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86 Cards in this Set
- Front
- Back
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Cerebral Palsy
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A static (not changing) encephalopathy (brain injury that is non-progressive disorder of posture and movement); etiologies are varaible- brain injury, trauma during birthing process; often associated with epilepsy, speech problems, vision compromise, and cognitive dysfunction; most will have neuromuscular challenges
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Most common speech disorder individuals with CP experience
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Dysarthria
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Prevalence of CP
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2-4/1000; 7-10,000 new babies born each year in the U.S.
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Physiologic CP
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look at what's going on with the individual e.g. they have spastic CP; use elements of physiology to label what their deficit(s) is
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Athetoid CP
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Physiological characteristic: constant uncontrolled motion of limbs, head and eyes; appear intoxicated, can walk but unsteady; speech tends to be slurred; imprecision with speech
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Ataxic CP
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physiological characteristic: poor sense of balance, often causing falls and tumbles; imprecise articulation
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Rigid-Spastic CP
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physiological characterisic: rigidity means tight muscles that resist efforts to make them move;
Spastic means tense, contracted muscles (most commone type of CP) |
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Atonic CP
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associated with marked hypotonia, brisk reflexes, and severe cognitive delays
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Mixed CP
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spastic and athetoid
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Monoplegic CP
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single limb; topographic classification
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Paraplegic CP
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lower limbs; topographic classification
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Hemiplegic CP
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one side of the body; topographic classification
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triplegic CP
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three limbs; topographic classification
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quadraplegic CP
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four limbs; topographic classification
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Diplegic CP
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symmetrical parts; topographic classification
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Etiologic CP- prenatal
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(70%)- something going on during prenatal development such as infection, anoxia, toxicity, vascular, Rh disease, genetic, congenital malformation of brain
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Etiologic CP- natal
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(5-10%)- anoxia, traumatic delivery, metabolic
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Etiologic CP- post natal
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trauma, infection, toxic, e.g. infant who is dropped = trauma; allergic reaction = toxic
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Clinical symptoms and complications of CP
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Spacticity, weakness, increase reflexes, clonus(repetitive movement), seizures, articulation and swallowing difficulties (these are typically treated by SLP) visual compromise, deformation, hip dislocation, kyphoscoliosis, constipation, urninary tract infection
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Management of CP
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Speech
OT PT Adaptive equipment (AA) Neurologic Surgical (Rhizotomy- nerves section- cut the nerves that are causing the muscle to be hypercontracted) Pharmaceutical (e.g. baclofen pumps, botoxin spacticity reduction) |
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Rrehabilitation challenges for those with CP
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Mobility
Communication Learning Self Care Self Direction Independent Living Economic Sufficiency *Help individual to grow to be as independent as possible |
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Speech
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just one modality of communication (others = gestures, facial expression), most natural, efficient and culturally acceptable form of communication, typically the long-term goal of individuals with impairments, not always achievable
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Communication
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Functions to control an individual's enviroment (to obtain or reject something), functions to regulate social interactions, functions to receive and convey information and other ideas, can be as simple as changing body tension
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Assistive technology
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Any item, piece of equipment, or system that is commonly used to increase, maintain, or improve functional capabilities of individuals with disabilities; used to enhance the effectiveness of one's communication
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Augmentative communication
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used by individuals who have some speech but are unintelligible or have limited abilities to use speech; facilitating their natural ability to communicate; e.g. person talks very softly so they use an amplifier to enhance communication
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Alternative Communication
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Used when an individual has no speech and must rely on another method to make their communicative intents (ideas, desires and needs) known; individual has unintelligible speech so substitute something that replaces natural speech; use gestures, signs, pointing device- create an alternate source of speech
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Purpose of AAC
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increase/improve an individual's ability to achieve basic communication functions in the environments and activities in which they participate or are expected to participate- gives someone the ability to have their needs met and share information
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AAC systems
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integrated group of components, including the strategies, aids, techniques, and symbols used to enhance communication; we all use a system to communicate;e.g. texting is part of our communicative system and it is an alternate communication device; e.g. answering maching allows us to communicate with someone even when they are not there
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Aided Communication
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the use of devices (computer), tools (pen), objects (pictures), individuals etc. to communicate;
-external materials and/or devices are necessary, generally less efficient |
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unaided communication
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use of one's own self (speech, gestures, body language) to communicate; no external material or device is necessary; generally more efficient; e,g, sign language
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low-tech aided communication
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pictures/objects
schedules menus pencil & paper communication board communication books |
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high-tech aided communication
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recorders
amplifiers synthetic speech comnputer based communication |
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core vocabulary
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used to meet basic communication needs in ALL environments
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Fringe vocabulary
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specific to certain environments; e.g. menun = eating, calendar = morning circle time, tv guide = leisure time,
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closed set of vocabulary
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Static- paper board--> items dont change
AND Dynamic- computerized device, pictures can easily change |
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Generative vocabulary
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picture/gesture sequencing
spelling talking e.g."hi im rick"- combining utterances and spell words |
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visual representation system
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real objects
miniature objects photographs realistic drawings line drawings symbols written words |
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type of access/selection for AAC devices
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Direct selection: method of choice, most efficient- quickest e.g. key boards or pointing to pictures
Indirect Selection: less efficient, more likely the choice with increased physical movement impairments e.g. single switch, multi switch, scanning, coding |
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Goal of AAC systems
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facilitate communication by increasing opportunities and reducing barriers
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increasing opportunities
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-way to facilitate communication
- shape communicative environment -peer involvement -patience -reinforcement |
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reducing barriers
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-way to facilitate communication
-policy -environment -resource -communication |
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AAC considerations
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-multi-modal system
-access rate- efficiency -adaptability- must grow with the user >pre-literate >literate >non-literate -support and acceptance |
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Caaruso & Strand Model
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adult model
sensorimotor planning sensorimotor programming neuromuscular execution |
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Sensorimotor planning
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initial process in the transformation from the cognitive/linguistic processes to speech movements- specifying motor goals
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frontal lobe's role in sensorimotor planning
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specify the direct and indirect system motor plans
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parietal lobe's role in sensorineural planning
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contribute to planning based on expected performance and aspects of internal (proprioceptive) feedback
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motor planning
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goal-orientated spatial and temporal specifications of speech movements (respiration, phonation, resonance, ariculation)
-described in PLACE and MANNER of production -coordination, sequencing of sounds and coarticulation |
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sensorimotor programming
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a set of muscle commands structured prior to onset of a movement & executed ina sequence while influenced by feedback
-accounts for major movement determinations of respiratory, phonatory, resonatory, and articulatory position and timing |
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Force function
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element of sensorimotor programming
level of muscle contraction to complete target |
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timing relations
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element of sensorimotor programming
temporal characteristics of within each element of the target |
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interstructural/component relations
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element of sensorimotor programming
positioning and timing across elements |
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status of the position dynamics
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element of sensorimotor programming
feedback to ensure movement adheres to the plan to reach the intended target |
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Sensorimotor programming: what do the programs specify?
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programs specify muscle tone, movement direction, force, range, rate, as well as mechanical stiffness of joints
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why is sensorimotor program flexible?
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to account for dynamic nature of phonological targets (e.g. coarticulation)
it prevents over- and under-shoot |
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speech motor equivalence
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the contributions of various structures (e.g. articulators) can vary considerably across multiple productions of a segment, yet the end product is perceptually consistent
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Neurosubstrates associated with programming
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basal ganglia control circuit
cerebellar control circuit fronto-limbic system SMA Cortex |
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Sensorimotor execution
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realization of the dynamix sensorimotor plan and programming
-even after speech has begun, system is flexible to make "on-line" changes due to the integrated rocess of all aspects of the sensorimotor system (planning, programming, execution) |
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Speech Movement
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production of acoustic signal (based on voltional recruitment of respiratory, phonatory, articulatory, musculature) in corrdinated and rapid fashions
very complex postures and dynamic characteristics (movements) are highly skilled volitional neuromuscular events functional trade-off between speech and accuracy (varies based on personal and situational factors) |
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Netsell's model
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respiration, phonation, resonance, and articulation all lead to/ have an impact on prosody; dysarthria can affect any/all of these subsystems
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Motor speech disorders
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speech disorders resulting from neurologic impairments affecting the motor planning, programming, neuromuscular control or execution of speech; disorder of speech with a sensorimotor difficulty
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Dysarthria
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neurologic speech disorder resulting from abnormalities in the strength, speed, range, steadiness, tone,or accuracey of movements required for control of the respiratory, phonatory, resonatory, articulatory and prosodic aspects of speech production; neurologic in origin; disorder of movement or control
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what causes the pathophysiologica disturbances responsible for dysarthria?
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central or peripheral nervous system abnormalities and most often reflect weaknesses; spacticity; incoordination; involuntary movements, excessive or reduced muscle tone
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Apraxia of speech
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neurologic speech disorder reflecting an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech;
occurs in the absence of physiologic disturbances associated with the dysarthrias and in teh absence of disturbance in the compent of language |
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Childhood Apraxia of Speech (CAS)- symptoms
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difficulty initiating speech movements, difficulty achieving and maintaining articulatory configurations, groping for articulatory posture,halting, effotful sequencing of phonemes, inabilitiy to imitate speech sounds in absence of structural or functional abnormalities of articulators, vowel distortion,timing errors,
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why does CAS have more widespread linguistic effects than adult apraxia?
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language is still developing in children
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Different terms for CAS
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developmental articulatory dyspraxia, verbal dyspraxia, developmental verbal apraxia, developmental apraxia of speech
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Dysarthria
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execution challenges
speech distortions consistent errors little or no groping for sounds all speech is affected little difference in errors based on types of speech (automatic vs. volitional) |
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Apraxia
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speech substituions
inconsistent errors groping for articulatory sound/target islands of fluency error differences based on types of speech (automatic is fluent, volitional is not) |
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Types of dysarthria
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flaccid
spastic ataxic unilateral upper motor neuron hyperkinetic hypokinetic mixed |
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Flaccid Dysarthria symptoms
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hypotonia, breathy voice, hypernasal
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Flaccid Dysarthria: lesions
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Lower motor neurons (LMN) located in cranial and spinal nerves
V. trigeminal nerve: jaw movement VII. Facial nerve: lower half of face IX. glossopharyngeal nerve: velum VII. hypoglossal: tongue |
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clinical Dx of flaccid dysarthria
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myasthenia gravis
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Spastic dysarthria: symptoms
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stiff, rigid muscle tone, strained, strangled speech
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Spastic dysarthria: lesions
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most commonly caused by stroke affecting the brainstem; must have bilateral damage
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clinical Dx of Spastic Dysarthria
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spasmodic dysphonia
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Ataxic Dysarthria: symptoms
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poor muscle coordination; gives impression of intoxication; weak muscle tone; unsteady in their gate; speech also sounds like they are intoxicated
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Ataxic Dysarthria: lesions
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lesions/damage to cerebellum
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Unilateral Upper Motor Neuron Dysarthria (UUMN): symptoms
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speech difficulties are minimal usually and often only occur during early stage following brain injury
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Unilateral Upper Motor Neuron Dysarthria:lesions:
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caused by damage to upper motor neurons on ONE side
usually caused by single stroke affecting middle cerebral artery can co-occur with Broca's aphasia or RHS, depending on hemisphere of damage |
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Hyperkinetic Dysarthria: symptoms
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too much movement of muscles; tremors (rhythmic muscle contraction and relaxation), tics (sudden repetitive nonrhythmic), involuntary movement can be quick or slow-->
*dystonia- slow movements *Chorea- quick movements |
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Hyperkinetic Dysarthria: causes
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damage to the extrapyramidal system; involves basil ganglia
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Hypokinetic dysarthria: symptoms
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muscles become rigid and stiff; too little muscle movement
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hypokinetic dysarthria: cause
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lesions to extrapyramidal tract; most common cause is Parkinson's disease
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Prosody
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Naturalness of speech
supersegmental aspects of speech >rate/duration >loudness/intensity >pitch/frequency linguistic stress social communication/pragmatics interpretation of prosody is done by right hemisphere |
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Mixed dysarthria:
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combination of dysarthrias; site of lesion not so precise
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treatment of dysarthria
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articulation: intelligibility drills, placement cues
resonance: prosthesis, medical intervention prosody: contrastive stress drills phonation: hypoadduction or hyperadduction exercies respiration: controlled respiration/phonation tasks; chunking |
