Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
62 Cards in this Set
- Front
- Back
|
ALS -umn and L____ signs in limbs and bulbar musculature -D_____/Dysphagia (25% deficits associated with b____musculature) -Yields S____ and/or flaccid dysarthria ((((initially pure, mixed, rarely equal presentat)) |
LMN Dysarthria bulbar spastic |
|
|
Loss of motor neurons in pre-p______ central cortex, corticos___ tracts, motor nuclei of c____ nervers, and a____ horns of spinal cord
ONSET- middle age to ______ --Death: r____ failure/infection (death 3-___ years onset) no cure |
post spinal cranial anterior 70 respiratory 5 |
|
|
Large # of ALS patients (__%) initially present with b____ symptoms |
25 bulbar |
|
|
CLINICAL FEATURES *F____ *C___ *Fasciculations *w_____ * muscle a______ *s______ |
fatigue cramping weakness atrophy spasticity |
|
|
NONSPEECH UMN (S___) *jaw j__ and sucking reflexes hyperactive g___ reflex slow (s____) orofacial movements P______ affect D_____ |
SPASTIC JERK GAG STIFF PSEUDOBULBAR DYSPHAGIA |
|
|
LMN (F_____) * Decrease g___ reflex *weak c____ *decrease f______ tone *lingual fasciculations and a______ D_______ |
Flaccid gage cough facial atrophy Dysphagia |
|
|
SPEECH: *L___, slowly produced speech *S___phrases and intervals between words and p___ *Grossly imprecise a______ *H_____ *Strain-S____ VOICE *m______ AND MONOLOUDNESS |
Labored Short/ phrases articulation hypernasal strangled monopitch |
|
|
MULTIPLE SCLEROSIS (White Matter) - Most common of a____ d____ central nervous system diseases -U___ cause (viral) -Affects w____ matter scattered across the n______ system |
acquired, demyelinating Unknown white nervous |
|
|
MS *Lesions observed across time and s____ *Multiple episodes over time/episodes affect different s___/systems *Destruction of m___ sheath that covers axon, and death of o_____ that produce myelin |
space structures myelin oligondendrocytes |
|
|
*MS Course of disease is u______ *Episode followed by complete r_____ *Episodes with constant p_____ *Exacerbating- r_____ progressing |
unpredictable remission progression remitting |
|
|
Clinical Features: *G____ decreased a______ *decreased S____ control *C____ dysfunction * D______ * N_______ * Intention T___ |
Gait Ambulation Cerebellar Dysarthria Nystagmus Intention tremor |
|
|
Nonspeech oral mechanism: *Reduced v___ capacity and inadequate v_____ *Facial p____ (Bell's palsy) *T____ neuralgia (sudden, brief periods of facial p___) *facial m______ (persistent q______) muscles on cheeks |
vital ventilation paralysis Trigeminal pain myokymia quivering |
|
|
Multiple Sclerosis *S____-a___ dysarthria most common (spastic with incoordination) *Impaired L___ and pitch c___ * Suddenly a_____ breakdowns * H_____ * S___ rate * Reduced p___ variability |
Spastic- axatic loudness control articulatory hypernasility slow pitch |
|
|
MIXED DYSARTHRIA - many other conditions yield mixed dys. *Progressive s____ palsy * Widespread a____ * W_____ disease * Tumors, t_____ |
supranuclear atrophy wilson's trauma |
|
|
WILSON'S DISEASE *Autosomal r___ metabolic disorder (25%) *Unable to process c____ in food |
recessive copper |
|
|
Wilson's Disease *See n____ and hepatic (l____) dysfunction may see hyperkinetic h___kin.. spastic.. ataxic pg. 281 in DUFFY (Dont memorize) |
neurologic liver hypokinetic
|
|
|
APRAXIA OF SPEECH *Inability to acc produce v_____ speech movements.. independent of d_____ (muscle weakness, spasticity, rigidity, hypo/hyper) a_____ or other non-v____ apraxis (limb a____) |
volitional dysarthria aphasia verbal apraxia
|
|
|
.."a phonetic-m_____ disorder of sp. production cause by inefficiencies in the t____ of a well-formed and filled phonologic frame to p____learned kinematic parameters assesmbled for carrying out the i_____ movement resulting in intra-and inter______ temporal and spatial segmental and p_____ distortions" |
motoric translation phonologic intended articulator prosodic |
|
|
AOS * Distortions of s___ and intersegment transitionalization resulting in extended duration of c____, vowels, and t__ between sounds, syllables, and w)___... These distortions often perceived as sound s____ and as the misassignment of s___ and other phrasal /sentence-level p____ abnormalities |
segment consonants time words substitutions stress prosodic |
|
|
AOS *Errors are relatively c____ in location within the utterance and in_____ in type. It is not attributable to deficits of m___ tone or reflexes, not deficits in processing of a___,tactile, kinesthetic, propropceptive, or l_____ info... In its extremely infreq. occurring "pure" form, not accompanied by m___physiology, perecept/lang |
consistent variable muscle auditory language
|
|
|
AOS *Disturbance in the p_____ or speech movements *Muscles capable of n______ function |
programming normal |
|
|
PLANNING - planning for speech takes place in m_____ association areas *P____/Broca's Area/ S_____ Motor area/ Prefrontal/p___association areas/ c_____circuit of the Basal Ganglia/ W_____ Area |
motor premotor supplementary parietal caudate wernickes |
|
|
PROGRAMMING *Speech "programming" is.. a set of m___commands that are structured before a movement s____ begins which can be delivered without reference to e___ feedback *Programs specify muscle: tone, m____ direction, force, r___, rate and mechanical s____ or joints |
muscle sequence external movement range stiffness |
|
|
PROGRAMMING BREAKDOWN *Programming for speech take place in: -B____ Ganglia (caudate/putamen) - Lateral C____ *S____ motor areas *premotor c___ *Frontolimbic system |
Basil cerebellum supplementary cortex primary
|
|
|
AOS *Often coexists with d____ and/or a_____ *Nearly always result of pathology in l_____ cerebral hemisphere |
dysarthria aphasia left |
|
|
AOS -Anatomy and Physiology *Motor and speech programming involves many areas *L_____ cerebral hemi involved in m___speech p____ |
Left motor programming |
|
|
Left cerebral hemi -L____ Input to MSP from left p____ area (temproprarietal cortex and posterior portions of frontal lobe) and b___ ganglia and t____ |
linguistic perisylvian basal thalamus |
|
|
AOS -Overlap between l___areas and MSP; so da,age to the p___ zone results in co-o____ of AOS and a____
-MSP transforms a___ phonemes to a neural code, which is to be executed by the m___ system |
linguistic perisylvian occurrence aphasia abstract motor |
|
|
AOS cortical areas involved *p___ area and b____ area *s____ motor area (medial aspect of frontal love) *P___ lobe somatosensory cortex *i______ *b____ gang- caudate/putamen |
premotor, Broca's supplementary parietal insula basal |
|
|
lesions that result in AOS; L___ posterior f___ or p___ lobes/ in the i_____ or in the b___ ganglia |
left frontal parietal insula basal |
|
|
AOS Etiologies *V____ lesions (stroke_ most common; l___hemi middle c____ artery *Diffuse diseases rarely produce i_____ AOS |
Vascular left cerebral isolated |
|
|
Nonverbal oral mechanism *May be no evidence of w_____; g__ reflex and chewing/s___ may be normal *Lesions are usually l__ enough, may be concomitant unilateral c_____ damage.....d____
*Possible s_____ deficits |
weakness gag swallowing large corticobulbar dysarthria sensory |
|
|
AOS *Nonverbal oral apraxia -inability to i___ or follow commands/perform v____ movements of speech structures * Can occur independently from AOS * (((box 3-1 pg 88))) sequencing is important (BOX 3-3) |
Imitate volitional |
|
|
AOS SPEECH *p___ level errors *I___ ERRORS (Errors vary as complex. artic. output varies) *I___ performance is poor *Patient is a___ of errors/ cant correct them |
phoneme inconsistent imitative aware |
|
|
*When patient tries to monitor speech to anticipate errors P____ deficits result *Oral n___ apraxia is often, but not always in conjunction with A_____ |
pROSODIC AOS |
|
|
OTHER *automatic-reactive speech better than v___-purposive speech *Artic may be better both a__and v__ stim than either one alone *___ work no effect/single word *I___ better than spontaneous speech *A___ may increase on c______ attempts |
volitional auditory/ visual Mirror Imitation accuracy /consecutive |
|
|
M___/inspirational instruct. effect accuracy Response d____ intervals/dont influence accuracy B___masking has no postive efffect d___auditory feedback may have n____ affect on accuracy a____ discrim bbetter than v____ production o____ perception and s___ may be impaired |
Motivation delay Binaural delayed... negative auditory / verbal oral/ sensation |
|
|
AOS *Speech assessment/Diagnosis *Use speech s____ motion rates (SMRs) and i___ of complex m_____ words and sentences -zip/zipper/zippering |
sequential imitation multisullabic |
|
|
AOS *look for t__ at which patient s__ or fails on tasks reflecting contimuum of speech programming demands (vowels, CV,CVC, AMRs, s___/speaking words) - pg 86-87 |
threshold succeeds singing
|
|
|
Patient Complaints: *s__ wont come out right a___ problems *not respiration/phonation/reson *speak s___ and carefully *l____ words difficult to pronounce |
Speech artic. slowly long |
|
|
AOS *TX- consider m___ Learning *R___ MOTOR DRILL: lots of trials *M___DRILL- quick dev.(poor generalization) *D__ DRILL slower development and good g_____ |
motor repetitive mass distributed- generalization |
|
|
Knowledge of Results *f___ *not too much detail INFLUENCE OF R___ *speed/accuracy trade-off * vary, working toward natural p____ |
frequent wrong rate prosody |
|
|
*phonetic p____/manipulate a____ * Phonetic derivation: use intact n__-speech gestures to elicit target s____ sounds *I____/integral stim: watch, listen, s____ produce, delay to produce |
placement/ articulators non speech Imitation simultaneously |
|
|
AOS *C_____ stress drill/change stress/rate/r___/intonation *M___ INTONATION THERAPY *Increase s___; contextual complexity |
contrastive rate Melodic speed |
|
|
family c____/education total c___ a___ communication |
counseling communication augmentative |
|
|
AOS by definition a m___speech disorder *Essential nature and characteristics of AOS must be consistent with the models of s____ production and with known p____ at the motor p___/programming levels |
motor speech pathology planning |
|
|
AOS P____, lexical /syntactic errors should not be lumped under AOS *Freq. concomitant errors at p__, syntactic, phonologic, lexical levles * happens because the responsible a______ areas very close in proximity and b/c many pathologies not strictly localizable (NOT AOS) |
Phonological phonetic anatomical |
|
|
DIFFERENTIAL DIAGNOSIS *Dysarthria (neuromuscular) - alterations in s___,tone, r____
AOS (neuromuscular) - no c____ |
strength range changes |
|
|
DYSARTHRIA - All components of s__ maybe affected
AOS - A____ |
SPEECH ARTICULATION |
|
|
DYSARHTIRA Aphasia (freq N_____ ASSOCIATED)
AOS Aphasia freq A____ associated with aphasia |
not always? |
|
|
DYSARTHRIA Variability - speech generally c___ (not influenced by a___/stimulus modality/linguistic variables )
AOS Variability (speech is v____) automatic=OK propositional (repeat what i say)/repetition influenced by multiple factors |
consistent automaticity
variable |
|
|
DYSARTHRIA *Error Types (d___/simplifications)
AOS *Perceived s___, additions, r___, prolongations, complications of t____ sounds |
distortions
substitutions repetitions targeted |
|
|
Dysarthria g______ rarely observed
AOS G____ highly prevalent |
groping groping |
|
|
ATAXIA - SPEECH AMRs I______
AOS -SPEECH AMRs R____ |
Irregular
Regular |
|
|
ATAXIA - NORMAL S____ (Rhythm is off)
AOS -Sequencing of SMR'S - A___ |
sequencing
abnormal |
|
|
ATAXIA P____ HIGHLY VARIABLE
AOS Prosody less v____ |
prosody variable |
|
|
ATAXIA islands error- free speech (u___) E ___ (Automatic/propositional speech)
AOS (Typical lslands of e___-free speech) a___ speech better than propositional speech
frequent s_______
|
unusual Equal error automatic substitutions |
|
|
Treatment - know when it will end! -remember e____ options/P____AAC/PACERS (Dont go there first)
WHO- I___/disability/ handicap |
external prostheses
Impairment |
|
|
*Speaker Oriented vs. Communication Oriented approaches *Speaker oriented Restore/C_____ (Reduce I_____) Then work on Efficiency, N____&Quality of communication
|
Compensate impairment naturalness |
|
|
Communication oriented modify the communicative i_____ |
interaction |
|
|
Treatment ... counseling.. e___ intervention; know the m___ plus the speech diagnosis
*Physiological support f___ then other interventions *learn about m___ learning * F_____ is often key!! |
early medical first motor flexibility
|
|
|
MIXED |
MIXED |
