Final Exam Flashcards
Define the neuromotor basis of hypokinetic dysarthria.
Rigidity/reduced Range Of Motion
Describe 1 key function of the basal ganglia
To plan and program postural and supportive components of motor movement
Describe 4 major motor symptoms associated with Parkinson’s disease.
- rest tremor
- rigidity
- akinesia
- loss of postural reflexes
Describe 4 other symptoms (including non-motor symptoms) associated with Parkinson’s disease.
- Gastro-instestinal issues
- depression
- sleep disorder
- sensory abnormalities
List a patient’s speech-related complaint that could help differentially diagnose hypokinetic dysarthria from other dysarthria types.
I feel like I am speaking loud enough
- List the most distinctive speech features of hypokinetic dysarthria according to Darley, Aronson, and Brown.
Monopitch,
reduced stress,
monoloudness,
inappropriate silences,
short rushes,
rapid rate,
reduced loudness level
Define the neuromotor basis of hyperkinetic dysarthria.
Involuntary movements
List 3 possible etiology that could lead to hyperkinetic dysarthria
- Unknown (most common)
- Toxic/Metabolic
- Degenerative
- Trauma
- Vascular
- Other
- Describe 4 of the major hyperkinetic movement disorders.
- Tremors
- Chorea
- Hemiballismus
- Dystonia
- Myoclonus
- Hemifacial spasms
- Tics
- List the most distinctive speech features of chorea according to Darley, Aronson, and Brown.
- rapid, unpredictable consonant and vowel distortions involving most speech articulators
- Prolonged Intervals
- Variable Rate
- Excess Loudness Variation
- List the most distinctive speech features of dystonia according to Darley, Aronson, and Brown.
- slowly varying or prolonged distortions of consonants and vowels.
- these distortions may affect a specific articulator in a fairly regular and predictable manner
- List the most distinctive speech features of spasmodic dysphonia according to Darley, Aronson, and Brown.
- Voice Stoppage (voice arrests or vocal spasms)
- Pitch Breaks
- Strained Voice
- Harsh Voice
- List the most distinctive speech features of essential tremor according to Darley, Aronson, and Brown.
- Rhythmic Voice Tremor
- Rhythmic Changes in Pitch
- Rhythmic Changes in Intensity
Define mixed dysarthria.
Disorders of multiple motor systems
Any combo of 2+ of the single dysarthria types are possible
- List 3 etiology that could lead to mixed dysarthria.
Degenerative (ALS), Vascular, Trauma, Demyelinating
- Define one difference between bulbar ALS and spinal ALS (related to initial stages)
Spinal- limb symptoms
Bulbar- speech and swallowing symptoms
- List the most distinctive speech features of mixed dysarthria (ALS) according to Darley, Aronson, and Brown.
-speech will be involved in most patients
* one study of 100 ALS pts indicated that 75% of patients
could not speak at the time of death
* features of spastic and flaccid dysarthria present to
varying degrees across patients
* features may evolve quite dramatically over time
- Define the neuromotor basis of apraxia.
Planning and programming errors
Describe Liepmann’s 2 step praxis system.
2-step process that results in the execution of a purposeful movement
Step 1- ideation (IDEA about what needs to be done)
Step 2- Production (execution of task)
- List 5 signs/symptoms of apraxia (motor)
- groping/multiple attempts at a movement
- spatial errors
- inaccurate positioning of a body part
- substitution of one action for another
- delayed initiation of a movement
- Contrast apraxia with dysarthria.
- fairly consistent errors (AOS highly variable errors)
- distortions more than substitutions (AOS frequent substitutions)
- errors often simplifications (AOS errors often complications)
- automatic non-speech oral movements impaired (AOS less impaired)
Contrast apraxia with aphasia.
- language comprehension normal in AOS
- word finding normal in AOS
- written language has normal syntax and semantics
- often co-occurs with Broca’s aphasia but AOS can occur in ‘pure’ form (13%
of pts)
- List the specific areas of the brain most commonly associated with apraxia.
Left hemisphere damage, regions of the cortex and subcortex that are involved in the planning of programming of complex volitional movements
Specific areas:
-the lateral premotor cortex
-the insula
-the internal capsule
-the pathways connecting the parietal lobe to the frontal lobe
- List the 4 speech features researchers have identified as being the most useful for identifying apraxia of speech.
Inconsistent articulatory errors
o these may be more complex errors rather than simplifications*
* *Effortful groping for correct articulatory postures at times with facial grimacing
o majority of errors are close approximations of target (place errors more frequent than manner and voicing)
Intrusive schwas, syllable segmentation and syllable lengthening (slow
rate and prosodic abnormality)
* *Difficulty initiating utterances
- List patient speech-related complaints that could help differentially diagnose apraxia from other motor speech disorders.
“I know the word I want to say but they won’t come out right”
- Describe why the Darley, Aronson and Brown classification system (Mayo Clinic) may not be appropriate for childhood motor speech disorders.
Systems are theoretically the same but actual mechanism is different due to development not fully completed, it is unclear whether the mechanisms are the same
- Contrast congenital conditions vs. postnatal/acquired conditions vs. degenerative conditions.
Congenital: Initial neurologic damage is static, however the impact continues throughout subsequent motor development.Stabilizes in adulthood.
Example: cererbral palsy
Postnatal/Acquired:
-Sudden onset, Neurologic recovery period, then Stabilization
-Despite stabilization…impacts development of later motor skills
Example: stroke, TBI, tumor, infection
Degenerative:
-Period of normal development prior to onset of progressive degeneration of neuromotor pathways
-If no medical treatment options available:
Treatment planning to meet communication needs while reflecting the expected deterioration of speech skills
Example: muscular dystrophy (Duchenne’s), cerebellar degeneration (Freidreich’s ataxia), dystonia, metabolic disease (Wilson’s disease)
Describe the primary and secondary characteristics of dysarthria in children and the role of the SLP as it relates to these characteristics.
- Primary: reductions in articulatory accuracy, intelligibility, speaking rate, and overall speech quality
- Secondary: results of primary conditions, including difficulties with literacy, language development, and personal-social development skills
- Define the primary goal of motor speech disorder management.
-Communication (restore, compensate, adjust)
-Maximize efficiency, effectiveness, and naturalness of communication
How do Restore, compensate, and adjust help therapy in relation to management of motor speech disorders.
Helps in direction of management
Purpose of restore strategies in management?
-reduce impairment, restore original function
-consider etiology, type, and severity of the disorder
-full or partial recovery expected, restore is the best method (e.g., stroke, traumatic injury)
Purpose of compensation strategies in management?
-promoting use of residual function
-good when restoration of original function is unlikely or uncertain (even in the short term)
-modifying rate, devices to amplify loudness of speech, augmenting speech with use of gestures
Purpose of adjust strategies in management?
-either temporary or personal adjustments to the person’s lifestyle
-responsibilities in daily life
-preparing for loss of speech/function
-minimizing adjustment in therapy so that their lifestyle can stay relatively normal
Describe 2 conditions in which a patient is not a good candidate for SLP therapy.
-medical prognosis may influence treatment decisions
-stamina and alertness may be fluctuating
-surgery that is upcoming (such as tumor removal) would not treat until after the surgery
- Describe 5 factors related to patient motivation and needs that could
influence SLP management decisions.
- personal goals
- premorbid personality
- lifestyle/living environment
- co-existing motor, sensory, cognitive deficits
- general health issues
- health care system
Speech Characteristics of Mixed Dysarthria
- Articulation (98%)
- imprecise consonants (95%)
- irregular articulatory breakdowns (14%)
- Abnormal AMRs (91%)
- slow (72%)
- imprecise (33%)
- irregular (33%)
- Phonation (57%)
- harshness (39%)
- reduced loudness (9%)
- strained (5%)
- Slow rate (23%)
- Hypernasal (11%)
- Weakness
- unilateral lower facial weakness (82%)
- unilateral lingual weakness (52%)
