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31 Cards in this Set
- Front
- Back
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Flaccid dysarthria
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Muscle weakness - imprecise consonants, breathiness, hypernasality and abnormal prosody (melody, intonation)
Caused by damage to the cranial nerves, spinal nerves and the neuromuscular junction. |
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Spastic dysarthria
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Harsh or strained-strangled phonation, imprecise consonants, hypernasality and abnormal prosody.
Caused by bilateral damage to the upper neurons of the pyramid and extrapyramidal systems. Often caused by brainstem strokes. |
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Unilateral upper motor neuron dysarthria
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Imprecise consonants. May be irregular sound breakdowns or harsh vocal quality.
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Hypokinetic dysarthria
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(Parkinsons) Harsh or breathy phonation, imprecise consonants and abnormal prosody. In some patients, increased rate of speech. Voice tremors
Caused by a reduction of dopamine in part of the basal ganglia. |
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Ataxic dysarthria
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'Drunk' quality. Problems controlling the timing and force of speech movements. Imprecise consonants, distorted vowels, irregular articulatory breakdowns and abnormal prosody.
Caused by damage to the cerebellum or the nerual tracts that connect the cerebellum to the rest of the CNS. |
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Hyperkinetic dysarthria
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Involuntary movements that inverfere with normal speech production. Unexpected inhalations and exhalations, irregular articulatory breakdowns and abnormal prosody.
Sometimes damage to the basal ganglia, but sometimes unknown |
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Mixed dysarthria
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Caused by neurological damage that extends to more than one portion of the motor system.
Any combination of the six pure dystarthrias. For example, a patient with parkinsonism could have a brainstem stroke that might result in hypokinetic-spastic mixed dysarthria. MS often mixed ataxic-spastic dysarthria. |
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The 5 components of speech
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Respiration
Phonation Resonance Articulation Prosody |
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Salient features of neuromuscular study
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Muscle strength
Muscle tone Accuracy Range of motion Speed Steadiness |
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Sign of a progressive neurological disorder
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Slow development of the problem
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Sign of an acute condition Eg. stroke
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Rapid onset of the problem
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Alternate motion rate
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Ability to move the articulators rapidly yet smoothly in a repetitive motion
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Sequential motion rate
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Ability to move the articulators in a rapid, smooth sequence of motions (eg. three sounds together)
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Two basic methods of evaluating motor speech disorders
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Instrumental and perceptual
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Increased tone/adduction - causes and therapy techniques
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UMN damage Misuse/ hyperfunction
Progressive relaxation Gentle onsets AFR |
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decreased tone/adduction - - causes and therapy techniques
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LMN damage Parkinson's disease
Poor respiratory support LSVT (or similar) Pushing Increasing respiratory support Amplification "loud" vs"soft" phrases |
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poor coordination with respiration and articulation - causes and therapy techniques
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Cerebellar damage oral/verbal dyspraxia
contrasting drills of voiced/voiceless consonants Minimal pairs (e.g. fine/vine) Sustained vowels |
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Examples of articulation therapy
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placement/overarticulation
minimal pairs Phoneme loaded drills "Functional" drills Slowing rate Intonation drills Volume drills |
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Outcome measures
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• Impairment: strength, ROM, steadiness etc
• Activity:intelligibility Participation:conversation,socialising • Wellbeing/distress AusTOMs • Frenchay Dysarthria Assessment • AIDSAssessment • Clientandotherfeedback |
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4 principles of motor learning
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Precursor to motor learning
Conditions of practice Feedback Effects of rate |
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Stages of motor learning
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1. Cognitive/novice
- simple tasks, high frequency feedback, block 2. Associative/advanced - complex tasks, random, lower frequency feedback 3. Autonomous/expert - complex tasks, transfer/generalise |
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Dysarthria assessments
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Frenchay
AIDS (assessing intelligibility in dysarthric speech) Perceptual speech assessments ( |
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General treatment principles for dysarthria
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Treat the speech component that will result in the greatest functional benefit most rapidly or will provide best support for improvement in other areas of speech
Depend on ax results impairment breakdown client preference/need imact on intelligibility client abilities nature of condition |
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Neural plasticity
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Use it or lose it
Use it and improve it Specificity Repetition matters Intensity matters Time matters Salience Matters Age matters Transference Interference |
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Approaches to treatment of adult motor speech disorders
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Physiological/motor system approach
- start with respiration as foundation for speech then phonation, then pitch/volume etc. Communication approach - establish effective communication ASAP Client centred approach - address client's main concerns first Neuromotor approach - follow principles of motor learning for neuroplasticity (none mutually exclusive - can use in combination) |
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Impediments to motor learning
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sensory impairment
poor sensory-motor integration poor awareness/self-monitoring cognitive impairment (still possible, just harder) |
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Examples of resonance Tx for adult motor speech disorders
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Palatal lift
- usually used with flaccid dysarthria CPAP (continuous positive airway pressure) - palate has to evaluate against resistance of air coming in through nose) |
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Respiration treatment
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Accent
x will use diaphragmatic breathing to hold an 'ah' vowel for 15 seconds x will |
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Phonation goals
-increased tone - decreased tone - coordination |
x will reduce strain in their voice to a moderate level
by using progressive relaxation, gentle onsets and AFR - x will reduce breathiness and increase loudness to be understood 100% on telephone (or restaurant etc./in a clinical setting) (if Parkinson's add an insight goal) LSVT - x will be able to sustain ah for 15 seconds at a consistent volume |
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Articulation goals
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LT
- x will effectively communicate his needs at home and in social environment 90% - During a five-minute phone call, x's grandchildren will not request clarification more than once - x will accurately determine the success of his communication attempts 90% of the time ST - x and partner will be able to explain nature of x's disorder, prognosis etc - will produce 10 consecutive productions of /a/ with duration of min 10 seconds and at SPL of at least 70dB w/o hyperfunction - x will read 10 short phrases aloud |
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Examples of prosody treatment for adult motor speech disorders
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Slowing rate - separating words, pacing baords, focus on clarity/precision, metronomes, tapping slow vs fast phrases
Intonation Drills - reading/repeating questions vs phrases 'high vs low' phrases Stress/emphasis - Q & As words with different meanings depending on emphasis e.g. record |
