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Motor speech > 2nd Exam > Flashcards

2nd Exam Flashcards

0
Q

Types of dysarthria

A
  1. flaccid
  2. spastic
  3. ataxic
  4. hypokinetic
  5. hyperkinetic
  6. unilateral upper motor neuron
  7. mixed
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1
Q

types of motor speech disorder

A
  1. Apraxia of speech

2. Dysarthria

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2
Q

Flaccid dysarthria

lesion location?

A

impairment of the final common pathway (LMN pathway).

nuclei, axons, or neuromuscular junctions of cranial/spinal nerves

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3
Q

Flaccid dysarthria

- impairment affects:

A
  1. muscle strength.
  2. muscle tone.
  3. speed, range, and accuracy of movements.
  • may affect only one muscle group.
  • may affect only one speech subgroup.
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4
Q

flaccid dysarthria

- clinical characteristics

A
  • weakness
  • hypotonia
  • diminished reflexes
  • fasciculations
  • atrophy
  • progressive weakness with use.
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5
Q

flaccid dysarthria

- etiologies

A
  • trauma
  • degenerative diseases: ALS and Progressive bulbar palsy.
  • muscular disease
  • neuromuscular junction diseases: Myasthenia Gravis and botulinium toxin exposure.
  • Brainstem stroke.
  • demyelinating diseases: Guillain-Barre, Chronic demyelinating polyneuritis.
  • infectious diseases: Poliomyelitis and herpes zoster
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6
Q

Spastic Dysarthria

- location of lesion

A
  • bilateral damage to the upper motor neuron system (UMN)
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7
Q

spastic dysarthria due to impairment of direct activation pathway.
- Characteristics -

A
  • loss of fine, discrete movements
  • increased muscle tone.
  • spasticity (muscles continuously contracted)
  • babinski reflex
  • pathologic oral reflexes
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8
Q

Spastic Dysarthria Characteristics

due to impairment of indirect activation pathway.

A
  • increase muscle tone.
  • spasticity
  • hyperreflexia
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9
Q

Clinical characteristics of Spastic Dysarthria

A
  • spasticity
  • weakness (especially distal)
  • reduced range of movement
  • slow movement
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10
Q

Spastic Dysarthria

- etiologies

A
  • vasculature problems (stroke- most likely brainstem stroke. vascular dementia)
  • Primary lateral sclerosis (degenerative motor neuron disease)
  • corticobulbar and corticospinal signs.
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11
Q

Ataxic Dysarthria

- location of lesion

A
  • damage to cerebellum
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12
Q

Ataxic Dysarthria

- impairments

A
  • coordination
  • decreased muscle tone.
  • slowness and inaccuracy of movement force, range, timing, direction.
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13
Q

Ataxic dysarthria

- clinical characteristics

A
  • problems with standing and walking
  • titubation (rhythmic tremor of body or head)
  • nystagmus
  • dysmetria
  • dysdiadochokinesis
  • decomposition of movement
  • possible intention tremor.
  • cognitive disturbances
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14
Q

Ataxic Dysarthria

- etiologies

A
  • degenerative diseases (hereditary ataxias, multiple sclerosis)
  • vascular lesions
  • tumors
  • trauma
  • toxins (drugs and alcohol)
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15
Q

Hypokinetic Dysarthria

- location of lesion

A
  • basal ganglia direct pathway
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16
Q

hypokinetic dysarthria

- impairments

A
  • rigidity
  • reduced force
  • slow individual movements but sometimes fast repetitive movements.
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17
Q

hypokinetic dysarthria

- clinical characteristics

A
  • resting tremor
  • bradykinesia
  • intermittent freezing
  • pill-rolling movements
  • masked facies (hypomimia) - decreased facial expressions.
  • reduced arm swing
  • micrographic writing
  • festation
  • impaired sensory functions
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18
Q

general management goals for motor speech disorders

A
  • restore lost function when possible
  • promote use of residual function (compensation, modifying aspects of speech, AAC, prosthetics)
  • reduce the need for lost function (adjust)
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19
Q

General treatment strategies for MSD

A
  • management goals
  • begin treatment ASAP
  • consider incorporating principles of motor learning
  • provide opportunities for practice
  • use drill
  • provide instruction
  • feedback is essential
  • incorporate principles of experience dependent neuroplasticity.
  • be cautious of “plateau”
  • compensation requires conscious effort.
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20
Q

approaches to management of MSD

A
  • medical (pharmacological or surgical).
  • prosthetic
  • behavioral management (pt and significant other(s))
  • speech management
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21
Q

Dysarthria - VP dysfunction

treatment approaches

A
  • biofeedback
  • resistance treatment during speech (CPAP)
  • Producing words containing pressure sounds with nares pinched closed.
  • modification of speaking
  • NO evidence for non-speech oral motor exercises or inhibition techniques.
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22
Q

Dysarthria- Respiratory dysfunction treatment

A
  • postural adjustment
  • try to incorporate respiration activities into speech tasks.
  • sustaining phonation with feedback
  • some non-speech tasks may be beneficial for improving respiratory support.
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23
Q

Dysarthria- phonatory dysfunction

- hypoadduction

A
  • effort closure techniques
  • Lee Silverman Voice Treatment (LSVT-LOUD)
  • resonant voice exercises
  • sirening
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24
Q

LSVT

A
  • think loud and big
  • intensive treatment
  • used to increase loudness and effort
  • must be certified.
  • work from short (single words) to longer material
  • use objective measure of loudness.
  • provide home practice (1hr/day)
  • provide lots of trails!! (15/item)

***Good quality “ahhhhh” 15 times - start each session this way!

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25
Q

phonatory dysfunctions-

Resonant Voice Exercises

A
  • m, n, r, j, l
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26
Q

Dysarthria - Articulatory Dysfunction Treatment

A
  • Traditional approaches (phonetic placement, phonetic derivation, integral stimulation).
  • rate modification - slowing
  • exaggeration of articulation
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27
Q

treatment for AOS

A
  • rate and rhythm control approaches
  • contrastive stress drills
  • articulatory and kinematic approaches
  • intersystematic facilitation/reorganization approaches (gestures and melodic intonation therapy)
  • motor learning
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28
Q

Treatment for AOS

- rate and rhythm approaches

A
  • metronome pacing (speech in time to metronome, usually 1 syllable per beat, start rate slow and gradually increase)
  • stress patterning (model 2 syllable word, accenting stressed syllable- client imitates, gradually increase word length)
29
Q

treatment for AOS - articulatory and kinematic approaches

A
  • phonetic placement/derivation
  • Key word approach
  • PROMPT
30
Q

AOS treatment with supporting evidence

A
  • Eight step continuum/integral stimulation.
  • PROMPT
  • Sound production treatment
31
Q

AOS treatment - motor learning

A
  • cognitive phase: break movement into component parts.
  • associative phase: linking parts into smooth action.
  • autonomous phase: making movements automatic.
32
Q

Hypokinetic dysarthria - etiologies

A
  • Parkinson’s disease (most common)
  • Parkinson-plus or atypical parkinsonism
  • dementing diseases
  • Toxic/metabolic conditions
  • trauma
  • infections
33
Q

Parkinson’s Disease

A
  • idiopathic & hereditary forms
  • progressive loss of cells in substantia nigra.
  • decreased dopamine in basal ganglia.
  • imbalance between ACh and dopamine in the basal ganglia.
  • treated with drugs that increase dopamine (side effects from these drugs)
  • when drugs fail, may be treated with with deep brain stimulation
34
Q

Side effects of parkinson’s drugs

A
  • on-off effects
  • worsening of hypokinetic dysarthria or appearance of hyperkinetic dysarthria.
  • confusion and hallucinations
  • dystonia and dyskinesia
  • impulsivity control, paranoia
35
Q

Deep Brain Stimulation

A
  • electrodes surgically implanted, most often in subthalamic nucleus.
  • may be unilateral or bilateral .
  • electrical impulses sent to electrodes via stimulator implanted under the skin.
  • stimulator connected to electrodes via wires
  • electrical impulses disrupt tremors and other motor problems.
  • limb movement problems responding to drugs and DBS better than speech problems do.
  • speech may worsen with drugs or DBS.
36
Q

types of parkinson-plus or atypical parkinsonism

A
  • progressive supranuclear palsy
  • shy-drager syndrome
  • corticobasal degeneration.
37
Q

Hyperkinetic Dysarthrias

- lesion location

A

basal ganglia indirect pathway

38
Q

hyperkinetic dysarthria

- primary effects

A
  • effects prosody

- involuntary movements

39
Q

hyperkinetic dysarthria

- types of involuntary movement

A
  • orofacial dyskinesia (orofacial movements)
  • tardive dyskinesia (side effect of antipsychotic drugs)
  • Myoclonus
  • tics
  • Chorea
  • ballismus (flailing movements)
  • athetosis (slow, writhing movements, twisting)
  • dystonia
  • spasm
  • tremor
40
Q

hyperkinetic dysarthria

- Myoclonus -

A
  • involuntary single repetitive brief jerks.
  • may be rhythmic or non-rhythmic.
  • palatal or palatopharyngeal myoclonus
41
Q

hyperkinetic dysarthria

- tics -

A
  • rapid stereotyped movements

- often irresistible urge to make the movement

42
Q

hyperkinetic dysarthria

- chorea -

A
  • involuntary, rapid, random, purposeless movements

- can be subtle or very obvious

43
Q

hyperkinetic dysarthria

- dystonia -

A
  • relatively slow movement.
  • focal mouth or orofacial dystonia
  • blepharospasm (forceful, strained closure of eyes)
44
Q

hyperkinetic dysarthria

- spasm -

A
  • tonic: prolonged or continuous.

- clonic: repetitive and brief

45
Q

hyperkinetic dysarthria

- tremor -

A
  • most common involuntary movement
  • resting tremor (repose)
  • action tremor (movement)
  • terminal tremor (as a target is approached, aka intention tremor)
46
Q

hyperkinetic dysarthria

- etiologies -

A
  • toxic- metabolic conditions (drugs, lead, mercury)
  • degenerative diseases (huntington’s chorea, dementias)
  • infectious diseases (Sydenham’s chorea, rubella, AIDS)
  • stoke
  • tumors
47
Q

unilateral upper motor neuron dysarthria

- lesion location -

A
  • damage to UMNs that innervate cranial or spinal nerves important to speech.
48
Q

Unilateral UMN dysarthria

- Clinical characteristics -

A
  • usually mild and short-lived.
  • hemiplegia or hemiparesis.
  • early: weakness, hyporeflexia, hypotonia.
  • later: spasticity, hypertonia.
  • contralateral lower face weakness.
49
Q

unilateral UMN dysarthria

- etiologies -

A
  • stroke (most common)
  • tumors
  • trauma
50
Q

mixed dysarthria

A
  • combination of 2 or more types of dysarthria

- more common than single dysarthrias

51
Q

mixed dysarthria

- etiologies -

A
  • degenerative diseases (1.motor neuron diseases: progressive bulbar palsy, pseudobalbar palsy, ALS. 2.multiple sclerosis.)
  • toxic metabolic causes (Wilson’s disease and hypoxic encephalopathy)
  • stroke (especially brainstem)
  • tumor (especially brainstem)
52
Q

Apraxia of Speech (AOS)

- Characteristics -

A
  • no universal agreement on the characteristics or underlying nature.
  • Darley (original characteristics)
  • ANCDS (Wambaugh et al)
  • Duffy’s (2013)
53
Q

AOS characteristics

- Darley -

A
  • struggle and groping
  • errors recognized
  • speech initiation a problem early but not later.
  • secondary prosody problems.
  • absence of weakness, incoordination, or change in muscle tone.
  • substitutions and additions most common.
  • better on involuntary/automatic speech than on voluntary.
  • greater error variability.
  • consonants more difficult than vowels and consonant clusters more difficult than singletons.
  • imitation produces more errors than spontaneous speech.
  • errors increase with word length.
54
Q

Characteristics of AOS

- ANCDS -

A
  • slow rate of speech.
  • sound distortion.
  • relatively consistent errors in terms of type and invariable in terms of location.
  • prosodic abnormalities
55
Q

Characteristics of AOS

- Duffy (2013)

A
  • consonant and vowel distortions
  • distorted additions, prolongations, voicing distinctions, anticipatory substitutions, perseverative substitutions.
  • slow rate
  • syllable segregations
  • relatively consistent error location and type
  • false articulatory starts and restarts
  • effortful visible and audible trial-and-error groping for articulatory postures.
  • error rate higher for nonsense words.
  • initiation of utterance particularly difficult.
  • error rates higher for volitional/purposeful speech vs automatic/reactive utterances
  • consonant clusters more often in error than singletons
  • errors not different for imitative vs spontaneous.
  • severe AOS: limited speech sounds, speech may be limited to a few meaningful or unintelligible utterances, automatic may not be better than volitional, predictable errors.
56
Q

ways to evaluate speech

A
  • perceptually
  • acoustically
  • physiologically
57
Q

purpose of assessment of speech

A
  • description and problem detection
  • establish diagnostic possibilities
  • establish diagnosis
  • establish implications for localization and disease diagnosis
  • specify severity.
58
Q

Salient features of MSDs

A
  • muscle strength
  • movement speed
  • range of motion
  • steadiness of movement
  • muscle tone
  • movement accuracy
59
Q

features of MSD

- muscle strength -

A
  • weakness most apparent in LMN lesions (flaccid dysarthria)
60
Q

features of MSD

- movement speed -

A
  • too fast is rare
  • rapid rate usually associated with decreased ROM.
  • reduced speed is more common.
  • strongly affects prosody
61
Q

features of MSD

- Range of motion -

A
  • more likely to be reduced than increased.
  • may be abnormally variable
  • effects noted in prosody.
62
Q

features of MSD

- steadiness of movement

A
  • physiologic tremor (present in all normal people, not visible, can occur in all voluntary muscle groups)
  • abnormal steadiness - involuntary movements (1. tremor: most common, repetitive, involuntary, relatively rhythmic, commonly affects phonation. 2. involuntary, random unpredictable movements: dystonia, dyskinesia, athetosis, chorea).
63
Q

features of MSD

- muscle tone -

A
  • may be reduced or excessive
  • may fluctuate
  • reduced tone: flaccid dysarthria
  • increased tone: spastic, hypokinetic
  • variable tone: hyperkinetic
64
Q

features of MSD

- movement accuracy -

A
  • accuracy impairment may result from several causes
  • impairment of force and range
  • problems in movement timing
65
Q

/Case History should include what?

A
  • basic data
  • onset and course of the problem
  • associated deficits
  • patients perception
  • consequences
  • management
  • patient awareness of medical diagnosis and prognosis
66
Q

informal perceptual tools for speech assessment

A
  • Mayo tests of motor programming (dysarthria)

- motor speech examination - Wertz et al 1984 - (apraxia)

67
Q

formal perceptual tests

A
  • Frenchay Dysarthria Assessment
  • Assessment of Intelligibility in Dysarthric speech (AIDS)
  • Speech Intelligibility Test (SIT) - computerized version of AIDS sentence test.
  • Apraxia Battery for Adults
68
Q

Assessment of non-speech movements

A
  • cranial nerve exam

- Duffy’s (2013) examination

69
Q

Motor Speech Examination (Wertz et al 1984) for AOS

A
  • Ogar et al, 2006: 4 subsets especially difficult for persons with AOS.
  • alternating diadochokinesis
  • multiple repetitions of multisyllabic words.
  • repetition of sentences
  • reading of the Grandfather Passage.

Motor speech (3 decks)

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