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COMDIS415 EXAM 2 > COMDIS415 MOTOR SPEECH DISORDERS > Flashcards

COMDIS415 MOTOR SPEECH DISORDERS Flashcards

1
Q

MOTOR SPEECH DISORDERS: What is it?

A

umbrella term to cover different areas
of disorder

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2
Q

Dysarthria

A

Deficits in neuromuscular system, the motor control system or both

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3
Q

Apraxia of Speech

A

Planning, programming, and execution of speech are impaired resulting in difficulties producing fluent, intelligible speech.

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4
Q

True or False?: It is the result of language or phonological disorder

A

False, it is not.

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5
Q

Planning and Programming

A

Happens BEFORE movement is initiated
- Planning relates to articulation
- Programming relates to the flow, timing, and force of speech
- Inability to group and sequence relevant muscles to plan or program a movement

APRAXIA OF SPEECH

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6
Q

Execution

A

Occurs at or after initiation
- when muscle goes to move, cannot execute movement
results in distorting, sound substitution
- Rooted in deficits of basic physiological or movement characteristics of the musculature (including tone, speed or range)

DYSARTHRIA

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7
Q

What happens during plan?

A

Setting sight on something, seeing how you should reach for it, how to extend arms, plan for forward movement

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8
Q

What happens during program?

A

How far do we need to reach , velocity, range of motion

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9
Q

what happens during execution?

A

Movement is sent to muscles to execute plan

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10
Q

Childhood Apraxia

A

Developmental, occurs in young kids

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11
Q

Acquired Apraxia

A

Occurs at any point throughout developmental life span
onset of neurological injury, brain injury

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12
Q

Planning/Programming Disorder (Apraxia of Speech)

A

Muscles are intact, muscles are fine
- Only planning that is affected, brain has difficulty
coordinating planning

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13
Q

Execution Disorder (Dysarthria)

A

Muscles cannot execute plan that the
brain is instructing (planning works)

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14
Q

What is noticed for speech in Childhood Apraxia?

A
  • Delayed onset of first words (produce later on not 12m)
  • Smaller inventory of spoken words
  • Articulatory groping: jaw, lip, tongue trying to move to the right positions, but nothing comes out
  • Vowel distortion - cant get tongue in right positions to use right vowel, so different one is produced
  • Wrong stress patterns
  • Separation of syllables (halting or abrupt)
  • Inconsistency in errors (cat, car, ker, tear; change with every repetition)
  • Cannot imitate certain words (say a word and repeat)
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15
Q

Severe Apraxia of Speech

A
  • affects intelligibility (more severe, less intelligible)
  • no patterns, inconsistent errors
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16
Q

Developmental | Congenital

A

Abnormal development of central nervous system E.g., Cerebral Palsy, genetic syndromes, AT BIRTH OR SURROUNDING BIRTH
- articulation is affected

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17
Q

Acquired

A

Damage to the central nervous system
E.g., stroke, tumors, traumatic brain injury, degenerative diseases

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18
Q

CHILDHOOD APRAXIA OF SPEECH (CAS)

A
  • Disorder of speech motor planning/programming
  • Difficulty with purposeful, voluntary movements for speech in the absence of weakness of paralysis
  • Primarily affects “articulation” while other speech systems are spared
  • Requires prolonged/intense treatment
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19
Q

Communication Profile: Co-occurring Communication Symptoms

A
  • Delayed language development
  • Expressive language problems
  • Difficulties with written language
  • Problems with social language
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20
Q

Communication Profile: Possible Co-occurring Non-Speech Symptoms

A
  • Gross and fine motor delays
  • Motor clumsiness
  • Limb Apraxia
  • Feeding difficulties
    (Inability to make precise or exact movements with
    a part of body like fingers, hands, feet, etc)
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21
Q

CAUSE ASSOCIATED WITH…

A
  • Various Neurological Etiologies (intrauterine/child- hood stroke, infection)
  • Complex Neurobehavioral Disorders (Autism, Fragile X Syndrome, Epilepsy)
  • Can also be idiopathic (disorder of unknown origin)
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22
Q

AGREED UPON SPEECH FEATURES OF CAS

A
  • Inconsistent speech errors (consonants and vowels) in repeated productions
  • Vowel errors
  • Lengthened and disrupted coarticulatory transitions between sounds and syllables
  • Inappropriate prosody – especially related to lexical or phrase stress
  • Frequency of these signs may change depending on task complexity, age, and severity
23
Q

OTHER OBSERVED CHARACTERISTICS (CAS)

A
  • Sound omissions
  • Substitutions
  • Reduced phonemic inventory
  • Errors changing or increasing with phonetic complexity
  • Groping
  • Slow rate
24
Q

CAS ASSESSMENT

A

Observe speech features (rate, consistency, lexical stress, accuracy) in:
- Tasks of increasing complexity
- Single words ( monosyllables vs multisyllabic words)
- Phrase level
- Sentence level
- Diadochokinetic Rate (DDK) (puh-tuh-kuh)
- Spontaneous vs. Automatic vs. Imitated Speech

25
Q

SPONTANEOUS SPEECH

A

PICTURE DESCRIPTION TASK, ENGAGING IN PLAY
HOW FUNCTIONAL IS SPEECH ARE THEY ABLE TO EFFECTIVELY GET MEANING ACROSS

26
Q

Automatic Speech

A

Less Impaired, phrases that are more automatic, happy birthday, hello how are you, less troublesome

27
Q

Imitated Speech

A

difficulty, omissions, vowel inconsistency, articulatory groping

28
Q

Speech Hierarchy

A

Start with least complex stimuli (single words, monosyllabic) and then make it more complex (multisyllabic)

29
Q

CAS Assessment: Dynamic

A

See how child responds to cues and how much cueing is need to support speech production
- Touch Cues: Have hands on child face, moving articulators, how to position them
- Visual Cues: Modeling where articulators should go
- Listening Cues

30
Q

CAS Assessment: Standardized

A

Example: Kaufman Speech Praxis Test
- May help, but are not sufficient to make diagnosis
- No single diagnostic tool to rule in or rule out CAS
- Diagnosis before age 3 is extremely challenging
(Diagnosis after age 3, not a clear speech sample before age 3)

31
Q

CAS TREATMENT GOAL

A

To increase speech production and intelligibility Focus: On the “movement” of sound, not necessary the “sound”

32
Q

CAS Treatment Approach: Sensory Cueing

A

PROMPT Therapy
Tactile Cues (need to be certified in this in order to implement it in therapy)

33
Q

CAS Treatment Approach: Motor Programming

A

start with simple, then move up until they can produce word
correctly ah-o first then work up to apple
- high repetition of speech movements, aiming for accuracy
consistency, making speech movements more common

34
Q

CAS Treatment Approach: Linguistic

A

language based focus: highlighting how different sounds, can be teaching them place, manner, voicing

  • different approach
35
Q

AOS SPEECH CHARACTERISTICS

A
  • Effortful, slow speech
    Unusual pausing
    Distorted speech sounds
  • Poor prosody
  • Difficulty initiating speech
    Groping of articulators
    Every characteristic is the same as CAS, just when onset is different
36
Q

causes of dysarthria

A

Congential - (cerebal palsy, Chiari malformation)
Acquired - Stroke, TBI, Parkinson’s, Multiple Sclerosis, ALS

37
Q

What is Dysarthria?

A

Group of neurogenic speech disorders characterized by abnormalities in:

  • Strength, speed, range, steadiness, tone or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production.

Adversely affects intelligibility and/or naturalness of speech Several different types (unlike Apraxia)

38
Q

DYSARTHRIA TYPES

A

Flaccid
Spastic
Ataxic
Hypokinetic
Hyperkinetic
Unilateral upper motor neuron
Mixed (e.g. spastic-ataxic; flaccid-spastic) Characteristics Undetermined

39
Q

PERCEPTUAL SPEECH CHARACTERISTICS

A

Respiration
Phonation
Pitch
Articulation
Resonance
Prosody

40
Q

Respiration

A

Loudness, length of phrases, inspiration/expiration

41
Q

Phonation

A

Pitch, steadiness of voice (tremor, breaks in phonation), stridor, grunts at the ends of phrases, monotone

42
Q

Articulation

A

Imprecise consonants, distorted vowels, articulatory blurring

43
Q

Resonance

A

Hyper-/hypo-nasality, nasal emission

44
Q

Prosody

A

Speech rate, stress, spacing between words/syllables

45
Q

DISTINGUISHED PHYSICAL CHARACTERISTICS

A

Muscle wasting, abnormal muscle tone, fasciculations, tremor, abnormal reflexes

46
Q

Muscle Wasting

A

Wasting or loss of muscle tissue

47
Q

Abnormal muscle tone

A

Muscle tone is too weak or greater than normal

48
Q

Fasciculations

A

Twitches of resting muscles

49
Q

Tremor

A

Involuntary movements of the head, jaw, lip, tongue, velum

50
Q

Abnormal reflexes

A

Hypo- or hyperactive gag reflex, jaw jerk, sucking reflexes

51
Q

ASSESSING DYSARTHRIA

A

Clinical Interview
Patient and family report
Medical history
Facilitators and barriers to communication
Oral motor exam
Speech production
Speech Intelligibility
Swallowing Cognition
Language

52
Q

ASSESSMENT MAY RESULT IN THE FOLLOWING OUTCOMES

A
  • Diagnosis of dysarthria and classification of dysarthria type
  • Clinical description of the dominant auditory-perceptual speech characteristics and the severity of the disorder.
  • Presence of co-morbid conditions, including apraxia of speech, aphasia, cognitive- communication disorder, or swallowing disorder.
  • Statement of prognosis and recommendations for intervention that relate to overall communication adequacy.
  • Identification of relevant follow-up services, including support for individuals with dysarthria.
  • Referral to other professionals as needed (e.g., neurologist, psychologist).
53
Q

DYSARTHRIA TREATMENT APPROACHES: RESTORATIVE

A

Aim to improve speech intelligibility, prosody, naturalness, Working on improving through oral mechanisms

54
Q

TREATMENT APPROACH: COMPENSATORY

A

Aim to improve ability to communicate (AAC may be used, cues may be taught)
Topic boards | alphabet boards
Voice banking
Pacing boards
Delayed/altered auditory feedback Communication strategies, GOOD FOR THOSE WITH ALS

COMDIS415 EXAM 2 (7 decks)

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