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51 Cards in this Set
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2 motor speech disorders |
dysarthria and apraxia; general term for speech disorders characterized by weakness in muscles involved in speech production |
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structural parameters affected that impact speech production and prosody in dysarthria |
a. range of motion b. strength/force c. coordination/direction d. range of muscle movement/velocity |
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"If you can't hear it, it's not dysarthria." |
voice gurgle, jittery or breathy vocal quality, etc. |
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dysarthria usually has a |
neurogenic cause; but can be functional |
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causes of dysarthria |
brainstem damage (LMN), damage to nerve fibers connecting motor neurons to speech muscles, nerve-muscle junction disease, muscle disease, etc. |
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speech dimensions of dysarthria: respiration |
low, speech limited to short phrases due to decreased respiratory support |
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speech dimensions of dysarthria: phonation |
breathy, caused by unilateral or bilateral vocal fold paresis or paralysis |
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speech dimensions of dysarthria: resonation |
hypernasality caused by weak movement of velum, leading to velopharyngeal incompetance, may also be hyponasal |
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speech dimensions of dysarthria: articulation |
distorted, imprecise consonants caused by weakness and incoordination of the mandible, lips, and tongue |
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6 types of dysarthrias |
-spastic -flaccid -ataxic -hyperkinetic -hypokinetic -mixed |
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spastic dysarthria- unilateral upper motor neuron (UUMN) |
mild; begins in motor strip and terminates in brain stem |
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spastic dysarthria- bilateral upper motor neuron (BUMN) |
severe; both tracts affected (ex. large tumor, multiple lesions or strokes, etc.); affects transmission of nerve impulses to cranial and spinal nerves that supply speech musculature -half originate on right, half on left |
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spastic dysarthria- unilateral upper motor neuron (UUMN)- SYMPTOMS |
-harsh/strained vocal quality -inconsistant hypernasality; palate not always adequately elevated -mild articulatory imprecision, slow/normal speech rate, inconsistent articulatory breakdown, diminished loudness |
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spastic dysarthria- bilateral upper motor neuron (BUMN)- SYMPTOMS |
-harsh/strained/strangled/tense vocal quality -very low-pitched vocal quality, may have pushing quality, glottal fry -imprecise articulation -slow, effortful, jerky, laborious -reduced DDK rates |
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flaccid dysarthria |
lower motor neuron disease (LMN)- affects cranial or spinal nerves or the motor unit itself -damage to any part of motor neuron can cause -disruption in connection out to the peripheral system -characterized by weakness in one or a combination of the speech subsystems -main symptom is lack of muscle tone with weakness or paralysis of affected muscles |
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flaccid dysarthria- symptoms |
-audible inspiration, shallow breathing, reduced breath support -hypernasality due to weakness in velum -nasal emission- air coming through nose during non-nasal sounds, may use mirror to check -breathiness or aphonia, weakness or paralysis of vocal folds, may be hoarse -imprecise articulation due to poor lip and tongue strength, may sound slurred |
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flaccid dysarthria associated with |
stroke, myasthenia gravis, Guillian-Barre syndrome |
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spinal cord damage |
-speech is affected due to weakening or paralysis of respiratory muscles -C3, C4, and C5 innervate diaphragm speech characteristics: -short utterances -low pitch voice -monotone pitch/loudness -weak, breathy vocal quality
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extrapyramidal disease |
-results from damage in and around the basal ganglia and involves various types of movement -hyperkinesia (too much movement)- excessive movement ranging from slow to fast, includes tremors, tics, chorea, and dystonia (ex. Huntington's) -hypokinesia (too little movement)- lack of appropriate movement, rigid muscles, too much muscle tone resulting in stiffness and poor range of motion (ex. Parkinson's) |
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hypokinetic dysarthria- speech characteristics |
-reduced loudness, monoloudness -reduced pitch variability, monopitch -extremely fast rate of speech along with short rushes of speech; trouble inhibiting and controlling movements -hoarse and breathy voice -slow and difficult initiation of volitional speech movements -difficulty with initiation |
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hyperkinetic dysarthria- speech characteristics |
-sudden, forced instances of inspiration or expiration, voice stoppages, periods of breathiness, strained/harsh voice quality -imprecise articulation -impaired prosody -intermittent intervals of hypernasality -difficulty in controlling the impulse -damage to basal ganglia |
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ataxic dysarthria |
-associated with damage to the cerebellar system -reflects a breakdown in motor organization and control -impairment in coordination of movement at any level of the speech subsystems -respiratory: uncontrolled changes in subglottic pressure -articulation- uncontrolled speech muscles, may not hit targets -resonation- fluctuation in velopharyngeal muscles, may or may not hear nasality |
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ataxic dysarthria- speech characteristics |
-inconsistant consonant errors, irregular articulatory breakdown -abnormal prosody- inappropriate loudness, modulation, poor pitch control -phoneme and syllable prolongations -slow rate |
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mixed dysarthria |
a combination of 2 or more of the pure types of dysarthria -relatively common -reflects the effects of multiple neurologic events or diffuse neurologic disease |
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muscle fasciculations |
looks like a bag of worms under the tongue |
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anarthric |
speech functionally unintelligible |
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evaluation of dysarthria- purpose of evaluation |
-determine if speech is abnormal -evaluate nature and severity of abnormalities -determine cause -determine if treatment is appropriate and what it will be |
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dysarthria evaluation- parts |
-patient interview -formal/informal assessment -OME -intelligibility testing -sustained phonation -DDK -pitch range -volume -language assessment |
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dysarthria evaluation tasks |
-alternating motion tasks (pucker/smile etc.) -DDK -conversation -sustained phonation -general observations |
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sustained phonation average |
18-21 seconds |
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formal assessments for dysarthria |
-Assessment of Intelligibility of Dysarthric Speech -Dysarthria Examination Battery -Frenchay Dysarthria Assessment
-perceptual ability (listening) is your best tool |
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perceptual evaluation |
evaluation of speech systems, emphasis on oral mechanism; uses passages -respiration (breath support) -phonation (pitch, loudness, volume) -resonation (nasality) -articulation (sound, syllable, word, etc.) -prosody |
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differential diagnosis |
process of narrowing possibilities and reaching conclusions about the nature of a deficit -speech exams should always lead to an attempt at a diagnosis, but may be within normal limits |
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general principles for dysarthria treatment |
primary goal: maximize effectiveness, efficiency, and naturalness of communication -medical intervention (pharmacological, surgical) -prosthetic devices -behavioral change- drill/motor practice |
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dysarthria treatment procedures- indirect |
-modifying muscle tone, posture, respiratory capacity |
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dysarthria treatment procedures- direct |
done under controlled conditions with a systematic approach -phonation -resonance -articulation -prosody -AAC device |
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types of apraxia |
-apraxia of speech -limb apraxia -oral apraxia |
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apraxia of speech |
inability to produce voluntary speech, either to command or imitation, despite the ability to perform automatic speech tasks without error -disorder in motor speech programming and sequencing -impairment in ability to plan, sequence, coordinate, and initiate movements of the articulators |
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limb apraxia |
inability to perform voluntary movements of non-paralyzed upper extremities |
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oral apraxia |
inability to perform voluntary movements of non-paralyzed oral musculature |
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apraxia and muscle strength |
apraxia has nothing to do with muscle strength- it has to do with motor coordination |
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apraxia and dysarthria |
frequently occur together |
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apraxia sites of lesion |
-damage to language dominant hemisphere -posterior inferior left frontal lobe or around Broca's area -occasionally in both frontal and parietal lobe (may be damage to pathway- arcuate fasciculus) |
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concomitant findings |
-hemiplegia/hemiparesis -spasticity -comonly have oral apraxia as well and occasionally limb apraxia -commonly co-occurs with Broca's aphasia -uncommonly occurs in isolation |
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characteristics of apraxia of speech |
-slowed speech, trial and error "groping" articulation attempts -inconsistant, highly variable error production -islands of fluent, error-free words, phrases, and sentences among effortful speech -difficulty initiating speech -disfluency- may repeat sounds/syllables when trying to get it right -errors increase with increasing word length/complexity -sound errors more substitutions, repetitions, additions, and prolongations than distortions or omissions |
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assessment of apraxia of speech |
evaluation of speech subsystems, usually done in conjunction with dysarthria assessment -observation for hallmark speech characteristics -non-speech oral movements -speech movements (DDK) -producing words, phrases, and sentences of increasing phonologic complexity |
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assessment protocols of apraxia of speech |
-perceptual skills still best assets -Apraxia Battery for Adults -Comprehensive Apraxia Test |
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general principles of treatment of apraxia |
-focus is on articulation (motor sequencing) -introduce strategies to help patient relearn points of articulation and organize movement sequences for speech -dependent on auditory comprehension abilities -intensive treatment required -rely on self-monitoring of errors -must consider any coexisting aphasia or cognitive deficits -maximize effectiveness, efficiency, and naturalness of communication |
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therapeutic procedures for apraxia of speech |
-intrasystem reorganization approaches -uses aspects of unimpaired speech system to compensate for deficits from apraxia -rely on nonverbal activities to facilitate control -eight step task continuum program |
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eight step task continuum program |
integral stimulation approach- initially present maximum stimulus prompts that are gradually faded to increase the amount of complexity of verbal responses; drill-based; "watch me, listen to me, say it with me" |
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dysarthria- sites of lesion |
spastic- UMN flaccid- LMN ataxic- cerebellar system -hypokinetic- extrapyramidal -hyperkinetic- extrapyramidal |
