Exam 2 Flashcards
- rate and rhythm control approach to treating AOS
- speech produced in time to a metronome
- usually about 1 syllable per beat
- rate initially slow, gradually increased
metronome pacing
- Due to damage to cerebellum
- Impairment affects:
- coordination
- decreased muscle tone
- Impairment results in slowness and inaccuracy of aspects of movement
Ataxic dysarthria
- articulatory and kinematic approach to treating AOS
- client consciously focuses on production in a word s/he can say
- clinician tries to generalize this correct production to other words
key word approach
vascular problems that could cause spastic dysarthria
- stroke- most likely brainstem, not unilateral cerebral
- vascular dementia
True or false apraxia of speech rarely occurs without an accompanying aphasia
True
Unilateral Upper Motor Neuron Dysarthria
Clinical characteristics (4)
- hemiplegia or hemiparesis
- early-weakness, hyporeflexia, hypotonia
- later- spasticity, hypertonia
- contralatral lower face weakness
- inflammatory demyelinating disease
- destruction of white matter in brain or spinal cord
- possible etiology of spastic dysarthria
leukoencephalitis
Unilateral Upper Motor Neuron Dysarthria
Etiologies (3)
- stroke- most common
- tumors
- trauma
- prolonged or continuous spasms
tonic spasm
Types of Neuromotor speech disorders (2)
- dysarthria
- apraxia of speech
Etiologies of Hyperkinetic dysarthria (5)
- toxic- metabolic conditions
- degenerative diseases
- infectious disease
- stroke
- tumors
errors in sequence and speed of parts of movement
decomposition of movement
How many types of dysarthria?
7
rhythmic tremor of body or head
titubation
Ways to evaluate speech (3)
- perceptually
- acoustically
- physiologically
neuromotor speech disorders management goals (2)
- restore lost function
- promote the use of residual function
- reduce the need for lost function
- rapid, stereotyped movements
- often irresistible urge to make the movements
tics
- most often due to impairment of basal ganglia indirect pathway
- often prominent effects on prosody
- different kinds of involuntary movements cause hyperkinetic dysarthrias
- orofacial dyskinesia
- tardive dyskinesia
- myoclonus
- tics
- chorea
- ballismus
- athetosis
- dystonia
- spasm
- tremor
Hyperkinetic dysarthrias
- rate and rhythm control approach to treating AOS
- model two syllable words, accenting the stressed syllable, client imitates
- gradually increase word length
stress patterning
- a combination of two or more types of dysarthria
- more common than single dysarthrias
mixed dysarthrias
Hypokinetic dysarthria impairment produces: (4)
- rigidity
- reduced force
- reduced range
- slow individual, but sometimes fast repetitive movements
- repetitive and brief spasms
clonic spasm
- biofeedback
- mirror under the nose
- nasal flow transucer (if available)
- resistance treatment during speech continuous positive airway pressure (CPAP)
- produce words containing pressure sounds with nares pinched closed
- modification of speaking (over articulation)
- no evidence for NSOMEs
- no evidence for inhibition techniques
treating velopharyngeal dysfunction associated with dysarthria
distrubance in trajectory or inability to control range
dysmetria
- electrodes surgically implanted, most often in subthalamic nucleus
- may be unilateral or bilateral
- electrical impulses sent to electrodes via stiumulator implanted implanted under the skin
- stimulator connected to electrodes via wires
- electrical impulses disrupt tremors and other motor problems
- limb movement problems respond better to drugs and DBS than speech problems
- speech may worsen with drugs or DBS
Deep brain stimulation (DBS)
- most often due to impairment of basal ganglia indirect pathway
hyperkinetic dysarthrias
- Impairment affects
- muscle strength
- muscle tone
- speed, range, and accuracy
flaccid dysarthria
Formal perceptual assessments for speech (4)
- Frenchay Dysarthria Assessment
- Assessment of Intelligibility in Dysarthric Speech (AIDS)
- Speech Intelligibility Test (SIT)
- Apraxia Battery for Adults
Clinical characteristics of ataxic dysarthria (8)
- problems in standing and walking
- titubation
- nystagmus
- dysmetria
- dysdiadochokinesis
- decomposition of movement
- possible intention tremor
- cognitive disturbances
- traditional approaches
- phonetic placement
- phonetic derivation
- integral stimulation-watch and listen tasks
- rate modification-slowing
- exaggeration of articulation
treatment of articulatory dysfunction associated with dysarthria
- articulatory and kinematic approach to treating AOS
- tactile cues are used to facilitate correct production
- requires extensive training to learn cues
PROMPT
face looks like they’re wearing a mask, lacks facial expression
masked facies/ hypomimia
degenerative diseases that are possible etiologies of mixed dysarthria (4)
- progressive bulbar palsy
- pseudobulbar palsy
- ALS
- MS
rate and rhythm control approaches to treating Apraxia of Speech (2)
- metronome pacing
- stress patterning
What is the most common cuase of hypokinetic dysarthria?
Parkinson’s Disease
Due to bilateral impairments of direct and/or indirect activation pathways
spastic dysarthria
- Parkinson’s Disease
- Parkinson-plus or atypical parkinsonism
- dementing diseases (Lewy body, Pick’s)
- Toxic/metabolic conditions
- trauma
- Infections
Etiologies of Hypokinetic Dysarthria (6)
What is the type of dysarthria based on?
the site of the lesion
- used to increase loudness
- think “loud and big”
- increase effort
- intensive treatment (4xs a week for 4 weeks)
- certification required
- work from short (single words) to longer material
- use of objective measures to monitor loudness (e.g., sound level meter)
- provide home practice materials (1 hour/day, 5 days)
- provide a lot of trials (15/item)
Lee Silverman Voice Therapy (LSVT)
Informal perceptual tools for speech assessment
- Mayo tests of motor programming
- Motor Speech Examination (Wertz et al. 1984)
- most common involuntary movement
*
tremor
Prosthetic options for neuromotor speech disorders (2)
- palatal lift prosthesis
- voice amplifier
What are the types of dysarthria? (7)
- flaccid
- spastic
- ataxic
- hypokinetic
- hyperkinetic
- unilateral upper motor neuron
- mixed
Assessments of non-speech movements (2)
- cranial nerve exam
- Duffy’s (2013) examination
Impairment of basal ganglia direct pathway
hypokinetic dysarthria
- postural adjustments
- try to incorporate respiration activities into speech tasks
- sustaining phonation with feedback (e.g. Visipitch)
- some non-speech tasks may be beneficial for improving respiratory support
- maximum inhalation and exhalation tasks
- breathing against resistance (masked or pused lips)
treatment for respiratory dysfunction associated with dysarthria
- involuntary single repetitive brief jerks
- may be rhythmic or non-rhythmic
- palatal or palatopharyngeal
myoclonus
Clinical characteristics Flaccid dysarthria (6)
- weakness
- hypotonia
- diminished reflexes
- fasiculations
- atrophy
- progressive weakness with use
- may affect a single muscle group
- may affect only one speech subgroup
- subtypes based on site of lesion
Flaccid dysarthria
Etiologies of flaccid dysarthria (7)
- trauma
- degenerative diseases
- muscle disease
- neuromuscular junction
- brainstem stroke
- demyelinating disease
- infectious diseases
parts of a case history (7)
- basic data
- onset and course of the problem
- associated deficits
- patient’s perception
- consequences
- management
- patient awareness of medical diagnosis and prognosis
- Due to impairment of the final common pathway (lower motor neuron)
Flaccid dysarthria
treatments that have supporting evidence for treating AOS (2)
- eight step continuum/integral stimulation
- PROMPT
slow initiation of movements
brodykinesia
Degenerative diseases that could cause flaccid dysarthria (2)
- amyotrophic lateral sclerosis (ALS)
- Progressive bulbar palsy
- for hypoadduction-effort closure techniques
- LSVT
- Resonant Voice Exercies
- Sirening
treatment of phonatory dysfunction associated with dysarthria
slow, writhing movements
athetosis
involuntary orofacial movements
orofacial dyskinesia
Neuromotor speech disorders
approaches to management (4)
- medical intervention
- prosthetic
- behavior management- patient and significant other(s)
- speech management
Articulatory and kinematic approaches (3)
- phonetic placement/derivation
- key word approach
- PROMPT
- due to damage to UMNs that innervate cranial or spinal nerves important for speech
- often mild and short lived
Unilateral Upper Motor Neuron Dysarthria
forceful, sustained closure of the eyes
blepharospasm
flailing movements
ballismus
- involuntary rapid, random, purposeless movements
- can be subtle or very obvious
chorea
- idiopathic and hereditary forms
- progressive loss of cells in the substantia nigra
- decreased dopamine the basal ganglia
- imbalance between ACh and dopamine in the basal ganglia
- treated with drugs that increase dopamine
- when drugs fail, may be treated with deep brain stimulation (DBS)
Parkinson’s Disease
short, rapid, shuffling steps
festination
intermittant freezing
akinesia
- resting tremor (about 3-8 Hz)
- brodykinesia
- intermittent freezing
- pill-rolling movement
- masked facies (hypomimia)
- reduced arm swing
- micrographic writing
- festination
- impaired sensory function
Clinical Characteristics Parkinsonism (9)
FAST
Face, Arm, Speech, Time
- degenerative motor neuron disease
- corticobulbar, corticospinal signs
- if dysphagia and dysarthria major components, it is called progressive pseudobulbar palsy
- possible etiology of spastic dysarthria
primary lateral sclerosis
Neuromuscular junction diseases that could cause flaccid dysarthria (2)
- myasthenia gravis
- botulinum toxin exposure (botulism)
clinical characteristics of spastic dysarthria (4)
- spasticity
- weakness (especially distal)
- reduced range of movement
- slow movement
Etiologies of spastic dysarthria
- vascular problems
- primary lateral sclerosis
- leukoencephalitis
