Defining, Understanding and Categorizing Motor Speech Disorders

Question 1

Why is there are an increase in motor speech disorders?

Answer 1

1. Because of increased survival rates for a number of neurologic diseases
2. Because increasing longevity in the general population gives neurologic disease more opportunity to emerge.

Question 2

Put this list in order of most common first to least common last :

apraxia of speech
dysarthira
Nonaphasic cognitive-communication disorders
aphasia

Answer 2

Most common : dysarthria
Nonaphasic cognitive-communication disorders
Aphasia
Apraxia of speech

Question 3

Give two examples of MSDs.

Answer 3

MSDs include the dysarthrias and apraxia of speech.

Question 4

What is dysarthria (5 points)?
See GitMind : https://gitmind.com/app/doc/68dd4f5930c0f2cc77509b6844979969 dysarthria
See GitMind: https://gitmind.com/app/doc/bbdd2fdfc1f4b9d032f665c85963bd0d la dysphonie

Answer 4

Dysarthria is a collective name for a group of neurologic speech disorders that reflect abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for the breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production.

The responsible neuropathophysiologic disturbances of control or execution are due to one or more sensorimotor abnormalities, which most often include weakness, spasticity, incoordination, involuntary movements, or excessive or variable muscle tone.

This definition explicitly recognizes or implies the following:

1. Dysarthria is neurologic in origin.
2. It is a disorder of movement.
3. It can be categorized into different types, each type characterized by distinguishable perceptual characteristics and, presumably, different underlying neuropathophysiologic factors. The ability to categorize the dysarthrias therefore has implications for the localization of the causal disorder

Question 5

What is apraxia of speech?

Answer 5

A neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech. It can occur in the absence of physiologic disturbances associated with the dysarthrias and in the absence of disturbance in any component of language.

Question 6

Dysarthria develops at some point during the disease course in about ___________ of people with Parkinson’s disease (PD).

Answer 6

90%

Source p.5 Duffy

Question 10

List some neurological diseases that are associated with dysarthria.

Answer 10

1. Parkinson’s 90%
2. Cerebral Palsy 90%
3. MS 50%
4. TBI 33%
5. Small strokes 25%
6. ALS 25%

Question 11

Motor Speech Disorders can be grouped into 5 categories based on etiology (cause) and neurology (disorders of the nervous system).

** Do a chart or draw these groupings and include actual disorders.

Answer 11

1. Age at onset. MSDs can be congenital (or developmental) or acquired.
   Âge d’apparition : Congénital ou acquis
   Peut se refléter dans les comportements du patient
   Peut avoir un impact sur la prise en charge et sur le pronostic
2. Course. MSDs can be congenital (e.g., cerebral palsy), chronic or stationary (e.g., cerebral palsy in adults; patients who have reached a plateau after a stroke), improving (e.g., during spontaneous recovery from a stroke or closed head injury), progressive or degenerative (e.g., amyotrophic lateral sclerosis or PD), or exacerbating-remitting (e.g., multiple sclerosis). Monitoring MSDs over time may actually help establish the course of disease or help eliminate diagnoses incompatible with a particular course.

Déroulement
Congénital
Chronique/stable
S’améliorant ou progressif/dégénératif
Exacerbation ou amélioration

3. Site of lesion. Lesions associated with MSDs can include such diverse loci as the neuromuscular junction, the peripheral and cranial nerves, the brainstem, the cerebellum, the basal ganglia, the pyramidal or extrapyramidal pathways, and the cerebral cortex. Establishing the lesion site is a primary goal of neurologic evaluation and one to which distinguishing among MSDs can contribute. Conversely, knowledge of the lesion site can predict certain speech deficits. Incompatibility of speech findings with known or postulated lesion sites can raise doubts about presumed localization or suggest the presence of additional lesions or even different diseases. For example, the presence of a mixed hypokinetic-spastic-ataxic dysarthria in someone with a diagnosis of PD should raise questions about the neurologic diagnosis or suggest the presence of neurologic dysfunction beyond that explainable by PD alone.

Site de la lésion
Aide à prédire certains troubles de la parole

4. Neurologic diagnosis. Broad categories of neurologic disease include degenerative, inflammatory, toxic-metabolic, neoplastic, traumatic, and vascular causes. Within each of these broad categories, more specific diagnoses are applied. By itself, an MSD usually is not diagnostic of a particular neurologic cause or disease. Because many diseases can affect multiple or variable portions of the nervous system, it is neither particularly useful nor feasible to classify MSDs by disease (e.g., “the dysarthria of multiple sclerosis,” or “the dysarthria of stroke”). At the same time, some dysarthria types are found very commonly in some neurologic diseases and rarely or never in others (e.g., when PD causes dysarthria, its type nearly always is hypokinetic; when myasthenia gravis causes dysarthria, its type is always flaccid). Therefore identification of a specific MSD may provide confirmatory evidence for disease diagnosis.

Étiologie/Diagnostic neurologique
Dégénératif
Inflammatoire
Toxique-métabolique
Néoplasique (tumeur)
Traumatique
Vasculaire

5. Pathophysiology. It is presumably the underlying pathophysiology (e.g., weakness, spasticity) that determines the distinctive pattern of speech deficits associated with each MSD. Therefore the presence of certain speech abnormalities, or combinations of them, suggests one or more pathophysiologic disturbances and vice versa.

Pathophysiologie sous-jacente
Détermine les traits perceptuels déviants

Question 12

Name six types of dysarthria .

Answer 12

1. flaccid,
2. spastic,
3. ataxic,
4. hypokinetic,
5. hyperkinetic,
6. mixed

Question 13

1. A problem with the lower motor neuron (final common pathway, motor unit) will result in what type of dysarthria (1) ?
2. What type of neuro-motor problem (2)?
3. Give one example of a visible symptom that would indicate there was a problem with the nervous system (3).
4. ***Give an example of a neurologic disorder with these characteristics.

Answer 13

1. Flaccid
2. Execution
3. Weakness, etc.
4. Myasthénie grave

Source p.9 Duffy, Table 1.1

Question 14

A problem with the bilateral upper motor neuron (direct and indirect activation pathways) will result in what type of dysarthria (1) ?

2. What type of neuro-motor problem (2)?
3. Give one example of a visible symptom that would indicate there was a problem with the nervous system (3).
4. Give an example of a neurologic disorder with these characteristics.

Answer 14

1. spastic
2. execution
3. spasticity, etc.
4. ALS or M.S.

Source p.9 Duffy, Table 1.1

Question 15

A problem with the cerebellum (cerebellar control circuit) will result in what type of dysarthria (1) ?

What type of visible symptom that would indicate there was a problem with the nervous system (2)?

3. ***Give an example of a neurologic disorder with these characteristics.

Answer 15

1. ataxic
2. incoordination, etc.
3. M.S. Mixed Dysarthria

Source p.9 Duffy, Table 1.1

Question 16

A problem with the substance noire will result in hypokinetic dysarthria.

1. What type of visible symptom that would indicate there was a problem with the nervous system (2)?
2. Give an example of a neurologic disorder with these characteristics.

Answer 16

Hypokinetic :

1. Rigidity; reduced range of movement; etc.
2. Parkinson’s disease

Source p.9 Duffy, Table 1.1

Question 17

A problem with the Basal ganglia control circuit (extrapyramidal) will result in hyperkinetic dysarthria.

1. What type of visible symptom that would indicate there was a problem with the nervous system?
2. Give an example of a neurologic disorder with these characteristics.

Answer 17

Hyperkinetic :

1 . Involuntary movements
2. Huntington’s Disease

Source p.9 Duffy, Table 1.1

Question 18

1. A problem with the left dominant hemisphere will result in what type of diagnosis ?
2. What type of neuro-motor problem ?
3. What type of visible symptom that would indicate there was a problem with the nervous system?

Answer 18

1. apraxia of speech
2. motor planning / programming
3. planning programming errors

Source p.9 Duffy, Table 1.1

Question 19

Neurologic disease affects speech in a manner that reflects its _______________ and underlying _____________.

Answer 19

1. localization
2. pathophysiology (disease)

Question 20

The speech disturbances associated with MSDs are perceptually distinct, and their recognition can contribute to the_________________ and __________ of neurologic illness.

Answer 20

1. localization
2. diagnosis

Question 21

The neurologic breakdown of speech can reflect disturbances in 4 areas. Name them.

Answer 21

1. motor planning,
2. programming,
3. control, or
4. execution

Question 22

Name the two main types of MSDs.

Answer 22

1. the dysarthrias
2. apraxia of speech

Question 23

The perceptual method for classifying MSDs developed by Darley, Aronson, and Brown forms the framework for the discussion of diagnosis and management of MSDs in the textbook and it can be summarized in 2 main points.

Answer 23

1. The perceptual method for classifying MSDs developed by Darley, Aronson, and Brown reflects presumed underlying pathophysiology and is related to nervous system localization
2. When a patient walks into my office, I will use my ears, eyes, and hands to observe their behaviour. If I observe weakness, spasticity, incoordiantion, rigidity, involuntary movements or planning/ programming errors, then this means that there is a disease/problem somewhere in the nervous system. Based on what I observe, the problem is in a very specific location that can be identified by referring to Table 1.1 on page 9 of Duffy or that can be inferred by someone who has a solid understanding of how the nervous system works.

Question 24

Nomemz les 3 facteurs pertinents aux troubles de la parole eux-mêmes.

Answer 24

1. Composantes de la parole impliquées
2. Sévérité
3. Caractéristiques perceptuelles

Question 25

What is the difference between rigidity and spasticity?

Answer 25

Rigidity is consistent tightness. Spasticity is a release in tightness at end rage.

Question 26

Where will you typically see rigidity?

Answer 26

Parkinsons Disease

Question 27

Where will you typically see spasticity?

Answer 27

AVC, TCC, la paralysie cérébrale