CH1-Define,Understand,Categorize MSDs Flashcards
1
Q
Name the motor speech planning processes
A
- Cognitive-linguistic processes
- Motor speech planning, programming, and control
- Neuromuscular execution
2
Q
Cognitive-linguistic processes
A
Organization of communicative intent (verbal intent to express thoughts, feelings, and emotions) into a code that abides by the rules of language.
3
Q
Motor speech planning, programming, and control
A
- intended verbal message must be organized for neuromuscular execution.
- includes:
- selection
- sequencing
- regulation
- of sensorimotor “programs” that activate speech muscles at appropriate times, durations, and intensities.
4
Q
Neuromuscular execution
A
- The neural and neuromuscular transmission and subsequent muscle contractions and movements of speech structures
- CNS and PNS activity must combine to executes speech motor programs
- innervates breathing, phonatory, resonatory, and articulatory muscles in manner that generates an acoustic signal that reflects the goals of the programs.
5
Q
Motor Speech Disorders
A
- speech disorders resulting from neurologic impairments affecting the planning, programming, control or execution of speech.
- includes :
- Dysarthrias
- Apraxia of Speech
6
Q
Dysarthria definition
A
- group of neurologic speech disorders that reflect abnormalities in :
- strength
- speed
- range
- steadiness
- tone
- accuracy
- of movements needed for the breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production.
- includes :
- weakness
- spasticity,
- incoordination,
- involuntary movements,
- excessive or variable muscle tone.
7
Q
Describe Dysarthria
A
- neurologic in origin
- disorder of movement
- categorized into different types
- each type is characterized by distinguishable perceptual characteristics and underlying neuropathophysiologic factors
- ability to categorize has implications for localization of causal disorder
8
Q
Apraxia of Speech Definition
A
- neurologic speech disorder
- reflects impaired capacity to plan or program sensorimotor commands necessary for directing movements
- results in phonetically and prosodically disordered speech.
- can occur in absence of physiologic disturbance in any component of language.
9
Q
Speech disturbances distinguishable from MSDs
A
- Other neurologic speech disturbances
- e.g. neurogenic stuttering, palilalia, echolalia, foreign accent syndrome, aprosodia associated with r. hemisphere dysfunction, some forms of mutism
- Cognitive, Linguistic, and Cognitive-Linguistic disturbances
- changes in verbal expression from language and other cognitive deficits (e.g. aphasia, akinetic mutism, other cognitive disturbances that inhibit speech)
- sometimes difficult to distinguis from MSDs due to co-occurance –> complicates examination & diagnosis.
- Sensory Deficits
- effects of deafness on speech development in childhood, and degradation of speech in adult acquired deafness
- Hearing loss effects on speech production are distinguishable from MSDs.
- Tactile, kinesthetic, proprioceptive sensation disturbances implicated in certain MSDs.
- Nonneurologic Disturbances
- Musculoskeletal Defects (e.g. laryngectomy, cleft lip & palate, fractures, abnormal variants of cavity size & shape.
- Nonneurologic and nonpsychogenic voice disorders (e.g. dysphonias associated with head/neck neoplasms, vocal abuse, hormonal disturbances)
- Functional (psychogenic) & related nonorganic speech disorders
- changes from abnormal psychological states (e.g. schizophrenia, depression, conversion disorder, subconcious learning or maladaptive compensation) can be in people who are otherwise psychologically healthy.
- can be difficult to distinguish from organic, structural neurologic disease; can accompany organic neurologic abnormalities.
- Normal variations in Speech Production
- Age-related changes in speech - normal aging causes changes in pitch, voice quality, stability, loudness, breathing, rate, fluency, prosody and fine motor control; can be similar to those associated with dysarthria
- Gender- differences in men/women can influence detection of abnormalities
- Variations in style - variations of personality, emotional state, and speaking role must be considered for differential diagnosis and treatment decision making.
10
Q
2 Categories of Methods for
Studying Motor Speech Disorders
A
- Perceptual Methods - relies primarily on auditory perceptual attributes of speech
- *Gold Standard - for clinical differential diagnosis, judgements of severity, management decisions, and assessment of meaningful temporal change.
- Instrumental Methods - 3 categories - acoustic, physiologic, and visual imaging
- not widely used; may be due to lack of widely accepted standards and normative data, limited experience
- contributes to description and understanding of MSDs & need for systematic research.
11
Q
Perceptual Methods for studying MSDs
A
- Gold Standard
- relies on auditory perceptual attributes of speech
- subject to unreliability among clinicians, difficult to quantify, cannot directly test hypotheses about pathophysiology underlying perceived speech abnormalities
- Evaluations of speech disorder always begins with perceptual judgement –> unlikely to be replated by other methods.
- Darley, Aronson, and Brown (DAB) pioneered modern use of auditory-perceptual assessment to characterize the dysarthrias and id clusters of salient perceptual characteristics associated with lesions in different portions of CNS and PNS.
- referred to DAB approach or Mayo approach
12
Q
Instrumental Methods of studying MSDs
A
- Acoustic - visually display and numerically quantify frequency, intensity, and temporal components of speech signal.
- Physiologic- moves “upstream” towards sources of activity that generate & control speech to establish relationship between pathophysiology and acoustic perceptual attributes of MSDs.
- Visual Imaging - instruments used for visually imaging parts of upper aerodigestive tract during speech; videodflouroscopy, nasoendoscopy, laryngoscopy, and videostroboscopy
13
Q
Acoustic Methods for studying MSDs
A
- can visually display and numerically quantify frequency, intensity and temporal components of speech signal.
- tightly linked to auditory-perceptual judgements of speech because use same data (the speech signal)
- Auditory speech signal important part of speech motor control –> strong justifications for use of acoustic methods in children and adults
- Quantitatively confirms/supports perceptual judgements of :
- speech rate (slow)
- voice characteristics (breathy, contains tremore or interrruptions)
- pitch and loudness variability
- resonance (hypernasal
- articulation (imprecise
- speech diadochokinetic rates (irregular)
- Instruments are affordable, accessible and efficient.
- Rhythm metrics, envelope modulation spectra
- can distinguish apraxia from normal speech and aphasia
- can provide quantifiable data for baseline, stability, improvement or deterioration over time & visual feedback for therapy.
14
Q
Physiologic Methods for studying MSDs
A
- examines sources of activity that generate and control speech.
- provides different explanation for disordered speech.
- Focuses on one or more of the following:
- Muscle contractions that generate movement
- movements of speech structures and airflow
- relationships among movements at different levels of the musculoskeletal speech system
- temporal parameters and relationships among central and peripheral neural and biomechanical activity
- temporal relationships withing and among CNS structures and networds during the planning, programming, and control of speech.
- Crucial in establishing relationship between pathophysiology (e.g. weakness, spasticity, incoordination) and acoustic & perceptual attributes of MSDs.
- Most common methods used - study movemnt of air and peripheral structures
- electromyography, kinematic measures (electroglottography, magnetometry) and aerodynamic measures (spirometry, nasal accelerometry).
- methods for imaging physiologic activity in CNS
- fMRI - functional magnetic resonance imaging
- PET - positron emission tomography
- SPECT- single-photon emission computed tomography
- EEG - multichannel electroencephalography
- TMS - transcranial magnetic stimulation
- MEG - magnetoencephalography
- has challenged perceptually based explanations for pathophys. of certain MSDs by clarifying whether disorders reflect weakness, spasticity, incoordination, reduced range of movement, etc.
15
Q
Visual Imaging Methods for studying MSDs
A
- Instruments used to visually image parts of upper aerodigestive tract during speech
- straddles boundary between perceptual and physiologic measures
- widely used for clinical purposes
- common methods: (all can be recorded, saved & analyzed)
- videofluoroscopy
- naseoendoscopy
- laryngoscopy
- videostroboscopy
- used to evaluate swallowing and velopharyngeal and laryngeal functions for speech.
- can strongly influence diagnosis and management recommendations when used in combination with auditory perceptual analysis.
- can be subject to challenges of reliability
18
Q
Major types of motor speech disorders
and their
localization and neuromotor bases
A
