Exam 2 Flashcards
Apraxia of speech (AOS) is what type of disorder?
What is it characterized by?
Is it due to impairment of muscle tone?
- a phonetic-motoric disorder
- impaired motor planning
- no
AOS is characterized by what type of errors?
articulation and prosodic errors
AOS sound errors are often?
distorted sound substitutions
True or false?
Sound errors that occur because of AOS may be perceived as sound substitutions, as in phonemic paraphasia.
True
Regarding AOS: prosodic abnormalities, and to some degree sound distortion, are due to?
extended transitions between sound, syllables, and words.
True or false?
AOS prosodic abnormalities are intersegmental errors that often result in rapid syllable transition in speech?
False - they result in syllable segregation in speech
What are 3 traditional criteria for differentiating between AOS and conduction aphasia that do not appear to be helpful?
1) visible articulatory groping
2) inconsistency of artic errors (both location and type)
3) sequencing errors
Name 5 behaviors that are inconsistent with an aphasia but are seen in AOS?
1) Sound distortions and distorted sound substitutions
2) abnormal prosody
3) inability to speed rate and maintain sound and prosodic integrity
4) abnormal anticipatory coarticulation
5) slow rate
True or False?
nonverbal oral apraxia is commonly seen along with AOS, but not in isolation,
False - seen along with AOS and in isolation
Damage to what areas are often the cause of AOS?
The premotor and supplementary motor cortex.
In pure AOS will there be a significant abnormality in muscle tone or reflex?
no
How are ataxic dysarthria and AOS similar?
They both may demonstrate the predominance of articulatory and prosodic abnormalities and have a normal oral mechanism exam.
What are 4 ways to distinguish an ataxic dysarthria from AOS?
1) speech AMRs are irregular in ataxic dysarthria but not AOS
2) irregular articulation errors and variable prosodic abnormalities are more pervasive in ataxic dysarthria
3) automatic speech is no better in ataxic dysarthria but may be better in AOS
4) perceived sound substitutions are much more common in AOS
Ataxic dysarthria or AOS?
1) Irregular speech AMRs
2) irregular artic errors and variable prosodic abnormalities
3) Automatic speech is no better
4) perceived sound substitutions
1) ataxic dysarthria
2) ataxic dysarthria
3) ataxic dysarthria
4) AOS
True or False?
AOS and aphasia commonly co-occur, usually with a nonfluent aphasia.
True
True or false?
Aphasia may mask AOS and AOS may mask a significant aphasia.
False - aphasia may mask an AOS but it is less likely that AOS will mask a significant aphasia since there will also be auditory comprehension and reading/writing problems.
Naturalness tends to focus on improving _____.
prosody
Is initial learning slower or faster with random vs. blocked practice?
slower
True or false?
Remediation should progress systematically through hierarchies of task difficulty
True
For severe impairments, you may need to start with non-speech movements, but they should be movements that are?
a piece of the intended speech movement
If strength training is done, they should be as ____ as possible.
speech-like
(i.e. they target a movement made during speech production such as elevating the jaw in order to approximate the lips for a bilabial sound.)
What are the 3 most common strategies for achieving compensated intelligibility?
1) increasing loudness
2) over articulation
3) modifying speech rate
What are the practice principles of motor learning?
1) Random practice facilitates the development of motor programs and thus facilitates learning, and is more efficient than blocked practice because it promotes generalization
2) intensive and repeated practice is necessary
Flaccid and ataxic dysarthria are or are not associated with lesions in the supratentorial (in the cerebral cortex/subcortical) lesions or ant/mid/post cerebral arteries?
Why or why not?
Not associated because flaccid and ataxic dysarthria are lower motor damage disorders
Hypokinetic dysarthria are or are not associated with lesions in the supratentorial (in the cerebral cortex) lesions?
Why or why not?
Are only associated with with supratentorial lesions because it is a umn damage disorder
Posterior fossa lesions and lesions in the distribution of the vertebrobasilar system can cause?
any type of dysarthria except hypokinetic
Damage to the spinal and peripheral levels are only associated with ?
flaccid dysarthria
Which disorder is only associated with lesions at the spinal and peripheral levels
flaccid dysarthria
True or false?
speech examination should always lead to an attempt at diagnosis.
True
When the results of the examination cannot go beyond description, the reasons should be?
stated explicitly
True or false?
A diagnosis should not be made if one cannot be determined
True
name 3 pre-practice principles of motor learning as they relate to therapy.
1) make sure patient understands why a task is important to learn
- involve the patient in goal-setting
- don’t tell the patient to “do the best you can”
2) make the task clearly understood
3) Provide observational learning through modeling and demonstration
- use picture, video tapes, and live demos
4) verbal pretaining is used to give the patient exposure to the stimuli that will be used in the task
- clinician systematically progresses through all the stimuli before the pt begins practice
- should cover all of the stimuli that will be targeted in tx session
- repeated demos
Parkinson’s always results in what type of MSD?
hypokinetic dysarthria
True or false?
Degenerative disease can cause any type of
true
True or false?
TBI can cause any type of dysarthria.
true
Diseases of the neuromuscular junction can result only in which condition?
flaccid dysarthria
During an OME, if a patient exhibits atrophy and fasciculations, to which MSD might this point? Hypotonia and are observed as well.
Flaccid dysarthria
During an OME, if a patient exhibits pathologic oral reflexes, hyperactive gag, and psuedobulbar affect (uncontrollable laughter or crying but don’t feel happy or sad), to which MSD might this point?
Spastic dysarthria
During an OME, if a patient has normal findings, nothing uncommon, but the jaw, face, and lingual movements are dysmetric (undershooting or overshooting their target) - which MSD would this indicate?
Ataxic dysarthria
During an OME, if a patient has masked like face, orofacial tremulousness and reduced ROM on nonspeech AMRs would indicate which MSD?
Hypokinetic dysarthria
During an OME, if a patient has quick or slow, patterned or unpatterned involuntary movements at rest, during sustained postures, AMRs would indicate which MSD?
Hyperkinetic dysarthria
During an OME, if a patient has unilateral facial weakness or unilateral lingual weakness without atrophy or fasciculation would indicate which MSD?
UUMN dysarthria
A patient’s speech is characterized by irregular artic breakdowns during connected speech, irregular AMRs and dysprosody.
Ataxic dysarthria
A patient’s speech is characterized by monopitch, monoloudness, reduced loudness and stress, a tendency towards a rapid rate and rapid and blurred AMRs are characteristic.
Hypokinetic dysarthria
A patient’s speech is characterized by mildness and somewhat nebulous abnormalities. Tendency for speech AMRs to be regular while some irregularity during connected speech
UUMN
Compensatory or restorative approach?
Trying to improve the physiology supporting speech
Restorative
Compensatory or restorative approach?
Use of internal strategies such as speaking louder, or external strategies like AAC.
Compensatory
Name the lesion locus for the following dysarthrias:
a. Flaccid
b. Spastic
c. Ataxic
d. Hypokinetic
e. Hyperkinetic
f. Unilateral Upper Motor Damage
g. Mixed
a. LMN
b. UMN (bilateral)
c. Cerebellum (control circuit)
d. Basal ganglia
e. Basal ganglia
f. UMN (unilateral)
g. Two or more of the above
When deciding whether or not someone is a candidate for a type of therapy include (6)?
1) medical prognosis
2) impairment and disability
3) environment and communication partners
4) motivation and needs
5) co-occurring impairments/conditions
6) healthcare system
What does treatment focus on?
intelligibility, efficiency, naturalness of speech, or any combination of these.
True or false?
Treatment should first focuses on what is quickest to fix and what will be most meaningful.
True
Approaches that use speech tasks or indirect non-speech like strengthening exercises or posture would be a compensatory or restorative approach?
Restorative
Making maximum use of residual physiological support would be a compensatory or restorative approach?
Compensated
true or false?
most treatment is focused on compensated intelligibility.
true
