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Motor Speech Disorders > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Define the neuromotor basis of hypokinetic dysarthria.

A

Rigidity/reduced Range Of Motion

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2
Q

Describe 1 key function of the basal ganglia

A

To plan and program postural and supportive components of motor movement

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3
Q

Describe 4 major motor symptoms associated with Parkinson’s disease.

A
  1. rest tremor
  2. rigidity
  3. akinesia
  4. loss of postural reflexes
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4
Q

Describe 4 other symptoms (including non-motor symptoms) associated with Parkinson’s disease.

A
  1. Gastro-instestinal issues
  2. depression
  3. sleep disorder
  4. sensory abnormalities
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5
Q

List a patient’s speech-related complaint that could help differentially diagnose hypokinetic dysarthria from other dysarthria types.

A

I feel like I am speaking loud enough

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6
Q
  • List the most distinctive speech features of hypokinetic dysarthria according to Darley, Aronson, and Brown.
A

Monopitch,
reduced stress,
monoloudness,
inappropriate silences,
short rushes,
rapid rate,
reduced loudness level

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7
Q

Define the neuromotor basis of hyperkinetic dysarthria.

A

Involuntary movements

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8
Q

List 3 possible etiology that could lead to hyperkinetic dysarthria

A
  1. Unknown (most common)
  2. Toxic/Metabolic
  3. Degenerative
  4. Trauma
  5. Vascular
  6. Other
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9
Q
  • Describe 4 of the major hyperkinetic movement disorders.
A
  1. Tremors
  2. Chorea
  3. Hemiballismus
  4. Dystonia
  5. Myoclonus
  6. Hemifacial spasms
  7. Tics
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10
Q
  • List the most distinctive speech features of chorea according to Darley, Aronson, and Brown.
A
  • rapid, unpredictable consonant and vowel distortions involving most speech articulators
  • Prolonged Intervals
  • Variable Rate
  • Excess Loudness Variation
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11
Q
  • List the most distinctive speech features of dystonia according to Darley, Aronson, and Brown.
A
  • slowly varying or prolonged distortions of consonants and vowels.
  • these distortions may affect a specific articulator in a fairly regular and predictable manner
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12
Q
  • List the most distinctive speech features of spasmodic dysphonia according to Darley, Aronson, and Brown.
A
  • Voice Stoppage (voice arrests or vocal spasms)
  • Pitch Breaks
  • Strained Voice
  • Harsh Voice
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13
Q
  • List the most distinctive speech features of essential tremor according to Darley, Aronson, and Brown.
A
  • Rhythmic Voice Tremor
  • Rhythmic Changes in Pitch
  • Rhythmic Changes in Intensity
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14
Q

Define mixed dysarthria.

A

Disorders of multiple motor systems
Any combo of 2+ of the single dysarthria types are possible

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15
Q
  • List 3 etiology that could lead to mixed dysarthria.
A

Degenerative (ALS), Vascular, Trauma, Demyelinating

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16
Q
  • Define one difference between bulbar ALS and spinal ALS (related to
    initial stages)
A

Spinal- limb symptoms
Bulbar- speech and swallowing symptoms

17
Q
  • List the most distinctive speech features of mixed dysarthria (ALS) according to Darley, Aronson, and Brown.
A

-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

18
Q
  • Define the neuromotor basis of apraxia.
A

Planning and programming errors

19
Q

Describe Liepmann’s 2 step praxis system.

A

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)

20
Q
  • List 5 signs/symptoms of apraxia (motor)
A
  1. groping/multiple attempts at a movement
  2. spatial errors
  3. inaccurate positioning of a body part
  4. substitution of one action for another
  5. delayed initiation of a movement
21
Q
  • Contrast apraxia with dysarthria.
A
  • 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)
22
Q

Contrast apraxia with aphasia.

A
  • 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)
23
Q
  • List the specific areas of the brain most commonly associated with apraxia.
A

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

24
Q
  • List the 4 speech features researchers have identified as being the most useful for identifying apraxia of speech.
A

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

25
Q
  • List patient speech-related complaints that could help differentially diagnose apraxia from other motor speech disorders.
A

“I know the word I want to say but they won’t come out right”

26
Q
  • Describe why the Darley, Aronson and Brown classification system (Mayo Clinic) may not be appropriate for childhood motor speech disorders.
A

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

27
Q
  • Contrast congenital conditions vs. postnatal/acquired conditions vs. degenerative conditions.
A

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)

28
Q

Describe the primary and secondary characteristics of dysarthria in children and the role of the SLP as it relates to these characteristics.

A
  • 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
29
Q
  • Define the primary goal of motor speech disorder management.
A

-Communication (restore, compensate, adjust)
-Maximize efficiency, effectiveness, and naturalness of communication

30
Q

How do Restore, compensate, and adjust help therapy in relation to management of motor speech disorders.

A

Helps in direction of management

31
Q

Purpose of restore strategies in management?

A

-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)

32
Q

Purpose of compensation strategies in management?

A

-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

33
Q

Purpose of adjust strategies in management?

A

-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

34
Q

Describe 2 conditions in which a patient is not a good candidate for SLP therapy.

A

-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

35
Q
  • Describe 5 factors related to patient motivation and needs that could
    influence SLP management decisions.
A
  1. personal goals
  2. premorbid personality
  3. lifestyle/living environment
  4. co-existing motor, sensory, cognitive deficits
  5. general health issues
  6. health care system
36
Q

Speech Characteristics of Mixed Dysarthria

A
  1. Articulation (98%)
    • imprecise consonants (95%)
    • irregular articulatory breakdowns (14%)
  2. Abnormal AMRs (91%)
    • slow (72%)
    • imprecise (33%)
    • irregular (33%)
  3. Phonation (57%)
    • harshness (39%)
    • reduced loudness (9%)
    • strained (5%)
  4. Slow rate (23%)
  5. Hypernasal (11%)
  6. Weakness
    • unilateral lower facial weakness (82%)
    • unilateral lingual weakness (52%)

Motor Speech Disorders (2 decks)

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