Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/43

Click to flip

43 Cards in this Set

  • Front
  • Back

Motor Speech Disorders

Speech disorders that occur due to neurologic impairment that affects:




- motor planning or programming,


OR


–Neuromuscular execution




-includes Dysarthria & Apraxia

**Dysarthria**

Collective name for group of neurologic speech impairs -reflect abnormalities in strength, speed, range, steadiness, tone / accuracy of movements req'd for all 5 aspects of speech.




-Characterized by slow, weak, imprecise, or uncoordinated movements of the speech musculature

Dysarthria affects:

Motor execution


(=Specification of precisely how the motor plan is to be achieved:


–Which muscles contract


–How much (movement range and direction)


–When (timing))


=Direct activation of motoneurons, muscle contraction, and movement

Types of Dysarthria

-Flaccid


-Spastic


-Ataxic


-Mixed


-Hypokinetic


-Hyperkinetic


-Unilateral UMN

**Factors that Impact Dysarthria**

*Age of onset (congenital or acquired (at any age))


*Cause (vascular, traumatic, infectious, neoplastic)


*Natural course (Developmental (CP), Recovering (stroke/TBI), Stable/Chronic (adult CP), Degenerative (ALS), Exacerbating-Remitting (some MS)


*Site of Lesion


*Underlying neurological diagnosis *Pathophysiology (spasticity, flaccidity, ataxia, tremor, dysmetria, involuntary movements) *Speech subsystems involved


*Perceptual characteristics


*SeverityFactors

**Apraxia of Speech**

Neurologic motor speech disorder reflecting an impaired capacity to plan / program sensorimotor commands needed for directing movements that result in phonetically & prosodically normal, volitional speech.

Apraxia affects:

Motor Planning


(=Selection of appropriate movement strategies in light of intended goals and prevailing physical conditions)


**Intelligibility vs. Comprehensibility**

INTELLIGIBILITY•Info only f/ speech signal




COMPREHENSIBILITY•Consideration of info f/ speech signal + context.

Darley, Aronson, & Brown

-Developed use of auditory-perceptual assessment to characterize types & physiologic bases of dysarthrias



•Their clusters of deviant perceptual dimensions formed impt framework for diagnosis & management of dysarthrias.

Aspects of Disability / Disorder

Impairment (body), Activity (limitation), & Participation (restriction - society),

Role of SLP in MSDs

*Differential diagnosis


*Intervention


-Rehab


-Mgmt / compensatory strategies


-Maint.


-Advocacy

Gray Matter vs. White Matter

Grey = Cells & Dendrites


White = Axons

Action Potentials vs. Synaptic Transmision

Action Potential: Electrical info down axon


Synaptic Transmission: Chemical info f/1 neuron to another

Meninges

*Dura


*Arachnoid


*Pia Mater




Spaces:


-Epidural


-Subdural


-Subarachnoid

Supratentorial Level of N.S.

*Hemispheres, Lobes, & CN I & II


*Basal Ganglia: Striatum (Caudate Nucleus & Putamen), Globus Pallidus


*Thalamus: Rt. & Lft.

Posterior Fossa

*Brainstem (Midbrain, Pons, Medulla)


*& Cerebellum

Spine

*Cervical: 8 S.N.s


*Thoracic: 12 S.N.s


*Lumbar: 5 S.N.s


*Sacral: 5 S.N.s

Peripheral

*CNs

**IMPT CNs for Speech & Swallowing**

CN V - Trigemnial: Motor for jaw, Sensory to face, teeth, anterior tongue


CN VII - Facial: Motor for face; taste; salivation


CN IX - Glossopharyngeal: Motor of pharynx & larynx; Sensory to posterior tongue & upper pharynx; taste; salivation


CN X - Vagus: Motor for palate; phonation; taste; & swallowing


CN XII - Hypoglossal: Motor for tongue

**Name all Cranial Nerves**

*CN I: Olfactory


*CN II: Optic


*CN III: Oculomotor


*CN IV: Trochlear


*CN V: Trigeminal


*CN VI: Abducens


*CN VII: Facial


*CN VIII: Auditory/Vestubular


*CN IX: Glossopharyngeal


*CN X: Vagus


*CN XI: Spinal Accessory


*CN XII: Hypoglossal

**UMN vs. LMN**

*UMN:


-originate in motor cortex;


-term. in CN nuclei of brainstem or ventral horn of spine




*LMN: Final Common Pathway; every neuron that exits brainstem / spine


-originate in CN nuclei of brainstem


-terminate on head & neck muscles
OR


-originate in ventral horn of spine


-terminate on all other muscles

**Speech Subsystems**

*Respiratory


*Phonatory


*Resonatory


*Articulatory


*Prosody

**Direct Activation Pathway**

*Pyramidal System = Conscious cntrl of voluntary motor


•Direct cntrl f/ cortex (1 synapse bxn origin & FCP)


•Tracts from cortex: Corticobulbar & Corticospinal


*UMN

**Indirect Activation Pathway**

*Extrapyramidal System = Automatic / Subconscious cntrl of muscle activities (posture, tone, & reflexes)


•Indirect cntrl f/ cortex (multiple synapses bxn cortex & termination in FCP)


•Tracts from cortex: Corticorubral to rubrospinal and Corticoreticular to reticulospinal


*UMN

**General Functions of Cerebellum**

Integrates & Coordinates execution of smooth, directed movements

**Motor Speech Examination**

-Differential Diagnosis (rule out / consistent w/ medical findings?)


-Chart Review


-Px History (signs v. symptoms)


-Oral Mech Exam (see other card)

**Oral Mechanism Exam**

Examination of muscles innervated by CNs: (@ min.: CNs V, VII, IX, X, and XII)


–Size, strength, symmetry, range, tone, steadiness, speed & accuracy


–Observe at rest, During sustained postures, During movement (Jaw ROM, etc)


•Intraoral exam


•Non-speech tasks


•Reflexes


•Respiratory exam

Testing CN VII during Oral Mech

Raise/lower eyebrows,


Smile,


Pucker,


Lip closure against resistance,


Puff cheeks full of air


& @ rest (symmetry) (LMN Impair: Upper & lower facial weakness; Weakness is unilateral to lesion; UMN Impair: Lower facial weakness; Weakness is contralateral to lesion)


Lagophthalmos: inability to shut eye completely

Testing CN III observations

Ptosis,


Double Vision (diplopia)

Testing CN V during Oral Mech

Clench teeth and feel masseter & temporalis

Testing CN XII during Oral Mech

Tongue deviation, atrophy, & fasciculations




Tongue deviates to weak side




LMN Impairment –Right side


UMN Impairment –Right side

Testing CN IX during Oral Mech Exam

Palatal Reflex (assymetrical, absent, etc.)

Testing CN X during Oral Mech Exam

Sustained Phonation


Wetness / Dryness of vocal quality

**Flaccid Dysarthria**

*Resulting from LMN pathology (CN / SN, Cranial or Spinal Nuclei, Neuromuscular Junction




-Can affect 1 or more speech subsystems:


**Respiration: short phrases, monoloudness **Articulation imprecision


**Laryngeal function: stridor, hoarseness, breathiness, diplophonia, monopitch **Velopharyngeal function: hypernasality / nasal air emission

Etiologies of Flaccid Dysarthria

•Trauma, (surgical, head / neck injury)


•Vascular disorders, (brainstem stroke) •Degenerative disease,(ALS)


•Demyelinating disease, (Guillain-Barre’ syndrome)


•Viral infections, (polio, herpes)


•Neuromuscular junction disease, (myasthenia gravis)

Flaccid Dysarthria - CN V Lesions

Typically not involved in isolation.


Etiologies: stroke, infection, AVM, tumors, & skull fractures.


•Unilateral Impair.: Jaw deviates toward weak side; Reduced contraction w/ bite


•Bilateral Impair: Jaw may hang open @ rest; can't close mouth; weakness w/ jaw closure & chewing

Flaccid Dysarthria - CN VII Lesions

•Etiologies: brainstem injuries, acoustic neuroma, herpes zoster, mono, vascular lesions, & trauma


•LMN damage impacts both upper & lower face muscles


•Unilateral impair: Ipsi hypotonia, unwrinkled forehead, droop eye/brow, eye [partially] open, asymmetry during movement


*Impact on speech:


–Unilateral impair: more visible than audible, mild artic imprec., Vowels OK


-Bilateral impair: Artic imprecision, flutter of cheeks when talking

Flaccid Dysarthria - CN IX Lesions

•Rarely damaged in isolation (b/c overlapping nuclei & proximity of other CNs: CNs IX & X impaired together)


•Etiologies: similar to others for lower brainstem•Reduced / asymmetrical gag reflex


•Pharyngeal elevation impact during swallowing •No taste f/ ipsilateral posterior 1/3 of tongue

Flaccid Dysarthria - CN X Lesions

-Etiologies: tumors, trauma f/ surgery, infection, stroke, G-B syndrome, motor neuron disease, aneurysms


*Nonspeech OME findings:


Pharyngeal Branch:


.UL: Soft palate hang low on side of lesion & uvula deviates to strong side;


.BL: Palate hang low @ rest & moves minimally/not at all during phonation; Gag reflex difficult to elicit; Nasal regurgitation occur during swallowing


-SLN branch: If recurrent laryngeal nerve branch isn’t affected, VFs may look normal; In unilateral lesions, affected VF vocal cord may appear shorter than normal; In bilateral lesions, both VFs may appear short & bowed


–Unilateral RLN (w/ or w/o SLN): Affected VF weak/paralyzed; May have dysphagia; weak cough & glottal coup


-Bilateral RLN (w/ or w/o SLN): Both VFs weak/paralyzed; Dysphagia; weak cough/coup, @ risk for airway compromise, Inhalatory stridor


*Speech findings:


-SLN & RLN affected: •Breathy / aphonia, Hoarseness, Reduced loudness, Diplophonia, Short phrases, Rapid vocal flutter•See these symptoms w/ UL damage & BL damage (worse)


Flaccid Dysarthria - CN XII Lesions

Etiologies: neck lesions, surgery, trauma, stroke, infection, tumor


-Unilateral lesions: Tongue weak (ipsilaterally) & deviate to weak side,


–Bilateral lesions: Bilateral atrophy & fasciculations; Protrusion (very) ltd in range; lateralization & elevation impaired

Flaccid Dysarthria - Multiple CN Lesions

•AKA “bulbar palsy”


•In brainstem, but, multiple CNs can be affected in diseases such as MG & ALS

Flaccid Dysarthria - Spinal Nerve Lesions

•Etiologies: SCI, MG, ALS, G-B Syndrome


•Nonspeech OME findings: Rapid, shallow breathing; Nasal flaring; use of upper chest & shoulder neck muscles to breathe; Unable to sustain subglottal air px


•Speech findings:Short phrases, red. loudness; Decr.pitch & loudness variability; speaking on residual air; Vx strained

Vagus (X) Nerve Branches

•Pharyngeal: Motor to pharynx & soft palate




•SLN (Superior laryngeal nerve)


–Internal: Sensory to laryngopharynx & supraglottic structures


–External: CT (cricothyroid muscle)




•RLN (Recurrent laryngeal nerve): Motor & Sensory to all intrinsic laryngeal muscles (except CT)