Chapter 12B. Dysarthria and Apraxia of speech Flashcards
Question 12 B-1:
Patients with Parkinson’s disease have which features of speech?
I. Decreased and monotonous speech
2. Increased rate of speech
3. Absence of fluctuation in loudness and pitch
4. Consonant substitution
Select: A = 1.2.3. B = 1. 3 C = 2. 4. 0 = 4 only. E = All
Answer 128-1: E.
Hypokinetic dysarthria is typical of patients
with Parkinson’s disease, and is characterized
by decreased speech with monotonous
loudness and pitch. Rate of speech is
increased. Consonant substitution is
occasional. Patients can improve with therapy
and drug treatment of the parkinsonism.
(pI62)
Question 12B-2:
Which of the following are features of speech in Huntington’s disease?
1. Decreased variability in rate and loudness
2. Sudden stoppages of speech
3. Soft-smooth voice
4. Hyperkinetic dysarthria
Select A = 1.2.3. B = I. 3. C=2.4. D =4 only. E= All
Answer 128-2: C.
Patients with Huntington’s disease have
hyperkinetic dysarthria with marked variation
in rate, loudness” and timing, with distortion
of vowels, harsh voice, and occasional
stoppages of speech. In many ways, this is the
opposite of hypokinetic dysarthria. (P 162)
Question 12B-3:
Apraxia of speech has which of the following features?
I. Effortful speech
2. Prominent difficulty with polysyllabic words
3. Abnormal prosody of speech
4. Difficulty initiating speech
Selecl: A = 1.2.3. B = I. 3. C = 2. 4. D = 4 only. E = All
Answer 128-3: E.
Apraxia of speech is uncommon, and
characterized by effortful speech, disrupted
prosotly, inconsistent articulation errors, and
difficulty initiating sounds. Polysyllabic
words and consonant shifts are particularly
difficult. Most patients have damage to the left
insula. (p 163)
Question 12B-4:
A 58-year-old man presents with inability to speak and is found on examination to have decreased facial movements. He can follow complex commands with his arms but is unable to do so with his cranial nerves, including inability to smile or close eyes on
command. During the interview, he does smile spontaneously and appropriately. Which of the following statements is true?
A. His deficit is psychogenic
B. He has pseudobulbar palsy
C. The most likely lesion is in the ventral midbrain and pons
D. He would be unable to yawn
Answer 12B-4: B.
This patient has the opercular syndrome, a
severe form of pseudobulbar palsy.
Pseudobulbar palsy presents with a
dissociation between automatic and voluntary
responses. patients are able to smile and
yawn reflexively in response to the
appropriate stimuli. but cannot do so on
command. This is not a psychogenic deficit.
and is due to multiple infarctions in the
perisylvian cortex and subcortical white
matter. Degenerative processes, including
primary progressive anarthria, can also
produce this presentation. (p 164)
Questions 12B-5 through 12B-9: For questions 12B-5 through 12B-9. Select the correct speech disturbance from the following list A. Flaccid dysarthria B. Spastic dysarthria C. Ataxia dysarthria D. Hypokinetic dysarthria E. Hyperkinetic dysarthria Question 12B-5: Marked variation in rate, loudness, and timing with distortion of vowels. Sudden stoppages of speech.
Answer 128-5: E.
Hyperkinetic dysarthria is usually seen in
hyperkinetic movement disorders such as
Huntington’s disease, and is characterized by
increased variation in rate, loudness, and
timing. Speech stoppages an occur. (P162)
Questions 12B-5 through 12B-9: For questions 12B-5 through 12B-9. Select the correct speech disturbance from the following list A. Flaccid dysarthria B. Spastic dysarthria C. Ataxia dysarthria D. Hypokinetic dysarthria E. Hyperkinetic dysarthria Question 12B-6: Spontaneous speech is irregular in timing with pauses. On testing, the patient has irregular timing of repeated phonemes with pauses.
Answer 128-6: C.
Ataxic dysarthria is usually due to cerebellar
dysfunction and presents with irregular timing
of speech. Scanning speech is one
manifestation of this, and is demonstrated by
this patient. Important causes are cerebellar
strokes, multiple sclerosis, tumors, and
cerebellar degenerations. (p162)
Questions 12B-5 through 12B-9: For questions 12B-5 through 12B-9. Select the correct speech disturbance from the following list A. Flaccid dysarthria B. Spastic dysarthria C. Ataxia dysarthria D. Hypokinetic dysarthria E. Hyperkinetic dysarthria
Question 12B-7:
Speech is breathy and nasal with indistinct consonants.
Answer 12B·7: A.
Flaccid dysarthria is due to dysfunction of the
lower motor neuron, and presents with
breathy, nasal speech with indistinct
pronunciation of consonants. Important causes
are myasthenia gravis, polymyositis, and
bulbar involvement of motor neuron diseases.
(p161)
Questions 12B-5 through 12B-9: For questions 12B-5 through 12B-9. Select the correct speech disturbance from the following list A. Flaccid dysarthria B. Spastic dysarthria C. Ataxia dysarthria D. Hypokinetic dysarthria E. Hyperkinetic dysarthria Question 12B-8: Patient has Parkinson's disease
Answer 12B·8: D. Hypokinetic dysarthria is typical of Parkinson's disease, and is characterized by decreased soft speech, with monotonous loudness and pitch. There are occasional consonant errors. The speech may improve with medical treatment of the parkinsonism. (p162)
Questions 12B-5 through 12B-9: For questions 12B-5 through 12B-9. Select the correct speech disturbance from the following list A. Flaccid dysarthria B. Spastic dysarthria C. Ataxia dysarthria D. Hypokinetic dysarthria E. Hyperkinetic dysarthria Question 12B-9: Patient with pseudobulbar palsy.
Answer 12B-9:
Spastic dysarthria is typically seen in patients
with bilateral corticospinal tract lesions. In
addition to motor signs of deficit, the patient
has defects of extra ocular motility and may
have spastic dysarthria. Spe«h is harsh.
strained. with reduced rate_ low pitch. and
consonant errors. (p 161-162)
Question 12B-10: Acquired stuttering is most commonly seen in patients with lesions in which region of the brain? A Left hemisphere cortex B. Right hemisphere cortex C. Left hemisphere thalamus D. Bilateral thalamus
Answer 128-10: A.
Acquired stuttering resembles developmental
stuttering and is characterized by hesitancy in
producing the initial phonemes with
dysrhythmia of speech. Elements of acquired
stuttering overlap with apraxia of speech,
which is not one of the options to be selected.
Apraxia of speech is similar in that patients .
have effortful speech with errors in speech.
Individual phonemes are well-pronounced, but
often in the wrong location and of the wrong
timing. Patients have difficulty initiating
speech in both disorders. (p163)
