dysarthria

Question 1

dysarthria definition

Answer 1

Neurogenic speech sound disorder.
Characterized by abnormal strength, speed, range, steadiness, tone, and accuracy of the muscles and movements for speech production.

Question 2

dysarthria NEUROPATHOLOGY

Answer 2

Due to stroke, infections, TBI, or progressive neurological diseases (e.g., PD, ALS, MS).
Different dysarthria types correspond to a different site of damage.

Question 3

dysarthria COMMUNICATION DEFICITS

Answer 3

Depending on the site of damage and muscles affected, there will be different deficits.
Can happen at any or all 5 levels of speech production: respiration (RESP), phonation (PHON), resonance (RESON), articulation (ARTIC), prosody (PROS).

Question 4

different dysarthrias chart, type, localization of damage, auditory signs & characteristic diseases

Answer 4

Question 5

key feature of each dysarthria
if no key feature, name health condition associated

Answer 5

Ataxic - incoordination
Flaccid - Weakness
Spastic- Effortful
Hyperkinetic - Irregular
Hypokinetic- Reduction

Flaccid-Spastic - ALS
Ataxic-Spastic - MS

Unilateral UMN - weakness, incoordination & spasticity

Question 6

differentiate between UMN damage and LMN

Answer 6

Question 7

diff dysarthria chart with pathophysiological signs and site of lesion

Answer 7

Question 8

ataxic dys characteristics

Answer 8

uncoordinated & cerebellum
- imprecise vowels & consonants “drunken speech”
- excessive and equal stress
- slow rate
- inappropriate silences within & between words
- gait disturbences
- monopitch, monoloud, harsh
- paradoxical breathing
- Distorted vowels
-Prolonged phonemes
- Irregular AMRs
■ telescoping/collapsing of syllables

Memory tool:
A.T.A.X.I.C.

Arhythmic speech: Irregular rhythm and inappropriate pauses.
Tone abnormalities: Voice may have a monopitch or monoloudness quality.
Articulatory imprecision: Slurred speech due to incoordination.
Xtra effort needed: Speaking may appear to be an effortful process.
Irregularities in speech rate: Might be excessively slow or, at times, too fast.
Coordination issues: This is the core issue—problems coordinating the movements of speech muscles.

Question 9

flaccid dys

Answer 9

weakness, LMN
- weak inhalation
- breathy voice, audible inspirations, short phrases
- hypernasality, NAE
- imprecise consonants (esp. high pressure)
- imprecise AMRs, slow & slurred DDKs
- tongue fasciculations
- diminishes reflexes
- hypotonia

memory tool: spicy, breathy voice, makes you go weak (inhalation, hypotonia), cant even speak right just ooos and aahhhs (vowels), make ya quiver (fasciculations)

Question 10

spastic dys

Answer 10

effortful, UMN
- Strangled (harsh, hyperadduction)
- Pitch breaks
- Articulatory imprecision
- Slow rate
- Tight muscles aka hypertonia
- Increased reflexes
- Cheweing/swallowing difficulty
- = excessive & equal stress
- slow & regular AMRS??

memory tool: SPASTIC + excessive & equal stress
- man doing karate and lifting weights at same time wants to strangle ya, with angry eyebrows and low pitch voice

Question 11

hyperkinetic dysarthria characteristics

Answer 11

irregular, BG, involuntary movements:

imprecise consonants,
distorted vowels,
prolonged phonemes,
irregular articulatory breakdowns,
**slow and irregular AMRs, **
hypernasality,
variable (irregular) rate,
**strained/strangled voice, **
harsh voice,
inappropriate silences,
transient breathiness,
voice stoppages,
excess and equal stress,
loudness variation,
sudden forced inspiration/expiration*

Question 12

memory tool for hypokinetic dysarthria characteristics

Answer 12

Reduction, BG
monopitch, monoloud
inappropriate silences
short rushes of speech
tendency for rapid/accelerated speech
rapid/blurred AMRS - fast and imprecise DDK
palilalia- delayed repetitions of words or phrases

mmory tool: hyPOPO lazy cop out of breath running for donut, mask like face, reduced lung capacity, rast rate, short rushes of speech, reduced stress, inapp. silences, C+V, mono pitch & loud

Question 13

flaccid-spastic characteristics

Answer 13

memory tool: “FALS MIX” can remind you of the disease “ALS” and the “MIX” of flaccid and spastic characteristics.

Flaccid qualities: Weakness, atrophy, and fasciculations of the speech muscles.
Articulatory imprecision
Low muscle tone (initially): From the flaccid component.
Strained-strangled voice quality: From the spastic component.
Monopitch and monoloudness: Reduced prosodic variation.
Increased muscle tone (as it progresses): From the spastic component.
Xtra effort: Speaking may appear effortful due to muscle weakness and spasticity.

Question 14

ataxic-spastic dysarthria

Answer 14

memory tool: P.H.A.R.M.S.

-Pitch & loudness problems
-HHarsh or breathy voice
-Articulatory imprecision:
-Reduced vital capacity: Limited breath affecting sustained speech.
-Misplaced emphasis: Impaired stress patterns in speech.
-Significant hypernasality

Or PHHARM: and put hypernasality with harsh & breathy

Question 15

Flaccid (LMN)
- Lesion location:

Answer 15

LMN (cell, axon, NMJ, or muscle)

Question 16

Common etiologies for LMN

Answer 16

: trauma, motor neuron disease, muscular dystrophy, myasthenia gravis, Guillain-Barré Degenerative disease, Brainstem stroke (CVA)

Question 17

Spastic (UMN)
- Lesion location:

Answer 17

UMN (bilateral; pyramidal or extrapyramidal)

Question 18

Common etiologies UMN lesion spastic d

Answer 18

: stroke, TBI, motor neuron disease (ALP, PLS), unknown etiology (10%)

Question 19

Unilateral UMN ____ subset of spastic)

Answer 19

(milder

Question 20

• Common perceptual features of Unilateral UMN:

Answer 20

slow rate, imprecise articulation, irregular articulatory breakdowns, harsh voice, reduced loudness

• Common perceptual features: imprecise consonants, rapid “blurred” AMRs, variable rate of speech, short rushes of speech, harsh voice, breathy voice, monopitch, low pitch, reduced stress, inappropriate silences, monoloud

Question 21

• Common etiologies for U UMN

Answer 21

: Parkinson’s disease/Parkinsonism, progressive supranuclear palsy, stroke, unknown etiology (4%), TBI

Question 22

hyperkinesias

Answer 22

Chorea: rapid, random movements of body part(s)
o Dystonia: co-contraction of antagonistic muscles – “frozen”
o Myoclonus: involuntary, repetitive jerks of a body part
o Voice tremors, spasmodic dysphonia

Question 23

common etilogolies hyperkinetic

Answer 23

unknown (67%), toxic/drug-induced, Huntington’s chorea, Tourette’s syndrome

Question 24

ataxic cerebellum pathophysiology

Answer 24

• Pathophysiology: incoordination, reduced range of motion, inaccuracy in force/timing/direction of movements, hypotonia, dysmetria (the inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated movements), sequencing errors
  o Size, strength, and symmetry may be WNL at rest
  o During movement/speech, over- or under-shoot targets

Question 25

ataxic perceptual features

Answer 25

- Common perceptual features: imprecise consonant, irregular articulatory breakdowns*, prolonged phonemes*, distorted vowels*, irregular AMRs, slow rate, prolonged intervals, harsh voice, monopitch, excess and equal stress*, loudness variation*

Question 26

common etiology for ataxia

Answer 26

- Common etiologies: cerebellar degeneration, multiple systems atrophy, multiple sclerosis, stroke/trauma, tumour

Question 27

Mixed dysarthria -

Answer 27

Manifestation of two or more dysarthrias in a single individual o Encountered more often than any other individual type of dysarthria (~30-35% of all dysarthrias)

Question 28

Common etiologies: for. mixed dys

Answer 28

o Motor neuron disease (ALS): flaccid-spastic o Multiple sclerosis: spastic-ataxic o Progressive supranuclear palsy: hypokinetic-spastic-ataxic o Friedrich’s ataxia: ataxic-spastic

Question 29

another dysarthria +apraxia chart

Answer 29

Question 30

AOS differential diagnosis

Answer 30

- Speech errors unrelated to muscle weakness, tone, range of motion, cognitive-linguistic difficulties - Predominantly articulatory and prosodic effects - Errors variable across trials/utterances o Automatic speech > volitional speech - Substitution/addition errors, dysfluencies (start/restart patterns) - Trial-and-error groping for correct articulatory postures; frequent attempts to self-correct

Question 31

AOS vs. ataxic dysarthria

Answer 31

Differences: o AMRs are usually irregular in ataxic dysarthria but regular in AOS (reverse for SMRs) o “Islands of effort free speech” (bypass planning mechanism) are unusual in ataxic dysarthria and very usual in AOS o Automatic speech is no better than volitional speech in ataxic dysarthria o Ataxic speakers rarely grope for articulatory postures and do not usually attempt to correct articulatory errors o Perceived substitutions are not as frequent in ataxic dysarthria as AOS

Question 32

Speech subsystems

Answer 32

- Respiratory - Phonatory/laryngeal - Resonatory - Articulatory - *Prosodic (doesn’t just live in one system – is a combination of all systems together)

Question 33

dysarthria is commonly found in...

Answer 33

- HD - MS - neuromuscular disease (e.g. myasthenia gravis, amyotrophic lateral sclerosis, muscular dystrophy) - Nonfluent variant primary progressive aphasia (nfvPPA) - PD - Stroke - TBI - Down syndrome

Question 34

Psychosocial Impacts

Answer 34

Communication demands effort and may need assistance. Time constraints can lead patients to abbreviate their messages. Interruptions can make patients feel rushed. Communication partners differ in their willingness to accommodate.

Question 35

Components of MSD assessment

Answer 35

- Medical history/clinical interview - Patient observations - Non-speech examination o Oral mechanism exam - Motor speech tasks - Evaluation of speech production (instrumental and non-instrumental) o Tasks by speech subsystem + prosody § Quantifiable measures! o Passage reading o Picture description o Spontaneous conversation o Intelligibility, comprehensibility, efficiency

Question 36

ways to test respiratory subsystem

Question 37

Motor control hierarchy (top down)

Answer 37

Primary motor cortex → motor association cortex (pre-motor cortex, supplementary motor area) → basal ganglia → cerebellum → lower motor neurons in brainstem/spinal cord → peripheral nerves → smooth/striated/cardiac muscles and glands

Question 38

DDK - AMR SMR

Answer 38

Diadochokinesis (DDKs): movement repetitions o Alternating Motion Rates (AMR): repetition of the same syllable /pa/, /ta/, /ka/ o Sequential Motion Rates (SMR): repetition of a movement sequence /pataka/ “buttercut”

Question 39

Principles of neuroplasticity

Answer 39

10 principles: 1. Use it or lose it (cortical loss from lack of activity) – failure to drive specific brain functions can lead to functional decline 2. Use it and improve it – training that drives a specific brain function can lead to enhancement of that function 3. Experience Specificity (changes occur only in the specific behaviour that you’re practicing) – the nature of the training experience dictates the nature of plasticity 4. Repetition matters – induction of plasticity requires specific repetition 5. Intensity matters (balance between enough stimulation to create change without overwhelming the system) – sufficient training intensity is required for the induction of plasticity 6. Time matters (and duration of practice – consolidation requires continuous, uninterrupted practice) – different forms of plasticity occur at different times in training 7. Salience matters (how important something is to the individual) – a training experience must be salient to induce plasticity 8. Age matters (neuroplastic ability is higher when we’re younger vs. when we’re older) – training induced in plasticity occurs more readily in younger brains 9. Transference (plasticity in one area can prime for plasticity in another area) – plasticity in response to one training experience can enhance the acquisition of similar behaviours 10. Interference (plasticity in one area can interfere with plasticity in another area) – plasticity in response to one experience can interfere with the acquisition of other behaviours

Question 40

But first (before practicing feedback conditions; pre-practice targets): o - If no, direct practice will not be effective o Consider:

Answer 40

Is the client motivated to learn? o Does the client understand the task? o Is the client stimulable for the desired response? - If no, direct practice will not be effective o Consider as “pre-practice” targets

Question 41

Practice conditions that are optimal for neuroplasticity

Answer 41

Practice conditions: 1. Practice amount (less vs. ***more***) 2. Practice distribution (massed vs. ***distributed***) 3. Practice variability (constant vs. ***variable***) 4. Practice schedule (blocked vs. ***random***) 5. Attentional focus (internal vs. ***external***) aka focus of effects of movements like the sound not the bodily movement itself like placement 6. Target complexity (simple vs. ***complex***) o Bold = ideal conditions for long-term retention; however, some of these things, in an earlier acquisition phase, may be better (e.g., stimulability and shaping the exact response you want)

Question 42

feedback conditions for neruoplasticity

Answer 42

- Feedback conditions: 1. Feedback type (performance vs. ***results***) 2. Feedback frequency (high vs. ***low***) 3. Feedback timing (immediate vs. ***delayed***) 4. Feedback control (other vs. ***self***)

Question 43

In rehabilitation, our goal is to use principles of neuroplasticity and motor learning to our advantage o Example:

Answer 43

In rehabilitation, our goal is to use principles of neuroplasticity and motor learning to our advantage o Example: regain lost functions, following stroke or injury o Use it or lose it risk assessment when recommending NPO or limited PO intake – dysphagia therapy providing ample opportunities to practice swallowing tasks may promote improved neuroplastic recovery compared to therapy that focuses on non-swallowing tasks o Use it and improve it maximizing opportunities for patients to use the skill/behaviour o Specificity how is training mirroring the desired outcomes (i.e., swallowing tasks vs. non-swallowing tasks) o Intensity consider the patient’s medical status and etiology – high intensity can sometimes result in greater harm than healing – integrating rest to reduce risk of overstimulation and/or overtraining o Time matters initiating high-quality therapy as soon as medically appropriate o Salience matters incorporating patient priorities into therapy goals o Age matters an older patient may have a longer recovery time and may need more repetitions of exercises or frequency of therapy sessions o Transference to what degree is the therapy plan relying on generalization (e.g., non-swallowing exercises) – integrating tasks more specific to swallowing may enhance recovery outcomes o Interference the patient may need to “un-learn” compensatory maladaptive behaviours

Question 44

Primary goal (aim) is to ___ - Start by ensuring the patient has ___ - Next, target what has the___ - Overarching aim: __

Answer 44

maximize the client’s ability to communicate some form of functional communication greatest effect on speech intelligibility/comprehensibility/naturalness increased participation

Question 45

The principles that support motor acquisition are ___ as those that support motor learning examples:

Answer 45

not the same as o The application of specific principles may be more appropriate at different times in the rehabilitation process ex 1. High (blocked) task repetitions with ***specific, frequent feedback and consistent *** practice conditions support the acquisition of a task/skill pt 2. As a skill becomes more automatic, shifting the practice and feedback conditions to be more variable will support learning

Question 46

Relating the Principles of Neuroplasticity to Treatment of MSDs:

Answer 46

Relating the Principles of Neuroplasticity to Treatment of MSDs: - Improve speech by speaking o Use it or lose it o Use it and improve it o Task specificity - Many opportunities for practice o Repetition matters o Time (of practice) matters - Early treatment is ideal (pending medical status) o Time (since injury) matters

Question 47

Association cortex

Answer 47

Main function: programming movements that are appropriate to the context ■ Includes: somatosensory association cortex, supplementary motor area, premotor area ■ Damage can result in difficulty selecting movements for speech

Question 48

Cerebellum ■ Main function: trajectory of movement ■ Lesions to cerebellum may cause ataxic dysarthria ● Ataxia is ipsilateral to side of lesion

Question 49

Basal Ganglia ■ Main function: initiation and speed of movement ■ Lesions to basal ganglia (e.g. due to Parkinson’s) can lead to slow movements → can cause slowed speech

Question 50

Cranial nerves involved in speech

Question 51

As spontaneous oral movements are apparently intact in apraxia, gross motor support and muscle weakness are not at issue.

Question 52

Anarthria

Question 53

Flaccid dysarthria is effectively treated with pushing and pulling exercises to help strengthen muscles and increase tone.

Question 54

People with spastic dysarthria need to practice relaxation exercises to reduce muscle tone and increase flexibility.

Question 55

UUMN

Question 56

Speech characteristics-unilateral UMN ■ Slow rate ■ Imprecise articulation ■ Irregular articulatory breakdowns ■ Strained voice ■ Reduced loudness ■ Unilateral facial weakness ■ Harsh voice

Question 57

Those with ataxic dysarthria benefit from rhythmic or metered cueing due to inability to adequately pace their speech production.

Question 58

Hyperkinetic dysarthria

Answer 58

○ Due to damage to the basal ganglia (excess dopamine) ○ Consequence: hyperkinesias (extra and involuntary movements) that interfere with speech production; impact varies with the type and severity and location of hyperkinesias ○ Etiology ■ Huntington’s, Tourettes ○ Involuntary movements ○ People with hyperkinetic dysarthria benefit from sensory tricks to reduce involuntary movements.

Question 59

Hypokinetic ○ Due to damage to basal ganglia (dopamine depletion) ○ Consequence: rigidity, reduced amounts of volitional movement, reduced range of motion present in remaining movements ○ Etiology- parkinson’s disease and repeated head trauma ○ Rigidity and decreased ROM

Question 60

treatment goals ○ Modifying respiratory, phonatory, articulatory, resonatory, and prosodic problems ○ Increasing efficiency, effectiveness, and naturalness of communication ○ Increasing physiological support ○ Teaching compensatory behaviours ■ AAC

Question 61

Some treatment strategies that are helpful for 1 dysarthria are counterproductive for another ■ E.g., relaxation techniques that are appropriate for treating spasticity should not be used for treating flaccid because muscles are already too loose and relaxed

Question 62

monopitch is common in

Answer 62

spastic, hypokinetic and may be in flaccid

Question 63

myoclonus aka __ is common in

Answer 63

involuntary twitching ; hyperk

Question 64

pitch breaks is known in

Answer 64

flaccid??

Question 65

diplophonia is in

Answer 65

flaccidd

Question 66

breathiness & flutter in

Answer 66

flasccid hypokinetic

Question 67

specifiic characteristic of imprecise consonants in diff dysarthrias

Answer 67

- weakness (flaccid, spastic) - slow (spastic) discoordinated (ataxic) reduced ROM (hypok) involuntary movements (hyper

Question 68

irregular artic breakdowns

Answer 68

artic

Question 69

normal rate

Answer 69

flaccid

Question 70

Apraxia articulatory characteristics

Answer 70

○ Groping to find the correct articulatory postures and sequences ○ Facial grimaces, moments of silence, phonated movements ○ Consonant phonemes involved more often than vowel phonemes ○ Errors are inconsistent and highly variable ○ Errors are primarily substitutions, additions, repetitions, prolongations ○ Attempts at self-correction

Question 71

Treatment of AOS ○ Behavioural treatment most effective ○ Easily produced words - need not be initial targets ■ More difficult words when taught successfully may promote better generalization ○ Speech movements as opposed to non-speech movements ○ Practice with variety of sound combinations and sounds ■ Repeated trials on same target response (drill) is essential for initial learning ○ Positive reinforcement and correct feedback ○ Articulatory accuracy, slower rate, systematic practice, gradual increase in rate, normal prosody ○ Instructions, demonstrations, modeling, shaping, phonetic placement, frequent cueing, rhythm, immediate positive/corrective feedback ○ Total communication ○ Teaching accurate/improved sound productions in conversational speech ○ Self-monitoring and self-correction of errors ○ Severe AOS - ask fam members to speak slowly, use shorter sentences, and talk only when client is focused

Answer 71

Ataxia Muscular incoordination and irregular movements

Question 72

Features of Childhood Apraxia of Speech ○ Inconsistent errors on consonants and vowels in repeated productions of syllables or words ○ Lengthened and disrupted coarticulatory transitions between sounds and syllables ○ Inappropriate prosody, especially in the realization of lexical or phrasal stress ○ Vowel and consonant distortions ○ Inconsistent voicing errors ○ Prosodic errors, especially equal stress and segmentation ○ Awkward and/or imprecise movement transitions ○ Groping and/or trial and error behaviour

Question 73

CAS vs dysarthria vs motor speech NOS

Question 74

Dysarthria/apraxia may co-occur with aphasia ○ Client has difficulty with speech as well as language ○ Communication may be especially difficult in this instance Dysarthria/apraxia may occur with cognitive-communication difficulties ● Client may have difficulty producing speech as well as language difficulties

Question 75

Childhood apraxia of speech may co- occur with ○ Delayed language development ○ Expressive language difficulties (e.g. grammatical errors) ○ Problems with learning to read, spell, and write ○ Problems with social language/pragmatics ○ May also have non-speech sensory and motor problems ■ Gross and fine motor delays ■ Motor clumsiness ■ Oral apraxia ■ Limb apraxia ■ Feeding difficulties ■ Abnormal orosensory perception

Question 76

Assess phonation, resonance, articulation, and prosody, using perceptual and acoustic measures ADD ACTIVITIES FOR EACH

Answer 76

Articulation - Evaluating consonant production, duration of speech sounds, phoneme repetition, and irregular breakdowns in articulation Resonance - Clinical observations regarding hyponasality, hypernasality, and NAE Prosody - Evaluating the rate of speech, phrase lengths, stress patterns, and pauses in speech Respiratory - Observations of forced inspiration/expiration, audible or breathy inspiration, and grunting at the end of expiration Phonatory - abnormal pitch, pitch breaks, abrupt variations, mono pitch, and diplophonia

Question 77

Members must make sure the word disorder is being used to describe symptoms ● Examples of terms that describe symptoms include: ○ Aphasias, dysarthrias, apraxias, including childhood apraxia of speech

Question 78

Restorative strategies

Answer 78

Therapy techniques that have the goal of restoring lost function by reducing the severity of the underlying deficits ○ See an improvement ○ Example- expiratory muscle strength training

Question 79

Compensatory strategies ○ Therapy strategies that have the goal of restoring lost function by compensating for underlying deficits ○ Example- AAC, amplification ○ only see improvement with restorative

Question 80

Expiratory muscle strength training

Question 81

Inspiratory muscle strength training

Question 82

Diaphragmatic breathing

Question 83

phrase grouping

Question 84

resonatory treatments

Question 85

Resistance Training for the Velum During Speech

Question 86

Nonspeech Velopharyngeal Exercises

Question 87

Palatal lift

Question 88

pharyngeal flap

Question 89

phonatory treatment

Answer 89

multiple

Question 90

Articulatory treatments

Question 91

Prosody treatments

Answer 92

Strategies for severe AOS ● To elicit vocalizations: ○ Shape phonation from a cough, yawn (relax VF), laugh ○ Push gently on stomach during the exhalation phase of breathing ○ Use automatic speech tasks, social response situations, singing ● Shape syllables from phonation ○ Humming → nasal context ● Shape words based on the existing sound repertoire (fine → fire, five) ● Shape words from stereotypic utterances (as in Multiple Input Phoneme Therapy) ● Use cues: auditory, visual, including written, tactile