Chapter 9: Motor Speech Disorders and Dysphagia Flashcards
What is Apraxia of Speech?
Neurogentic speech sound disorders dur to sensorimotor problems in creating motor plans and positioning and sequentially moving muscles for the volitional production of speech
What are clinical characteristics of AOS?
- Slower rate of speech
- disordeted speech sound substitutions and additions
- Syllable segmentation
- Articulatory groping
- false starts and restarts
- Prosodic impairments
- Longer utterances causing more errors than shorter utternances
Assessment of AOS
- Obtain a detailed case history
- Look through medical records
- Interview patients and their family members
- Record the patient’s speech samples and transcribe the responses
- Evoking imitative production of a speech sound
- Evoking repetitive production of syllables and multisyllables (p^p^p^ or p^t^k^)
- Evoking repitition of progressively longer words
- Evoking repeated, imitative production of words and phrases
- Evoking imitative produciton of sentences
- Counting response (count 1 to 20)
- Picture description
- Assess oral reading
- Assess limb movements to evaluate limb apraxia
- Administering a standaridzed test
What is Dysarthria?
Neurologically based speech sound disorders characterized by abnormal strength, speed, range, steadiness, tone, and accuracy of movement in speech production
They may be evident in respiration, phonation, articulation, prosody, and resonance
Ataxic Dysarthria (lesion site, neuromoor basis, and common etiologies)
Lesion Site: Cerebellum
Neuromotor basis: Incoordination
Common Etiologies
- Cerebellar strokes
- Degenerative ataxia
- Tumors
- TBIs
- Toxic Conditions
- Inflammatory conditions
- Demyelinating diseases
Speech characteristics of Ataxic Dysarthria
Articulation
- Imprecise consonants
- Irregular articulatory breakdowns
- Distortion of vowels
Prosody
- Excessive and even stress
- Prolonged phonemes and intervals between words or syllables
- Slow rate of speech
Phonation
- Monopitch
- Monoloudness
-Harshness
Resonance
- Intermittent hyponasality (not prominent characteristic)
Respiration
- Exaggerated and paradoxical movement during speech produciton
Flaccid Dysarthira (lesion site, neuromoor basis, and common etiologies)
Lesion Site: Lower motor neuron (LMN)
Neuromotor basis: Weakness and Hypotonia
Common Etiologies
Any damage to the LMN connection to muscles and/or the cranial nerves involved in speech production
- Degenerative diseases
- motor neuron diseases
- progressive bulbar disease
- MSA
- myasthenia gravis
- botulism
- vascular diseases
- brainstem stroke
- infections (Polio, AIDS)
- Guillain- Barré syndrome
- surgical trauma
Flaccid Dysarthria Speech characteristics
Articulation
- Imprecise consonants
- weak pressure consonants (damage to V, VII, XII)
Phonation/ Phonatory Prosodic
- Breathy
- audible inspiration
- harshness
- monopitch
- monoloudness or reduced loudness
- short phrases
Resonance
- Hypernasality
- nasal emission
- short phrases
Respiration
- Reduced subglottal air pressure
- weak inhalation
Hyperkinetic Dysarthira (lesion site, neuromoor basis, and common etiologies)
Lesion Site: Basal ganglia and/ or Basal ganglia connections within the CNS
Neuromotor basis: Abnormal, extra movements
Common Etiologies
- Huntington’s disease
- Sydenham’s chorea
- brainstem stroke
- TBI
- toxic conditions
- metabolic conditions (tardive dyskinesia)
- tourette syndrome
- seizure disorders
- spasmodic dysphonia
Hyperkinetic dysarthira speech characteristics
Articulation
- Imprecise consonants
- distorted vowels
- prolonged phonemes
Prosody
- Slower rate of speech
- prolonged interword intervals
- inappropriate silent periods
- phoneme prolongations
- excess and equal stress
- reduced stress
- short phrases
Phonation
- Monopitch
- monoloudness
Resonance
- Hypernasality
Respiration
- Audible inspiration
- forced/ sudden inspiration or expiration
Hypokinetic Dysarthira (lesion site, neuromoor basis, and common etiologies)
Lesion Site: Basal ganglia and/ or Basal ganglia connections within the CNS
Neuromotor basis: Reduced range of motion, rigidity, and reduced movement
Common Etiologies: Parkinson’s disease (most common), Stroke/ vascular diseases, toxic and metabolic conditions, repeated TBI, infections (HIV, Creutzfeld-Jakob disease)
Hypokinetic Dysarthria speech characteristics
Articulation: Imprecise/ distorted consonants, stops sounding more like fricative, mushy fricatives
Prosody: Reduced stress, inappropriate silent intervals, short rushes or speech, variable and increased rate in segments, and short phrases
Phonation: Monopitch, monoloudness, low pitch, and harsh and continuously breathy
Resonance: Mild hypernasality
Respiration: Reduced vital capacity, irregular breathing, and faster rate of respiration
Spastic Dysarthira (lesion site, neuromoor basis, and common etiologies)
Lesion Site: Upper motor neuron (bilateral)
Neuromotor basis: Weakness and Spasticity
Common Etiologies:
Multiple strokes that damage pyramidal and extrapyramidal tracts, brainstem stroke, Primary lateral sclerosis (PLS), Multiple Sclerosis (MS), TBI, brainstem tumor, viral or bacterial infection of cerebral tissue, and cerebral palsy (children)
Spastic Dysarthira Speech Characteristics
Articulation: Imprecise consonants and distorted vowels
Prosody: Excess and equal stress, reduced stress, slow rate, and short phrases
Phonation: Hyperadduction of vocal folds, continuous breathy voice, harshness, low pitch, pitch breaks, strained/strangled voice quality, monopitch, and monoloudness
Resonance:Hypernasality
Respiration not really effected
Mixed Dysarthira (lesion site, neuromoor basis, and common etiologies)
Lesion Site: damage to various parts of the nervous system
Neuromotor basis: Flaccis-spastic and ataxic- spastic
Common Etiologies:
MS, Amyotrophic lateral sclerosis (ALS), Friedreich’s ataxia, and Wilson’s disease
