369
Neuropathology of the Dysarthrias 369 Communicative Disorders Associated with Dysarthria 369
Types of Dysarthria 370 Assessment of the Dysarthrias 374
Treatment of the Dysarthrias 375
Dementia 377 Definition and Classification of Dementia 377 Dementia of the Alzheimer Type (DAT) 378
Frontotemporal Dementia (Including Pick's Disease) 379
Dementia Associated with Parkinson's Disease 380 Dementia Associated with Huntington's Disease 381 Infectious Dementia 382
Other Forms of Dementia 383 Assessment of Dementia 384
Clinical Management of Dementia 384
Right Hemisphere Syndrome 386 Foundational Concepts 386 Symptoms of Right Hemisphere Syndrome 387
Assessment of Right Hemisphere Syndrome 388
Treatment of Right Hemisphere Syndrome 389
Traumatic Brain Injury (TBI) 390 Definition and Incidence of TBI 390 Common Causes ofTBI 391
Types and Consequences of TBI 391 General Assessment of Patients with TBI 392
Assessment of Communicative Deficits Associated with TBI 393
Treatment of Patients with TBI 393
Swallowing Disorders 395 Nature and Etiology of Swallowing Disorders 396 Normal and Disordered Swallow 396
Assessment of Swallowing Disorders 398 Treatment of Swallowing Disorders 399
Chapter Highlights 403
Study and Review Questions 404
References and Recommended Readings 408
Study and Review Answers 413
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CON TEN T S • xiii
CHAPTER 9
Communication Disorders in Multicultural Populations 415
Foundational Issues 416 Demographic Data 416
General Cultural Considerations 416
ASHA Guidelines Regarding Multicultural Issues 418
Speech-language Characteristics of ClD Clients 419 Dialects ofAmerican English 419
African American English 420
Characteristics ofAAE Morphology, Syntax, and Articulation 421
Spanish-Influenced English 422
English Influenced by Asian Languages 427
language Differences and language-learning Disabilities 429 Differentiating Language Differences From Language-Learning Disabilities 430
Acquiring a Second Language 431
Basic Interpersonal Communication Skills and Cognitive-Academic Language Proficiency 434
Assessment of ClD Clients 436 Legal Considerations 437
Considerations in the Use of Standardized Tests 437
Alternatives to Standardized Tests 440
Working with Interpreters in the Assessment Process 442
Treatment Considerations in Service Delivery to ClD Clients 443 Children with Language-Learning Disabilities 444 Prevalence and Incidence Rates of Medical Conditions and Communication Disorders 445
Potential Sociocultural and Linguistic Barriers to Service Delivery 446 Adults with Neurologically Based Disorders ofCommunication 446
Chapter Highlights 450
Study and Review Questions 451
References and Recommended Readings 457
Study and Review Answers 461
CHAPTER 10
Audiology and Hearing Disorders 463
Anatomy and Physiology of Hearing 464 The Outer Ear 464 The Middle Ear 464
The Inner Ear 465
The Auditory Nervous System 466
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xiv • CON TEN T S
Acoustics: Sound and Its Perception 468 The Source of Sound 468
Sound Wav~s 469
Frequency and Intensity 470
Sound Pressure Level and Hearing Level 471
The Nature and Etiology of Hearing loss 472 Normal Hearing 472
Nature of Hearing Impairment 473
Conductive Hearing Loss 473
Sensorineural Hearing Loss 476
Mixed Hearing Loss 480
Auditory Nervous System Impairments 482
Assessment of Hearing Impairment 485 Audiometry: Basic Principles 485
Pure-Tone Audiometry 485
Speech Audiometry 486
Acoustic Immitance 486
Other Methods 487
Hearing Screening 488
Assessment of Infants and Children 488
Interpretation of Hearing Test Results 489
Management of Hearing Impairment 491 Communication Disorders of People with Hearing Impairment 491
Aural Rehabilitation: Basic Principles 495
Amplification 495
Communication Training 500
Chapter Highlights 505
Study and Review Questions 506
References and Recommended Readings 510
Study and Review Answers 512
CHAPTER 11
Assessment and Treatment: Principles of Evidence-Based Practice 515
Evidence-Based Practice in Speech-language Pathology 515
Standard Assessment Procedures 516 Screening 517
Case History 517
Hearing Screening 520
Orofacial Examination 520
Interview 520
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CON TEN T S • xv
Speech and Language Sample 521
Obtaining Related Assessment Data 523
Principles of Standardized Assessment 524 Nature and Advantages of Standardized Assessment 524
Limitations of Standardized Tests 525
Prudent Use of Standardized Tests 525
Types of Scores in Standardized Assessment 526
Validity and Reliability of Standardized Tests 527
Rating Scales, Questionnaires, and Developmental Inventories 530 Rating Scales 531
Questionnaires 531
Developmental Inventories 532
Alternative Assessment Approaches 532 Functional Assessment 532
Client-Specific Assessment 534
Criterion-Referenced Assessment 534
Authentic Assessment 535
Dynamic Assessment 535
Portfolio Assessment 535
Comprehensive and Integrated Assessment 535
Treatment of Communication Disorders: Basic Concepts 537 Treatment: Definition 537
A Treatment Paradigm for Communication Disorders 538
Basic Treatment Terms 539
Reinforcers and Reinforcement: Basic Definitions 542
An Overview of the Treatment Process 545 Selection of Treatment Targets 545
Treatment Sequence 547
Maintenance Program 548
Follow-Up 549
Booster Treatment 549
A General Outline of a Treatment Program 550 General Outline 550
Cultural-linguistic Considerations in Assessment and Treatment 551 The Need for Individualized Assessment and Treatment 551
Chapter Highlights 553
Study and Review Questions 554
References and Recommended Readings 558
Study and Review Answers 560
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xvi • CON TEN T S
CHAPTER 12
Research Design and Statistics: A Foundation for Clinical Science 563
Essentials of the Scientific Method 563 The Philosophy of Science: Basic Precepts 564
Validity of Measurements 566
Reliability of Measurements 566
Experimental Research 568 Foundational Concepts 568
Group Designs of Research 569
Single-Subject Designs 571
Varieties of Descriptive Research 576 Foundational Concepts 576
Ethnographic Research 580
Evaluation of Research 581 Internal Validity 581
External Validity 584
Levels of Evidence for Evidence-Based Practice 585
Data Organization and Analysis: Principles of Statistics 587 Foundational Concepts 587
Statistical Techniques for Organizing Data 588
Types of Measurement Scales 590
Chapter Highlights 592
Study and Review Questions 593
References and Recommended Readings 598
Study and Review Answers 599
CHAPTER 13
Special Topics in Speech-language Pathology 601
Counseling 601 Qualities Necessary for Effective Counseling 602
Approaches to Counseling 602
Special Issues in Counseling 606
Reactions and Emotions Related to Communication Disorders 606
Defense Mechanisms 607
Medical Speech-language Pathology 608 Practice and Responsibilities of Speech-Language Pathologists 609
Medical Team Specialists and Their Roles 610
Infectious Disease Control 612
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CON TEN T S • xvii
Working with HIV and AIDS Patients 613
Medical Imaging Techniques 614
Craniofacial Anomalies and Genetic Syndromes 615 Craniofacial Anomalies 616
Cleft Lip 616
Cleft Palate 616
Genetic Syndromes 624
Medically Fragile Infants 632 General Facts 632
Chapter Highlights 636
Study and Review Questions 637
References and Recommended Readings 641
Study and Review Answers 644
CHAPTER 14
Professional Issues 647
ASHA and the Professions 647 The American Speech -Language-Hearing Association 648
The Professions of Speech-Language Pathology and Audiology 651
The Scope of Practice: Speech-Language Pathology 651
ASHA Accreditation 652
Issues in Certification and Licensure 653 Clinical Certification 653
Speech-Language Pathology Assistants 655
State Regulation of the Profession 656
Legislative Regulation of the Profession 656 Federal Legislation Affecting School Settings 657
Individuals with Disabilities Education Act (IDEA) 658
Federal Legislation Affecting Employment Settings 658
Federal Legislation Affecting Health-Care Settings 659
Future Trends 661
Chapter Highlights 662
Study and Review Questions 662
References and Recommended Readings 665
Study and Review Answers 666
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xviii • CON TEN T S
APPENDIX 667
Nature and Purpose of the PRAXIS 667
Study Tips for Preparing for the PRAXIS 673
Tips for Taking the PRAXIS 674
References and Recommended Readings 675
Index 677
About the Authors 701
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