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motor speech > benchmark 3 - final > Flashcards

benchmark 3 - final Flashcards

1
Q

hyperkinetic dysarthria is what level of motor organization

A

extrapyramidal

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2
Q

t/f abnormal involuntary movement are often called hyperkinesia

A

true

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3
Q

what are the 3 main cerebral structures of extrapyramidal level

A

basal ganglia
subthalamic nucleus
substantia nigra

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4
Q

hyperkinetic dysarthria symptoms

A
  • involuntary, unprogrammed, extra movements
  • occurs in any muscles or group of muscles
  • the inhibitory nature of extrapyramidal level is inhibited
  • result from a failure of extrapyramidal level to inhibit the extra impulses from the cortex
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5
Q

3 general classifications of hyperkinetic dysarthria

A

quick, slow, tremor

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6
Q

what is QUICK hyperkinetic dysarthria

A
  • quick, unsustained, involuntary movements
  • myoclonus: FASTEST
  • tourette’s (tics): FAST
  • chorea: SLOWER than tics and clonus
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7
Q

myoclonus (quick hyper)

A
  • FASTEST hyperkinetic disorder
  • characterized by involuntary single or repetitive brief jerks of a body part
  • sudden large transient “shock like” contraction –> can be momentarily postponed/reduced
  • involuntary, irregular jerks in chest, larynx, VP, lips, tongue and jaw
  • irretractable hiccups
  • idiopathic or brain/spinal injury; meds reaction
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8
Q

myoclonus: essential assessment

A

conversational speech is usually unaffected
respiration, phonation and vowels are unprogrammed
palatal myoclonus (resonance) –> tends to go away during sleep
AMR/SMR: fleeting interruptions

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9
Q

Tourette’s (tics) (quick hyper)

A
  • involuntary, compulsive, rapid, nonrhythmic movement –> can be postponed but not suppressed
  • postponing can make worst
  • rapid and arrhythmic tic movements
  • odd vocalizations
  • facial grimaces
  • slower palatal myoclonus (resonance)
  • etiology is unknown
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10
Q

Tourette’s (tics): essential assessment

A

Type of quick hyperdysartheira

  • simple phonic tics (noises) –> like sniffing, throat clearing, barking
  • complex phonic tics (linguistically meaningful) –> coprolalia (profanity), echolalia, palilialia, loud talking
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11
Q

Chorea (quick hyper)

A
  • quick rapid involuntary, irregular, fleeting, unpredictable, non stereotyped movement
  • contraction than release = smoother dance-like movement
  • can occur at rest but increases with voluntary movement
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12
Q

t/f Sydenham’s chorea is not progressive

A

true

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13
Q

two common type of chorea

A
  • sydenham’s –> childhood fever
  • huntington’s chorea –> progressive genetic with dementia
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14
Q

Chorea essential assessment

A
  • **every aspect of speech is affected
  • highly variable, can not predict
  • respiration –> bursts of loudness
  • phonation –> roughness, strain-strangled, low pitch
  • articulation –> irregular breakdown, variable rate, prolonged phonemes
  • AMR/SMR –> slow, unpredictable
  • vowel –> short, irregular pitch
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15
Q

Slow hyperkinetic dysarthria

A
  • Athetosis –> slow
  • Dystonia –> slowest
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16
Q

Athetosis - slow hyperkinetic dysarthria

A
  • involuntary, irregular, unpredictable, non-stereotyped movements interfering with all skilled movement –> slightly slower than chorea
  • stiff, high muscle tone, hypercontraction
  • fluctuating b/w flaccid spastic tone, distal movement, tremors increase with stress
  • shallow noisy stridor breathing
  • facial grimacing
  • etiology –> early onset from birth trauma and anoxia OR later onset –> stroke; tumor in basal ganglia
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17
Q

Athetosis - slow hyperkinetic dysarthria –> essential asessment

A

conversational speech

  • bursts of loudness
  • groaning voice, explosive, phonation arrest
  • lack of coordination of voicing and articulation
  • amr/smr –> unpredictable
  • vowel –> reduced duration, irregular pitch
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18
Q

Dystonia - slow hyperkinetic dysarthria

A
  • involuntary, random movements interfere with all skilled movements; action-induced (not seen at rest); contractions build up slowly; reduced strength
  • primary dystonia is hereditary; secondary is brain trauma or inflammation (encephalitis)
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19
Q

3 types of dystonia

A
  • generalized
  • segmental
  • isolated/focal
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20
Q

generalized dystonia

A

generalized –> whole body; starts in childhood with foot turning in
- symptoms improve with sensory tricks such as touching chin,face or pencil b/w teeth during speech (more of a sensory feedback issue than psychological)
- breathing irregular, abnormal posture
- larynx - indirect exam –> VFs appear normal; endoscopy –> reveals involuntary hyperadd/abduction during speech
- involuntary movements in velopharynx and lips, tongue jaw

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21
Q

segmental dystonia

A
  • segmental –> 2+ structures; starts as adult; clenching in eyes+lips/jaw = meige; clenching in jaw+tongue = oromandibular meige
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22
Q

isolated/focal dystonia

A
  • isolated/focal –> one area, starts as adult
    types: spasmodic dysphonia (laryngeal dystonia; most common); blepharospasm (difficult to open eyes); torticollis (humped to one side); limb dystonia (writers cramps)
  • females are more affected
  • action induced –> speaking; symptoms emerge during connected speech
  • improves with laugh, singing, whisper, etc.
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23
Q

generalized dystonia - essential assessment

A
  • bursts of loudness
  • rough, strangled voice
  • breathy
  • irregular articulatory breakdown with prolonged phonemes
  • amr/smr: reduced duration
  • vowels are reduced, variability in pitch
24
Q

two types of spasmodic dystonia

A

adductor ->
- 80-90% of cases
- larynx stiffens and forcefully adducts the VFs
- hyperadduction including glottic closure increases subglottic pressure
- spasms occur on voiced sounds
- strained strangled voice
- effortful phonation

abductor –>
- spasms in posterior cricoarytenoid muscles
- involuntary abduct VFs
- occurs on voiceless speech sounds
- prolonged voiceless sounds (prolonged H—-arry)
- breathy voice

25
Q

differential diagnosis for adductor vs abductor spasmodic dysphonia

A

adductor –> spasms occur on voiced speech sounds (difficult to say aunt annie’s alligator)
abductor –> prolonged voiceless sounds (difficult to say H—-ary; h—–at)

26
Q

hyperkinetic dysarthria - tardive dyskinesia and tremors

A

results from exposure to neuroleptic drugs –> usually goes away after stopping meds
preventable

types:
tardive dyskinesia –> akathisia, difficulty not moving; occurs during sleep and rest; smacking of lips, tongue protrusion, rapid, involuntary jerking/slow movements

27
Q

what is akathisia

A

restlessness; quivering

seen in tardive dyskinesia

28
Q

slow hyperkinetic dysarthria - tremors - types

A
29
Q

tremors affecting speech or motor control

A

rest tremor –> no
action/kinetic –> yes; connected speech
postural –> yes; sustained sounds
isometric –> yes; motor strength
physiological tremor –> yes; connected speech and sustained sounds

30
Q

what is an essential tremor

A

stand alone tremor with no other issues

mild = change in F0 and loudness; rhythmic changes in pitch and loudness
moderate to severe = connected speech
severe = voice arrests

31
Q

what is a tremor as a symptoms

A

tremors are symptoms of PD, CP, ALS, MS, etc

32
Q

what is anarthria

A

absence of speech due to loss of movement supporting speech production

occurs with brainstem stroke

33
Q

what is mutism

A

absence of speech that is not anarthria

2 types akinetic and cerebellar

akinetic = happens due to diminished motivation
cerebellar = post brain surgery to remove tumor

34
Q

locked-in syndrome

A

occurs due to brainstem stroke

anarthria is accompanied by total immobility of the body except eye movement and blinking

35
Q

apraxia - cortical level

A

insert screenshot
- breakdown in programming motor movement
- individual muscles are good
- affect any type of learned motor function

36
Q

apraxia - cortical level - etiology

A
  • stroke or acquired brain injuries
  • dementia
  • PD and HD
37
Q

ideomotor apraxia

A

incorrect initiation of gestures and motor planning, sequencing, planning, groping

38
Q

ideational apraxia

A

incorrect use of items; seen in dementia

39
Q

t/f apraxia of speech can be motor component of aphasia

A

true –>
aphasia may be primary disorder - usually Broca’s

important to assess language as well

40
Q

apraxia - larynx assessment

A

perseverate, groping errors at adduction (onset of phonation)

41
Q

apraxia - essential assessment

A
  • type of errors is relatively consistent
  • usually more difficult when they repeat the model
  • altered prosody; aphonic
  • articulation - struggles initiating speech; errors increase with longer words (thick, thicken, thickening), intrusive “schwa”
  • SMR: irregular articulatory breakdowns; MORE impaired than AMR
  • AMR: more difficult on complex sequence and repeat words of increasing length
  • *deterioration of accuracy with repeating words of increasing length
42
Q

nonverbal oral movement apraxia assessment

A

disorder of planning and executing nonspeech oral motor movements
- cough, smile, blow, puffy cheeks, protrude tongue
- assess spontaneous and volitional speech

43
Q

automatic speech movements assessment for apraxia

A

automatic speech movements
- count 1-30
- days of week
- sing HBD (singing is usually easier)

44
Q

volitional speech in apraxia

A

The problem lies with the inability to plan the movements of articulators for the purposes of volitional (on command) speech, thus it is often referred to as a “motor planning disorder.” The term volitional in the context of Apraxia means that the child has difficulty making speech movements when he/she is consciously aware of trying to do so or in instances

45
Q

differential diagnosis of dysarthria and apraxia

A
46
Q

t/f when apraxia co-occurs with dysarthria there is diffuclty with sequencing and intiaiting movement; concominant motor weakness

A

true

47
Q

why assess apraxia at SW level, multisyllabic, sentence level

A

increased complexity = greater breakdown
pot –> potter –> pottery

48
Q

t/f initiating motor planning is difficult in apraxia

A

true

49
Q

framework for therapy

A

motor learning theory –> work on meaningful linguistic units; feedback; self-correction; random practice

cognitive load –> give one stimulus at a time; work on several areas in one session; may motivate, might be too hard, must monitor performance to determine

50
Q

t/f chunking (phrase modiciation) is important for breath support

A

true

51
Q

t/f to facilitate respiration like increase/reduce loudness patient is prompted to take deeper breaths and then start phonation after inhale

A

true

52
Q

t/f to facilitate phonation semi-occluded vocal tract exercises generate back pressure and efficient VF vibration

A

true

53
Q

t/f to facilitate resonance by increasing resonance focusing on oral resonance; bark like a seal or blowing exercises

A

true

54
Q

t/f apraxia is more a language based treatment than dysarthria

A

true

55
Q

management of apraxia of speech guidelines

A
56
Q

apraxia programs

A

eight step continuum -> watch, listen, say it with me
PROMPTS

motor speech (3 decks)

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