Artic Subsystem Flashcards
Currently, articulation may be the _______ target in dysarthria treatment
last
Why would articulation be the last target in dysarthria treatment?
we can improve articulation indirectly by assessing and treating respiratory, laryngeal and VP systems first
T or F: compensations are the articulatory level are common
True
What articulatory compensations occur in ALS
- tongue & jaw for VPI
- jaw for tongue
What articulatory compensations occur in PD?
tongue for jaw
What is the ROM for jaw opening?
3-20mm
What is the ROM for lip protrusion/separation?
10-12mm
What is ROM for tongue elevation and tongue protrusion?
10-15mm
What is the articulatory speed of the tongue tip
70-100mm/s
What is the articulatory speed of the tongue dorsum
40mm/s
What is the articulatory speed of the jaw
15-30mm/s
The _______ is the fastest articulator
tongue tip
Does the tongue move faster for /r/ or plosives
/r/ is faster than plosives, but movement for plosives is still faster than other sounds
T or F: different underlying pathophysiologies can have identical effects on speech articulation
true
Define weakness
reduced ability to produce force
Define fatiguability
decrease in strength over time
The maximum of the tongues force is 6-30N, but speech needs only _____% of max strength
5-20%
If we want to make statements about articulator strength then we have to ___________
objectively measure strength
Name an instrument to test tongue and lip strength and fatiguability
IOPI
T or F: muscle spindles and golgi tendon organs have typical distribution in speech musculature
false
How do we infer tone in speech musculature?
infer from observations at rest and reduction in ROM and speed
T or F: strengthening exercises are not recommended in individuals with spasticity
True
In terms of kinematics and acoustics, what can we expect in dysarthria?
- smaller displacements (reduced ROM)
- longer segments
- reduced speed of motion
- coordination problems in ataxic dysarthria/ any severe dysarthria
- reduced acoustic contrast between vowels and reduced spectral distinction between consonants
What terms from the MAYO clinic apply to the artic subsystem?
- imprecise consonants
- distorted vowels
- prolonged phonemes
- repeated phonemes
- irregular articulatory breakdowns
Intelligibility isn’t the same thing as _________
articulatory proficiency
which subsystem is the highest predictor of intelligibility?
artic
Problems in lips/jaw lead to difficulties producing _________
bilabials and vowels
Problems with the tongue tip lead to difficulties producing ____________
lingual consonants and vowels
Problems with the tongue back lead to difficulties producing ____________
velars and back vowels
Typical errors in dysarthria are __________
distortions
In ALS the ______ is worse, in PD the _________ is worse
tongue
jaw and lips
If a patient uses a bite block and speech production improves, what does this mean?
the jaw is impaired
If a patient uses a bite block and speech production worries, what does this mean?
the tongue or lips are impaired
What is the purpose of a bite block?
to assess tongue and lip mobility independently from the jaw
Coordination and sequencing between articulators is likely the key in speech, so we need to be cautious when _________ speech components
isolating
List the treatment principles for artic subsystem
- treatment hierarchy
- multimodality and increase sensory stimulation
- use intact modalities
- avoid working on sounds in isolation unless very early in acquisition stage
- Motor therapy (intense + carefully selected stimuli + carefully organized practice and feedback schedule)
List the Tx techniques for the artic subsystem
- elicitation with ‘shaping and cueing’
- articulation (intelligibility) drills
- prosodic methods (speaking rate)
- bite block
- augmented visual feedback
- botox injections
- non speech (strength, relaxation, stretching)
- minimal pairs
- discovery learning
- clear speech
What is the goal of discovery learning?
- pt figures out what works
- to develop strategies to make self to be understood (e.g., alphabet supplementation, slowing of the rate; identifying a topic; clear speech strategy for certain sounds)
Why would decreasing speaking rate work as artic tx?
more time to achieve articulatory targets on one hand for speaker – more time for listeners to process speech signal
What are some rate control techniques?
- DAF
- finger tapping
- pacing boards
- alphabet boards
- rhythmic cueing (metronome)
Describe all the effects that clear speech Tx has on speech
- increased contrast between speech sounds (vowels and consonants)
- longer syllable durations and longer pauses
- increased loudness and F0
- found to improve intelligibiltiy
What is one downfall of clear speech
-it requires increased effort and is fatiguing
What are some arguments for NS-OME?
- Speech is a motor act, might be similar to other motor acts (e.g., chewing)
- Shared movement characteristics and demands
- Get rid of linguistic component
- Hierarchy of non-speech, some near speech
(e. g., visuo-motor tracking) - Subsystem analysis (part-whole argument)
- done as a warm up
- increased awareness of articulators
What are some arguments against NS-OME?
- Task specificity - control of motor behaviour is task specific not effector specific
- Acoustic signal is a component of movement, build into the motor program
- Differential effects of tx on speech and non-sp
- Documented differences in muscle function b/n speech and chewing/ swallowing/ jaw wags behaviors/ blowing
- Lack of documented relationship between strength and intelligibility (confound of severity)
- artic strength needs are low compared to max strength
- NS-OME encourage gross and exaggerated ranges of motion, not small, coordinated movements that are required for talking.
When are NS-OMEs actually recommended?
- patients with oral motor deficits
- patietns with severe impairments (obviously reduced strength and obviously unable to perform OM tasks - i.e. blowing out candles)
- Don’t expect changes in speech!!
