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102 Cards in this Set
- Front
- Back
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Motor Speech Disorder
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disorders of speech resulting from neurologic impairment affecting the motor programming or neuromuscular execution of speech
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Dysarthria
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speech disorder resulting from weakness, paralysis, or incoordination of the muscles of the speech mechanism. EXECUTION
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Apraxia
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a speech disorder which results from an impairment in motor programming for speech. Cannot generate plan
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Oral Mechanism Exam
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oral facial exam, cranial nerve assessment (move mouth, pucker lips, etc) perceptual assessment, acoustic and physiologic assessment
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Diadochokinesis
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the normal ability to perform rapidly alternating muscular movements, as flexion and extension. Test for Parkinson's disease. Given three sounds, pa ta ka. Produce sounds in sequence
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What are the primary means for assessing motor speech disorders
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Perceptual
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What types of apraxia exist?
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Difficulty with voluntary movements but reflexes are ok. Oral and Limb... Speech (diff. with speech movements) and voicing
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Childhood apraxia of speech?
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can be difficult to distinguish from severe articulation disorder, hard to diagnose especially in very young children
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What is acquired apraxia of speech?
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Result of storke or brain damage to specific area in frontal lobe of brain
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What are common errors made by people with apraxia of speech?
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Inconsistent errors (multiple reps not the same), more errors as complexity increases, more errors on nonsense words as compared to real words, stress does not increase errors
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Contrast apraxia of speech and dysarthria
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apraxia occurs with breakdown within the speech programming areas of brain. Dysarthria results from a breakdown with execution.
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Flaccid Dysarthria
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imprecise articulation, slow speaking rate, reduced oral movements, breathy voice, hypernasality, problem chewing and swallowing, drooling, assoc with syndromes, loss of function of one or more cranial nerves, stroke, or muscular problems
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Spastic Dysarthria
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Assoc. with bilateral strokes or brain damage to both sides of the cortex. Char.-imprecise consonants, slow speaking rate, strained-strangled voice, pitch brakes. fluctuate between laughing and crying for no reason, facial expression does not match inner feeling
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Ataxic Dysarthria
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assoc. with damage to the cerebellum. i.e. cerebellar degen. Char.- irreg. articulatory breakdowns and distorted vowels, harsh voice
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Mixed
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Multiple sclerosis
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Multiple Sclerosis
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destruction of the myelin sheath around neurons, nerve conduction is slower, not all clients exhibit dysarthria but becomes more common in later stages (mixed dysarthria-ataxic and spastic mostly) etiology-unknown (environ. with genetic predisposition is likely) more common in women. can begin with visual disturbances. symptoms-imprecise articulation, hypernasality, reduced pitch variability, slow rate, harsh or breathy voice
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Hypokinetic
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Masklike facial appearance (little if any facial expression) drooling and infrequent swallowing, tremor of lips and jaw at rest and during speech movement. Imprecise articulation, variable rate with short rushes of speech, syllable reps, monopitch and monoloudnes
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Hypokinetic-Parkinson's disease
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cause-unknown. can have parkinsonian symptoms from other causes,
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Hyperkinetic
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additional movements during speech. Dyskensia (abnomral, involuntary movements
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Hyperkinetic-Focal Cranial Dystonias
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imprecise consonants, distorted vowels, harshness and strained-strangled voice, excess loudness variations and alternating loudness, voice stoppage and tremor
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Hyperkinetic-Huntington's Chorea
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personality changes, dementia, drooling, chewing and swallowing problems, quick unpredictable movements, imprecise consonants and vowels, variable rate excess loudness variations
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What type of dysarthria is usually associated with bilateral strokes or other kinds of damage to both sides of cortex?
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Spastic
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What kind of dysarthria is associated with damage to the cerebellum?
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Ataxic
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What kind of dysarthria often arises from multiple sclerosis?
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Mixed
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What are the earliest symptoms of M.S.?
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Visual disturbances, gait and sphincter problems, or other sensory problems.
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What are the cardinal symptoms of hypokinetic dysarthria?
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Little if any facial expression, drooling and infrequent swallowing, and tremor of lips and jaw at rest and during movement
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Do most people with Parkinson's disease have speech and voice problems?
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Yes, voice problems develop first.
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Contrast Hypo and Hyper kinetic disarthria
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Hyper-too much movement. Hypo-slow muscle movement and stiff muscles.
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What are some diseases that five rise to hyperkinetic dysarthrias?
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Focal Cranial Dystonia and Huntington's Chorea
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Huntington's Chorea and speech symptoms
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Autosomal dominant trait, personality changes, dementia, hyperkinetic dysarthria. Speech Prob-imprecise consonants and distorted vowels, irregular articulatory breakdowns, voice stoppages
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What is differential diagnosis in motor speech disorders??
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Diagnosis that differentiates a person's disorder from other similar disorders.
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What are two motor speech disorders that you might have difficulty diagnosing differentially?
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Spastic dysarthria from flaccid
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What speech subsystems must be assessed when diagnosing a motor speech disorder?
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Respiratory, phonatory, resonatory, and articulatory
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Would you ever use standardized tests for a client with a motor speech disorder? Why?
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Yes, it can help compare these people with the norms. There are standardized tests for motor speech disorders.
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What voice quality might be associated with flaccid dysarthria?
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Breathy and hypernasality
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Voice quality associated with spastic dysarthria?
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strained-strangled voice quality. Pitch breaks
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What is the most important assessment tool used by most SLP's in assessing clients with MSD's?
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Listen for accuracy, hyper/hypo nasality, loudness, race... tool is your ear
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What is the primary goal of treating a motor speech disorder? Are all clients going to achieve near-perfect speech?
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Maximize intelligence while minimizing decreases in the naturalness of the speech. NO
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In the treatment of apraxia of speech, what kind of cues might be necessary for the client?
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What kind of apraxia is present (oral, limb, speech, and voicing)
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What is the underlying physiological mechanism causing hypernasality?
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the soft palate does not close the nasopharynx
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What is the Lee Silverman voice treatment?
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Technique for improving the voice volume of patients with Parkinson's diesease and other neurological disorders.
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Aphasia
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language disorder that results from damage to the portion of the brain that is responsible for language. Most people-left side of brain
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CVA
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cerebrovascular accident
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Arteriosclerosis
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hardening of arteries
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Embolism
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when embolus migrates from one part of body through blood vessels and causes blockage
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Thrombosis
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clot inside blood vessel
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Brodman's Areas
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Frontal Cortex, middle frontal area 46. Attention and working memory
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Broca's Area
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left anterior region lesion of frontal lobes
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Wernicke's Area
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area 22. Left posterior lesion. Most people, left hemisphere. Comprehension impaired. Production fluent but nonsensical.
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Arcuate Fasciculus
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neural pathway connecting Wernicke's to Broca's
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Semantic paraphasia
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misselection of words. some relationship to the intended utterance (bread for food)
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Neologistic jargon
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e.g. chossl for chair, rugal for notebook
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phonemic paraphasia
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e.g. pon for pot
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telegraphic speech
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speech produced by a person who have suffered injury to Broca's area
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Speech apraxia
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disorder in which the person has trouble saying what he or she wants to say correctly an consistently
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anomia
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problem with word finding
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What is the primary cause of aphasia?
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Stroke or CVA
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What are two kinds of strokes?
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Ischemic (complete or partial occlusion of arteries) Hemorrhagic (Burst blood vessel)
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Who was Paul Broca and what contribution did he make to the study of language and the brain?
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Studied brains of aphasic paiteints. "tan" is only words spoken by first patient. Left Ant. Lesion. Right hemiparesis (weakness) non fluent, telegraphic, speech apraxia, agrammatic in production but may also be seen in comprehension. E.g. "the boy pushed the girl" (OK) "the boy was pushed by the girl" (Diff)
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What are the major symptoms of a patient with a left anterior cortical lesion versus a patient with a left posterior cortical lesion?
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LAL-nonfluent, comprehension relatively o.k. LPL-fluent, comprehension impaired
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What labels to we typically five to the types of aphasia associated with LPL and LAL?
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LAL-Broca's Aphasia... LPL-Wernicke's
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Describe general char. of Broca's and Wernicke's aphasia assoc with video
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Broca's repeat of "tan", nonfluent, speech apraxia,. Wernicke's comprehension impaired, production is fluent but lack of content, contains paraphasias. Video-talk alot
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What kinds of errors might Broca's aphasia patients have in comprehension?
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agrammatic
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Give examples of semantic paraphasias?
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stool for chair, boy for girl, spoon for fork
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Examples of neologisitc jarogon?
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chossl for chair, rugal for notebook
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Examples of phonemic paraphasia?
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pon for pot
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Are semantic paraphasia, neologistic jargon, and phonemic paraphasia char. of Broca's or Wernicke's?
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Wernicke's
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What are stereotypies in expressive aphasia?
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Results from bisected Arcuate Fasciculus. Patient exhibits repeat of same word, head nod, left hand gesture, is aware when they mess up. can count
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Global aphasia?
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massive left perisylvian lesion involving Broca's and Wernicke's and Arcuate Fasciculus. Production, comprehension, and rep. are all impaired.
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Problems with motor control of right limbs would be a characteristic part of symptoms of what kind of aphasia?
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Broca's
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What are some language deficits you see in patients with right hemis. cortical lesions?
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Reduced eye contact, deficits in production and comprehension of sarcasm, production and comprehension of facial expression, relevance, organization. Left neglect (safety issues, but also results in communication, reading deficits) deficits in inferencing: indirect requests, jokes, sarcasm, metaphors
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Observations made of the video showing woman with right hemisphere brain damage?
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Speech is good
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What did woman with R. hemis. brain damage do when asked to draw pic of flower?
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Could draw whole flower but not left side of stem or flower box.
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What are some interventions for people with right hemisphere brain damage?
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Visual and auditory recognition, self-monitoring and paralinguistics, conversational skills and tracking of complex information, sequencing and explaining complex tasks, synthesis of skills within convos.
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How are primary and secondary damage defined in relation to traumatic brain injury?
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Primary damage-result of impact (size depends on nature of impact) 2ndary damage- infection, hyoxin, edema, increased intracranial pressure, infarction, hematomas
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What are some differnces between closed and open head injuries?
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Closed-inward compression of skull at point of impact (coup) and subsequent rebound effects (contra coup) Open-scalp and skull are penetrated e.g. bullets and knives
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What is meant by coup and contra coup head injuries?
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Forces of blow to head cause brain to bounce roughly on rough inner surfaces of skull and twist inside skull
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Can contra coup effects be serious?
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Yes, rough surfaces lead to widespread damage and some common traits among many TBI patients. e.g. coma (orientation/cognitive deficits and slowed processing speed)
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Why do TBI patients often succumb to coma following the injury?
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Damage to central portions of brainstem
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What are the cognitive disturbances that are often sequeled to TBI?
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Orientation, attention, memory, problem solving and reasoning and executive functions (frontal lobe)
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What are some typical language disturbances for patients with TBI?
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3/4 of patients, aphasia-like e.g.g anomia, confused language, and pragmatics
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What is dementia?
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Progressive decline in cognitive function due to damage or disease
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What are some diseases that lead to dementia?
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Alzheimer's disease, Parkinson's, Huntington's, AIDS dementia complex
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Why is prognosis poor for patients with dementia?
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it is progressive disease
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Describe video when patient was told story that had dementia
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Could not repeat story that was just told, naming fluency
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Four phases of normal swallow
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oral, pharyngeal, esophageal
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Bolus
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Round mass moving through digestive system
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Stripping action of tongue
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rapid tongue motion at the end of the oral phase of swallowing
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dysphagia
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diff. swallowing
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feeding disorder
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difficulties related to eating and drinking, problems gathering food and getting ready to suck, chew, or swallow it. Behavioral or sensory disorders
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Nasogastric tube
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passage from nose to stomach
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Gastrostomy tube
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through skin and stomach wall
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jejunostomy tube
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through abdomen into jejunum
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where is the upper esophageal sphincter?
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superior portion of esophagus
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what is the Upper es. sphincter activity during resting?
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swallowing-relaxing and tightening the sphinctors at the top and bottom of the esophagus
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what is the role of the epiglottis in swallowing?
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closes off the trachea to prevent choking
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What is aspiration?
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choking
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Highest incidence of dysphagia?
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nursing home
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What are some causes of feeding/swallowing disorders in infants?
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neurological impairment, cardio-respiratory compromise, structural abnormalities
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Differences in anatomy and physiology of swallowing between adults and newborns?
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Adult swallow is fully developed and stable, oral space of newborn is small, lower jaw is small and retracted, sucking pads present, tongue takes up more space, restricted tongue movement, can nose breathe while swallowing, soft palate and epiglottis approximate each other, larynx is higher in the neck, eustachian tube is horizontal.
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Is it fine to have an infant fed by gastrostomy tube for a period of three to six months?
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No, long-term feedings may result in discomfort with selective eating and food refusal.
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Two instrumental evaluations of swallowing function
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modified barium swallow/videoflouroscopic swallowing study. and Fiberoptic endoscopic evaluation of swallowing.
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