COMDIS415 MOTOR SPEECH DISORDERS Flashcards
MOTOR SPEECH DISORDERS: What is it?
umbrella term to cover different areas
of disorder
Dysarthria
Deficits in neuromuscular system, the motor control system or both
Apraxia of Speech
Planning, programming, and execution of speech are impaired resulting in difficulties producing fluent, intelligible speech.
True or False?: It is the result of language or phonological disorder
False, it is not.
Planning and Programming
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
Execution
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
What happens during plan?
Setting sight on something, seeing how you should reach for it, how to extend arms, plan for forward movement
What happens during program?
How far do we need to reach , velocity, range of motion
what happens during execution?
Movement is sent to muscles to execute plan
Childhood Apraxia
Developmental, occurs in young kids
Acquired Apraxia
Occurs at any point throughout developmental life span
onset of neurological injury, brain injury
Planning/Programming Disorder (Apraxia of Speech)
Muscles are intact, muscles are fine
- Only planning that is affected, brain has difficulty
coordinating planning
Execution Disorder (Dysarthria)
Muscles cannot execute plan that the
brain is instructing (planning works)
What is noticed for speech in Childhood Apraxia?
- 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)
Severe Apraxia of Speech
- affects intelligibility (more severe, less intelligible)
- no patterns, inconsistent errors
Developmental | Congenital
Abnormal development of central nervous system E.g., Cerebral Palsy, genetic syndromes, AT BIRTH OR SURROUNDING BIRTH
- articulation is affected
Acquired
Damage to the central nervous system
E.g., stroke, tumors, traumatic brain injury, degenerative diseases
CHILDHOOD APRAXIA OF SPEECH (CAS)
- 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
Communication Profile: Co-occurring Communication Symptoms
- Delayed language development
- Expressive language problems
- Difficulties with written language
- Problems with social language
Communication Profile: Possible Co-occurring Non-Speech Symptoms
- 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)
CAUSE ASSOCIATED WITH…
- Various Neurological Etiologies (intrauterine/child- hood stroke, infection)
- Complex Neurobehavioral Disorders (Autism, Fragile X Syndrome, Epilepsy)
- Can also be idiopathic (disorder of unknown origin)
AGREED UPON SPEECH FEATURES OF CAS
- 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
OTHER OBSERVED CHARACTERISTICS (CAS)
- Sound omissions
- Substitutions
- Reduced phonemic inventory
- Errors changing or increasing with phonetic complexity
- Groping
- Slow rate
CAS ASSESSMENT
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
SPONTANEOUS SPEECH
PICTURE DESCRIPTION TASK, ENGAGING IN PLAY
HOW FUNCTIONAL IS SPEECH ARE THEY ABLE TO EFFECTIVELY GET MEANING ACROSS
Automatic Speech
Less Impaired, phrases that are more automatic, happy birthday, hello how are you, less troublesome
Imitated Speech
difficulty, omissions, vowel inconsistency, articulatory groping
Speech Hierarchy
Start with least complex stimuli (single words, monosyllabic) and then make it more complex (multisyllabic)
CAS Assessment: Dynamic
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
CAS Assessment: Standardized
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)
CAS TREATMENT GOAL
To increase speech production and intelligibility Focus: On the “movement” of sound, not necessary the “sound”
CAS Treatment Approach: Sensory Cueing
PROMPT Therapy
Tactile Cues (need to be certified in this in order to implement it in therapy)
CAS Treatment Approach: Motor Programming
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
CAS Treatment Approach: Linguistic
language based focus: highlighting how different sounds, can be teaching them place, manner, voicing
- different approach
AOS SPEECH CHARACTERISTICS
- 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
causes of dysarthria
Congential - (cerebal palsy, Chiari malformation)
Acquired - Stroke, TBI, Parkinson’s, Multiple Sclerosis, ALS
What is Dysarthria?
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)
DYSARTHRIA TYPES
Flaccid
Spastic
Ataxic
Hypokinetic
Hyperkinetic
Unilateral upper motor neuron
Mixed (e.g. spastic-ataxic; flaccid-spastic) Characteristics Undetermined
PERCEPTUAL SPEECH CHARACTERISTICS
Respiration
Phonation
Pitch
Articulation
Resonance
Prosody
Respiration
Loudness, length of phrases, inspiration/expiration
Phonation
Pitch, steadiness of voice (tremor, breaks in phonation), stridor, grunts at the ends of phrases, monotone
Articulation
Imprecise consonants, distorted vowels, articulatory blurring
Resonance
Hyper-/hypo-nasality, nasal emission
Prosody
Speech rate, stress, spacing between words/syllables
DISTINGUISHED PHYSICAL CHARACTERISTICS
Muscle wasting, abnormal muscle tone, fasciculations, tremor, abnormal reflexes
Muscle Wasting
Wasting or loss of muscle tissue
Abnormal muscle tone
Muscle tone is too weak or greater than normal
Fasciculations
Twitches of resting muscles
Tremor
Involuntary movements of the head, jaw, lip, tongue, velum
Abnormal reflexes
Hypo- or hyperactive gag reflex, jaw jerk, sucking reflexes
ASSESSING DYSARTHRIA
Clinical Interview
Patient and family report
Medical history
Facilitators and barriers to communication
Oral motor exam
Speech production
Speech Intelligibility
Swallowing Cognition
Language
ASSESSMENT MAY RESULT IN THE FOLLOWING OUTCOMES
- 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).
DYSARTHRIA TREATMENT APPROACHES: RESTORATIVE
Aim to improve speech intelligibility, prosody, naturalness, Working on improving through oral mechanisms
TREATMENT APPROACH: COMPENSATORY
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
