final exam Flashcards
flaccid dysarthria
impairments of lmns in cranial or spinal nerves (pns damage)
flaccid dysarthria causes
caused by any disorder that disrupts flow of neural impulses along lmns travel to reach muscles
location of damage flaccid
final common pathway
final common pathway
last and only road nueral impulses from umns travel to reach muscles
flaccid injuries
brainstem stroke, growing tumor, viral or bacterial infections, physical trauma, surgical accidents, mysathenia gravis, guillain-barre syndrome, polio, muscular dystrophy, progressive bulbar palsy
speech charateristics flaccid
- May NOT demonstrate deficits in all areas; severity level will vary
- Hallmarks: slow-labored articulation, marked degrees of hypernasal resonance, hoarse-breathy phonation
resonance characteristcs flaccid
- Hypernasality most common
- Nasal emission
- Weak pressure consonants
- Shortened phrases
articulation characteristics flaccid
imprecise consonant production
phonation characteristics flaccid
Phonatory incompetence (incomplete adduction of VFs during phonation) giving hoarse-breathy voice
respiration characteristics flaccid
- May not be affected
- If it is, you would see reduced loudness and speaking on residual air
prosody characteristics flaccid
- Monopitch, monoloudness
- Not unique to flaccid so not a diagnostic marker
evaluation tasks
- Look for clusters of symptoms when trying to diagnose
- Conversational speech and reading: Can evoke errors of resonance, arctic, respiration, and prosody
- AMR: /puh puh puh/ /tuh tuh tuh/ /kuh kuh kuh/. Will highlight a slowed rate of phoneme production
- Prolonged vowel: Will elicit breathy voice quality heard in phonatory incompetence
- Speech stress test: Necessary IF myasthenia gravis is suspected
treatment flaccid
- Treatments are according to which cranial nerve
- Needs and abilities vary greatly
resonance treatment flaccid
Velar strength-training procedure; modification of speech; reduce rate
phonation treatment flaccid
Pushing and pulling procedures, hard glottal attack
prosody treatment flaccid
Pitch range exercises, intonation profiles, contrastive stress drills
respiratory treatment flaccid
Correct posture, prosthetics, speaking immediately on exhalation
spastic dysarthria
bilateral damage to umn tracts
pyramidal system spastic
damage = weak/slow skilled movements
extrapyramidal system spastic
damage = weakness, increased muscle tone (spasticity), and abnormal reflexes
injuries spastic dysarthria
- stroke - most common; only occurs in LH and RH as a combo OR single in brainstem
- degenerative diseases: ALS, multiple sclerosis
- TBI
-infection
-tumors
speech characteristics spastic
-imprecise consonants, monopitch, monoloudness, reduced stress, harsh vocal quality
- Errors result bc of spasticity, slowness, weakness in vocal-tract muscles
articulation characteristics spastic
Imprecise consonant productions, vowel distortions
phonation characteristics spastic
Harsh vocal quality, Strained-strangled, Low pitch
resonance characteristics spastic
hypernasality
prosody characteristics spastic
Monopitch, monoloudness, short phrases, short rate of speech
evaluation tasks spastic
- Conversational speech and reading
- AMR (ppp, ttt, kkk)
- Vowel prolongations
treatment spastic
- Phonation deficits: work on relaxation, easy onset of phonation, yawn-sigh, tongue and lip stretching
- Articulation deficits: intelligibility drills, phonemic placement, minimal contrast drills
- Prosody deficits: pitch range exercises, contrastive stress drills, chunking utterances
- Resonance deficits: pharyngeal flap, palatal lift
special spastic
- Pseudobulbar affect- uncontrollable crying or laughing
- Drooling and swallowing issues
- Pseudobulbar palsy- weakness and slowness in same muscle
uumn dysarthria
- caused by damage to upper motor neurons one side of the brain that supply cranial and spinal nerves involved in speech production
- usually less severe than with bilateral damage
location of damage uumn
- Lower face and tongue
- Any condition that damages upper motor neurons on one side of brain after damage to either left or right hemisphere
injuries uumn
- Most frequent cause is stroke; specifically stokes involving frontal lobe
- Tumors and TBI can be a cause, but they are uncommon
speech characteristics uumn
- Weakness in lower face, lips, and tongue on opposite side of lesion
- Mild or moderate speech production errors - often short term with recovery after days or weeks
articulation uumn
-primary deficit
- Imprecise consonant production, articulatory breakdowns, slow and irregular AMRs
phonation uumn
Mild to harsh vocal quality
resonance uumn
Hypernasality
prosody and respiration uumn
Rarely impaired
evaluation tasks uumn
- Medical records
- Conversational speech or reading paragraph
- AMR tasks
- Prolonged vowel
treatment uumn
- Coexciting deficits are usually treated
- Artic may be so minor that SLP may decide not to treat
- Intelligibility drills, phonetic placement, exaggerating consonants, minimal contrast drills
ataxic dysarthria
due to damage to cerebellum or its neural pathways
location of damage ataxic
cerebellum, inferior peduncles, middle peduncle, superior pedunle, cerebellar control circuits
cerebellum ataxic
coordinate timing and force of muscular contractions; attached to brainstem; communicates with rest of CNS through 3 bundles of neural tracts called cerebellar peduncles
inferior peduncles ataxic
receives sensory info
middle peduncle ataxic
smooths and refines the planned movement
superior peduncle ataxic
Sends out the motor impulses
cerebellar control circuits ataxic
neurons that course through 3 cerebellar pathways
injuries ataxic
- Stroke
- Toxic conditions
- Metabolic conditions
- Traumatic head injury
- Tumors
speech characteristics ataxic
- Movements appear poorly coordinated, problems controlling timing/force for speech, slurred, monotonous arctic, primarily disorder of artic and prosody
- Scanning speech - slow, deliberate production of syllables with each syllable in a word receiving equal stress
articulation ataxic
- Imprecise consonant production
- Distorted vowels
- Irregular articulatory breakdowns
- Decomposition of movement: manifestations of cerebellar dysfunction, where instead of smooth coordinated movements, they are distinct and jerky
prosody ataxic
- Equal and excess stress
- Prolonged phonemes and prolonged intervals between phonemes
- Monopitch and monoloudness
phonation ataxic
- Harsh vocal quality
- Voice tremor
resonance ataxic
- Hyponasality
respiration ataxic
- Uncoordinated movements in respiratory muscles, contributing to speech deficits
- Paradoxical movements: movements that occur when muscles work against each other rather than in coordination
evaluation tasks ataxic
- Speech alternate motor tasks: slower than normal, difficulty maintaining steady rhythm with repetition
- Reading, conversational speech, and repeating sentences containing numerous multisyllabic words
respiration treatment ataxic
- Do not need to address strengthening
- Concentrate on controlling airflow more accurately during speech, as uncoordinated movements of respiratory muscles cause speech on residual air, affecting prosody and phonation
- Slow and controlled exhalation
- Speak immediately on exhalation
- Stop phonation early
- Optimal breath group - teaching how many syllables or words can be said clearly on one full inhalation
prosody treatment ataxic
- Slow rate
- Incorporating more typical stress and intonation into utterances
- Rate control: Reciting syllables to a metronome, Finger or hand tapping, Cued reading material
- Stress and intonation: Contrastive stress drills, Pitch range exercises, Intonation profiles, Chunking utterances into syntactic units
articulation treatment ataxic
- Intelligibility drills
- Phonetic placement
- Exaggerating consonants
- Minimal contrast drills
hypokinetic
any process that damages basal ganglia (extrapyramidal system)
main cause of hypokinetic
- Parkinsonism - collective term for different disorders sharing many similar symptoms
- Causes:
Idiopathic parkinson’s disease
Neuroleptic-induced parkinsonism
Postencephaltic parkinsonism
Traumatic head injury
Toxic metal poisoning
Stroke
symptoms hypokinetic
- Resting tremor
- Bradykinesia: slow, reduced range of movement
- Rigidity
- Spasticity
- Akinesia: delay in initiation of movements
- Postural reflexes
location of damage hypokinetic
dysfunction in basal ganglia; depends on balanced interaction of dopamine and acetylcholine
speech characteristics hypokinetic
harsh vocal quality, reduced stress, monoloudness, imprecise consonants; significant indvidual differences
prosody hypokinetic
monopitch, reduced stress, and monoloudness most common
articulation hypokinetic
imprecise consonants, repeated phonemes, palilalia
phonation hypokinetic
harsh/breathy quality, aphonia, low pitch
respiration hypokinetic
sometimes noted
evaluation tasks hypokinetic
-conversational speech and reading: evoke errors of prosody
-AMRs: highlight artic errors
-vowel prolongations: assess vocal quality
pharamcologic treatment hypokinetic
-L-dopa
-replacing dopamine in striatum
-correct neurotransmitter imbalance by decreasing acetylcholine activity in striatum
surgical treatments hypokinetic
-ablative surgery
-deep brain stimulation
-stem cell implantation
articulation treatment hypo
- Most common deficit: imprecise consonants due to reduced range of motion in arctic
- Compounded by increased ate
- Rate reduction, stretching, traditional artic tasks
phonation treatment hypo
- Adduct VFs only partially or have harsh or breathy voice quality
- Pushing and pulling procedure, hard glottal attack, LSVT
respiration treatment hypo
- Speaking immediately on exhalation
- Stop phonation early
- Optimal breath group
prosody treatment hypo
- Intonation profiles
- Contrastive stress drills
- Chunking utterances into syntactic units
- All used to Slow rate
hyperkientic dysarthria
caused by damage to the basal ganglia
causes of hyperkinetic dysarthria
- Myoclonus - involuntary and brief contractions of part, whole, or group of muscles in same area
- Tics
- Essential tremor - benign hyperkinetic movement disorder that causes tremulous movements in affected body parts
- Dystonia
- Degenerative diseases
- Traumatic head injury
- Stroke
- Infections
evaluation tasks hyper
-Vowel prolongation
- AMRs
- Conversational speech and reading
- Careful observation of associated involuntary movements
treatment hyper
-Pharamacologic - drugs that suppress involuntary movements that cause speech deficits
- Botox
- Deep brain stimulation
treatment for huntingtons disease
- Early stages - maintain normal prosody and optimal rate
- Middle stages - rate of speech, rhythmic breathing and relaxation, speaking on exhalation
- Progressive dementia - work closely with caregivers
treatment for tic disorders
Behavioral treatments:
- Habit reversal training
- Relaxation therapy may be helpful when combined with other treatment procedures
- Exposure response prevention
- Comprehensive behavioral intervention for tics
dystonia (part of hyper)
- Causes involuntary, prolonged muscle contractions
dystonia artic hyper
imprecise consonants, distorted vowels, irregular articulatory breakdowns, prolonged phonemes
prosody dystonia
monopitch, monoloudness, inappropriate silences, shortened phrases
phonation dystonia
harsh vocal quality, strained-strangled quality, excess loudness variation
respiration and resonance dystonia
less impacted
treatment dystonia
- Sensory tricks - idiosyncratic strategies that can suppress involuntary movement for a time
- Bite blocks - to stabilize jaw during speech
- Easy onset of phonation
chorea (part of hyper)
- Sydenham’s chorea - rare disorder affecting children after rheumatic fever
- Huntington’s disease - progressive inherited disorder
- Tardive dyskinesia - caused by taking certain antipsychotics
- Stroke - rare to cause chorea
speech characteristics chorea
Prolonged intervals between syllables and words, inappropriate silences, prolonged phonemes, intermittent breathy voice quality
mixed dysarthria
- when neurologic damage extends into two or more parts of motor system; any combo of pure dysarthrias
- Prominence of each pure dysarthria within mixed dysarthria within mixed dysarthria varies significantly among individuals
injuries mixed dysarthria
- Single or multiple strokes
- Brain tumors
- Traumatic head injuries
- Degenerative diseases
- Infectious diseases
- Multiple sclerosis
- multisystems atrophy
- amyotrophic lateral sclerosis
- wilson’s disease
-friedreich’s ataxia
multiple sclerosis
- Progressive demyelinating disease
- Can occur in brainstem, cerebellum, cerebral hemispheres, and spinal cord
- Can cause any pure or any combo of mixed dysarthria
- Ataxic-spastic most common
multisystems atrophy
- Collective term for group of degenerative disorders, many including parkinsonian symptoms:
- Shy-drager syndrome
- Progressive supranuclear palsy
- Olivopontocerebellar atrophy
amyotrophic lateral sclerosis
- Progressive degeneration of any four areas of motor neurons
- Often progresses from affecting two motor neuron groups to all four
- Mixed dysarthria predominates throughout much of this disorder
wilson’s disease
- Very rare hereditary disease preventing normal metabolism of dietary copper
- Penicillamine successful in treating most patients
- Dysarthria of earliest signs
- ataxic-spastic -hypokinetic present in many
friedreich’s ataxia
- Rare, inherited, progressive disorder
- Causes neuron degeneration in cerebellum, brainstem, and spinal cord
- Untreatable, fatal
- Ataxic-spastic most prevalent
treatment mixed
- General rule: first treat component most severely affecting speech production
- When all are equally affected: respiration, resonation, phonation, articulation, prosody (RRPAP)
- AAC for ALS
apraxia of speech
disorder of motor timing and sequencing
ideational apraxia
uncommon; disturbance in conception of object or gesture
ideomotor apraxia
disturbance in performance of movements needed to use object, make gesture, sequence movements
location of damage apraxia
Motor speech programmer - neural network in the brain that sequences motor movements needed to produce speech.
- first analyzes linguistic, motor, sensory, and emotional info
- Near perisylvian area of left hemisphere
injuries apraxia
- Stroke
- Degenerative disease
- Trauma
- tumor
speech characteristics apraxia
- Primarily disorder of articulation and prosody
- Slow, labored, halting speech
- Instances of groping
articulation apraxia
most common errors
prosody apraxia
frequently abnormal
respiration apraxia
may have difficulty taking deep breath on command
resonance and phonation apraxia
seldom issues
assessment strategies apraxia
- SMRs - sensitive assessment
- Conversational speech and reading aloud - determine effects of prosody
- Repeating words of increasing length
- Reading or repeatin low-frequency, multisyllabic words in isolation or sentences
categories to determine correct diagnosis apraxia
- Primary clinical characteristics
- Non Discriminative clinical characteristics
- Behaviors usually found in disorders other than apraxia
- Behaviors that rule out presence of apraxia
treatment apraxia
Goal: help patient relearn motor sequences to produce phonemes accurately
sequencing treatment apraxia
- Repetitive and intensive drill
- Patients learn to self-monitor
- Concentrate on functional words
articulatory kinematic treatments apraxia
Concentrate on improving timing and placement of articulatory movements through modeling, positioning of articulators, and repetition
rate and rhythm procedues apraxia
Assume apraxia primarily result of timing errors
AAC apraxia
Recommended with limited verbal communication
interystemic facilitation and reorganization treatment apraxia
Patient’s communicative strengths used to assist verbal speech
parkinsonism
known cause
parkson;s disease
unknown etiology
important to know parkinsonism
- Basal ganglia damage
- Festinating speech: same as gait just speech related
- Festinating gait: walking starts slow → fast, quick, short
features of CAS
- inconsistent errors
- inappropriate prosody
-groping
-vowel errors
treatments CAS
-prompt
-rest
-dttc
-NDP3
-cycles
prompt
-tactile-kinetshetic-propriocetive based tx
-emphasizes normalization of speech movement patterns in an age-appropriate, functional lexicon of words
ReST
-high intensity practice of randomly presented pseudowords with varying phonetic structure and lexical stress
dttc
-cueing hierarchy
-never in isolation, start with the easiest and work it up
NDP3
-bottom-up approach builds from single sounds to syllables and syllable sequencing
- primary clinical characteristics
-prosody
-slow speech rate
-slow speech rate w/pauses
-distorted phonemes with substitutions
-consonants and vowels are distorted
-inconsistent articulation errors
- nondiscriminitive clinical characteristics
-self-corrects and shows signs of awareness
-difficulty initiating speech
-speech errors increase as word length increases
-artic groping
- behaviors usually found in disorders other than AOS
-demonstrates difference between expressive and receptive speech and language skills
-has transposition errors
-anticipatory articulation errors
-presence of limb or oral apraxia
- Behaviors that rule out presence of AOS
-fast speech rate
-normal speech rate
-normal prosody
