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motor speech > chapter 4 > Flashcards

chapter 4 Flashcards

1
Q

what is caused by impairments of lower motor neurons in cranial or spinal nerves

A

flaccid dysarthria

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2
Q

flaccid dysarthria is characterized by

A

slow-labored articulation, marked degrees of hypernasal resonance, hoarse breathy phonation

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3
Q

side effects of flaccid dysarthria

A

paralysis, weakness, hypotonicity, atrophy, hypoactive reflexes of involved speech subsystem musculature

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4
Q

cranial nerves of speech production

A

trigeminal, facial, glossopharyngeal, vagus, accessory, and hypoglossal

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5
Q

damage to the cranial nerves can be caused by

A

brainstem stroke, growing tumor, viral or bacterial infections, physical trauma, or surgical accidents

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6
Q

trigeminal nerve (V)(5)

A

attached to brainstem at level of pons, divided into 3 branches; bilateral intervention

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7
Q

3 branches of trigeminal nerve

A

opthalmic, maxillary, and mandibular

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8
Q

branch of the trigeminal nerve most important for speeech and innervating muscles in lower jaw and velum

A

mandibular

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9
Q

damage to trigeminal nerve can

A

unilateral or bilateral

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10
Q

facial nerve (VII)(7)

A

branches out from brainstem just below trigeminal nerve, dividing into cervicofacial and temporofacial branch; mixed bilateral and contralateral innervation

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11
Q

damage to facial nerve

A

can cause weakness or paralysis in all muscles on same side of face, resulting in drooping of the eyelid, mouth, cheek, and other structures

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12
Q

glossopharyngeal nerve (IX)(9)

A

orginates in brainstem at medulla, coursing out to pharynx; innervates stylopharyngeus and superior pharyngeal constrictor muscles; damage also affects vagus nerve; bilateral innervation

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13
Q

nerve that plays role in speech resonance and phonation by shaping pharynx into appropriate positions needed to produce various phonemes correctly

A

glossopharyngeal nerve

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14
Q

vagus nerve (X)(10)

A

one of the most important cranial nerves for speech production; bilateral innvervation

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15
Q

three branches of vagus nerve

A

pharyngeal, external superior laryngeal branch, recurrent nerve branch

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16
Q

pharyngeal branch

A

damage can affect movement of velum, resonance

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17
Q

external superior laryngeal nerve branch

A

damage can affect pitch

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18
Q

recurrent nerve branch

A

damage of branch causes breathy phonation; innervates all laryngeal muscles except cricothyroid

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19
Q

accessory nerve (XI)(11)

A

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

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20
Q

hypoglossal nerve (XII)(12)

A

provides motor innervation for all intrinsic and most extrinsic muscles of the tongue; primarily bilateral innvervation

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21
Q

primary characteristic of hypoglossal nerve damage

A

imprecise articulation, phoneme distortion, or slow lingual movements; weakness of tongue or paralysis

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22
Q

injury to phrenic nerve

A

paralyzed diaphragm, decreases loudness; shortened, breathy, or strained vocal quality

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23
Q

lesions can occur in

A

cranial nuclei, nerves themselves, or neuromuscular junction, or muscle

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24
Q

physical trauma

A

surgical trauma with accidental cut of cranial nerve or head and neck injury

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25
Q

brainstem stroke

A

cerebrovascular accident (CVA); occurs with interruption of blood flow to brain as artery breaks or is blocked

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26
Q

mysasthenia gravis cause

A

affects neuromuscular junction, caused by antibodies that block/damage muscle tissue

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27
Q

temporary treatment for myasthenia gravis

A

injection of edrophonium chloride (Tensilon)

28
Q

symptoms of mysathenia gravis

A

rapid fatigue of muscular contractions over short time, with recovery after rest; hypernasality, decreased loudness, breathy voice quality, decreased articulatory precision

29
Q

assessment of mysathenia gravis

A

stress test involving asking patient to count from 1 to 100 or to read lengthy paragraph

30
Q

guillain-barre syndroe

A

results in demyelinzation; frequently occurs after certain kinds of infections and immunizations

31
Q

symptoms of guillain-barre syndrome

A

flaccid dysarthria, dysphagia

32
Q

recovery for guillain-barre syndrome

A

high recovery rate, lasting weeks or months, 5% die in acute stages

33
Q

polio

A

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

34
Q

muscular dystrophy

A

causes progressive degeneration of muscle tissue, can result in muscles weakness in many muscles served by cranial nerves

35
Q

progressive bulbar palsy

A

can affect both UMN and LMN, although often only present in LMN, with LMN damage causes flaccid dysarthria; UMN and LMN causes mixed dysarthria

36
Q

reduced maximum phonation time

A

females typically 15-20 sec & males typically 20-25 sec

37
Q

resonance

A

reflects bilateral damage to pharyngeal branch of vagus innervates most muscles of the velum

38
Q

errors of resonance

A

hypernasality, nasal emission, weak pressure consonant, shortned phrases

39
Q

nasal emission

A

weak velopharyngeal closure

40
Q

weak pressure consonant

A

decreased intraoral air pressure

41
Q

shortened phrases

A

wasted air that escaped through nasal cavity during speech

42
Q

articulation

A

imprecise consonant production: severity varies, damage to facial and hypoglossal nerves

43
Q

damage to trigeminal nerve (articulation)

A

difficulty elevating jaw sufficently to bring articulators into contact with each other

44
Q

phonation

A

phonatory incompetence: incomplete adduction of VFs during phonation

45
Q

phonation caused by damage to recurrent banch of vagus nerve

A

breathy voice quality or whisper, weak or paralyzed adductor or abductor muscles

46
Q

strong confirmation of flaccid dysarthria in relation to phonation

A

combined Prescence of hypernasality and phonatory incompetence

47
Q

respiration

A

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

48
Q

symptoms of respiration

A

reduced loudness, shortened phrase length, strained vocal quality if speaking on residual air to prolong phrase length, minikoudness, monopitch; infrequent inhalation when speaking

49
Q

prosody

A

weakened laryngeal muscles that are unable to make many fine VF adjustments necessary for normal pitch and loudness variations

50
Q

symptoms of prosody

A

monopitch and monoloudness; NOT a diagnostic marker for flaccid dysarthria

51
Q

key evaluation tasks for flaccid dysarthrias

A
  • conversational speech and reading, AMR tasks, prolonged vowel, speech stress test
52
Q

conversational speech and reading

A

can evoke errors of resonance, artic., respiration, and prosody

53
Q

AMR task

A

will highlight a slowed rate of phoneme production

54
Q

prolonged vowel

A

helpful in eliciting breathy voice quality heard in phonatory incompetence; also useful for observing respiratory weakness

55
Q

speech stress test

A

necessary in suspected cases of mysathenia gravis

56
Q

treatment of motor speech disorders

A

-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

57
Q

Rosenbeck 6 reccomendations

A
  • 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
58
Q

damage to trigeminal nerve unilateral

A

negligible effect on speech production

59
Q

damage to trigeminal nerve bilateral

A

rare; can leave jaw muscles very weak or in severe cases, cause inability to close jaw; may need jaw sling to compensate

60
Q

damage to vagus nerve

A

affects glossopharyngeal and accessory cranial nerves, close proximity to each other

61
Q

treatment for resonance vagus

A

velar strength-training procedure’ modification of speech; reduce rate; more open-position mouth during speech; increase loudness

62
Q

treatment for phonation vagus

A

pushing and pulling procedures, holding breath, hard glottal attack, head turning and sideways pressure on the larynx

63
Q

treatment for prosodic deficits vagus

A

pitch range exercises, intonantion profiles, contrastive stress drills, chunking utterances into syntactic units

64
Q

damage to facial and hypoglossal nerves

A

affects speech production primarily by decreasing lip strength and range of movement; traditional artic. drills recommended

65
Q

treatment for respiratory weakness

A

correct posture, compensatory prosthetic devices, speaking immediately on exhalation, cueing for complete inhalation

motor speech (12 decks)

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