Csd 310 - Neuromotor Speech Disorders

Front 1

This motor speech disorders affect motor planning and programming.

Back 1

acquired and developmental apraxia

Front 2

This motor speech disorder affects speech movements and execution.

Back 2

dysarthria

Front 3

Apraxia and dysarthria do NOT affect what?

Back 3

speech perception
comprehension
language

Front 4

Every motor speech process contains some elements of __________. ______________ disturbances can have an effect on _________ __________ ____________.

Back 4

cognition
Cognitive
motor speech production

Front 5

Central and peripheral nervous systems must activate and manipulate what five systems to accurately represent the goals of the motor program (neuromuscular execution)?

Back 5

respiration
resonation
phonation
articulation
prosody

Front 6

The effects of a neuropathology on speech are usually _________, _____________, and clinically ____________ and _________________.

Back 6

lawful
predictable
unique
recognizable

Front 7

Dysarthria is characterized by ______, ______, ____________, and/or _______________ movements of speech musculature.

Back 7

slow
weak
imprecise
uncoordinated

Front 8

Dysarthria is ___________ in origin and associated with ______ and or ________ ________ system structures involved in motor activities.

Back 8

neurological
central
peripheral
nervous

Front 9

Dysarthria involves neuromuscular execution that may affect what regarding movements?

Back 9

range
speed
strength
timing
accuracy

Front 10

List the variations within dysarthria.

Back 10

age of onset
cause
natural course
site of lesion
speech components involved
perceptual characteristics
severity

Front 11

Apraxia is described as a lack of ________ which is that ___________ process by which __________ directs _______ action.

Back 11

praxis
neurological
cognition
motor

Front 12

Apraxia is NOT a _________, ___________, or __________ problem.It indicates a problem with motor ____________ of sequential movement for __________ ________ __________.

Back 12

paralysis
weakness
incoordination
programming
volitional speech production

Front 13

List some perceptual characteristics of apraxia.

Back 13

-disturbances in articulation, rate, prosody
-artic errors, inconsistent (vowel and consonant distortions)
-difficulty initiating and transitioning from one sound to another
-often increase in errors with increase in length or complexity
-oral apraxia may or may not present

Front 14

List the six types of motor speech disturbances.

Back 14

flaccid
spastic (unilateral UMN, bilateral UMN)
ataxic
hypokinetci
hyperkinetic
mixed

Front 15

Individuals with cerebral palsy often demonstrate a high incidence of what?

Back 15

motor speech disability

(three types: spastic, athetosis, ataxic)

Front 16

What provides subglottic air pressure that set vocal folds into vibration?

Back 16

respiration

Front 17

Deficits of respiration can result in what?

Back 17

short phrases
reduced loudness
breathy voice quality

Front 18

What component of speech produces voiced phonemes through vocal fold vibration?

Back 18

phonation

Front 19

Deficits in phonation can result in what?

Back 19

weak or incomplete adduction (breathy or harsh quality)
adduction that is too tight (strained or strangled quality)
reduced ability to change pitch or loudness

Front 20

What component of speech gives proper placement of oral or nasal tonality onto phonemes by raising and lowering the velum?

Back 20

resonance

Front 21

Deficits in resonance reusult in what?

Back 21

hypernasality

Front 22

What is shaping of the vocal airstream into phonemes?

Back 22

articulation

Front 23

Deficits of articulation can result in what?

Back 23

imprecise consonants
distorted vowels
inappropriate silences
irregular articulatory breakdowns

Front 24

What component of speech is responsible for melody, pitch, loudness, and intonation?

Back 24

prosody

Front 25

Deficits in prosody can result in?

Back 25

monopitch
monoloud quality
irregular pitch varations
sudden changes in loudness
prolonged intervals between syllables and words

Front 26

Which dysarthria reflects problems in the nuclei, axons, or neuromuscular junctions that make up the motor units of the final common pathway or lower motor neurons?

Back 26

flaccid dysarthria - caused by a disorder that affects innervation of speech component muscles

Front 27

List the primary deviant speech characteristics of flaccid dysarthria.

Back 27

hypernasality
imprecise consonants
breathiness
monopitch
nasal emission
audible inspiration
harshness
short phrases
monoloudness

Front 28

What are some nonspeech signs of flaccid dysarthria?

Back 28

fasciculations (twitches)
atrophy of the tongue
poor elevation of soft palate
grimacing

Front 29

Which cranial nerves are likely damaged in flaccid dysarthria?

Back 29

trigeminal (V)
facial (VII)
glossopharyngeal (IX)
Vagus (X)
Accessory (XI
Hypoglossal (XII)

Front 30

What is the most important spinal nerve for respiration?

Back 30

phrenic nerve

Front 31

What can damage do the phrenic nerve do?

Back 31

paralyze the diaphragm resulting in weakened inhalation

Front 32

Which type of dysarthria is caused by bilateral damage to direct (pyramidal) and indirect (extrapyramidal) motor pathways (UMN disorder)?

Back 32

spastic dysarthria

Front 33

Which dysarthria is characterized by imprecise articulation, monotonous pitch, loudness, and poor prosody?

Back 33

spastic

Front 34

In this dysarthria muscles can be stiff and move sluggishly through a limited range - speech is labored and words may be prolonged.

Back 34

spastic

Front 35

Spastic Dysarthria:

- Damage to pyramidal system results in _________ and _______

- Damage to extrapyramidal system results in __________, increased muscle tone (_________), and abnormal _________ reflexes

- Weakness and slowness most evident in _______ and ____ movements

- Spasticity most evident in _________ muscles (hyperadduction of vocal folds) and might also be in ________

Back 35

weakness, slowness
weakness, spasticity, muscle
tongue, lip
laryngeal, velum

Front 36

In spastic dysarthria, speech errors are the result of what?

Back 36

spasticity, slowness, and weakness in the muscles of the vocal tract

Front 37

In spastic dysarthria, which component of speech is the least affected?

Back 37

respiration

Front 38

What nonspeech characteristics are common of spastic dysarthria?

Back 38

pseudobulbar affect (uncontrollable lauging or crying)
drooling

Front 39

This is a distinguishable motor speech disorder that is associated with damage to the upper motor neurons that carry impulses to the cranial and spinal nerves that supply the speech muscles.

Back 39

unilateral upper motor neuron dysarthria

Front 40

Which type of dysarthria has demonstrable weakness in the lower face, lips, and tongue on the opposite side of the lesion?

Back 40

unilateral upper motor neuron

Front 41

What provides a degree of redundancy that helps to preserve many (but not all) functions?

Back 41

bilateral input from UMNs

Front 42

What is the primary characteristic of unilateral upper motor neuron dysarthria?

Back 42

mild articulation deficit

- highly amenable to treatment
- temporary

Front 43

Unilateral UMN dysarthria may also co-occur with aphasia or apraxia of speech when the lesion is in the ______ hemisphere or with other cognitive problems when the lesion occurs in the ______.

Back 43

left
right

Front 44

What is the most affected speech characteristic in unilateral UMN dysarthria?

Back 44

articulation - 98% in one study
- imprecise consonant production most likely marker
- severity ratings from mild-moderate most common
- slow AMRs (alternate motion rate) - pu tu ku

Front 45

In unilateral UMN dysarthria, what is the most common characteristic of phonation that you will see?

Back 45

mild to moderate harsh vocal quality (39% in one study)

Front 46

This results from damage to the cerebellum and speech errors are related to timing and syllabic stress.

Back 46

ataxic dysarthria

Front 47

What are the primary speech errors of ataxic dysarthria?

Back 47

articulation (intermittent and range from mild to severe) and prosody (ranges from reduced to unnatural stress)

Front 48

What type of vocal quality do you see with ataxic dysarthria?

Back 48

harsh with monotonous pitch and volume

Front 49

What type of dysarthria presents with unsteady, slurred speech sounding drunken or scanning speech?

Back 49

ataxic dysarthria

Front 50

Remember, the cerebellum functions to ____________ timing and force of ____________ ____________ so that skilled, ___________ movements are ____________ for the task.

Back 50

coordinate
muscular contractions
voluntary
appropriate

Front 51

Planned motor impulses or planned speech acts are sent from the _________ to the ___________.

Back 51

cortex
cerebellum

Front 52

The cerebellum coordinates and refines ____________ speech movements according to ___________ information about the positions and conditions of the _____________. It has prior __________ on what the __________ target movement should be.

Back 52

preliminary
sensory
articulators
practice
skilled

Front 53

Connections to ______________ system allow the cerebellum to make _________ adjustment in _________ and _______ of movements to compensate for ________________ change in circumstances of __________.

Back 53

extrapyramidal
rapid
timing
force
unexpected
movement

Front 54

Impairment in waking is one very obvious sign of what?

Back 54

cerebellar involvement

Front 55

In general, difficulty with coordination of voluntary movements is characteristic of what?

Back 55

cerebellar involvement

Front 56

Overall coordination problems (scanning speech, slow speech, etc.) is a speech characteristic of what type of dysarthria?

Back 56

ataxic

Front 57

What is the most prevalent articulation error type in ataxic dysarthria?

Back 57

imprecise consonant articulation

also see:
irregular articulatory breakdown
distorted vowels

Front 58

Name some of the prosody characteristics of someone with ataxic dysarthria.

Back 58

stress differences
prolonged phonemes
prolonged intervals between phonemes
slow rate of speech
monopitch & monoloudness

Front 59

Although it occasionally occurs, what is not a prominent characteristic in ataxic dysarthria?

Back 59

resonance problems

Front 60

List respiration issues associated with ataxic dysarthria.

Back 60

-uncoordinated movements in respiratory muscles
- exaggerated or pardoxical movements (when different muscles work against each other)

Front 61

What type of dysarthria is associated with deficits in basal ganglia control circuit pathology that may affect any or all of the five components of speech (most evident in voice, articulation,and prosody)?

Back 61

hypokinetic dysarthria

Front 62

Speech characteristics of what reflect the effects of rigidity, reduced form and ROM, and slow but sometimes fast repetitive movements of speech?

Back 62

hypokinetic dysarthria

Front 63

Which type of dysarthria is also characterized by reduced vocal loudness with concomitant harsh-hoarse vocal quality, slow speaking rate with rapid fire articulation, excessive pauses, prolonged syllables, monoloudness, and reduced phonation time?

Back 63

hypokinetic dysarthria

Front 64

What is the only dysarthria associated with possible increased rate of speech?

Back 64

hypokinetc dysarthria

Front 65

Which dysarthria has most cases sharing one eitology and what is that etiology?

Back 65

hypokinetic dysarthria
parkinsonism

Front 66

Hypokinetc doesn't mean ______ ______ (like hypotonia). It literally means ______ _________ and is associated with ___________ tone.

Back 66

low tone
less motion
increased tone

Front 67

Parkinson's disease describes a ______________ of symptoms with __________ cause (__________). Parkinsonism is a more general term for syndromes that are ___________ to Parkinson's disease but cause is _________.

Back 67

constellation
unknown
idiopathic
similar
known

Front 68

Diagnosis of Parkinson's disease must demonstrate at least two of what four classic signs?

Back 68

tremor at rest
rigidity
akinesia/bradykinesia
loss of postural reflexes

Front 69

List symptoms not typically seen in PD.

Back 69

pyramidal tract signs (exaggerated reflexes, extensor plantar response)
intention tremor
ataxia and other signs of cerebellar dysfunction
early profound dementia

Front 70

What is the most common characteristic of Parkinsonism?

Back 70

resting tremor - seen most in hands and fingers
can reduce or disappear when completely relaxed or in voluntary motion

Front 71

List 5 main characteristics of Parkinsonism.

Back 71

resting tremor
bradykinesia
rigidity
akinesia
disturbed postural reflexes

Front 72

This is described by slow and reduced range of motion, masked faces, shuffling walk, and is not the result of muscle weakness.

Back 72

bradykinesia

Front 73

This is described by increased muscle tone (greater than normal state of contraction at rest and in action), lead pipe resistance (constant resistance when limb pulled to extended position, as though bending soft metal), and cogwheel resistance (subtle, rhythmic alteration in rigidity as body is moved).

Back 73

rigidity

Front 74

This is described as difficulty initiating or stopping movements - person may get stuck in a position.

Back 74

akinesia

Front 75

This is described as being seen during automatic tasks, like walking without arm swing and having difficulty with balance during walking.

Back 75

disturbed postural reflexes

Front 76

What is important to remember in Parkonsinism?

Back 76

reduction of dopamine production - resulting in too much excitatory neuronal firing and not enough inhibitory, which yields rigidity, bradykinesia, etc.

Front 77

What is the most common etiology of Parkinson's disease?

Back 77

idiopathic - unknown

Front 78

What is the common age of onset of Parkinsonism?

Back 78

40-70

Front 79

What may be one of the first presenting symptoms of PD?

Back 79

hypokinetic dysarthria
along with:
restlessness
rapid tiredness
sensory signs (coldness, numbness, tingling)

Front 80

In 50-70% of the cases, what treatments are often successful in treating the major symptoms of Parkinsonism (but don't stop progression of disease)?

Back 80

L-dopa

Front 81

What percentage of Parkinsonism patients also have dementia?

Back 81

8-30%

Front 82

How many Parkonsinism patients also have significant depression?

Back 82

50%

Front 83

What speech characteristics are most noticeable in Parkinsonism?

Back 83

errors of prosody and articulation

- give the impression that sequencing and placement is accurate but range of movements is restricted
-speech movements compressed and abbreviated
-result of bradykinesia, akinesia, and rigidity

Front 84

Which prosody characteristics are most prominent in Parkinsonism?

Back 84

monopitch, reduced stress, and monoloudness

- Due to limited range of motion in laryngeal musculature and lack of vigor in contractions
- Most evident in conversational speech, reading sentences or paragraphs, or trying to convey emotions through speech
-inappropriate silences
-Speech rate anomalies
-Increased rate of speech
-Short rushes of speech

Front 85

List some of the articulation errors associated with Parkinsonism.

Back 85

imprecise consonants
Caused by reduced range of motion of articulators
Stops can sound like fricatives because the articulator fail to completely block the airflow.
Fricatives and affricates can sound distorted
Unusual dysfluencies
Repeated phonemes at the beginning of an utterance- (neurologically-based nonfluencies)
Palilalia-compulsive, rapid repetition of a word or phrase

Front 86

In Parkinsonism what is common yet not one of the most noticeable speech errors?

Back 86

harsh or breathy voice quality

Caused by incomplete vocal fold closure during phonation
When combined with decreased loudness, might lead to lack of speech intelligibility

Front 87

List another phonation problem associated with Parkinsonism (besides harsh or breathy voice quality).

Back 87

Lower pitch

But some might also have higher pitch
Significant individual to individual differences in pitch

Front 88

Which component of speech is not really a common problem with Parkinsonism?

Back 88

resonance

Front 89

List some respiration issues associated with Parkinsonism.

Back 89

rapid rate
paradoxical movements of muscles of exhalation and inhalation
reduced ROM of respiratory muscles
result in shallow breath support, poorly controlled exhalations for speech, and short breathing cycles

Front 90

What type of dysarthria is difficult to define because it is caused by many disorders and is actually a group of various motor speech disorders?

Back 90

hyperkinetic dysarthria

Front 91

Most hyperkinetic dysarthria is caused by what?

Back 91

Dysfunction in basal ganglia and produces involuntary movements that interfere with speech.

Front 92

In hyperkinetic dysarthria, muscle tone ranges from ___________ to ____________ or fluctuating between the two.

Back 92

hypeotonic
hypertonic

Front 93

Hyperkinetic dysarthria is characterized by variable ____________ ____________, vocal ___________, and prosodic _____________.

Back 93

articulatory imprecision
harshness
abnormalities

Front 94

Hyper = _____ _________
Kinetic = _____________

Back 94

too much
movement

Front 95

Many disorders are associated with damage to the __________ __________ including the ________ nucleus, _________ and ___________ ____________.

Back 95

basal ganglia
caudate
putamen
globus pallidus

Front 96

What structures play a role in smoothing out the rough and exaggerated movements planned in the cerebral cortex?

Back 96

the basal ganglia
caudate nucleus
putamen
globus pallidus

Front 97

Different disorders of BG can have ____________ _________ on movements (ex: Parkinsonism and Huntington's).

Back 97

opposite effects

Front 98

Speech characteristics of hyperkinetic dysarthria of chorea depend on the __________, all ____________ of speech are affected, and movements are _____________.

Back 98

severity
components
unpredictable

Front 99

In hyperkinetic dysarthria of dystonia there are _______ errors of articulation than in chorea and ______ prosodic errors than in chorea.

Back 99

more
less

Front 100

List some articulation errors in hyperkinetic dysarthria of Dystonia.

Back 100

imprecise consonants
distorted vowels
irregular articulatory breakdowns
prolonged phonemes

Front 101

List some prosody errors in hyperkinetic dysarthria of dystonia.

Back 101

monopitch
monoloudness
inappropriate silences
short phrases

Front 102

List some phonation errors in hyperkinetic dysarthria of dystonia.

Back 102

harsh vocal quality
strained-strangled quality
excessive loudness variation

Front 103

In hyperkinetic dysarthria of dystonia what is not a common problem but may affect loudness levels?

Back 103

respiration

Front 104

In hyperkinetic dysarthria of dystonia what speech component has mild (if present at all) errors?

Back 104

resonance

Front 105

Apriaxia of speech is most frequently due to _________ in hemisphere dominant for ____________. The most frequently cited is BA ____ - third _________ convolution.

Back 105

stroke
language
44
fontal

Front 106

In comparison of speakers with and without apraxia, all had lesions in the discrete region of what?

Back 106

left postcentral gyrus of insula

Front 107

With apraxia of speech, speech is __________, groping and ___________. There is effort to _______ _________. Most difficulties are at the ___________ of the word.

Back 107

halting
labored
self-correct
beginning

Front 108

Speech errors of apraxia are __________, may produce ______________ phrases and ____________ in which there are no _____________ periods of normal ___________ or _________.

Back 108

inconsistent
sterootypic
dysprosody
extended
rhythm
stress

Front 109

The most common problems with apraxia are in what component of speech?

Back 109

articulation
- substitutions are more common than other errors
-distortions may also occur and be perceived as substitutions

Front 110

Prosody in apraxia is frequently ___________ possibly due to the ___________ - may be _____________ behaviors or both.

Back 110

abnormal
apraxia
compensatory

Front 111

List other prosodic errors of apraxia.

Back 111

slower rate
stress equal across syllables
silent pauses (groping)
normal variations of pitch & loudness often reduced

Front 112

In apraxia, voluntary __________ tasks may be affected but ___________ ____________ isn't affected.

Back 112

respiratory
reflexive respiration

Front 113

What is seldom problematic in apraxia?

Back 113

resonance

Front 114

What component of speech is associated with more severe apraxias and is typically not as severe as articulation deficits?

Back 114

phonation

Front 115

In assessment of motor speech disorders, what is the goal of differential diagnosis?

Back 115

to differentiate among the speech disorders and relate them to the neurologic diagnosis

Front 116

In instrumental assessment what should be used?

Back 116

instrumentation to measure voice parameters, respiratory systems

Front 117

In treatment of apraxia, you should focus on ___________. Use a _______-_________ approach, although _________ inputs may be used to facilitate _________ responses.

Back 117

articulation
motor-based
sensory

Front 118

In treatment of apraxia, look at ___________, control, __________ of speech musculature. ______ systems may be appropriate if __________.

Back 118

accuracy
coordination
AAC
severe

Front 119

In treatment of dysarthria, ________, _________ communication is the goal. Also look at __________ and improved intelligibility.

Back 119

effective
efficient
articulation

Front 120

List some other approaches to dysarthria treatment.

Back 120

motor
linguistic
augmentative
prostheses
surgical
medication