adult speech Flashcards by Gracie Nabors

A disorder of motor execution

dysarthria

How well did you know this?

Not at all

Perfectly

assessment steps for dysarthria

information gathering
cog-comm assessment/language
- orientation
- 1-2 step directions
- expressive language
-receptive language
oral peripheral exam
- muscle strength, ROM, speed, accuracy
auditory peripheral exam
diadochokinesis
connected speech sample

How well did you know this?

Not at all

Perfectly

formal assessment for dysarthria

Frenchay Dysarthria Assessment (12+)

How well did you know this?

Not at all

Perfectly

muscular weakness, hypotonia, stiffness/tightness

spastic dysarthria

How well did you know this?

Not at all

Perfectly

etiologies for spastic dysarthria and SoL

CVA
als, ms
brainstem stroke
TBI
inflam disease

bilateral upper motor neurons

How well did you know this?

Not at all

Perfectly

speech production errors - spastic dysarthria

resp - generally not an issue
artic - imprecise consonants
prosody - monopitch, monoloudness, reduced pitch
res - hypernasal
phonation - harsh vocal quality, strain-strangled

How well did you know this?

Not at all

Perfectly

assessment for spastic

conversational speech
diadochokinesis
- AMR highlight slowed rate
vowel prolongation

How well did you know this?

Not at all

Perfectly

Treatment for spastic

resonance - surgical flap, teflon injection, palatal lift
- velar strengthening - blowing and sucking, ^ loudness, slow rate, open mouth
artic - intell drills, phonetic placement, exaggerating, minimal contrast
prosody - pitch range, intonation profiles, contrastive stress
phonation - head and neck relax, easy onset, yawn- sigh

How well did you know this?

Not at all

Perfectly

muscular weakness and hypotonia

flaccid dysarthria

How well did you know this?

Not at all

Perfectly

etiologies for flaccid dysarthria
and sol

mysathenia gravis
polio
guillain-barre
tumors
brainstem stroke
sol - lower motor neurons in one or more cranial or spinal nerves

How well did you know this?

Not at all

Perfectly

flaccid dysarthria speech production errors

respiration - shallow breathing, stridor
resonance - hypernasal
artic - imprecise consonants
prosody - reduced pitch and loudness
phonation - breathy

How well did you know this?

Not at all

Perfectly

assessment for flaccid dysarthria

convo speech and reading
AMRs highlight slow rate
prolonged vowel for breathiness
speech stress in suspected myasthenia gravis

How well did you know this?

Not at all

Perfectly

treatment for flaccid

respiration - correct posture, speak immediately on exhalation
resonance - increase loudness, reduce rate, open mouth
artic - intell drills, phonetic placement, exaggerating consonants
prosody - pitch range, intonation, contrastive stress, chunking utterance
phonation - pushing and pulling, holding breath, hard glottal attack

How well did you know this?

Not at all

Perfectly

imprecise, jerky, poorly coordinated movements, inaccurate force, range, timing, direction

ataxic dysarthria

How well did you know this?

Not at all

Perfectly

etiologies and site of lesion for ataxic

SoL- cerebellum
- degen diseases
- CVA
- toxic conditions
- TBI
- Tumor

How well did you know this?

Not at all

Perfectly

speech production errors for ataxic

respiration - slow and controlled, speak on exhale, stop phonation
artic - traditional artic therapy
prosody - rate control and stress/ intonation: contrastive stress drills, pitch range, intonation

How well did you know this?

Not at all

Perfectly

hyperkinetic dysarthria sol and etiologies

Huntingtons TBI stroke infections

How well did you know this?

Not at all

Perfectly

excessive and involuntary movements

hyperkinetic dysarthria

How well did you know this?

Not at all

Perfectly

site of lesion and eitologies for hyperkinetic

basal ganglia
huntington’s
tbi
cva
infections

speech production errors for hyperkinetic

resp - unexpected inhalations or exhalations
reson - hypo or hypernasal
artic - imprecise consonants
prosody - prolonged intervals, pitch, monopitch
phonation - harsh, strain/strangled

assessment for hyperkinetic

vowel prolongation
AMRs- speech rate variations, breakdowns
convo speech

muscle rigidity, reduced ROM, slowed movement

hypokinetic dysarthria

SOL and etiologies for hypokinetic

basal ganglia
- TBI
- CVA
- tumors
- infections
- anoxia

speech production errors for hypokinetic

resp - reduced breath support impacts loudness and phonation
res- no
artic - imprecise consonants
prosody - monopitch, monoloudness, reduced stress, increased rate
phonation - breathy and soft

assessment for hypokinetic

convo speech - rate and prosody errors AMRs - artic errors vowel prolongation - vocal quality

treatment for hypo

compensatory resp- speak immediately on exhalation, cues to increase inhalation, slow and controlled exhalation prosody- rate control, intonation stress profiles, drills phonation- voice amps LEE SILVERMAN TREATMENT

main types of intervention dysarthria

compensatory techniques - slowing down, over artic, open wide environmental - provide main topic before speaking, watch for turn-taking, ask yes/no communication repair strategies - total rep, partial rep, spelling the first few letters, elaboration, simplifying message

a deficit in the ability to smoothly sequence the tongue lips, jaw; a disorder of motor planning

apraxia of speech

clinical characteristics of AOS

artic - subs and distortions rate - slowed, lengthened segments, increased intersegment durations prosody - equal stress, pitch and loudness errors automatic speech less impacted errors increase with word length artic groping

assessment for AOS

AMR pa pa pa, ta ta ta, ka ka ka SMR ptk (SMR more effected) muscle strength and ROM Apraxia Battery for Adults Behavioral checklists

Treatment for AOS

Hierarchy of difficulty Modeling and repetition various placement cues minimal pairs Rosenbek 8-step continuum Sound production Treatment Script Training Metrical pacing Hand tap

Rosenbek 8-step continuum

max to min cues watch me listen to me then simultaneous production end - role playing

sound production treatment hierarchy

target minimal pair item printed letter integral stimulation artic placement cues

disorders in oral domain

lip closure tongue control during bolus hold bolus preparation/mastification bolus transport/ lingual motion initiation of pharyngeal swallow

disorders in pharyngeal domain

soft palate elevation laryngeal elevation anterior hyoid movement - partial/ no movement affects larynx elevation, epiglottis inversion epiglottis movement laryngeal vestib control pharyngeal stripping wave pharyngeal contraction

cranial nerves involved in swallowing

5 trigeminal 7 facial 9 glossopharyngeal 10 vagus 11 spinal accessory 12 hypoglossal

signs and symptoms of dysphagia

drooling/increased secretions weight loss coughing/choking difficulty chewing/ pocketing swallow delay changes in diet food stuck nasal regurgitation

assessment for dysphagia

Chart Review Patient Interview and Observations Bedside Eval -oral mech -respiratory check -position patient -ask to swallow before anything in the mouth -ice chip spoon -during trials, place hand under chin -consistencies- ice chips, water/thin, nectar, pudding, solid SAFE MASA MBS FEES

allows you to see oral and pharyngeal phase

Modified Barium Swallow Study

passes transnasally to the pharynx can only see pharyngeal stage before and after swallow

FEES

Compensatory techniques for dysphagia

seating - up straight if able chin down head rotation to weak side - closes off weak backward head tilt sour bolus food placement external cheek pressure labial support chin support labial and chin support smaller bites, spoon only, multiple swallows supraglottic swallow effortful swallow Mendelsohn

supraglottic swallow (5 steps)

Take a breath/hold it take a bite of food/sip swallow (hold breath) cough on exhale swallow again

diet changes

thin liquids, nectar/honey/pudding, mechanical soft

thin liquids best for

reduced pharyngeal wall contraction, reduced cricopharyn opening

nectar/honey/pudding best for

poor bolus control, delayed swallow trigger