Dysarthria Flashcards
what is dysarthria?
Speech production deficit resulting from neuromotor damage to PNS or CNS
Dysarthria and apraxia are both motor speech disorders, NOT characterized by…
- language disorders
- Cognitive disorders (such as dementia or TBI)
- Result of abnormal anatomical structures, sensory loss (hearing loss or vision loss) or psychological disturbance (intellectual disability)
what are the 7 types of dysarthria?
- Flaccid dysarthria
- Spastic dysarthria
- Unilateral upper motor neuron dysarthria
- Ataxic dysarthria
- Hypokinetic dysarthria
- Hyperkinetic dysarthria
- Mixed dysarthria
What causes flaccid dysarthria?
Damage to lower motor neurons (cranial nerves, spinal nerves, or the neuromuscular junction)
Characteristics of flaccid dysarthria
muscle weakness causing: imprecise consonants, breathy phonation, hypernasality, shallow breath support, abnormal prosody
Muscle weakness is associated with what type of dysarthria
Flaccid dysarthria
Spastic dysarthria results from?
Bilateral damage to the upper motor neurons (pyramidal system & extrapyramidal system)
Often caused by brainstem strokes
Spastic dysarthria is characterized by?
Spasticity/stiffness and weakness in speech musculature causing: harsh or strained, strangled phonation; imprecise consonants; hypernasality; abnormal prosody
Which dysarthria is primarily characterized by stiffness
Spastic dysarthria
Unilateral upper motor neuron results from?
Unilateral damage to upper motor neurons
Unilateral upper motor neuron dysarthria is characterized by
Imprecise consonants
Irregular articulatory breakdowns
Harsh vocal quality
Variable combinations of weakness, spasticity/stiffness, and incoordination
Imprecise consonants is most characteristic of what type of dysarthria?
Unilateral upper motor neuron dysarthria
Ataxic dysarthria is a result of…
Damage to the cerebellum- neural tracts that connect the cerebellum to the CNS
Incoordination is most characteristic of what type of dysarthria
Ataxic dysarthria
Characteristics of ataxic dysarthria
Incoordination
Problems controling the timing and force of speech movements, resulting in drunken like voice quality
Imprecise consonants
Distorted vowels
Irregular articulatory breakdowns
Abnormal prosody
Which type of dysarthria is often perceived as a drunkard voice quality
Ataxia due to the inability to control the timing and force of speech movements
Hypokinetic dysarthria is a result of…
Damage to the basal ganglia control circuit
Reduced dopamine in part of the basal ganglia
What degenerative disorder is the most common cause of hypokinetic dysarthria
Parkinsons disease
Characteristics of hypokinetic dysarthria
Reduced range and speed of speech movements= rigidity, reduced ROM, poor movement scaling)
Harsh or breathy phonation
Imprecise consonants
Abnormal prosody
Could have increased rate of speech
Hyperkinetic dysarthria results from…
Damage to the basal ganglia control circuit
or sometimes unknown etiology
What degenerative disease is most associated with hyperkinetic dysarthria
Huntingtons disease
what are the characteristics of Hyperkinetic dysarthia
involuntary movements interfering with speech production
Unexpected inhalations & exhalations
Irregular articulatory breakdowns
Abnormal prosody
What can cause mixed dysarthriaa
Any neurological damage that extends to more than one portion of the motor system
Mixed dysarthria is characterized as?
Any combination of the characteristics of dysarthrias
What are the 3 standardized tests for dysarthria
- Frenchay dysarthria assessment
- Assessment of intelligibility of dysarthric speech
- Speech intelligibility test for windows
What is the only standardized test that provides differential diagnosis for dysarthria
Frenchay dysarthria assessment-2
The frenchay dysarthria assessment-2 gives what information?
Differential diagnosis
Intelligibility
& what speech subsystem is most affects intelligibility
The assessment of intelligibility of dysarthric speech provides what information
Intelligibility of single-word and sentence level
Speaking rate
Estimate of severity and communication efficiency
The speech intelligibility test for windows provides what information
Automatic program for single-word and sentence intelligibility
Rate of speech
Communication efficiency
Name the standardized tests for apraxia of speech
Apraxia Battery for Adults-2
What are 3 reasons evaluating and diagnosing motor disorders is challenging
- difficult to distinguish between dysarthria’s
- lack skills to determine which speech errors are most characteristic of suspected motor disorder
- Lack detailed knowledge of the human motor system
Purpose of evaluation of motor speech disorders
-Identify the presence of disorder
-Identify individual’s strengths and weaknesses
-Understand prognosis
-Determine a treatment plan
Hayes and Pindzola came up with 2 universal goals of any speech language evaluation… what are they
- understand a patient’s problem
- determine beginning level of treatment
What are the two basic methods of evaluating motor speech disorders
- instrumentation
- Perceptual analysis
Instrumentation evaluation is what type of measure?
Objective measure
It relies on sophisticated devices to objectively measure components of speech production
Perceptual analysis evaluation is what type of measure?
Subjective measure
It relies on clinician’s observations (ears and eyes) to judge speech production
Duffy suggested questions for a motor speech evaluation.. why? What do these questions help do?
They help to make an accurate diagnosis
What are Duffy’s suggested questions for making a motor speech evaluation
- is there a problem with the pt’s speech?
- if there is a problem, what is the best way to describe the problem?
- does the problem seem to be the result of a neurologic disorder? or more of a structural deficit?
- Is the problem related strictly to speech production, or is it more of a problem with language (like aphasia)?
- If its a speech production problem, do most of the problems seem to be related to sequencing of phonemes? (like apraxia of speech)
- If there are no phoneme sequencing errors, what are the characteristics of the pt’s speech errors and any associated motor problems? (type of dysarthria)
There are 5 components necessary for normal speech, list them in order of most to least important
- respiration
- phonation
- resonance
- articulation
- prosody
What happens if one or any combination of the 5 components necessary for normal speech is affected by a neuromotor disturbance?
A motor speech disorder will result
What determines the type of motor speech disorder?
The location in the nervous system
What is the function of the respiration component for speech production
Provides subglottic air pressure needed to set VFs into vibration; provides full and steady supply of air
If the respiratory system is impaired, how is speech production affected?
Muscles will be weak moving air in and out of lungs, reducing amount of air for speech production
Voice quality will be: short phrases, reduced loudness, and breathy voice
What is the function of phonation for speech production?
production of voiced phonemes through VF vibration in the larynx needing adequate length, mass, and tension
1. complete adduction of the VFs
2. Sufficient subglottic air pressure to initiate vibration
3. Adequate tension to adduct the VFS
If the phonation component is impaired, how is speech production affected?
Voice quality: weak, fried, harsh, hoarse, breathy, and/or strangulated
If muscles are weak–> flaccid dysarthria
If muscles are stiff–> spastic dysarthria
The function of resonance component for speech production
Velum moves up and down & is primarily responsible for proper placement of oral or nasal tonality onto phonemes during speech production
Difference between oral resonance and nasal resonance
-Oral resonance: velum is raised, closing off the nasal cavity from vocal air stream, allowing air to ONLY escape the oral cavity
-Nasal resonance: velum is lowered, while the oral cavity is closed off by the lips of tongue, allowing air to ONLY escape from the nasal cavity
If the resonance component is impaired, how is speech production affected?
May cause hypernasal voice quality
Hypernasality is when oral sounds are produced with nasal resonance; this happens because the velum doesnt raise, allowing air to escape the nasal cavity during production of non-nasal sounds
What is the function of the articulation component of speech production
Articulators (different structures within the vocal tract) shape the vocal airstream into different phonemes
In order to do this, the articulators have to perform movements with appropriate timing, direction, force, speed, and placement
If the articulation component is impaired, how is speech production affected
May affect the lips, tongue, jaw, velum, or vocal folds
This results in various articulation errors: unintelligible speech due to distorted vowels, imprecise consonants, inappropriate silences, irregular articulatory breakdowns, slurred speech
What is the function of the prosody component of the speech mechanism
It is the melody of speech, using stress and intonation, to convey meaning
To have accurate and clear prosody, the phonatory, respiratory, resonance, and articulatory system must be coordinated and accurate
If prosody is impaired, how will the speech production be affected
Respiratory and phonatory muscle weakness and slowness can cause flat rate of motion, impaired timing of muscle contractions and impaired strength of muscles. This will cause the prosody to be monopitch and monoloudness
Involuntary movements can result in irregular pitch variations, sudden increases or decreases in loudness, and prolonged intervals between syllables or words
There are salient speech features of all voluntary movements, what are they?
- Muscle strength
- Speed of movement
- Muscle Range of motion
- Accuracy of movement
- Motor steadiness
- Muscle tone
Explain the 6 salient speech features
- muscle strength is required to perform speech production tasks
- Speed of movement- speech requires rapid tongue and VF muscle movement
- Range of motion- speech requires the articulators to travel distances during the course of a movement
- Accuracy of movement- speech requires the preciseness of strength, speed, range, direction, and coordinated timing
- Motor steadiness- speech requires the ability to hold a body part (articulator) still
- Muscle tone- speech requires muscle tone ready for quick movement
How is muscle strength assessed?
-Pt press tongue against tongue blade
-Stress Testing Task (count to 100 aloud as quick as possible)
How is speed of movement assessed?
Diadochokinetic rate (DDK) tasks- number of times pt produces the phoneme divided by the duration of task in one breath
1. ALternate motion rate (AMR)
2. Sequential motion rate (SMR)
What are the two types of DDK rate tasks
Alternate motion rate (AMR)
Sequential motion rate (SMR)
What is Alternate motion rate
Pt says “puh puh puh” “tuh tuh tuh” and “kuh kuh kuh” as rapidly as possible on one breath
This helps to evaluate back and forth movement
What is sequential motion rate
Pt says “puh-tuh-kuh” as rapidly as possible on one breath
This helps to evaluate sequential movements from front to back
How is range of movement assessed
Pt extends or holds articulators in various positions
If available, a laryngoscope can be used
How is accuracy of movement assessed?
- Alternate motion rate or Sequential motion rate- used to assess accuracy, without evaluating rate
- Conversational speech- informal language sample observations
- Spoken paragraph reading
How is motor steadiness assessed?
Pt phonates holding a position or prolonged vowel
How is muscle tone assessed?
Observe the patients speech and infer
Observe affected body parts
How would impaired muscle strength affect each of the 5 components of speech production?
- Respiration muscle weakness- decreased subglottic air pressure
- Articulatory muscle weakness- unintelligible, imprecise articulation
- Resonance muscle weakness- hypernasality
- Phonatory muscle weakness- breathy voice
- affect on Prosody- monopitch, monoloudness
Reduced speed of movement is characteristic of?
Most types of dysarthria
Which type of dysarthria is unlikely to have reduced speed of movement?
Hypokinetic dysarthria, it may have increased speed of movement
If muscle range of motion is impaired, what is the result?
Inability to fully open jaw
Inability to completely adduct the VFs
Prosody may be affected: gurgled or slurred speech
If accuracy of muscle movement is impaired, what is the result?
Distorted consonants
Intermittent hypernasality
If motor steadiness is impaired, what is the result?
Tremors
Large, involuntary movements that interfere with voluntary movements
Inability to maintain a still position or produce a prolonged steady/smooth vowel
If muscle tone is impaired, what is the result?
If muscle tone is Increased: spasticity/stiffness or rigidity (spastic dysarthria)
Voice quality: harsh, intermittent breaks, abrupt loudness, and strained
If muscle tone is decreased: weakness or paralysis (flaccid dysarthria)
Voice quality: slurred, breathy, reduced loudness
How long does it take to administer a motor speech evaluation?
Normal versions are 30 to 40 mins
Short versions are 10 to 15 mins
What should be assessed in a motor speech evaluation?
The five components of speech production & the six salient freatures
What are the 5 components of a motor speech evaluation?
- Background info and medical history
- Face and jaw muscles at rest and during movement
- Tongue at rest and during movement
- velum and pharynx at rest and during movement
- larynx function
What is being assessed during the background info and medical history portion of a motor speech evaluation?
-Rate of onset (sudden or gradual)
-Site of lesion
-Current status of problems
-Additional info: impact of problem, specific challenging phonemes, muscle related problems, consistency of issues, duration of problem, possible cause, pt goals
What is being during the face and jaw muscles at rest and during movement portion of a motor speech evaluation?
Function of the facial nerve (CN 7): facial muscles
Function of the trigeminal nerve (CN 5): jaw muscles
Look for:
1. abnormal muscle tone or strength
2. assymetrical faacial features
3. restricted range of motion
What is being assessed during the tongue at rest and during movement portion of the motor speech evaluation?
Function of the hypoglossal nerve (CN 12)
What is being assessed during the velum and pharynx at rest and during movement portion of the motor speech eval?
Function of the vagus nerve (CN 10)
It is difficult to see structures clearlym so most obvious anatomical and functional deviation are observed
What is being assessed during the laryngeal function portion of the motor speech eval?
Observation of larynx directly
Instrumentation: laryngeal mirror or flexible endoscope
What are specific tasks to assess face and jaw muscles at rest and during movement? Name at least 4
-Is mouth symmetrical
-Can pt’s lips be forced open
-does face have expressionless, masklike appearance
-when pt looks up, are wrinkles on both halves of forehead
-is smile symmetrical
-can pt pucker lips
-can pt puff out cheeks and hold air in oral cavity as you squeeze cheeks
-does jaw hand loosley or devate to one side when mouth is wide open
-is pt able to move jaw to right and left
-can pt keep jaw closed while examiner attempts to open it
-can pt keep jaw open while examiner attempts to close it
What are specific tasks to assess tongue at rest and during movement? Name at least 4
- Significant effects on the articulation of speech sounds
- Does size of tongue appear normal at rest?
- Is tongue symmetrical and still at rest?
- Are fasciculations present when the tongue is at rest?
- Is pt able to protrude tongue completely?
- Can pt keep tongue tip at midline while examiner pushes tongue to each side?
- Is pt able to touch upper lip with tongue tip?
- Can pt keep tongue tip pressed against inside of cheek as examiner pushes the cheek inward?
- Can pt move tongue from side to side?
What are specific tasks to assess velum and pharynx movement at rest and during movement?
- Does velum rise symmetrically each time pt says /a/?
- Is there pharyngeal gag reflux when back of pharynx is touched with tongue depressor?
What are specific tasks to assess laryngeal function?
- Can pt produce sharp cough?
- Can pt produce sharp glottal stop?
- Is inhalatory stridor present?
What is a subjective analysis of motor speech mechanism?
Auditory-perceptual evaluation of the motor speech mechanism
What are the components of the auditory-perceptual evaluation?
- phonatory-respiratory system
- resonation system
- combined systems
- stress testing
- nonverbal oral apraxia
- apraxia of speech
- connected speech
Auditory-perceptual evaluation tasks to test the phonatory-respiratory system
-deep breath & say /ah/ as long, steady, and clearly as possible
-latency period between signal to say /ah/ and initiation of phonation?
-evaluate the quality, pitch, and loudness of pt phonation
Auditory-perceptual evaluation tasks to assess the resonation system
-Take a deep breath and say /u/ as long as possible
-Same task as above, holding one nostril at a time with a small mirror under nostril to evaluate nasal emission of air during phonation (fogging of mirror)
Auditory-perceptual evaluation tasks to assess combined system tasks
-Alternate motion rate (AMR): Take a deep breath and say ‘puh, puh, puh’ as long, fast, and evenly as possible
-Sequential motion rate (SMR): Make three sounds together
Auditory-perceptual evaluation tasks of stress testing of motor speech mechanism
Pt counts from 1 to 100 as quickly as possible
Auditory-perceptual evaluation tasks to test for nonverbal oral apraxia
-Pt performs voluntary, nonverbal oral movements without clinicians’ demonstration beforehand: blowing, smacking lips, cough, cluck tongue
Auditory-perceptual evaluation tasks to test for apraxia of speech
- Repeat or read words of increasing complexity beginning with same CVC syllable
- Repeat words with simple CVC consisting of identical initial and final consonants
- Count from 1 to 20
- Count from 20 to 1
- Cookie theft spontaneous description
- Read the generated cookie theft description sentences (4 sentences) on demand
Auditory-perceptual evaluation tasks analyzing connected speech
Pt is recorded while reading a standard passage (Rainbow passage, Grandfather passage, Zoo passage) & rated on performance
-Qualities evaluated: clarity of production, articulatory accuracy, prosody, voice breaks, quality of voice, etc.
