Differential Diagnosis

Question 1

Apraxia of Speech

Answer 1

impairment in motor planning, programming; consonant and vowel distortions/substitutions; effortful, strained; slow rate; telescoping speech; breakdown around clusters; AMRs

Question 2

Ataxia of Speech

Answer 2

incoordination; clumsy speech; unsteadiness during vowel prolongation, alterations in loudness and pitch; increased errors w/ increased length, sound prolongations, distorted substitutions & additions, syllable and word segmentation; slow/irregular rate; scanning speech; harsh; slow irregular AMRs; dysmetria (over/undershoot)

Question 3

Flaccid Dysarthria

Answer 3

weakness; LMN (fasiculations); breathy, hoarse, reduced maximum vowel duration (weak vocal fold); weak cough; hypernasality; monopitch and monoloudness; harsh vocal onset

Question 4

Spastic Dysarthria

Answer 4

spasticity; bilateral UMN; strained, harsh, strangled voice, grunt @ end of expiration; slow rate; increased effort; equal stress; pseudobulbar affect/hemiplegia/facial droop common; AMRs=slow, regular

Question 5

Unilateral UMN Dysarthria

Answer 5

variable combinations of weakness, spasticity, incoordination; imprecise consonants, slow AMRs, harsh voice, mild hypernasality, contralateral weakness of lower face, tongue; increased tone and reflexes; increased effort/fatigue

Question 6

Hypokinetic Dysarthria

Answer 6

rigidity, reduced ROM, breathiness (sometimes aphonia) or harsh/hoarse, reduced volume, loudness decay, vocal flutter/rapid voice tremor, reduced max vowel prolongation; rapid, blurred rate/short rushes of speech (parkinsons)

Question 7

Hyperkinetic Dysarthria

Answer 7

exaggerated pauses, tremor on vowel prolongations, repetitions on oral reading, strange interjections/intermittent noises in speech

Question 8

Tx recommendations: Apraxia

Answer 8

articulation drills; repetition/oral reading; segmentation and phonetic spelling

Question 9

Tx recommendations: Ataxia

Answer 9

pacing strategies; slow speech

Question 10

Tx recommendations: Flaccid

Answer 10

breath support; palatal obturator

Question 11

Tx recommendations: Spastic

Answer 11

Laryngeal massage; botox; slow, passive stretching

Question 12

Tx recommendations: Hypokinetic

Answer 12

LSVT; loud/slow speech practice

Question 13

Tx recommendations: Hyperkinetic

Answer 13

Pharmocological (botox, unintended for seizures/tremor); Behavioral (rate reduction, breathy/hard vocal onset, postural strategies); Instrumental biofeedback (EMG feedback for facial muscles; breathing patterns visual feedback); bite block