chapter 4 Flashcards
what is caused by impairments of lower motor neurons in cranial or spinal nerves
flaccid dysarthria
flaccid dysarthria is characterized by
slow-labored articulation, marked degrees of hypernasal resonance, hoarse breathy phonation
side effects of flaccid dysarthria
paralysis, weakness, hypotonicity, atrophy, hypoactive reflexes of involved speech subsystem musculature
cranial nerves of speech production
trigeminal, facial, glossopharyngeal, vagus, accessory, and hypoglossal
damage to the cranial nerves can be caused by
brainstem stroke, growing tumor, viral or bacterial infections, physical trauma, or surgical accidents
trigeminal nerve (V)(5)
attached to brainstem at level of pons, divided into 3 branches; bilateral intervention
3 branches of trigeminal nerve
opthalmic, maxillary, and mandibular
branch of the trigeminal nerve most important for speeech and innervating muscles in lower jaw and velum
mandibular
damage to trigeminal nerve can
unilateral or bilateral
facial nerve (VII)(7)
branches out from brainstem just below trigeminal nerve, dividing into cervicofacial and temporofacial branch; mixed bilateral and contralateral innervation
damage to facial nerve
can cause weakness or paralysis in all muscles on same side of face, resulting in drooping of the eyelid, mouth, cheek, and other structures
glossopharyngeal nerve (IX)(9)
orginates in brainstem at medulla, coursing out to pharynx; innervates stylopharyngeus and superior pharyngeal constrictor muscles; damage also affects vagus nerve; bilateral innervation
nerve that plays role in speech resonance and phonation by shaping pharynx into appropriate positions needed to produce various phonemes correctly
glossopharyngeal nerve
vagus nerve (X)(10)
one of the most important cranial nerves for speech production; bilateral innvervation
three branches of vagus nerve
pharyngeal, external superior laryngeal branch, recurrent nerve branch
pharyngeal branch
damage can affect movement of velum, resonance
external superior laryngeal nerve branch
damage can affect pitch
recurrent nerve branch
damage of branch causes breathy phonation; innervates all laryngeal muscles except cricothyroid
accessory nerve (XI)(11)
spinal part; originates in medulla just below vagus nerve; works in conjunction with vagus nerve helping innervate intrinsic muscles of velum, pharynx, and larynx; contralateral innvervation
hypoglossal nerve (XII)(12)
provides motor innervation for all intrinsic and most extrinsic muscles of the tongue; primarily bilateral innvervation
primary characteristic of hypoglossal nerve damage
imprecise articulation, phoneme distortion, or slow lingual movements; weakness of tongue or paralysis
injury to phrenic nerve
paralyzed diaphragm, decreases loudness; shortened, breathy, or strained vocal quality
lesions can occur in
cranial nuclei, nerves themselves, or neuromuscular junction, or muscle
physical trauma
surgical trauma with accidental cut of cranial nerve or head and neck injury
brainstem stroke
cerebrovascular accident (CVA); occurs with interruption of blood flow to brain as artery breaks or is blocked
mysasthenia gravis cause
affects neuromuscular junction, caused by antibodies that block/damage muscle tissue
temporary treatment for myasthenia gravis
injection of edrophonium chloride (Tensilon)
symptoms of mysathenia gravis
rapid fatigue of muscular contractions over short time, with recovery after rest; hypernasality, decreased loudness, breathy voice quality, decreased articulatory precision
assessment of mysathenia gravis
stress test involving asking patient to count from 1 to 100 or to read lengthy paragraph
guillain-barre syndroe
results in demyelinzation; frequently occurs after certain kinds of infections and immunizations
symptoms of guillain-barre syndrome
flaccid dysarthria, dysphagia
recovery for guillain-barre syndrome
high recovery rate, lasting weeks or months, 5% die in acute stages
polio
an infection viral disease that attacks cell bodies of LMN; most frequently affects cervical and thoracic spinal nerves causing: labored inhalation during speech, shortened speech phrases, speaking on residual air, decreased loudness
muscular dystrophy
causes progressive degeneration of muscle tissue, can result in muscles weakness in many muscles served by cranial nerves
progressive bulbar palsy
can affect both UMN and LMN, although often only present in LMN, with LMN damage causes flaccid dysarthria; UMN and LMN causes mixed dysarthria
reduced maximum phonation time
females typically 15-20 sec & males typically 20-25 sec
resonance
reflects bilateral damage to pharyngeal branch of vagus innervates most muscles of the velum
errors of resonance
hypernasality, nasal emission, weak pressure consonant, shortned phrases
nasal emission
weak velopharyngeal closure
weak pressure consonant
decreased intraoral air pressure
shortened phrases
wasted air that escaped through nasal cavity during speech
articulation
imprecise consonant production: severity varies, damage to facial and hypoglossal nerves
damage to trigeminal nerve (articulation)
difficulty elevating jaw sufficently to bring articulators into contact with each other
phonation
phonatory incompetence: incomplete adduction of VFs during phonation
phonation caused by damage to recurrent banch of vagus nerve
breathy voice quality or whisper, weak or paralyzed adductor or abductor muscles
strong confirmation of flaccid dysarthria in relation to phonation
combined Prescence of hypernasality and phonatory incompetence
respiration
weakened respiration may or may not be a component of flaccid dysarthria; decreased inhalation or impaired control of exhalation during speech with damage to cervical and thoracic spinal nerves responsible for innervating diaphragm and intercostal muscles
symptoms of respiration
reduced loudness, shortened phrase length, strained vocal quality if speaking on residual air to prolong phrase length, minikoudness, monopitch; infrequent inhalation when speaking
prosody
weakened laryngeal muscles that are unable to make many fine VF adjustments necessary for normal pitch and loudness variations
symptoms of prosody
monopitch and monoloudness; NOT a diagnostic marker for flaccid dysarthria
key evaluation tasks for flaccid dysarthrias
- conversational speech and reading, AMR tasks, prolonged vowel, speech stress test
conversational speech and reading
can evoke errors of resonance, artic., respiration, and prosody
AMR task
will highlight a slowed rate of phoneme production
prolonged vowel
helpful in eliciting breathy voice quality heard in phonatory incompetence; also useful for observing respiratory weakness
speech stress test
necessary in suspected cases of mysathenia gravis
treatment of motor speech disorders
-use assessment data to identify deficits
-begin working with patients using appropriate treatment goals
-increase complexity of tasks as patients improve
-work toward generalization of improvements
Rosenbeck 6 reccomendations
- help patients recgonize differences in their speech
- help patients have a willingness to change their speech for the better
- work closely with patients when setting goals of treatment
- increasingly insist that patients are talking therapeutically in their sessions, eventually even while engaged in small talk
- ensure patients are learning to listening, evaluate, and self-correct their speech
- be sure to progressively add cogntive-lingustic load to treatment tasks to ensure patients are working toward generalization
damage to trigeminal nerve unilateral
negligible effect on speech production
damage to trigeminal nerve bilateral
rare; can leave jaw muscles very weak or in severe cases, cause inability to close jaw; may need jaw sling to compensate
damage to vagus nerve
affects glossopharyngeal and accessory cranial nerves, close proximity to each other
treatment for resonance vagus
velar strength-training procedure’ modification of speech; reduce rate; more open-position mouth during speech; increase loudness
treatment for phonation vagus
pushing and pulling procedures, holding breath, hard glottal attack, head turning and sideways pressure on the larynx
treatment for prosodic deficits vagus
pitch range exercises, intonantion profiles, contrastive stress drills, chunking utterances into syntactic units
damage to facial and hypoglossal nerves
affects speech production primarily by decreasing lip strength and range of movement; traditional artic. drills recommended
treatment for respiratory weakness
correct posture, compensatory prosthetic devices, speaking immediately on exhalation, cueing for complete inhalation
