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Clinical Methods > Final > Flashcards

Final Flashcards

1
Q

Where is the site of lesion for hyperkinetic dysarthria?

A

the basal ganglia control circuit, the association cortex makes a rough plan of movement, basal ganglia smooths and refines the movement, thalamus makes further refinements, and the primary motor cortex sends the plan for refined movement to the muscles.

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2
Q

What does “hyperkinetic” mean?

A

too much movement

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3
Q
  1. Why don’t we fully understand the basal ganglia?
A

within the striatum there are more than 100 neuroactive chemicals, disruptions in the multitude of neurochemicals is likely the cause of hyperkinetic movement

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4
Q
  1. Name some disorders that can cause hyperkinetic dysarthria
A

chorea, myoclonus, tics, essential tumor, dystonia, degenerative disease, TBI, CVA, and infection

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5
Q
  1. What is Huntington’s Disease
A

progressive inherited disorder, onset typically at middle age. Children have 50% chance of inheriting the disorder.

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6
Q
  1. Which components of speech will be affected by hyperkinetic movements?
A

symptoms manifest all areas of speech, phonation, respiration, resonance, and articulation. Hyperkinetic is characterized by variable articulatory imprecision, vocal harshness, and prosodic abnormalities

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7
Q
  1. Why might you see unexpected inhalation and exhalations of air in chorea?
A

choric movements are unpredictable and purposeless and the affected person may try to hide the behavior by making them appear purposeful. Severe choric movements interfere with nearly all voluntary movements.

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8
Q
  1. What is the most common hyperkinetic movement disorder?
A

chorea

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9
Q
  1. How might we distinguish essential tremor from parkinsonism tremor?
A

Essential tremors are faster, disappear with movement, and is not accompanied by other neurological symptoms such as bradykinesia or dementia

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10
Q
  1. Discuss dystonia
A

*disorder of muscle tone, causes involuntary, prolonged muscle contractions that interfere with normal movement or posture.
*Have a slower, more sustained quality. Muscular contractions may appear and disappear during an on going movement.
*Described as waxing and waning, Can appear in many muscles of the body, can affect a single muscle or a group. It is categorized according to the number of affected body parts.
Focal: dystonic movement or posture is present in only one part of the body such as the tongue, jaw, arm, or hand.
Segmental: dystonic movement or posture includes 2 or more parts of the body such as Meige syndrome in which the the dystonic movements affect the neck, larynx, soft pallet, jaw, and face
Generalized: dystonic movement or posture affects all four limbs and the torso and neck
Hemididystonia: affects 2 or more body parts on the same side of the body

  • sensory tricks can help but not long term
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11
Q
  1. What are some disorders where dystonia might be a primary symptom
A

Oromandibular dystonia, spasmodic torticollis, drug induced (tardive) dystonia, meige syndrome, and spasmodic dysphonia

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12
Q
  1. What is the most prominent speech error in dystonia
A

articulation- imprecise consonants, distorted vowels, irregular articulatory breakdowns, prolonged phonemes

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13
Q
  1. What are some key evaluation tasks for hyperkinetic dysarthria
A

vowel prolongation, AMRs, conversational speech and reading passages, and observation of associated involuntary movements

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14
Q
  1. What is the most common treatment for hyperkinetic dysarthria
A

varied given that the conditions are highly variable. Interventions center around medical and behavioral techniques
Pharmacologic: meds used to suppress involuntary movements which cause speech deficits.
Botox: has shown high success rates
Deep brain Stimulation (DBS):
Behavioral: sensory tricks, bite blocks, easy onset of phonation

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14
Q
  1. What is the most common treatment for hyperkinetic dysarthria
A

Medical: pharmacological, botox injections, deep brain stimulation
Behavioral: sensory tricks, bite blocks, easy onset of phonation

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15
Q

How does mixed dysarthria occur

A

when neurological damage extends into 2 or more parts of the motor system. The speech characteristics are a combination of the characteristics of the pure dysarthrias.

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16
Q
  1. Discuss mixed dysarthria
A

May occur from 1 single incident or be a culmination of many events. Characterized by the combination of characteristics found in the single (pure) dysarthria. Extremely common diagnosis Neurological insults such as stroke, tumor, and TBI often cross topographical and structural neurological boundaries. Mixed is a result of such damage crossing these anatomical boundaries and thus affecting various components of the motor system.

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17
Q
  1. Give some examples of combinations of neurological sites of lesion that might result in mixed dysarthria and name the dysarthria type
A

MS: lesions occur in the brain stem, cerebellum, cerebral hemispheres and spinal cord.
ALS: spinal nerves, cranial nerves, UMN, LMN

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18
Q
  1. Give some examples of combinations of neurological sites of lesion that might result in mixed dysarthria and name the dysarthria type
A
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19
Q
  1. Discuss Multiple Scleroris and its neurological site of lesion
A

the myelin covering of axons in the CNS degenerates. Most common of the demyelinating diseases. Usually occurs in individuals are I=in their 30s and more women than men. Studies suggest it may be an immunologic disorder triggered by a virus. Myelin degeneration usually appears first as small points of inflammation, the inflammation increases in severity until the myelin and cells that produce it are destroyed.
* can affect white matter as well as grey, can occur in the brainstem, cerebellum, cerebral hemispheres, and spinal cord.

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20
Q
  1. What is the most common type of mixed dysarthria in MS
A

ataxic-spastic

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21
Q
  1. What is Multisystems Atrophy
A

progressive condition, not a single disorder. It is a collective term for a group of degenerative disorders many of which include parkinsonian symptoms. Shy-Drager syndrome, progressive supranuclear palsy, and olivopontocerebelar atrophy

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22
Q
  1. What is Wilson’s Disease? What is the common type of mixed dysarthria associated with it
A

Rare hereditary disease preventing the normal metabolism of dietary copper. Pharmacological treatments are successful in treating the majority of patients if caught early enough. Dysarthria is one of the earliest diagnostic signs. Hypokinetic symptoms are most prominent in conjunction with ataxic and spastic as well

23
Q
  1. What is Friedreich’s Ataxia
A

A rare, inherited, and progressive neurological disorder. Results in neuron degeneration of the cerebellum, brain stem and spinal cord. An untreatable disease that is often fatal within 10-15 years post diagnosis. Ataxic-spastic is the most prevalent type noted

24
Q
  1. What is amyotrophic lateral sclerosis
A

Relentless progressively disease with rapid decline, A progressive degeneration of any of 4 areas of the motor neurons,
1. Spinal nerves at junction with spinal cord.
2. cranial nerves at junction with brain stem
3. UMNs of corticospinal tracts
4. UMNs of the corticobulbar tracts
Typically flaccid-spastic
average onset is 56 years
no known etiology

25
Q
  1. How do you proceed with treating mixed dysarthria? Which dysarthria do you treat first
A

In general the clinician should first treat the component that is the most severely impacting clear speech production.
Dworkin suggested the following order
Respiration- resonance- phonation- articulation- prosody

26
Q
  1. How do you proceed with treating mixed dysarthria? Which dysarthria do you treat first
A

first treat the component that is most severely affecting speech production. If equal then address the component of speech being affected the most

27
Q
  1. How do we sequence the speech components based on Dworkin’s (1991) work
A

Respiration- resonance- phonation- articulation- prosody

28
Q

What are the errors in apraxia of speech

A

primarily a disorder of articulation and prosody, characterized by slow, labored, halting speech and instances of articulatory groping.

29
Q
  1. What distinguishes apraxia of speech from dysarthria
A

Apraxia is not caused by muscle weakness, abnormal muscle tone, reduced range of movement, and decreased muscle steadiness,

30
Q
  1. Differentiate between ideomotor apraxia and ideational apraxia
A

Ideational: uncommon disorder, may be a result of damage to the left parietal lobe. Disturbance in conception of object or gesture, the patient no longer understands its purpose. May be masked by aphasia as it often accompanies ideational apraxia.
Ideomotor: Disturbance in performance of the movements needed to use an object, make a gesture or sequence movements. Patients have not lost the knowledge of an object, but instead have a deficit in the ability to carry out the motor plan needed to use an object. Typically affects the voluntary movements. Subcategories include: limb apraxia, nonverbal oral apraxia, apraxia of speech

31
Q
  1. Differentiate between ideomotor apraxia and ideational apraxia
A

Ideomotor: a disturbance in the performance of the movements needed to use an object, make a gesture, or complete a sequence of individual movements. They have not lost their knowledge of an objects or gestures function instead they have a deficit in the ability to carry out the the motor plan needed to use the object
Ideational: the inability to make use of an object or gesture because the person has lost the knowledge or idea of the objects function. They no longer know the objects purpose.

32
Q
  1. Differentiate between nonverbal oral apraxia and apraxia of speech
A

Nonverbal Oral Apraxia: known as the “buccofacial apraxia” “facial apraxia”, “orofacial apraxia”, or “lingual apraxia”. The deficit in the ability to sequence nonverbal, voluntary movements of the tongue, lips, jaw, and other associated oral structures.
Might include protruding of the tongue, whistling, biting the lower lip, and puffing out the cheeks. May also have trouble taking a deep breath when asked to or they may be unable to swallow on command. Common in left hemisphere damage and can co-occur with aphasia
Apraxia of Speech: deficit in the ability to select and time-sequence the motor commands needed to correctly position the articulators during the voluntary production of phonemes. Caused by damage to the left frontal lobe especially near Broca’s area

33
Q
  1. What does ideomotor apraxia typically affect more, spontaneous movements or voluntary movements
A

Voluntary movements

34
Q
  1. Apraxia of speech is primarily a disorder of which two speech components
A

primarily a disorder of articulation and prosody

35
Q
  1. What does Brookshire (2007) suggest are four condtions that can cause errors tha appear to be similar to apraxia of speech but must be ruled out
A

muscle weakness, sensory loss, comprehension deficit, and incoordination

36
Q
  1. Given three patients one with mild, one with moderate, and one with severe apraxia of speech, which of the three will exhibit more apraxic errors and why
A
37
Q
  1. What is one of the most sensitive evaluation tasks for identifying AOS
A

analyzing the results from the assessment to determine the kinds of errors present

37
Q
  1. What are some exclusionary characteristics that rule out apraxia of speech
A

the patient demonstrates a fast rate of speech, the patient a normal rate of speech, and the patient has normal prosody

38
Q
  1. Are treatments for apraxia of speech mostly medical, surgical, prosthetic, or behavioral
A

Almost all are behaviorally based procedures. Most are 1:1 sessions in which the clinician and patient work on a sequence of tasks that progress from simple to complex verbal productions of target words or phrases

38
Q
  1. What are articulatory kinematic treatments
A

an 8 step sequence structured activities that moves the patient from repeating target phonemes with the clinician to independent productions of utterances in role-playing situations.
Considerations:
1. begin with the easiest speech sounds and then more difficult ones. Vowels, nasals, and stops are easier than fricatives, affricates and consonant clusters.
2. patient begins to sequence sounds together gradually increase the distance between points of articulatory contact in the target words.
3. choose initial phonemes of target words carefully, words that begin with vowels, nasals, or stops
4. gradually increase length of the target words, best to start with short words that have repeating syllables such as BB, so-so, ta-ta, Once mastered systematically begin using longer words that have more complex syllable structure
5. for real words start with words that appear more often in day-to-day speech
8 steps:
1. watch me and say the word in unison
2. watch me listen to me, clinician mouths the word, patient says the word
3. watch me, listen to me. patient then repeats the word independently
4. patient repeats the word independently several times
5. SLP presents the word on paper and patient says the word while looking at it.
6. SLP presents the word on paper, removes it, and then the patient says the word.
7. patient says the word in response to a question
8. role playing with the clinician, family, or friends, is used to evoke the target word in an appropriate conversational text

39
Q
  1. What factors determine the choice of procedure to use with patient’s with apraxia of speech.
A

Patient preference, severity of the apraxia, clinicians preference

40
Q
  1. Why might you see unexpected inhalation and exhalations of air in chorea?
A

because the movements have unpredictable timing and the persons attempts to correct the movement

41
Q
  1. Discuss dystonia
A

Hyperkinetic movement disorder of muscle tone. It causes involuntary, prolonged muscle contractions that interfere with normal movement or posture. These contractions are slower and demonstrate a more sustained quality than seen in chorea. Contractions wax and wane during ongoing movement. Sensory tricks may provide some temporary relief. It is characterized by the number of body parts that are affected.

41
Q
  1. Discuss dystonia
A

Hyperkinetic movement disorder of muscle tone. It causes involuntary, prolonged muscle contractions that interfere with normal movement or posture. These contractions are slower and demonstrate a more sustained quality than seen in chorea. Contractions wax and wane during ongoing movement. Sensory tricks may provide some temporary relief. It is characterized by the number of body parts that are affected.

42
Q

How does mixed dysarthria occur

A

occurs when neurologic damage extends into 2 or more portions of the motor system.

43
Q

How does mixed dysarthria occur

A

occurs when neurologic damage extends into 2 or more portions of the motor system.

44
Q
  1. Discuss Multiple Scleroris and its neurological site of lesion
A

progressive demyelination disease that attacks the axons of the CNS. Most often diagnosed when a patient is in their 30’s Lesions can occur in the brain stem, cerebellum, cerebral hemispheres, and spinal cord. May result in any pure or any combination of mixed dysarthria. Ataxic-Spastic is the most commonly diagnosed, though on average motor speech symptoms are often mild.

44
Q
  1. Discuss Multiple Scleroris and its neurological site of lesion
A

progressive demyelination disease that attacks the axons of the CNS. Most often diagnosed when a patient is in their 30’s Lesions can occur in the brain stem, cerebellum, cerebral hemispheres, and spinal cord. May result in any pure or any combination of mixed dysarthria. Ataxic-Spastic is the most commonly diagnosed, though on average motor speech symptoms are often mild.

45
Q
  1. What is the most common type of mixed dysarthria in MS
A

Ataxic-Spastic

46
Q
  1. What is Multisystems Atrophy
A

collective term for a grouping of degenerative disorders, many of which include Parkinsonism symptoms.
Shy-drager syndrome- progressive course, often fatal. Does not result in dementia, Parkinsonism symptoms present.
Progressive supra nuclear palsy- progressive course, characteristic symptom is restricted voluntary eye movements, Parkinsonism symptoms with rigidity, dementia and dysphagia.
Olivopontocerebellar atrophy- ataxic symptoms present, potential choreiform movements and mild dementia.

46
Q
  1. What is Multisystems Atrophy
A

collective term for a grouping of degenerative disorders, many of which include Parkinsonism symptoms.
Shy-drager syndrome- progressive course, often fatal. Does not result in dementia, Parkinsonism symptoms present.
Progressive supra nuclear palsy- progressive course, characteristic symptom is restricted voluntary eye movements, Parkinsonism symptoms with rigidity, dementia and dysphagia.
Olivopontocerebellar atrophy- ataxic symptoms present, potential choreiform movements and mild dementia.

47
Q
  1. Differentiate between nonverbal oral apraxia and apraxia of speech
A

Nonverbal Oral Apraxia: a deficit in the ability in the ability to sequence nonverbal, voluntary movements of the tongue, lips, jaw, and other associated oral structures. Orofacial movements affected might include protruding the tongue, whistling, biting the lower lip, and puffing out the cheeks
Apraxia of Speech: a deficit in the ability to select and time sequence the motor commands needed to correctly position the articulators during the voluntary production of phonemes. Specific to the movements needed to produce phonemes

48
Q
  1. Differentiate between nonverbal oral apraxia and apraxia of speech
A

Nonverbal Oral Apraxia: a deficit in the ability in the ability to sequence nonverbal, voluntary movements of the tongue, lips, jaw, and other associated oral structures. Orofacial movements affected might include protruding the tongue, whistling, biting the lower lip, and puffing out the cheeks
Apraxia of Speech: a deficit in the ability to select and time sequence the motor commands needed to correctly position the articulators during the voluntary production of phonemes. Specific to the movements needed to produce phonemes

49
Q
  1. What does Brookshire (2015) suggest are four condtions that can cause errors tha appear to be similar to apraxia of speech but must be ruled out
A

muscle weakness, sensory loss, comprehension deficit and incoordination

50
Q
  1. What are some exclusionary characteristics that rule out apraxia of speech
A

the patient demonstrates a fast rate of speech, patent has a normal rate of speech, patient demonstrates normal prosody

51
Q
  1. Are treatments for apraxia of speech mostly medical, surgical, prosthetic, or behavioral
A

Nearly all are behaviorally based

Clinical Methods (3 decks)

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