Slpa Motor Speech Disorders - Exam 1

Front 1

How do you differentially diagnose aphasia?

Back 1

An impairment due to brain damage that interferes with the capacity to interpret and formulate language symbols across all modalities.
-not attributed to dementia, sensory loss, or motor dysfunction

Front 2

Describe apraxia.

Back 2

An articulatory disorder. Impairment of the capacity to program the positioning of speech muscles and the sequencing of muscle movements for the volitional production of phonemes.
-No significant weakness, slowness, or in-coordination of these muscles in reflex and automatic acts.
-Prosodic alternations may be associated with articulation problems, possibly for compensation.
-Inability to plan and program.

Front 3

How do you differentially diagnose language of confusion?

Back 3

An impairment of language accompanying neurologic conditions.
Characterized by reduced recognition and understanding/responsiveness to the environment, faulty memory, unclear thinking, and disorientation in time and space.
-often traumatically induced
-Structured language events are usually normal
-Open-ended language situations elicit irrelevance, confabulation.
-ex.- do not know the time of day, confused about what they ate for dinner

Front 4

Describe dysarthria.

Back 4

A group of speech disorders resulting from disturbances in muscular control-weakness, slowness, or in-coordination of the speech mechanism due to damage to the central or peripheral nervous system or both.
-The term encompasses several or all of the basic processes of speech: respiration, phonation, resonance, articulation, and prosody.
-Not having the speed and accuracy to do what you need to do.

Front 5

What are the 5 stages the authors of the text propose to improve communication among the medical team?

Back 5

Stage 1: No detectable speech disorder
Speech features: No observable changes
Intervention: Confirm normalcy, outline future intervention needs and resources
Page 324: Client may report that extra attention or effort is needed to produce speech. Listeners are unaware of changes but patients are concerned about changes.
Stage 2: Obvious speech disorder when intelligible speech
Speech features: No reduction in intelligibility, speech disorder is obvious, probably interferes with naturalness
Page 325: Intervention is focused on assisting them to maintain or enhance their communicative participation by analyzing patterns of communicative needs, as well as success and failure in common situations
Stage 3: Reduction in Intelligibility
Speech features: Some reduction in intelligibility, perhaps alternatives in speaking rate, probably unnatural
Page 327: People with reduced speech intelligibility can improve their communicative participation by providing their partners with extra information. Techniques for enhancing comprehensibility into three general categories: those techniques that are managed by the speaker with dysarthria, those that are the primary responsibility of the communication partner, and those that require interaction between the speaker and the partner.
Stage 4: Natural Speech Supplemented with AAC Techniques
Speech features: Natural speech is no functional for all speaking situations, short rushes of poorly articulated speech
Intervention: To improve comprehensibility. Topic supplementation, alphabet supplementation, portable typing systems
Page 335: Simultaneous use of natural speech and low-tech augmentative strategies (alphabet boards, topic supplementation, and gestures).
Stage 5: No Useful Speech
Speech features: Natural speech not functional for any speaking situations
Intervention: Augmented communication, multi-modal AAC approaches

Front 6

hypokinetic movement

Back 6

lesion in basal ganglia circuit. Characterized by limited range of movement, bradykinesia, fatigue, difficulty initiating movement, and disordered rates of movements

Front 7

dystonia

Back 7

characterized by slow hyperkinesis in which individual muscles or muscle groups exhibitinvoluntary tonic contractions of variable duration. Muscles may contract involuntarily and fail to relax when not in use. Characteristic of hyperkinetic disarthria. Etiology: lesion in basal ganglia circuit

Front 8

discoordination

Back 8

related to cerebellar disfunction/lesion, characteristic of Ataxic Dysarthria.

Front 9

bradykinesia

Back 9

a slowness of movement, characteristic of hypokintetic dysarthria. Either drug induced or related to Parkinson’s. Etiology: lesion in basal ganglia circuit.

Front 10

chorea

Back 10

Rapid involuntary, purposeless movements of the extremities, head, neck, or trunk. Movements are irregular and asymmetrical. Etiology: lesion in Basal ganglia circuit.

Front 11

athetosis

Back 11

type of dystonia most commonly seen in children with cerebral palsy. Caused by contraction of already hypertonic muscles and characterized by continuous, writhing movements. Etiology: lesion in Basal ganglia circuit

Front 12

resting tremor

Back 12

Signal comes out of basal ganglia causing tremor when there is not motion happening
*Lesion in basal ganglia
*Part of hypokinetic dysarthria

Front 13

rigidity

Back 13

Lesion of the basal ganglia
*Equal contraction of the tensor and flexor muscles so that the body part will not move

Front 14

intention tremor

Back 14

Triggered by voluntary movement
*Lesion in basal ganglia
*Part of hyperkinetic dysarthria

Front 15

flaccidity

Back 15

- Due to lower motor neuron damage
- Lesions: Intermedulary -- within the brainstem (Low: 10th cranial nerve; High: 5th or 7th cranial nerve)

Front 16

extramedullary

Back 16

outside the brainstem but in the brain (Cranial nerves as they exit the brain)

Front 17

extracranial

Back 17

outside the cranium (peripheral cranial nerves; motor endplates)

Front 18

spasticity

Back 18

Loss of motor/reflex inhibition; excessive motor contraction
*Lesion in motor cortex (upper motor neuron bilateral) corticobulbar tracts
*Speech characteristics: rough phonation, strained-strangled, short breath groups, hyperynasality, imprecise articulation

Front 19

dysmetria

Back 19

No notion of range in space (over/under shooting targets)
*Part of Ataxic dysarthria
*Lesion in cerebellum

Front 20

What is the chronic disability model?

Back 20

Conceptualization of the various levels of a chronic disability (impairment, activity, participation)

Front 21

Describe the impairment level of chronic disabilities model.

Back 21

Cellular to Subsystem Levels, Loss and/ abnormality of mental, emotional, physiological, or anatomical structure or function
Level – Organs and organ systems
Examples: atrophy of muscles, imprecision of movement, reduced movement rate of respiratory, laryngeal, velo-pharyngeal, or articulatory subsystems

Front 22

Give examples of impairment intervention.

Back 22

- Reduce Impairments,
- Eliminate maladaptive behaviors
- Learn behavioral compensations
- Receive prosthetic intervention (palatal lift)

Front 23

Describe activity level of chronic disabilities model.

Back 23

restriction of lack of ability to perform an action or activity in the manner of within the range considered normal that results from impairment
Level – Organism – action, activity, performance
Assess – Intelligibility, Rate, Naturalness

Front 24

Give examples of activity intervention.

Back 24

- Clear speech,
- proper phrasing,
- appropriate stress patterning,
- optimal speaking rate

Front 25

Describe participation level of chronic disabilities model.

Back 25

constricted involvement in life
Level – societal situations
Example – Communication effectiveness in communicative situations

Front 26

Give examples of participation intervention.

Back 26

optimize communication effectiveness in social situations
- Control Audience size,
- Reduce noise,
- amplify voice,
- manage breakdowns,
- prepare listeners

Front 27

Give an example of activity related to quality of communication life.

Back 27

how well you are getting by talking to someone on the phone.

Front 28

Relationship among levels of chronic disability

Back 28

The various “levels of disability” may or may not be correlated, as many different factors influence the functional capabilities and the societal acceptance of an individual with chronic disability
- just because you improve at one level, doesn’t necessarily carry over to all

Front 29

What are the five classifications of dysarthria?

Back 29

1) Flaccid dysarthria
2) Spastic dysarthria
3) Ataxic dysarthria
4) Hypokinetic dysarthria
5) Hyperkinetic dysarthria

Front 30

symptoms of flaccid dysarthria

Back 30

• *breathy voice
• *inspiratory stridor
• hypernasality
• *nasal emission
• imprecise articulation
• short breath groups

Front 31

symptoms of spastic dysarthria

Back 31

• *phonation rough, strained-strangled
• breathy groups short
• hypernasality
• imprecise articulation

Front 32

symptoms of ataxic dysarthria

Back 32

• voice symptoms-normal, unsteady, excessive loudness, voice tremor (4-7 HZ)
• resonance-usually normal
• *articulation-irregular articulatory breakdowns

Front 33

symptoms of hypokinetic dysarthria

Back 33

• monoloudness
• reduced loudness
• monopitch
• breathy/rough phonation
• *excessive rate
• *rushes of speech
• *difficulty initiating speech

Front 34

What is the associated neuropathology with flaccid dysarthria?

Back 34

o pathophysiology-weakness, hyptonia, slowness, fatigue
o lesion location-trigeminal, facial, vagus, and hypoglossus cranial nerves

Front 35

What is the associated neuropathology with spastic dysarthria?

Back 35

o pathophysiology-spasticity, hyper-reflexia, hypertonia, slowness, reduced range of
o motion
o lesion location-motor cortex, upper motor neuron (bilateral)-corticobulbar tracts

Front 36

What is the associated neuropathology with ataxic dysarthria?

Back 36

o lesion location-cerebellar loop, cerebellum, cerebellar pathways
o pathophysiology-discoordination, dysmetria, slowness

Front 37

What is the associated neuropathology with hypokinetic dysarthria?

Back 37

o lesion location-basal ganglia loop, basal ganglia, basal ganglia pathways
o pathophysiology-limited range of movement, bradykinesia (slowness of movement),
o fatigue, difficulty initiating movement, disordered rates of movements

Front 38

What is the associated neuropathology with hyperkinetic dysarthria?

Back 38

o lesion location-basal ganglia loop, basal ganglia, basal ganglia pathways
pathophysiology-chorea, athetosis, dystonia

Front 39

What are the similarities and differences between spasticity and rigidity?

Back 39

-Rigidity is an increase in muscle tone, not dependent on rate. Felt
in both agonist and antagonist muscles. Generally associated with
basal ganglia damage (Parkinson's disease) and hypokinetic dysarthria.
"inflexibility or stiffness"-yahoo

-Spasticity is a form of rigidity (still excelssive muscle tone). It
is rate-dependent. Generally involving UMN damage. Loss of inhibitory
control can cause an ongoing level of contraction, with decreased
ability to volitionally control the muscle contraction, and increased
resistance felt on passive stretch.
"continuous resistance to stretching by a muscle due to abnormally
increased tension"-

Front 40

Describe the role(s) of the cerebellum.

Back 40

coordination for speech and coordination for speech while doing other motor activities.

Front 41

Describe the role(s) of the premotor area

Back 41

planning motor movements

Front 42

Describe the role(s) of the primary motor cortex

Back 42

executing motor movements

Front 43

Describe the role(s) of the basal ganglia

Back 43

plans rate, speed, and range of movements

Front 44

Describe the role(s) of the Cortico-bulbar tract-

Back 44

info carried from the motor cortex to brainstem for speech (i.e., soft palate)

Front 45

Describe the role(s) of the Cortico-spinal tract

Back 45

info carried from the motor cortex to spinal cord if for respiration or limbs

Front 46

Describe the role(s) of facial nerve

Back 46

movement of the face (e.g., cheeks, lips) and production of saliva

Front 47

Describe the role(s) of the vagus nerve

Back 47

vocal folds and velopharyngeal mechanism control

Front 48

Describe the role(s) of the accessory nerve

Back 48

controls the sternocleidomastoid and trapezius muscles

Front 49

Describe the role(s) of the hypoglossus nerve

Back 49

tongue movement

Front 50

Describe the role(s) of the thalamus

Back 50

the relay station that takes info from the basal ganglia (i.e., rate/speed and range) and sends it to the motor cortex (i.e., motor execution)

Front 51

What is the dysarthria intervention staging system?

Back 51

The dysarthria intervention staging system is for speakers with a wide variety of etiologies. These stages are helpful in treatment planning. They are characterized in terms of severity, into five stages.

Front 52

What are the 5 dysarthria intervention staging system stages?

Back 52

Stage 1: No detectable speech disorders
Stage 2: Obvious speech disorder with intelligible speech
Stage 3: Reduction in speech intelligibility
Stage 4: Natural speech supplemented by augmentative techniques
Stage 5: No functional speech

Front 53

What natural courses are commonly associated with neurological
disorders for improving?

Back 53

-TBI
-Apraxia
*get them functional, keep them functional

Front 54

What natural courses are commonly associated with neurological
disorders for stability?

Back 54

-Cerebral Palsy
*preparing them to live with this condition

Front 55

What natural courses are commonly associated with neurological
disorders for degeneration?

Back 55

-Parkinson’s
-ALS
-MS
*speech gets worse
*intelligibility will drop
*our goal is to help them compensate and function

Front 56

How do the differing natural courses change intervention strategy?

Back 56

When working with someone on the degenerative course, you are working more on managing the course of the impairment, developing compensatory strategies for speech, and supplementing the speech with AAC. Whereas the people on the improving course are getting supplemental speech with AAC but also reestablishing the subsystems for speech.
*compensate verbal and with AAC.

Front 57

What is speech intelligibility

Back 57

*A measure of the understandability of the speech signal only.
*The listener is a listener (judge) only! (Needs to be unfamiliar with the text)

Front 58

What is alphabet supplemented speech intelligibility?

Back 58

* The speaker uses an alphabet supplementation board and points to the first letter of each word they are producing.
*End of the day our goal is to try to get to an acoustic signal that listeners can understand.

Front 59

What is comprehension?

Back 59

refers to how understandable the message as a whole is.

Front 60

What is the difference among speech intelligibility, supplemented speech
intelligibility, and comprehension

Back 60

-Intelligibility is how understandable the speech signal is at the SOUND or WORD level
-Supplemented speech intelligibility is using information independent from the speech signal to increase intelligibility. This is considered to be compensatory information (e.g. alphabet boards, semantic topic boards, word/phrase dictionary)
-Comprehension refers to how understandable the message is as a whole. By using supplemented speech it increases the intelligibility of the words and sounds, which in turn increases the listeners comprehension.

Front 61

How would you assess Speech intelligibility for an adult who can read at a high school level?

Back 61

Word & Sentence Intelligibility Test (Yorkston & Beukelman)

Front 62

How would you assess Speech intelligibility for a child four years of age

Back 62

Augmented Speech Comprehensibility in Children (Dowden)
(Pictures: apple, crayon, hotdog, etc.)
TOCS

Front 63

How would you assess Communication effectiveness of an adult with acquired dysarthria

Back 63

Communication Effectiveness- Participation (rating scale)
Never--1 2 3 4 5--Always

1. Conversing with familiar listeners
2. Conversing with strangers
3. Conversing with familiar listeners over the phone
4. Conversing with strangers over the phone
5. Conversing in noise
6. Conversing while traveling in a car
7. Conversing at a distance
8. Speaking in front of a group
9. Speaking in special circumstances

Front 64

how would you assess listener load?

Back 64

Attention Allocation
Minimal-- 1 2 3 4 5 6 7-- Full Attention

Front 65

What is the impact on intelligibility measures of judge familiarity with the passage or message?

Back 65

• Familiarity increases the intelligibility.
• It is important for the listener to be a naive, unfamiliar judge to show accurate intelligibility.

Front 66

How can judge familiarity be controlled in a clinical setting?

Back 66

• Since it is important for the listener to be unfamiliar, computerized assessments such as the Assessment of Intelligibility of Dysarthric Speech help with randomization
• There is a large pool of words and sentences that the computer draws from

Front 67

Why do parents apparently routinely over-estimate the intelligibility of their children’s speech?

Back 67

• Parents are around their child more often than SLP’s or caregivers
• The topic of which the child and parent are talking about is already known
• Parents adjust down questions so the child does not have to be as intelligible when answering

Front 68

What can a clinician do to help parents understand that their child’s
speech may be more difficult to understand than they assume?

Back 68

• An SLP could record the child’s speech with single word utterances and sentences. They could then share the unknown words and topic with the parent and allow them to determine what their child is saying. Usually the parent will not be able to identify most of the single word utterances or phrases because it is out of context.

Front 69

What is the relationship between information from the speech signal and
signal-independent information

Back 69

Speakers and their communication partners achieve mutuality using two types of information: (a) information exclusively from the speech signal and (b) information about context that is independent of the speech signal (*signal-independent information). When the speech signal information is rich and speech intelligibility is high, messages are comprehensible even in the face of limited contextual information. However when the speech signal is degraded because of reduced intelligibility due to severe-motor speech disorder, contextual information that is independent of the speech signal becomes critical for the maintenance of message comprehensibility. Supplemented intelligibility in combination with speech naturalness is associated with communication effectiveness.
*Signal- independent information is supplemental and helps the listener (e.g., semantic context, syntactic context, alphabet, gestures).

Front 70

Summarize some speaker strategies as well as some listener strategies that might improve communication interaction effectiveness.

Back 70

Preparing Your Partner- Make sure partner is paying attention. Say their name to let them know they need to listen.
Setting the Topic- Identify the topic before you begin. This can be done in a variety of ways.
Using Grammar to Enhance the Message- Talk in complete sentences because this is predictable.
Use of Gestures- Use gestures that support communicative intent.
Use of Turn Maintenance Signal- Develop a signal with the listener to show that you have something to say. Also, signal when you are finished.
Timing of Important Communication Exchanges- Try to keep important communication interactions earlier in the day or when you have more energy. This will increase the likelihood of intelligible senteces.
Selecting a Conducive Environment- Pick a quiet area with good lighting and little noise or distractions.
Listener strategies:
Maintain Topic Identity- The listener is equally responsible for being on the appropriate topic. Check to make sure.
Pay Attention to the Speaker- Sit directly in front of speaker and eliminate other auditory and visual distractions.
Piece Together Clues- Take fragmented cues and piece together to complete your partner’s idea. Maintain awareness of all clues. Check to make sure you are piecing correctly.

Front 71

For what type of dysarthric speaker would you use alphabet supplementation?

Back 71

• The type of dysarthria is not critical in determining who should use alphabet supplementation, but the severity of the dysarthria is. Generally, the best candidates are those with severe or profound dysarthria. Speakers with intelligibility over 80% may receive some minor benefits, however the accompanying reduction in speaking rate or naturalness is often considered unacceptable by the speakers.

Front 72

What is the tx effect for alphabet supplementation?

Back 72

-alphabet supplementation for words intelligibility: consistent 11.3%
-alphabet supplementation for sentence intelligibility: 25.5% (variability in tx effects for moderate to severe dysarthria) (less severity= more consistent tx effect) (variability in tx effect for severe individuals because of the slowed rate of speech with the use of alphabet supplementation. Some individuals have greatly increased intelligibility as they slow their rate while others already speak with a slow rate so their intelligibility does not improve as much)

Front 73

What is topic supplementation?

Back 73

use of a communication board that provides topics such as small talk, personal, weather, sports, health, etc. The person points to these topics before speaking to give the listener more background knowledge on the conversation piece.

Front 74

What is the “treatment effect” of topic
supplementation on single word? AND sentence intelligibility?

Back 74

-single-word: consistent treatment effect intelligibility for habitual speech (28% across severity)
-very little gain (10.7%) for sentence intelligibility

Front 75

what is knowledge of results?

Back 75

Feedback whether the motor sequence was performed correctly (word produced correctly) i.e. “that was correct” or “opps, that was wrong”

Front 76

What is knowledge of performance?

Back 76

Feedback about how a movement was performed (tongue, lips, jaw) i.e. “you put your tongue between your teeth instead of on the top of your mouth” or “ great, you put your tongue to the top of your mouth”

Front 77

what is more effective for motor learning: knowledge of results OR performance?

Back 77

knowledge of results

Front 78

what is massed practice?

Back 78

when the target is drilled over a particular amount of time

Front 79

What is distributed practice?

Back 79

when the target skill is drilled in a short amount of time, throughout a period of time

Front 80

Which is better for generalization of learning massed or distributed practice?

Back 80

distributed practice

Front 81

what intervention strategy goes with impairment level?

Back 81

Reduce Muscle Tone

Front 82

what intervention strategy goes with activity limitation level?

Back 82

*Reduce Speaking Rate
*Speak louder
*Speech amplifier

Front 83

what intervention strategy goes with participation restriction impairment?

Back 83

Alphabet supplementation
*Listener training
*Topic Supplementation

Front 84

what intervention strategy goes with environmental factors level?

Back 84

reduce noise

Front 85

what is restoration in terms of intervention?

Back 85

reduce the impairment—(use residual speech a bit better) work towards normalization

Front 86

What is compensation in terms of intervention?

Back 86

reduce activity imitation through behavioral and prosthetic intervention (e.g., palatal lift), electronic intervention.

Front 87

supplementation?

Back 87

provide information in addition to speech signal; another avenue towards communication.

Front 88

True or false: Sometimes we become so focused on restoration that you forget about communication today.

Back 88

true: Need to mix compensation and restoration

Front 89

what is instruction in motor learning?

Back 89

the SLP is teaching the client how to do the motor task. Make sure the client understands the task and why it is being taught. This stage includes instruction, modeling, and some practice. Goal is to be at 80% accuracy before moving on.

Front 90

what is practice in motor learning?

Back 90

Once the child has reached 70-80% (usually 80%) accuracy, move to practice. During practice, the SLP is NOT the primary facilitator. Parents, caregivers, or possibly computers take over. It is important to be at 80% accuracy before moving on - the goal is to have errorless learning so that the client is not practicing incorrect sounds/motor movements.

Front 91

describe when to begin generalization for motor learning.

Back 91

occurs when the client uses the correct motor movements outside of practice/instruction in other contexts.

Front 92

describe the cerebellar and basal ganglia loops and their roles in speech motor control.

Back 92

?????????????????

Front 93

What is an neurological etiology (medical condition) that might cause each
type of dysarthria

Back 93

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