Neurology for the Speech-Language Pathologist - E-Book

Wanda Webb, Richard K. Adler

• Publisher: Mosby
• Year: 2016
• ISBN:
  9780323394284
• Edition: 6
• Topic: Medicina
• Subtopic: Audiologia e logopedia

The concise, easy-to-understand Neurology for the Speech-Language Pathologist, 6th Edition provides students and clinicians with a practical guide for the study and understanding of neurology in speech-language pathology (SLP). Correlated with clinical syndromes and diseases seen in SLP, it gives you a solid understanding of the nervous system, including: development of the nervous system, organization of the brain, protective mechanisms, descending motor and ascending sensory pathways, and cranial nerves. New content, case studies, and a strong clinical focus make this new edition essential as you move into practice.

• Case studies and clinical applications in clinically oriented chapters provide you with realistic clinical applications.
• Presents complex information clearly in a concise, easy-to-understand manner.
• Clinical emphasis throughout makes this text valuable as you move into clinical practice — and prepare for the Praxis exam.
• Evolve companion website has vocabulary flashcards and study questions with answers so students can assess their knowledge.
• Key terms in each chapter and an end-of-text glossary give you easy access to accurate, concise definitions.

• NEW! Separate section on pediatric speech and language disorders, including a chapter on the developing brain.
• EXPANDED! Updated sections on neurodiagnostic and neuroimaging procedures, as well as childhood apraxia of speech, fluency disorders, Autism, and TBI.
• NEW! Updated discussion of the anatomy and function of the cerebellum gives you the most current information.
• UPDATED! Covers the latest neuroimaging research on anatomy, physiology, and disorders of speech-language.
• EXPANDED! Discusses the brain connectivity and the neural network underlying learning and language.
• EXPANDED! Addresses motor control for speech production so you stay in the know.

1

Introduction to Speech-Language Neurology

We must admit that the divine banquet of the brain was, and still is, a feast with dishes that remain elusive in their blending, and with sauces whose ingredients are even now a secret.

MacDonald Critchley, The Divine Banquet of the Brain, 1979

Chapter Outline

Why Neurology?

Recent Contributors to the Study of Neurologic Communication Disorders

Historic Roots: Development of Speech-Language Pathology as a Brain Science

Early Language Models

World War I

Modern Times

Directions and Planes

How to Study

Key Terms

agnosias

anterior

aphasia

apraxias

association fiber tracts

asymmetry

behavioral neurology

Carl Wernicke

cephalic

clinical neurology

computed tomography (CT)

dorsal

dysarthrias

inferior

localization of function

Noam Chomsky

Norman Geschwind

Pierre Paul Broca

plasticity

posterior

rostral

superior

ventral

Why Neurology?

The 1990s were labeled by the U.S. Congress as the Decade of the Brain. Likewise, 1990 was the year of the Americans with Disabilities Act (ADA). In 2006, American Speech-Language-Hearing Association (ASHA) members learned about the reauthorization of the IDEA (Individual Disability Education Act). Since the inception of the federal laws to help and protect Americans who have a variety of disabilities, including communication and hearing disorders, ASHA academic and clinical standards have undergone major changes as well. A tremendous expansion of knowledge has occurred in the neurosciences, including increased complexities of the types and severity of disorders treated by all speech-language pathologists (SLPs), from the school-based SLP and educational audiologist to the hospital-based certified SLP professional. ASHA has recognized these advances in neuroscience by realizing that an SLP or audiologist must have an expanded knowledge of neuroanatomy and physiology to remain a viable member of either the Individual Educational Plan (IEP) or the interdisciplinary team (IDT). That is why academic and clinical standards for all SLPs and audiologists underwent a major change in the early twenty-first century.

For the student of speech-language pathology and audiology, these governmental reform acts and advances in neuroscience have played a significant role in forming the current academic and clinical standards used by ASHA. The new certification standards required as of July 2004 mandate particular knowledge and skills for students to be prepared to serve a variety of communication and hearing disorders in children and adults. From an undergraduate’s general education, which is now required to include biologic and physical sciences, to the graduate student’s in-depth study of stroke, traumatic brain injury (TBI), or autism, academic programs have had to increase neuroscience offerings. The work of the linguist, the cognitive psychologist, and the neuroscientist, as well as the SLP and audiologist, has brought to the field of communication sciences and disorders an accelerated knowledge of the specialized brain mechanisms that underlie speech, language, and hearing and their disorders. Specialists now possess the knowledge and skills to understand, implement, analyze, and synthesize the neurologic bases of speech, language, and hearing, as well as the skills required to meet the ADA, IDEA, and new ASHA standards.

Widespread interest in the study of neurogenic issues has increased among speech and language students as opportunities for clinical experiences and employment in schools, hospitals, rehabilitation centers, and other health care agencies continue to increase. Increased longevity of human beings has caused a greater incidence of hearing, speech, and language disorders such as presbycusis, dementia, aphasia, dysarthria, and apraxia. With improving medical technology, traumatically brain-injured infants, children, and adults are now saved from death much more frequently than in the past. The speech and language disorders of these survivors present new and greater challenges to the SLP and audiologist.

In 1986, when the first edition of this text appeared, only half of undergraduate and graduate training programs in communication disorders offered specific coursework in neurology with an emphasis on speech and language mechanisms. As of this new edition, 30 years later, the majority of the 300 programs (www.asha.org) in the field provide such coursework. In 2004 Adler² surveyed all accredited ASHA programs in Speech-Language Pathology and Audiology. The survey consisted of questions asking academic programs to give information about the anatomy and physiology (A&P) and neuroanatomy and physiology (N&P) courses required in their undergraduate and master’s degree course sequences. Results indicated that the A&P course is offered in every program, and more than 70% of the accredited programs offered N&P courses. Many of these courses in neuroanatomy are on the graduate level, and all respondents made it clear that the N&P course is quite relevant and is required for all students to meet the standards and prepare students for challenging SLP positions.

Accompanying a growing interest among neurologists in communication sciences and disorders has been a parallel increase in the number of practicing SLPs. In the past 4 decades, membership in ASHA has risen from 2203 in 1952 to more than 173,000 members and affiliates in 2013 (www.asha.org). Although not all of these individuals are interested in neurologic disorders, many are, and for those who wish to study and specialize in neurologic speech and language disorders, a certification body, the Academy of Neurologic Communication Disorders and Sciences, accepts qualified members. Specialization in adult neurologic impairment, child neurologic impairment, or both is possible. In the past 5 to 10 years, ASHA special interest divisions have begun the process of specialization certifications in many areas, including child language, swallowing, fluency, and intraoperative monitoring. Most SLPs and audiologists work in schools, hospitals, or medical center or university clinics. All settings currently use an IDT approach and call the team a variety of names, including IDT, IEP team, clinical rounds team, or interdisciplinary management team (IMT). Regardless of name, the main function is to assess the client, discuss results from all disciplines, write a treatment plan that includes goals and objectives, and ensure that all goals and objectives have one outcome—the improvement of speech and language functioning for that client. The client might be seen in a school setting, a hospital, an outpatient clinic, a developmental center, through a home health agency, in a rehabilitation center, a university clinic, or in an office of a private practice. The SLP provides important information to what is usually a team of educational or medical professionals regarding a person’s speech and language deficits and assets as related to brain functioning.

Recent Contributors to the Study of Neurologic Communication Disorders

During the past 4 decades, two towering figures have dominated the field of language and speech. One, a neurologist, was Norman Geschwind (1926-1984). He almost single-handedly resurrected the early neurologic literature of Europe focusing on language disorders and related deficits. Geschwind brought this body of knowledge to the attention of the American medical audience when interest in aphasia and related disorders was waning. He particularly highlighted the value of identifying lesions in the connective pathways of the brain, as well as diagnosing lesions in the traditional localized cortical areas of the brain that had been associated with language disorders for more than a century. His masterwork, “Disconnection Syndromes in Animals and Man,” was published in Brain more than 49 years ago.²¹

Geschwind taught brilliantly at Harvard University Medical School for many years and inspir...