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Motor Speech > Final Quiz > Flashcards

Final Quiz Flashcards

1
Q

Flaccid dysarthria overall definition

A

Perceptually distinct group of motor speech disorders caused by injury or disease of one or more cranial or spinal nerves

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2
Q

Flaccid dysarthrias may manifest in _____, _____, or _____ parts of speech

A

Respiratory, resonatory, articulatory

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3
Q

Flaccid dysarthria affects the _____, ______, and ______ of speech movements

A

rate, range, accuracy

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4
Q

All subtypes of flaccid dysarthria share a lesion somewhere between ____ and ____

A

brainstem or spinal cord and muscles of speech

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5
Q

Spastic dysarthria definition

A

Perceptually distinct group of motor speech disorders that are produce by damage to the direct and indirect activation pathways of the CNS

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6
Q

Spastic dysarthria may manifest in the ____, ____, ____, or ____ parts of speech

A

Respiratory, phonatory, resonatory, and articulatory

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7
Q

Spastic dysarthria accounts for ___% of all dysarthrias and ____% of all MSDs

A

7.3, 6.8

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8
Q

General features of spastic dysarthrias reflect the effects of __________

A

Excessive muscle tone

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9
Q

Spastic dysarthria is primarily a problem of ______, as opposed to planning, programming , or control

A

Neuromuscular execution

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10
Q

The direct activation pathways are primarily ____, meaning impulses through them tend to lead to ____ and ____ movement

A

facilitatory, skilled, discrete

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11
Q

________ accounts for 60% of the etiology of cases of spastic dysarthria

A

Degenerative neurological disease such as ALS or PLS(Primary lateral sclerosis)

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12
Q

General etiology spastic dysarthria

A

Any process that damages the direct and indirect pathways bilaterally can case spastic dysarthria (degenerative disease, vascular, congenital, traumatic, inflammatory, toxic, and metabolic diseases).

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13
Q

Vascular etiologies of spastic dysarthria can include

A

nonhemorrhagic stroke, hemorrhagic stroke, anoxic or hypoxic encephelopathy

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14
Q

Congenital etiologies of spastic dysarthria can include

A

Cerebral palsy

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15
Q

Demyelinating disease etiologies of spastic dysarthria can include

A

Multiple sclerosis

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16
Q

______ seems to account for most deviant speech characteristics in spastic dysarthria

A

Effects of spasticity and weakness on speed, range, and force of movement

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17
Q

Clinical signs accompanying spastic dysarthria can include

A

Weakness, loss of skilled movements, spasticity, hyperactive reflexes, pathologic reflexes

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18
Q

Salient effects of UMN lesions on speech movements in spastic dysarthria include

A

Spasticity, weakness, reduced range of movement, slowness of movement

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19
Q

Other comorbid conditions in spastic dysarthria can be

A

Dysphagia, pseudo bulbar effect

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20
Q

Major clusters of speech characteristics in spastic dysarthria include

A

Prosodic excess, articulatory-resonatory incompetence, prosodic insufficiency, phonatory stenosis

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21
Q

Most distinctive clues to the presence of spastic dysarthria are

A

Strained-harsh voice quality, reduced pitch and loudness variability, slow speech rate, and slow and regular AMRs

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22
Q

Spastic dysarthria has a correlation with _____ disease

A

Cerebellar

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23
Q

Ataxic dysarthria general definition

A

Perceptually distinct motor speech disorder associated with damage to the left cerebellar control circuit (problems with motor control)

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24
Q

Ataxic dysarthria may manifest in the ____, _____, ____, and _____ components of speech

A

respiratory, phonatory, resonatory, articulatory

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25
Q

Ataxic dysarthria most evident in ___ and ___ aspects of speech

A

Articulation and prosody

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26
Q

General etiology of ataxic dysarthria

A

Any process that damages the cerebellum or cerebellar control circuit such as degenerative, demyelinating, vascular, neoplastic, inflammatory/infectious, endocrine, structural, traumatic, immune mediated, toxic, and metabolic diseases

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27
Q

_____ is the most common etiology in ataxic dysarthria

A

Degenerative disease

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28
Q

Degenerative etiologies of ataxic dysarthria can include

A

Cerebellar degeneration, NOS, unspecified etiology, spinocerebellar ataxia, multiple system atrophy, hereditary,

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29
Q

Unspecified etiologies in ataxic dysarthria can include

A

Cerebellar disease, NOS, indeterminate cerebellar lesion

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30
Q

Vascular etiologies of ataxic dysarthria can include

A

Stroke (cerebellar or brainstem), AVM, anoxia

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31
Q

Demyelnating etiologies in ataxic dysarthria include

A

Multiple sclerosis, chronic inflammatory, demyelinating polyradiculopathy

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32
Q

Tumor etiologies of ataxic dysarthria can include

A

Cerebellar or brainstem tumor, paraneoplastic cerebellar degeneration

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33
Q

Traumatic etiologies of ataxic dysarthria

A

Postoperative (tumor, AVM, deep brain stimulatory)

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34
Q

Toxic/metobolic etiologies of ataxic dyarthria can include

A

Hypothyroidism, lithium toxicity

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35
Q

Other etiologies of ataxic dysarthria are

A

Episodic ataxia, cerebral palsy, autoimmune disease, NOS, pervasive developmental disorder

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36
Q

Ataxic dysarthria results from damage to the ______ or most frequently damage to the ___ or ___

A

Cerebellar control circuit, lateral hemispheres, paravernal areas or vermis

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37
Q

Ataxic dysarthria is most perceptible in the ___ and ___ aspects of speech

A

Articulation and prosody

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38
Q

___ and ___ appear responsible for slowness of movement and inaccuracy in force, range, timing, and direction of speech movements in ataxic dysarthria

A

Inaccuracy and reduced muscle tone

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39
Q

Cerebellar lesions can be identified by

A

Neuroimaging studies

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40
Q

Aside from degenerative disease, ___, ____, and ___ are other common etiologies of ataxic dysarthria

A

Demyelinating, vascular, undetermined

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41
Q

People with ataxic dysarthria often complain of ____ and ____

A

Slurred speech, “drunken” quality to their speech

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42
Q

Most distinctive clues to the presence of ataxic dysarthria include

A

Irregular articulatory breakdowns, irregular speech AMRs, Excessive and equal stress, distorted vowels, excess loudness variation

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43
Q

Acoustic and physiologic studies of ataxic dysarthria have corroborated perceptual characteristics such as

A

Slowness of movement, problems with timing

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44
Q

Diagnosis of ataxic dysarthria and correlation with cerebellar function can _______

A

Aid localization and diagnosis of neurologic disease

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45
Q

Hypokinetic dysarthria general definition

A

Perceptually distinct motor speech disorder associated with the basal ganglia control circuit

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46
Q

Hypokinetic dysarthria may manifest in the ____, _____, ____, or ______ aspects of speech

A

Respiratory, phonatory, resonatory, articulatory

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47
Q

Hypokinetic dysarthria may be most evident in the ____, ____, or ____ aspects of speech

A

voice, articulation, prosody

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48
Q

______ is a significant contributor to hypo kinetic dysarthria

A

Decreased range of movement

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49
Q

General etiology of hypo kinetic dysarthria

A

Any process that interferes with the basal ganglia control circuit (Degenerative, vascular, traumatic, infectious, inflammatory, neoplastic, toxic, metabolic diseases)

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50
Q

____ is the most frequent cause of hypo kinetic dysarthria

A

Parkinson’s Disease

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51
Q

Degenerative disease accounts for ___% of etiologies of hypokinetic dysarthria

A

87%

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52
Q

Possible degenerative etiologies of hypokinetic dysarthria (87%)

A

PD, Parkinsonism, multiple system atrophy, progressive supranuclear palsy, Lewy body disease, corticobasal degeneration, frontotemporal dementia, parkinsonism + ALS

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53
Q

Possible vascular etiologies of hypokinetic dysarthria (4%)

A

Nonhemorrhagic stroke, vascular parkinsonism; hypoxia

54
Q

Multiple possible causes of hypokinetic dysarthria (3%)

A

PD+stroke, corticobasal degeneration + normal pressure hydrocephalus; degenerative CNS disease + right cerebral hemorrhage; lymphoma + strokes; neurofibromatosis + seizures

55
Q

Traumatic etiologies of hypokinetic dysarthria (2%)

A

Deep brain stimulation for PD; tumor resection, postoperative

56
Q

Undetermined etiologies of hypokinetic dysarthria (2%)

A

Basal ganglia disorder, undetermined; CNS disease, undetermined

57
Q

Infectious disease etiologies of hypokinetic dysarthria (1%)

A

Encephalitis

58
Q

Other etiologies of hypokinetic dysarthria (1%)

A

Stiff person syndrome

59
Q

What is Differential Diagnosis?

A

narrowing diagnostic possibilities and reaching conclusions about the nature of a deficit; requires application of knowledge and clinical skill to a specific population

  • diagnosis should be related to suspected or known neurologic diagnosis or lesion localization
  • multiple diagnoses are possible
  • normal speech is a possible diagnosis
60
Q

Differential Diagnosis of Dysarthrias

A

can be difficult because there is overlap in the characteristics of dysarthrias
- dysarthrias differ in their anatomic and vascular localizations, etiologic distributions, oral mechanism findings, and speech characteristics

61
Q

Distinguishing AOS from dysarthrias

A

depends on recognizing deviant speech characteristics commonly associated with AOS that are uncommon in dysarthrias

62
Q

Name elements associated with vascular parkinsonism

A

Gait difficulty, postural instability, dementia, corticospinal signs, pseudo bulbar effects, pathologic reflexes

63
Q

Deviant speech characteristics in hypokinetic dysarthria include

A

the effects of rigidity, reduced force, and range of movement and slow individual and sometimes fast repetitive movements

64
Q

Parkinson’s disease is …

A

a degenerative condition associated with a depletion of dopamine in the striatum of the basal ganglia

65
Q

Symptoms of Parksinon’s are often managed by…

A

Medications that restore the balance between dopamine and other neurotransmitters in the basal ganglia

66
Q

Name elements associated with vascular parkinsonism

A

Gait difficulty, postural instability, dementia, corticospinal signs, pseudo bulbar effects, pathologic

67
Q

Drugs that can cause parkinsonism

A

Neuroeleptic and illicit drugs, drugs that interfere with the brain’s ability to store dopamine

68
Q

Distinguishing between aprosodia and certain dysarthrias

A

rely on certain speech characteristics and the clinical setting in which they occur.

69
Q

Common complaints of patients or significant others with hypokinetic dysarthria

A

Voice is weak or quiet, Rate is too rapid, deterioration with fatigue toward the end of a parkinsonian medication cycle , drooling and swallowing, facial masking and general reduction in the visible range of articulator movement during speech

70
Q

Acquired Psychogenic and Related Disorders: Schizophrenia

A

Schizophrenia: usually begins in adolescence or early adulthood

  • delusions, hallucinations, disorganized/catatonic behavior affecting flattening and disorganized speech
  • specific conditions that can lead to schizophrenia include closed head injury, encephalitis, temporal lobe epilepsy, Huntington’s chorea, Wilson’s disease and demyelinating disease
71
Q

Psychogenic Nonorganic Speech Disorders (PNSDs)

A

Voice disorders represent the largest category of PNSDs
- characterized by aphonia, hoarseness or strained dysphonia

Stuttering-like disfluencies are the next largest category of PNSDs

Articulation, prosodic deficits, infantile speech and mutism can also reflect psychogenic disorders

72
Q

Hyperkinetic dysarthria may manifest in the ___, ___, ___, or ___ aspects of speech

A

Respiratory, phonatory, resonatory, articulatory

73
Q

Acquired Psychogenic and Related Disorders: Depression

A

An affective disorder of mood

  • primary depression can exist without any nonaffective psychiatric disorder or any serious organic disorder
  • secondary depression is associated with a preexisting organic or psychiatric illness
74
Q

Acquired Psychogenic and Related Disorders: Mania

A

Near emotional mirror image of depression
- excited mood, euphoria, low frustration tolerance, elevated self-esteem, poor judgement, disorganization, paranoia, little need for sleep, high energy

75
Q

Hyperkinetic dysarthria can be caused by any process that damages the circuitry associated with ____

A

Hyperkinesias

76
Q

Common etiologies of hyperkinetic dysarthria include

A

Toxic-metabolic, degenerative, infectious, vascular, traumatic, neoplastic, and inflammatory disease

77
Q

What is dementia pugilistic and what is its relation to dysarthria

A

Repeated head trauma as occurs in boxers damages substantia nigra over time and may lead to parkinsonism- hypokinetic dysarthria

78
Q

Other Neurogenic Speech Disturbances: Aphasia

A

a disturbance of language that can alter the characteristic of speech
- grammatical and syntactic deficits, word retrieval deficits and phonologic errors alter the rate, fluency and prosodic flow of verbal expression

79
Q

Drugs that can cause parkinsonism

A

Neuroeleptic and illicit drugs, drugs that interfere with the brain’s ability to store dopamine

80
Q

Toxins that can cause parkinsonism include

A

Chronic exposure to heavy metals, chemicals such as carbon disulfide, cyanide, methanol, temporary parkinsonism can occur during alcohol withdrawal

81
Q

Common complaints of patients or significant others with hypokinetic dysarthria

A

Voice is weak or quiet, Rate is too rapid, deterioration with fatigue toward the end of a parkinsonian medication cycle , drooling and swallowing, facial masking and general reduction in the visible range of articulator movement during speech

82
Q

Speech characteristics in hypokinetic dysarthria

A

Flat attenuated fused and sometimes accelerated speech pattern, mono pitch, mono loudness, reduced stress, short phrases, variable rate, short rushes of speech and imprecise articulation, inappropriate silences, breathy dysphonia, reduced loudness, and increased rate of speech

83
Q

Hyperkinetic dysarthria general definition

A

Perceptually distinct motor speech disorder with basal ganglia control circuit pathway

84
Q

Hyperkinetic dysarthria may manifest in the ___, ___, ___, or ___ aspects of speech

A

Respiratory, phonatory, resonatory, articulatory

85
Q

Basal ganglia control circuit includes the

A

Basal ganglia, thalamus, cerebral cortex

86
Q

Destruction of the sub thalamic nucleus causes ….

A

reduced inhibitory output from the basal ganglia, resulting in increased thalamic and subsequent cortical firing- uninhibited abnormal movements are “released” through the motor cortex to the corticospinal and coritcobulbar pathways

87
Q

Hyperkinetic dysarthria can be caused by any process that damages the circuitry associated with ____

A

Hyperkinesias

88
Q

Common etiologies of hyperkinetic dysarthria include

A

Toxic-metabolic, degenerative, infectious, vascular, traumatic, neoplastic, and inflammatory disease

89
Q

Hyperkinesia definition

A

Abnormal or excessive involuntary movements

90
Q

Other Neurogenic Speech Disturbances: Neurogenic Stuttering

A

Characterized by various patterns of dysfluency that may occur with or without accompanying aphasia, AOS or dysarthria

91
Q

Other Neurogenic Speech Disturbances: Palilalia

A

compulsive repetition of words and phrases, often in a context of increasing rate and decreasing loudness

  • bilateral basal ganglia pathology
  • frequently associated with hypokinetic dysarthria
92
Q

Other Neurogenic Speech Disturbances: Echolalia

A

motorically normal, unsolicited repetition of another’s utterances
- repetition can be rote or modified in a way that suggests linguistic processing

93
Q

Other Neurogenic Speech Disturbances: Aphasia

A

a disturbance of language that can alter the characteristic of speech
- grammatical and syntactic deficits, word retrieval deficits and phonologic errors alter the rate, fluency and prosodic flow of verbal expression

94
Q

Other Neurogenic Speech Disturbances: Aprosodia

A

a disturbance that has been associated with right hemisphere dysfunction although it can be associated with various site lesions, MSDs, and cognitive and affective deficits

95
Q

Other Neurogenic Speech Disturbances

A

Can alter speech in ways that are not attributable to commonly described dysarthrias or AOS
- other alterations in speech can be due to cognitive, affective or linguistic disturbances

96
Q

What is Neurogenic Mutism?

A

The absence of speech

  • can reflect psychiatric disturbances
  • can be organic but nonneurologic (profound congenital hearing loss, peripheral structural loss/laryngectomy)
  • can be caused by congenital or acquired neurologic diseases that affect the PNS or CNS anywhere from the brain stem to the cortex
97
Q

How can neurogenic mutism occur?

A

Neurogenic mutism can result from severe dysarthria, AOS, aphasia or nonaphasic cognitive affective conditions
- can occur post seizures or after surgical re-sectioning of the corpus callosum

98
Q

What is Anarthria?

A

speechlessness due to severe loss of neuromuscular control over speech

  • most severe form of dysarthria
  • neuromotor system does not permit speech
  • patients do not speak because they cannot speak
  • most commonly results from bilateral or diffuse neurologic damage
  • when a single vascular event causes anarthria, its locus is usually in the brainstem
99
Q

What is Locked-In Syndrome?

A

anarthria accompanied by quadriplegia and total body immobility except for vertical eye movements and blinking
- individual is conscious and sufficiently intact cognitively
(individuals w/ ALS and AAC devices)
- caused by occlusion of the basilar artery, which affects the ventral aspect of the pons

100
Q

What is coma?

A

a state of unarousable unresponsiveness and absence of sleep/wake cycles on EEG in response to an injury that suppresses or damages neuronal networks that permit consciousness

  • voluntary behavior is absent, eyes remain closed and there is no evidence of purposeful movement or localizing responses
  • any observable actions are reflexive
101
Q

What is speech arrest?

A

associated with partial seizures

speech in progress at onset of seizure is halted, consciousness is maintained

commonly occurs with frontal lobe seizures

102
Q

Neurogenic mutism that arises from acquired neurologic disease can be due to…

A
  • Severe dysarthria (anarthria)
  • AOS
  • Aphasia
  • various nonaphasic cognitive and affectiveconditions
103
Q

Mutism in the acute period following the onset of aphasia or associated with AOS…

A

is not unusual, but does not usually persist

104
Q

Apraxia of Speech (AOS)

A

A neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosaically normal speech

105
Q

AOS accounts for….

A

6.9% of all motor speech disorders

106
Q

AOS can occur…

A
  • in the absence of physiologic disturbances associated with the dysarthrias and in the absence of disturbance in any component of language
  • with other motor and sensory signs of left hemisphere damage
  • as the only evidence of neuropathy
107
Q

The MSP is….

A

Motor Speech Programmer

  • motor planning/programming component of motor speech control
  • organizes the motor commands that ultimately result in the production of temporarily ordered syllables, word and phrases at particular rates and patterns of stress and rhythm
  • relies heavily on the left hemisphere’s capacity to prepare for speaking and to drive the acquisition and execution of learned motor speech programs
108
Q

Broca’s area roles in MSP

A
  • candidate region for contributing to the specification of speech movements base don input from the language network and sensory modalities
  • storehouse and processor for previously acquired, highly practiced speech routines and their serial organization and guidance
  • often identified as lesion site in people with AOS
109
Q

Supplementary Motor Area roles in MSP

A
  • may be important to nonmotoric speech planning and sequence learning
  • involved in the initiation and control of speech production
  • tied to cognitive and emotional processes that drive or motivate action
    connects with the primary motor cortex and Broca’s area, the basal ganglia and limbic system
110
Q

Parietal areas (somatosensory cortex + supramarginal gyrus)

A
  • important in integrating sensory info for skilled movements and their sequencing for lengthy utterances
  • transferring that information into plans and targets for action
  • matching feedback during speech with internal representation of utterance
111
Q

What other areas have a role in motor control and MSP activities?

A

Basal ganglia and cerebellum

112
Q

What can cause AOS?

A

Any process that compromises dominant hemisphere functions for MSP can cause AOS

  • Stroke is the most common cause of AOS
  • tumors or trauma can also cause AOS
  • occasionally it is a sign of a degenerative CNS disease
113
Q

The clinical characteristics of AOS are NOT attributable to…

A

the physiologic disturbances that explain the dysarthrias or the language processing disturbances that explain aphasia

114
Q

AOS is a result of abnormality in the ___ hemisphere

A

Left

115
Q

AOS is often a secondary diagnosis when ____ is the primary communication disorder

A

Aphasia

116
Q

People with AOS can also have…

A

nonverbal oral apraxia (NOVA) and/or limb apraxia, but the three conditions can also occur independently

117
Q

When AOS occurs in association with dysarthria, it most often occurs with…

A

UUMN dysarthria or spastic dysarthria

118
Q

Deviant speech characteristics associated with AOS:

A
  • distorted sound substitutions and additions
  • decreased phonemic accuracy with increased rate
  • attempts to correct articulatory errors that cross phonemic boundaries
  • groping for articulatory postures
  • greater difficulty on volitional than automatic speech acts
  • greater difficulty on sequential motor rates and multi-syllabic word tasks than alternate motion rates and single syllable tasks
119
Q

People with AOS may have:

A
  • a limited phonetic repertoire
  • little difference between voluntary and automatic speech utterances
  • a highly consistent pattern of perceived speech errors
120
Q

How can AOS be distinguished from errors of aphasia?

A

AOS = articulatory distortions, reduced rate and various prosodic abnormalities help distinguish AOS from aphasic phonologic errors

121
Q

Hyperkinesia definition

A

Normal or excessive involuntary movements

122
Q

Dyskinesia definition

A

Abnormal involuntary movements regardless of etiology

123
Q

What is tardive dyskinesia

A

Common side effect of antipsychotic drugs - stereotyped and repetitive lip smacking, pursing, puffing and retraction, tongue protrusion or opening closing, or lateral jaw movements

124
Q

What is Akathisia?

A

Inner sense of motor restlessness which can be manifested by overt motor restlessness (weight shifting, pacing) to relieve the sensation

125
Q

What is myoclonus?

A

Involuntary single or repetitive brief lighting-like jerks of a body part

126
Q

In myoclonus, jerks can be ____ or ______ and cannot be inhibited willfully

A

rhythmic, nonrhythmic

127
Q

How is myoclonus induced?

A

Can occur spontaneously or be induced by visual, tactile, or auditory stimuli or sometimes by voluntary movements

128
Q

Myoclonus can occur in the following conditions

A
  • Dementing illnesses (Creutzfeldt Jacob disease, Lewy body dementia, progressive myoclonic ataxia)
  • Uncommon syndromes such as opsoclonus-myoclonus syndrome
  • Post-anoxic and metabolic encephalopathies
  • TBI
129
Q

How is action myoclonus induced?

A

Volitional muscle activity

130
Q

Most common etiology of action myoclonus is

A

Anoxic encephalopathy - principle damage to the globes pallidus, hippocampus, deep folia in the cerebellum, deep layer of the cerebral cortex

131
Q

Action myoclonus is a product of….

A

Unrestrained synchronous or repetitive firing of thalamocortical neurons in the ventrolateral thalamus - the main relay nucleus from the cerebellum to the cortex

Motor Speech (3 decks)

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