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motor speech disorders > chapter 3 > Flashcards

chapter 3 Flashcards

1
Q

What is the goal of motor speech evaluation?

A
  • Understand a patient’s problem

- Determine beginning level of treatment

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2
Q

what are the 2 basic methods of evaluating motor speech disorders?

A

instrumentation

perceptual analysis

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3
Q

what is perceptual analysis?

A

relies on clinician’s ears (and eyes) to judge

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4
Q

What are the suggessted questions for motor speech evaluations?

A
  1. Is there a problem with the patient’s speech?
  2. If there is a problem, what is the best way to describe it?
  3. Does the problem seem to be the result of a neurologic disorder?
  4. If it seems to be neurologic in origin, did it appear suddenly or slowly?
  5. Is the problem related strictly to speech production, or is it more of a problem with language, such as aphasia?
  6. If it is a problem of speech production, do most of the problems seem to be related to the sequencing of phonemes?
  7. If there are no phoneme sequencing errors, what are the characteristics of the patient’s speech errors and any associated motor problems?
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5
Q

what are some other goals/ considerations for motor speech evaluations?

A
  • prognosis
  • treatment focus
  • treatment termination
  • baseline for measuring change
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6
Q

what are the five necessary components for normal speech production?

A

Respiration, phonation, resonance, articulation, prosody

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7
Q

what happens when their is a neuromotor disturbance in any of the 5 components for speech?

A

dysarthria or apraxia

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8
Q

what is dysarthria?

A

Speech production deficit resulting from neuromotor damage to PNS or CNS

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9
Q

what is apraxia of speech?

A

Motor speech disorder often associated with damage to left hemisphere of brain

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10
Q

what area of the 5 components does dysarthria impact?

A

any of the 5

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11
Q

what area of the 5 components does apraxia impact?

A

articulation and prosody

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12
Q

is apraxia of speech caused by msucle weakness or slowness?

A

no, caused by left hemisphere damage

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13
Q

what is the cause of flaccid dysarthria?

A

Damage to cranial nerves, spinal nerves, or neuromuscular junction

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14
Q

what is the cause of spastic dysarthria?

A

Bilateral damage to the upper motor neurons of the pyramidal and extrapyramidal systems; often caused by brainstem strokes

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15
Q

what causes unilateral UMN dysarthria?

A

Unilateral damage to upper motor neurons

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16
Q

what causes ataxia dysarthria?

A

Damage to the cerebellum or the neural tracts that connect the cerebellum to the rest of the CNS

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17
Q

what are problems related to ataxic dysarthria?

A

Problems controlling the timing and force of speech movements, results in speech that often has a “drunken” quality.

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18
Q

what are the symptoms of UMN dysartria?

A

Imprecise consonants are the most common characteristic; there may be irregular articulatory breakdowns or harsh vocal quality in some patients

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19
Q

what is the result of spastic dysarthria?

A

Spasticity and weakness in the speech musculature that results in harsh or strained-strangled phonation, imprecise consonants, hypernasality, and abnormal prosody

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20
Q

what is the result of flaccid dysarthria?

A

Muscle weakness resulting in imprecise consonants, breathy phonation, hypernasality, shallow breath support, and abnormal prosody

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21
Q

what is the cause of hypokinetic dysarthria?

A

A reduction of dopamine in part of the basal ganglia; Parkinsonism is the most common cause of this dysarthria

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22
Q

what is the result of hypokinetic dysarthria?

A

A reduction in the range and speed of speech movements; harsh or breathy phonation imprecise consonants, and abnormal prosody (in some patients, there is increased rate of speech)

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23
Q

what is the cause hyperkinetic dysarthria?

A

Often associated with damage to the basal ganglia but in some conditions the cause is unknown

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24
Q

what ist he result of hyperkinetic dysarthria?

A

Involuntary movements that interfere with normal speech production; unexpected inhalations and exhalations, irregular articulatory breakdown, and abnormal prosody

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25
Q

what is the cause of mixed dysarthria?

A

Neurological damage that extends to more than one portion of the motor system

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26
Q

what it he result of mixed dysarthria?

A

Any combination of the characteristics in the six pure dysarthrias

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27
Q

what is respiration?

A

primary function for speech production

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28
Q

what is a result of nerve damage that impacts respiration?

A

short phrases and reduced loudness + breathy voice

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29
Q

what is phonation?

A

production of voiced phonemes through vocal fold vibrations in larynx

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30
Q

what is normal phonation?

A

complete adduction of vocal folds; sufficient subglottic air pressure

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31
Q

what happens if the nerves innervating phonation are impacted?

A

flaccid dysarthria, spastic dysarthria, neuromotor damage to laryngeal muscles

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32
Q

what is resonance?

A

proper placement of oral or nasal tonality onto phonemes during speech by lowering or raising the velum

33
Q

what is oral resonance?

A

Produced when velum is raised and closes off nasal cavity from vocal air stream

34
Q

what is nasal resonance?

A

Produced when velum is lowered (so airstream goes through the nose) and oral cavity is blocked by the lips or tongue

35
Q

what happens when nerves innervating velar muscles are damaged?

A

Damage to nerves innervating velar muscles may cause hypernasal quality

36
Q

what is articulation?

A

shaping of vocal air stream into phonemes

37
Q

what happens when there is neuromotor damage to articulators?

A

articulation errors lol

38
Q

what type of articulation errors can occur?

A

be imprecise consonants, distorted vowels, inappropriate silences, and irregular articulatory breakdown

39
Q

what is prosody?

A

melody of speech, using stress and intonation to convey meaning

40
Q

what happens when neuromotor damage affects prosody?

A

monopitch and monoloud quality; involuntary movements resulting in pitch variations, loudness, and prolonged intervals

41
Q

what are the standardized tests for dysarthria?

A

Frenchay Dysarthria Assessment-
Assessment of Intelligibility of Dysarthric Speech
Speech Intelligibility Test for Windows

42
Q

what does the frenchay dysarthria assessment do?

A

aids in differential diagnosis among the dysarthria

43
Q

what does the assessment of intelligibility of dysarthria speech do?

A

provides an objective assessment of single-word and sentence intelligibility

44
Q

what does the speech intelligibility test for windows do?

A

computer version of Assessment of Intelligibility of Dysarthric Speech

45
Q

what is the apraxia battery for adults-second edition?

A

designed to diagnose apraxia of speech in adolescents and adults.

46
Q

what is the only published adult apraxia test?

A

Apraxia Battery for Adults-Second Edition

47
Q

what info does the Apraxia Battery for Adults-Second Edition

provide?

A

on severity, treatment suggestions, and changes over time

48
Q

what are the 6 salient features that need to constantly be assessed?

A 
Muscle strength
Speed of movement
Range of motion
Accuracy of movement
Motor steadiness
Muscle tone
49
Q

what happens if you have decreased muscle strength?

A

Can affect respiration, articulation, resonance, phonation, prosody

50
Q

how can you assess muscle strenght?

A

Asking patient to press tongue against tongue blade or to count aloud from 1 to 100

51
Q

what happens if you have reduced speech of movement?

A

characteristic of most dysarthrias except hypokinetic dysarthria

52
Q

what are some speech assesed tasks?

A

Alternate motion rates (AMR)

Sequential motion rates (SMR)

53
Q

what happens when you have reduced range of movement?

A

Inability to open jaw or completely adduct vocal folds

Prosody to be affected

54
Q

how can you assess range of movement?

A

Asking patient to extend or hold articulators in various positions

55
Q

what happens when you have reduced accuracy of movement?

A

Distorted consonants; intermittent hypernasality

56
Q

how can you assess accuracy of movement?

A

Conversational speech; spoken paragraph reading

57
Q

what may be a result of lack of motor steadiness?

A

Tremors

Large, involuntary movements that interfere with voluntary movements

58
Q

how can you assess motor steadiness

A

Hold a position or prolong a vowel

59
Q

what happens if you have reduced muscle tone?

A

weakness or paralysis

60
Q

what happens if you have increased muscle tone?

A

spasticity or rigidity

61
Q

how can you assess muscle tone?

A

Inferring when listening to patient’s speech

Looking at affected body parts

62
Q

how long does a motor speech evaluation take?

A

30-40 minutes

63
Q

how long does the short version of a motor speech exam take?

A

10-15 minutes

64
Q

what are some important things to gather from case history?

A

Rate of onset
Site of lesion
Current status of problem
Visual acuity, hearing acuity, evidence of limb involvement

65
Q

what are you looking for when you look at face and jaw muscles at rest and during movement?

A

Abnormal muscle tone or strength
Asymmetrical facial features
Restricted range of movement

66
Q

what cranial nerve is involved with the tongue?

A

hypoglossal cranial nerve (XII)

67
Q

what cranial nerve innervates the velum and pharynx?

A

vague nerve (x)

68
Q

can you observe the laryngeal muscle during an oral mech?

A

no, need instrumentation

69
Q

what are some tasks that you can do to assess laryngeal function?

A

Can patient produce sharp cough?
Can patient produce sharp glottal stop?
Is inhalatory stridor present?

70
Q

what are specific tasks to assess phonatory respiratory system?

A

Deep breath and say “ah”, holding as long and steadily as clearly can
Latency period between signal to say “ah” and initiation of phonation?
Quality, pitch, loudness, and phonation

71
Q

how to assess resonation system?

A

Take deep breath and say /u/ as long as possible

Same task as above, but clinician squeezes nose

72
Q

how to assess combined systems?

A

AMR (puh, puh, puh)

SMR (puh, tuh, kuh)

73
Q

how to screen for for myasthenia gravis

A

ask Patient to count quickly from 1 to 100

74
Q

how do you test for non-verbal oral apraxia of speech

A

Have patient perform voluntary, nonverbal oral movements without demonstrating beforehand

75
Q

what is nonverbal oral apraxia of speech?

A

disruption in sequencing of oral movements that are nonverbal

76
Q

how do you test for apraxia of speech?

A

Repeat or read words of increasing complexity, beginning with same CVC syllable
Repeat words with simple CVC consisting of identical initial and final consonants
Count from 1 to 20 and backward
Read sentences, including spontaneously and on demand

77
Q

how do you analyze connected speech?

A

have pt. read standard reading passage

78
Q

how do you assess intelligibilty?

A

word, phrase, sentence, or conversational level

motor speech disorders (3 decks)

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