Communication Disorders, Swallowing Disorders, and Speech Therapy – An Introduction
言语治疗概论-0001

Zhejiang Chinese Medical University
浙江中医药大学

Instructor: Manwa L. Ng（吴民华）, PhD.

Group Projects

Grouping: 4 groups of 3 or 4 students (total = 15 students)
(Final Grouping)

Topics

1. Voice disorder
2. Autism Spectrum Disorder
3. Parkinson’s Disease
4. Ankyloglossia
5. Swallowing Disorders

Format

Each group will deliver a 20-minute presentation in English. To facilitate the presentations, you are strongly encouraged to make use of audio/visual aid and PPT for your presentations. Each presentation will be followed by a brief Q&A session of 5 minutes. Your presentations will be rated by both your teachers – myself and Ms Zhang. Details of assessments are provided below.

Assessment

Your final grade of the course will be evaluated based on two assessments: (1) group project and presentation, and (2) end-of-semester exam.

(1) Voice Disorder

A new female kindergarten teacher who just graduated from university is complaining voice loss from time to time during the semester. She complains that she has voice loss, or hoarse voice often, and the condition is worse during weekdays. She is not able to raise her pitch at times and finds her voice low in the classroom. She loves her job a lot and she does not want to miss any day of school. This is why she goes to work even when she experiences voice problem. She does not smokes but admints that she drinks liquor almost every night due to work pressure.

During a doctor’s visit, the doctor suspects that she may have growth on her vocal folds and is then referred to an ENT doctor. After ENT’s visit, it is confirmed that she has bilateral vocal nodules, and her voice problem is considered mild to moderate. The doctor recommends that she should receive a surgery immediately.

In your presentation, make sure you include the following components:

1. What is vocal nodule? What are the risk factors of vocal nodules? Talk about the onset and course of development of vocal nodules.
2. How does vocal nodule affect one’s voice? What is the recommended treatment for vocal nodules?
3. How is dysphonia assessed? instrumental and perceptual? What do we mean by a “mild-to-moderate” voice disorder?
4. As the Speech Therapist of the teacher, what is your recommendation? Do you think she should immediately undergo a surgery to remove the nodules? What are the possible consequences of vocal surgery?

(2) Autism Spectrum Disorder

Chuck is a 8-year-old boy who has been diagnosed with Autism Spectrum Disorder (ASD). Three years ago, his parents noticed that Chuck showed delays in social communication skills (lack of conversational speech, poor eye contact), repetitive and stereotyped behaviors (toe walking, likes to follow the same routes everyday). He was then assessed to have a borderline IQ of 70. A little overweight with a BMI of 30.1, Chuck is going to primary school. However, he has been demonstrating different inappropriate behavior in class such as biting, spitting, and growling at his classmates. According to his teachers, Chuck has particular difficulty staying in his seat and participating in class activities.

One day when Chuck’s parents were talking to their friend, she suggested that her friend’s kid has similar problem. But their kid is now taking a medicine called Ritalin® and things seem to be much better now.

Imagine you are the speech therapist of Chuck.

In your presentation, make sure you include the following components:

1. What is ASD? What are the risk factors and course of development of ASD? What are the common symptoms of ASD?
2. What is the role of speech therapists in the management of kids with ASD?
3. What is Ritalin®? How does it work?
4. As Chuck’s speech therapist, what is your treatment plan? What are the target areas you would like to treat/manage?

(3) Parkinson’s Disease

Joey’s grandfather who is now 82 years ago is referred to you, a practicing speech therapist. Joey said that his grandfather has been showing tremulous hand movement since 3 years ago. He is now having difficulty in walking, especially when starting to walk. Joey said that his gradfather hand shaking is so serious that he cannot drink soup with a spoon, as the soup will be spilled all over. In addtion to walking and shaking, Joey noticed that his grandfather’s voice is very soft and sometimes it is hard to understand. He needs to take breaths more frequently when he talks. Joey also feels that his grandfather’s tongue is not working properly when speaking, as if he has a candy in his mouth.

As his speech therapist, you are inclined to think Joey’s grandfather is having Parkinson’s disease.

In your presentation, make sure you include the following components:

1. What are the risk factors of Parkinson’s Disease? How is PD diagnosed? What is the treatment and prognosis of PD?
2. What is the cause of PD? and PD effects on speech production.
3. How is severity of PD assessed? What do you think Joey’s grandfather’s severity?
4. What would you suggest to be done in order to confirm Joey’s grandfather’s condition?
5. What are the treatment methods available? Surgical? Pharmaceutical? Behavioral?

(4) Ankyloglossia

The parents of a student attending Primary 5 is suggesting their son is suffering some problems with his tongue and the problem is causing him a lot of errors when speaking English. They said that he has particular difficulty in producing the English /r/ sound, as in the words “ray” and “red”. You are a speech therapist and the student is now referred to you.

During a visit with you, the parents mentioned about a surgery that can help his son to speak better English. They said there is a small surgery that cuts parts of the tongue and it is commonly carried out by an ENT (Ear Nose Throat) doctor inside a small clinic. The surgery is quick and the patients usually walk away from it in several hours.

In your presentation, make sure you include the following components:

1. What is the possible problem that the student is having?
2. How does this problem affect tongue movement and spoken English, especially for the English vowel /r/? How will the sound be like then? What is the outcome of his English if he really suffers this problem?
3. What is the surgery the parents are saying? How is it done? What are the possible complications of the surgery?
4. Do you suggest that the boy should have this surgery? Why? and Why not? (Make sure your arguments are based on the perspective of language and communication, and outcome of surgery, etc.)

(5) Swallowing Disorder

A 75 year old lady who had a stroke last year has been referred to you. Her attending physician noted that she is suffering from a problem with swallowing. Over the last 6 months, the patient has been admitted to hospital complaining sudden onset of fever and has been on antibiotic medication all the time. According to the nurse who took care of the patient, the patient does not seem to have a problem with swallowing as she never choke or show any irritative feeling during feeding. However, the patient’s daughter complained that her mom can never swallow safely and should be on tube feeding. The patient was referred to a radiologist for Barium swallow examination. Attached is a snapshot sent by the radiologist. Imagine now you are assigned to be her speech therapist.

In your presentation, make sure you include the following components:

1. Do you think the patient has dysphagia? what are the different stages of swallowing? What are the anatomy and physiology behind these stages?
2. Why do you think the nurse and the daughter do not agree with each other?
3. What else needs to be done to confirm your suggestion in question (1)?
4. Describe what you see from the VFSS provided by the radiologist.
5. Why has the patient been on antiobiotic medication for the past 6 months?
6. As her speech therapist, what would you suggest to be done to the patient?

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