Motor Speech Disorders

Front 1

What is cerebral palsy?

Back 1

a developmental, nonprogressive disorder of motion and posture due to the neonatal brain before, during or after birth in about 1.5-2/100 kids.

Front 2

Cerebral Palsy: general characteristics?

Back 2

persistance of primitave reflexes, delays in reaching milestones and movement disorders

Front 3

Cerebral Palsy: classifications?

Back 3

1. spastic (hypertonia)-75% of cases, UMN damage, too much muscle tone (b/c inhibitory tracts are effected)
2. athetoid- slow involuntary movements
3. ataxic (damage to cerebellum)- incoordinated mvmts
4. mixed variety
5. flaccidity (hypotonicity)- LMN damage, too little contraction of muscles, lack of reflexes

Front 4

cerebral palsy: types of paralysis that can happen.

Back 4

1. hemiparesis- involvement on one side
2. diplegia- involvement of trunk and limbs, especially legs
3. triplegia- like diplegia but one arm is involved
4. quadraplegia
5. paraplegia- only legs involved

Front 5

cerebral palsy: speech impairments

Back 5

-sucking and/or swallowing problems are common, drooling
-dysartthria occurs 31-88% of the time w/ no consistent pattern
- spastic cerebral palsy- low pitch, hypernasality, pitch breaks, breathy voice, excess or equal stress
-children may have inadequate respiratory support

Front 6

cerebral palsy: natural course and treatment

Back 6

-non-progressive, but symptoms may change as children grow and become exacerbated during times of rapid growth
-tx depends on type and severity of CP and dysarthria

Front 7

What is ALS?

Back 7

-a progressive, degenerative disease involving both the brain and spinal cord of adults (UMN and LMN). Difficult to dx, cause is unknown, no cure, ave. survival rate 3 years

Front 8

General characteristics of ALS?

Back 8

-damage to UMN causes muscle weakness, increased muscle tone (spacticity), hyperflexia, clonus, and/or plantar extensor responses.
-damage to LMN cause muscle weakness, flaccid, atrophy, hypo-reflexia, fasciculations and/or fibrillations
Symptoms:
spinal-spinal nerves that innervate the arms and legs
bulbar-nerves that innervate the muscles of speech and swallowing
mixed

Front 9

speech characteristics of ALS?

Back 9

-swallowiing probs
-classified as mixed dysarthria
respiratory function is often affected, laryngeal dysfunction, velopharyngeal dysfunction, and artic probs

Front 10

natural course of ALS?

Back 10

degenerative and leads to death, usually by respiratory failure. Initially no speech disorder, then obvious disorder

Front 11

what is Progressive bulbar palsy?

Back 11

Usually limited to bulbar muscles
Age of onset 10-20 years
Presenting symptoms
-Facial paralysis
-Dysphagia
-Flaccid dysarthria

Front 12

what is Moebius Syndrome?

Back 12

-Congenital bilateral facial paralysis of facial nerve (7th) with abducent nerve paralysis
-Etiology Unclear
-Hypoplasia (lack of tissue development) of brain stem nuclei and cranial nerves
-Usually notice after birth when infant has difficulty nursing and closing eyes
-Feeding problems reported in 1/3rd of cases

Front 13

what is Duchenne Muscular Dystrophy?

Back 13

-Progressive disorder.
-most common and severe disease of the muscles that leads to spastic dysarthria.
-X-linked (only boys),
-onset between 2-5 years old,
-lack of protein (dystrophin),
-results in a series of events leading to destruction of muscle cells,
weaknesses in primary characteristics, weakness starts with pelvis and trunk and moves to all striated muscles. In the last stages, flaccid dystarthria is seen and cause of death is usually respiratory failure because muscles can’t contract to breath.

Front 14

what is Childhood Apraxia of Speech?

Back 14

There is no definitive diagnosis, it’s a motor planning/programming disorder, difficulty formulating and executing motor plans for voluntary, purposeful movements of speech in the absence of paralysis or weakness of the speech musculature.

Front 15

Characteristics of CAS?

Back 15

General Characteristics/ Speech Impairments: Errors include stress and prosody errors, sound sequencing difficulties (trouble consistently planning), more errors in longer utterances, initial and final consonant deletion, substitutions, cluster reduction, slow rate of speech (because can’t plan quickly), limited repertoire of sounds, vowel errors (unlike kids w/phono disorders), oral apraxia (moving tongue), and may have sensory, fine motor or gross motor difficulties.
Hallmark Characteristics: syllable omissions (mulitsyllable words) and groping/ inconsistent errors.
Not a problem of cognition or a language issue!

Front 16

What is Traumatic Brain Injury (TBI) ?

Back 16

Injuries to the head resulting in either temporary or permanent brain damage. A leading cause of death and injury in children under 40 because of MVAs, males 15-24 are at greatest risk, elderly and infants are at risk. Non-progressive.

Front 17

Characteristics of TBI?

Back 17

- depends on type of brain injury.
Primary Damage- caused by the actual impact.
Secondary Damage- from the impact includes edema (tissue swelling), hypoxia (low level of oxygen), anoxia, hypotension (low blood pressure level), vasospasm (constriction of blood vessels resulting in deficient blood supply), there is a production of free radicals and molecules (floods of amino acids- axonal injury).

Front 18

Recovery of TBI?

Back 18

-Emerging motor mvmt (that occurs during recovery) including tremors and dystonic mvmts (twisting/ abnormal posture).
-Verbal Improvement- noisy, disinhibited (as they emerge from a coma), confusion and disorientation
-Post-traumatic Amnesia- period of time from the point of injury to return to ‘continuous memory’ to ‘full recovery.’

Front 19

Speech characteristics related to TBI?

Back 19

Speech characteristics are diffuse and variable. 60% are acutely diagnosed with dysarthria (some resolve and it goes away), 10% are chronically diagnosed with dysarthria (usually a mixed type).

Dysarthria with TBI is usually mixed (spastic-flaccid, spastic-ataxic, ataxic-flaccid).

Front 20

What is Multiple Sclerosis (MS) ?

Back 20

MS is a disease of the white matter of the CNS. Scattered lesions or plaques produce varying combos of motor, sensory or cognitive impairments- Dysarthria is common. Unknown etiology, prevalence in northern U.S. is 1/1000, median age of onset is 27, symptoms depend on the site of lesions.

Front 21

What is MS Characterized by?

Back 21

progressive neurological deficits and most commonly a remitting-relapsing course. *Signs and symptoms include balance abnormalities (70%), impaired sensation (71%), paraparesis (62%), difficulty with micturition (62%) and optic neuritis (55%).

Front 22

Natural Courses of MS?

Back 22

*The course varies widely.
1. Benign (on-going attacks but then recover)
2. Relapsing remitting (Most common-85%)
3. Chronic progressive (primary and secondary progressive)
4. Malignant progressive (very rare)

Front 23

What is Parkinson’s Disease?

Back 23

Parkinson’s disease is a progressive neural degenerative disease caused by degeneration of the dopaminergic pathway from the substantia nigra to the striatum (nigrostriatal bundle). Overativity of the indirect pathway is a major factor. Average age of onset is 63 but 8% of patients show symptoms before age 40. About 1/272 people in the US have Parkinson’s. There are medications available (best is L-dopa) but if that doesn’t work there is a surgical intervention called “deep brain stimulation.” “Deep brain stimulation” is used in the advanced stages of the disease (when medications don’t work).
(*associated with the loss of dopaminergic neurons in the basal ganglia (substantia nigra) and brain stem).

Front 24

Parkinsons Disease is Characterized by/ Symptoms of...

Back 24

Hypokinsesia (too much inhibition), bradykinesia (slow to initiate movement), rigidity and resting tremor. Person’s have normal sensation and intellect but dementia may occur as degeneration progresses.
*The books says classic syndromes are bradykinsesia and rigidity.

To help remember- TRAP! (Tremor, Rigidity, Akinesia (radical bradykinesia, p. 121) and Postural instability) (118).

Front 25

Speech Characteristics of Parkinsons disease?

Back 25

(It seems to be that the main probs are poor respiratory support leading to probs with voice (pohnation, monotone) and artic probs due to incoordination of the laryngeal and oral activity (126-7).

First there are no detectible speech disorders but then reduced loudness (maybe also weak or breathy voice). “Lee Silverman” is a common intervention approach here. Eventually there is less and less intelligibility (rate variable, monotone, reduced ROM of oral strux, breathy). Introduce AAC devices. Eventually a small percent of person’s with Parkinson’s become anarthric (no useful speech).

Front 26

Natural Course of Parkinsons disease?

Back 26

This is a degenerative disease although medications have helped extend lives. *But this sometimes means that persons live in retirement centers, nursing homes, etc. for longer (120).

Front 27

Unilateral Cortical Lesions

Back 27

may produce a contralateral weakness of the articulators (facial and lingual), transient, mild dysarthria may result. Artic is the most affected- slow rate! VPI, respiratory dysfunx is uncommon.

Front 28

Bilateral Cortical Stroke

Back 28

bilateral lesions of the corticobulbar tracts necessary to produce permanent dysarthria secondary to CVA.
-spastic (because motor nuclei aren’t getting intervation from either cortex).
-pseudobulbar palsy (trouble chewing, swallowing, speaking).

Front 29

Brainstem CVA

Back 29

-Lesion in the area of vertebrobasilar circulation
-upper cervical spinal cord, cerebellum, medulla oblongata, pons.
-15% of all strokes
-bulbar palsy- bilateral impairment

Speech characteristics depend on the sight of lesion. Could be weakness, hypotonia, or flaccid dysarthria 9marked hypernasality and nasal emission of air, continuouis breathing during phonation, audible inspiratory stridor.

Front 30

. Locked- In Syndrome (LIS)

Back 30

Occlusion of basilar artery, severe movement disorder that affects speech musculature and limbs.
-inability to control muscles voluntarily or reflexively
-language and cognition relatively intact (because stroke was at brainstem, not in brain).
-eye movements may be affected (early recovery of horizontal eye movement is a good prognostic indicator).