Final Review Flashcards
A speech production deficit resulting from neuromotor damage to the PNS or CNS with damage affecting any of the five components of speech production
Dysarthria
Damage to which motor component results in speaking in short phrases, reduced vocal intensity, and a breathy vocal quality?
respiration
Damage to which motor component results in breath, harsh quality or strained-strangled quality?
Phonation
Damage to which motor component results in a hypernasal quality?
Resonance
Damage to which motor component results in imprecise consonants, distorted vowels, inappropriate silences, and irregular articulatory breakdowns?
Articulation
Small involuntary movements tat may occur in a muscle when motor innervations ahs been lost through damage to lower motor neurons are called:
Fasiculations
Simultaneous phonation of two sounds is known as:
Diplophonia
List and Define the 5 motor components of speech:
a. Respiration: supplies all air for speech and subglottic pressure; All begins with the breath
b. Articulation: use of different articulators to form phonemes using the air supply as well.
c. Phonation: the amount of breath support used in producing the different phonemes; vocal fold adduction/ abduction
d. Prosody: Intonation, pitch and stress emphasized during speech
e. Resonance: Oral resonance- when the velum closes blocking air from the nasal cavity Nasal Resonance- velum lowers blocking air from the oral cavity and lips
What are the 6 salient features of speech?
Muscle Strength, Muscle Tone, Motor Steadiness, Range of Motion, Accuracy of movement, speed of movement
Having a patient produce a sharp cough assesses:
vocal fold adduction
Unilateral upper motor neuron dysarthria primary affects which motor speech component?
Articulation
In most cases of unilateral upper motor neuron dysarthria, the effects of this disorder are judged to be:
Mild or Moderate
How would a clinician determine if a patient with flaccid dysarthria has a problem with respiration versus phonation?
Have the patient produce a good cough and a hard glottal stop
In ALS the ultimate cause of mortality is:
Respiration Failure
Name two evaluation tasks that assess lingual strength:
a. Ask the client to stick the tongue out and to the left and to the right
b. Apply resistance and ask the client to push. Have the client count fro m1-100 aloud.
What are AMR’s?
Alternate movement rate: have client produce “puh puh puh” as quickly and clearly as possible
What are SMR’s?
Sequential Movement Rate: have the client produce “puh tuh kuh” as quickly and clearly as possible
Explain the difference between the upper motor neuron and the lower motor neuron involvement as it related to muscle compromise.
Upper motor neurons are involved in the CNS while the lower motor neurons are involved in the PNS
Parkinsonism is the most common cause of which kind of dysarthria:
Hypokinetic
result of bilateral damage in the upper motor neurons, which results in weak/slow movement, increased muscle tone (spasticity), and abnormal reflexes.
Spastic Dysarthria
is a disorder in which the client has difficult sequencing the movements needed for speech (groping)
Apraxia of Speech
Three branches of the Vagus Nerve:
a. Pharyngeal
b. External Superior Laryngeal
c. Recurrent Laryngeal
The mandible at rest (static) and using voluntary movement (dynamic), is controlled by Cranial Nerve _____
V- Trigeminal
The tongue at rest and during voluntary movement is controlled by cranial nerve ______
XII Hypoglossal
The velum and pharynx at rest and during voluntary movement are controlled by Cranial Nerve _______
X- Vagus IX Glossopharyngeal
Difficulty controlling the timing and force of speech movements resulting in speech that is characterized as having a drunken quality is known as __________
Ataxic Dysarthria
What is the difference between hypotonic and hypokinetic?
a. Hypotonic is decreased muscle tone and activity.
b. Hypokinetic is not a lot of movement
c. While hypokinetic is a dysarthria, hypotonic is a characteristic of flaccid dysarthria
A delay in the initiation of movements, consistent with Parkinsonism is known as:
Bradykinesia
A movement disorder (dancelike) distinguished by random involuntary movements of limbs, trunk, head and neck is known as:
Chorea
Give two tasks that would allow you to assess NON-Verbal oral movement control/sequencing:
a. Open you mouth stick your tongue to the left than the right
b. Open your mouth, bite, repeat
You are assessing a 75 year old left CVA with a right sided hemi; when you ask him to protrude his tongue WHICH side does it deviate and why?
Deviate to the right side because that side is much weaker than the left. The strength from the left side of the tongue will push the tongue towards the side of weakness
Name the most common speech production error in the following Dysarthrias:
a. Flaccid: hypernasality, imprecise consonants
b. Spastic: Imprecise consonants, monopitch
c. Unilateral UMN: Imprecise consonants, slow AMRs
d. Ataxic: imprecise consonants, equal and excess stress
e. Hypokinetic: monopitch, reduced stress
f. Hyperkinetic: imprecise consonants, prolonged intervals
Give an example of a degenerative disease that can result in a diagnosis of dysarthria and identify the type of dysarthria it is typically associated with:
Chorea = hypokinetic Parkinson's = hypokinetic
Uncontrolled laughing or crying that occurs independently of emotions secondary to neurological damage:
Pseudobulbar affect
What is nonverbal oral apraxia:
When a person has difficulty sequencing movement not related to speech
What is Apraxia of Speech:
When a person has difficulty sequencing the movements of the articulatory necessary for speech production
What is flaccid dysarthria:
Paralysis, atrophy, hypotonicity, and weakness as a result of damage to the LMN on both spinal and cranial tracts; damage to the PNS
What is Spastic dysarthria::
Weak/slow movements, increased muscle tone, abnormal reflexes as a result of bilateral damage in the UMN
Key difference between hyper- and hypo nasality with regard to velopharyngeal function:
a. Hypernasality: velum is at rest and does not seal anything, allowing air to come thru the nose; too much movement
b. Hyponasality: the velum is raised and seals everything off “not a lot of movement”
A breathy wheeze that can be heard during inhalation is known as:
Inhalatory Stridor
Difference between Velopharyngeal incompenetence and velopharyngeal insufficiency?
VIC: is possible but hard to obtain; deaf speech
VIS: when it is not physically possible, Cleft Palate
Damage to the ________ can result in ataxic dysarthria.
Cerebellum
Bilateral damage to the UMN can result in ______ dysarthria.
Spastic
Unilateral damage to the UMN can result in _______ dysarthria.
Unilateral UMN
Damage to the LMN can result in _________ dysarthria.
Flaccid
TREATMENT FOR RESONANCE DISORDERS / DEFICITS (Incompetence vs. Insufficiency)
a. Surgical and prosthetic (pharyngeal flap/ Teflon injection / palatal lift)
b. CPAP ( a nasal mask that sends air into the nasal cavity while patient speaks – causes resistance)
c. No evidence for other velar strengthening exercises
d. Reduced rate of speech
e. Open oral posture / exaggeration
f. LSVT
g. Visual feedback (mirror held under nostrils)
Example goal for client with a resonance disorder:
Client will increase rate of speech with 70% accuracy when provided with gradually fading multimodal cues.
TREATMENT FOR PHONATION DISORDERS / DEFICITS
a. Pushing and pulling procedures
b. LSVT
c. Holding breath
d. Hard glottal attack
e. Head and neck relaxation
f. Easy onset exercises
g. Yawn-sigh exercises
Example goal for client with phonation disorder:
Client will increase sustained /a/ by 70% using pushing and pulling procedures.
TREATMENT FOR ARTICULATION DISORDERS / DEFICITS
a. Passive to active stretching exercises
b. Intelligibility drills
c. Phonetic placement
d. Over articulation drills
e. Minimal contrast drills
Example goal for client with articulation disorder:
Client will produce alveolar sounds in isolation with 70% accuracy when presented with a model.
TREATMENT FOR PROSODIC DISORDERS / DEFICITS
a. Pitch range exercises
b. Intonation profiles
c. Contrastive stress drills
d. Chunking of utterances
Example goal for a client with prosody disorder:
Client will increase range of pitch by singing up and down the scale with 70% accuracy when provided with visual and verbal models.
TREATMENT FOR RESPIRATORY DISORDERS / DEFICITS
a. Slow and controlled exhalation
b. Speak immediately on exhalation
c. Stopping phonation early
d. Spirometry training
e. Diaphragmatic exercises
Example goal for a client with respiratory disorder:
Client will increase respiratory support by practicing diaphragmatic breathing exercise 10 minutes daily.
Write a goal for a client who has a left CVA to improve weakness.
Client will demonstrate increased ROM on the right side with 70% accuracy when provided gradually fading multimodal cues.
Narrowing of the trachea; postural modification; slow and controlled exhalation; abdominal breathing exercise
Tracheal Stenosis
Stems from a deficiency of the neurotransmitter dopamine in the brain tremor seen at rest; Symptoms involve slow movements (bradykinesia), rigidity (stiffness), and problems with walking/balance; L-dopa increases dopamine in the brain
Parkinsons Disease
Distortion of neurological impulses somewhere in the brain; Mechanics involve the deep nuclei and white matter of the brain, including the thalamus and striatum; Rhythmic trembling of hands, head, legs, voice, tongue, jaw, or trunk; Action tremor
Essential Tremor
Tongue-tie; lingual frenulum tethers the bottom of the tongue’s tip to the floor of the mouth
Ankyloglossia
(Infants) simple surgical procedure done to clip and add movement
Frenotomy
(Older children or adults) if frenulum is too thick for frenotomy
Frenuloplasty
Therapy that utilizes musical parts of speech (melody & rhythm) to improve expressive language by capitalizing on preserved function singing and engaging language capable regions in the undamaged right hemisphere.
MIT
Common communication impairments seen in MS patients include:
a. Difficulty with precision of articulation
b. Poor speech intelligibility
c. Reduced ease of conversational flow
d. Change in speaking rate, loudness, and voice quality.
What are the three types of dysarthria associated with MS:
Spastic, Ataxic, Mixed
A genetic disorder that causes developmental disabilities and neurological problems, such as difficulty speaking, balancing and walking and, in some cases, seizures; Chromosome 15
Angelman Syndrome
Is a condition that causes narrowing (stenosis) and enlargement (aneurysm) of the medium-sized arteries in your body
Fibromuscular dysplasia (FMD
Progression of this disease is fast, with most individuals dying from respiratory failure within 3-5 years following onset of symptoms. However, a small percentage of patients survive for 10 or more years
ALS
It is possible that Hawking has ALS from some cause that tends to stop progressing at some point (although he has functionally progressed due to aging, it is unlikely that he has an active disease process killing more motor neurons). So he has survived much longer than the average ALS patient because he probably has it from a different underlying cause.
.
Is a neurological disorder throughout the brain that results in life-long impaired motor, memory, judgment, processing, and other cognitive skills? Also impacts the immune and central nervous systems. Each person has different abilities and weaknesses as dyspraxia often comes with a variety of comorbidities
Dyspraxia
Uncommon motor speech disorder in which child has difficulty making accurate movements when speaking; The brain does not plan for oral movement (lips, tongue, jaw) needed for speech; The child knows what he/she wants to say but cannot articulate to form the proper speech production
CAS
Rare brain malformation characterized by the absence or underdevelopment of the cerebellar vermis- part of the brain that controls balance and coordination, as well as a malformed brain stem.
Joubert Syndrome
Automatic speech tasks are accurate; Articulatory kinematic treatments: Improve the timing and placement of articulatory movements through modeling, positioning of articulators, and repetition.
Apraxia of Speech
What is LSVT stand for?
Lee Silverman Voice Treatment
What is LSVT uses for:
Primarily for people with Parkinson disease however can be used with other neurological disorders and children
increases loudness through cueing and intensive repetitions to increase automaticity ; People with Parkinson’s disease have decreased ability to sense and hear their own loudness.
LSVT
How does LSVT affect swallowing?
Improved Swallowing
LSVT loud increased neuromuscular control of upper aerodigestive tract, increased tongue base function during both oral and pharyngeal phases of the swallow
What are the Pros of LSVT?
Inexpensive, easy to administer, simple directions, not much equipment needed
What are the cons of LSVT?
timely to report, not always able to follow required session length, ENT evaluation, medication side effects, dementia
Form of NMES (neuromuscular electrical stimulation)
Vital Stim
Vital Stim is a modality to be used with _________ exercise.
traditional
The intended purpose of vital stim is to:
Reeducate the muscles and improve swallowing
How does Vital Stim work?
a. Electrodes are placed externally on anterior neck based on impairment. You want to align the electrodes with muscle fibers of the muscle group you are targeting. Device or stimulator sends a current from one electrode to another through tissue (through and past neurons) At a certain intensity an action potential is triggered
b. When the current reaches a motor point: motor neuron you will get a muscle contractions; sensory neuron will give a sensation or activation of a reflex
Who can benefit from vital stim?
a. Patients with motor or sensorimotor based oropharyngeal dysphagia
b. Any etiology other than mechanical causes require surgery
c. Any age
d. Need intact cranial nerves
What does IOPI stand for?
Iowa Oral Performance Instrument
What does the IOPI do?
Measures lingual strength and endurance and labial strength; good for evaluation and treatment; visual feedback provided during exercise
qWhat are the pros to using IOPI:
Easy Directions
Easy to Administer
Biofeedback
what are the cons to using IOPI:
Expensive
Not all patients understand directions
No research to prove it improves swallow function
LSVT can be used with which populations:
Resonance disorders, Phonation disorders, Voice Patients, Helps with Swallowing
How does LSVT help with swallowing:
You are improving respiratory drive and vocal fold adduction
You would not use LSVT with a cardiac patient why?
Fatigue
Always target what is affecting intelligibility first.
.
Resonance Disorders = reduced rate of speech; velar exercises usually don’t work have to do surgery
.
You have a patient that had a left CVA so they have _____ facial paresis. Write a goal:
Right
Patient will demonstrate increase ROM on the right side by performing oral-motor exercises with 70% accuracy with gradually fading multimodal cues.
You can use yawn-sigh technique with someone who has what type of voice______-
strange-strangled
“effortful closure techniques”, pushing and pulling procedures help the vocal folds adduct providing increase in muscle contractions in torso and neck.
Pushing & Pulling Procedures
Example of Pushing and Pulling Procedure
For ex: patient will push up on a chair while phonating an open vowel or pull up on a table while phonating a vowel
Holding deep breath of air requires the ability to fully adduct vocal fold, the tighter the adduction, the better the air is held in lungs. Inhale deeply and hold breath, using a small mirror to detect any nasal emissions
Holding Breath
Patient will hold a deep breath, “bear down”, and attempt to phonate an /a/. Tight phonation should be modified into a more normal vocal quality as soon as possible to avoid negative side effects of consistent hard glottal attacks during speech.
Hard Glottal Attack
Turn head to affected side or push larynx with hand from affected side when there is paralysis or weakness on one vocal fold. Weakened vocal fold will be brought closer to the stronger/opposite fold
Head Turning and Sideways Pressure on Larynx
Head rolling motion where clinician sits behind client and takes their head/neck in their hands and gently tilts it back, then forward, and left and right. Then you should move to Easy Onset
Head and Neck Relaxations
Patient should exhale while producing a small sigh and initiate an open vowel. Then shape these into words that begin with vowels or a breathy consonant. Ultimate goal is to have easy speech in conversation
Easy Onset
Patient is asked to inhale slowly while opening mouth like a yawn. When inhalation is complete, the patient begins to exhale while producing a sigh and this relaxes the neck muscles and reduce hypertension of the larynx. Then shape these into words that begin with vowels or a breathy consonant. Ultimate goal is to have easy speech in conversation
Yawn-Sigh Exercises
patient is given lists of words/sentences to read and clinician turns away as to only rely on the client’s production of word. If clinician is unable to determine what word it is, client is asked to determine why word is unclear and then retry. If at that point it is still misunderstood, the clinician will look at target word/sentence and explain why it was intelligible.
Intelligibility Drills
patient is instructed by the clinician of the correct position of the articulators before they attempt target sound. Educates patients on the placement of articulators for speech sounds, which is helpful for dysarthric patients who understand they are not producing the sound correctly, but don’t know why.
Phonetic Placement
known as “overarticulation” when patient is told to focus on producing each consonant fully, especially medial and final sounds.
Exaggerating Consonants
patient will concentrate on minimal pairs on consonants and vowels to increase intelligibility.
minimal contrast drills
clinician should use a gauze pad and stretch the client’s tongue forward, left, right for 10 seconds. These should increase accuracy, speech, and strength of tongue. Active patient should move tongue to nose, corners of mouth, chin, press tongue tip to the cheek
Tongue Stretching Exercises
: clinician should grasp one of the lips and carefully pull it out and away from face for 10 seconds. Active patient should make their own movements of smiles, pursing lips, puffing cheeks
Lip Stretching Exercises
Stretching exercises to lessen rigidity in jaw muscles. First patient holds jaw completely open with and without physical assistance from clinician. Then patient holds jaw lateralized first to the right then left.
Jaw Stretching Exercises
patient should perceive different pitch changes in clinician’s voice, and if they are unable to then their prosody prognosis is not good. If they are able to, patient should prolong /a/ at the highest and lowest pitch they can. Then ask patient to sing up and down the pitch range in 8 different notes. Lastly, the patient should read sentences with up and down arrows for pitch changes
Pitch Range Exercises
Prompts use lines to determine if the pitch is flat or drop/rise in pitch. Goal is to have patient take the pitch changes produced in structured activity and begin to use them in conversational speech
Intonation Profiles
Clinician asks a question and patient answers it by adding stress on key word to convey the intended meaning of the answer.
Contrastive Stress Drills
teaches patient to inhale at points in an utterance at which natural pauses occur such as clauses or phrases. With these pauses, individuals with spastic dysarthria are able to maintain a more natural rhythm in their speech
Chunking Utterances into Sytactic Units
Sets the pace of syllable production and has the patient say each syllable to each beat of the metronome. Although it may seem unnatural at first, it’ll allow the client to understand and identify an appropriate rate of speech
Reciting Syllables to a Metronome
Substituted for a metronome to pace syllable production
Finger or Hand Tapping
Clinician points to a word or syllable at the desired rate and asks patient to read material at that pace. Clinician uses slash marks to separate pauses in reading
Cued Reading material
pharyngeal flap, Teflon injection, palatal lift
Surgical/ Prosthetic
A nasal mask that sends air into the nasal cavity while patient speaks – causes resistance
CPAP
Slowly desensitizing the tongue and velum to a foreign object in the mouth. A reduction in velar hypertonicity is completed when tongue blade covered by a finger cot against velum and lastly the tongue blade should press up on the velum as if a palatal lift is in place
Decreasing Velar Hypertonicity
Pertinent for hypernasality, mirror is used to provide visual feedback to the patient regarding nasal escape of air
Visual Feedback
tends to mask the hypernasal quality in individuals. Louder speech also increases intelligibility. Model appropriate loudness and provide visual feedback through devices like sound pressure meter or Vocalite
Increasing Loudness
Small amplifier can be used for those who are breathy and soft.
Voice Amplifiers
Electric devices to provide auditory or visual feedback on pitch, loudness, and rate of speech.
Instrumental Biofeedback
effortful phonation program that is used for Parkinson’s to increase loudness and phonation
LSVT
Patient should inhale fully and then exhale in slow, steady stream. Use a stopwatch and time the length of exhalation. Ultimate goal is to increase length and steadiness of airflow over session.
Slow & Controlled Exhalation
It should be used to initiate phonation the moment they begin exhalation. Helps with coordination of respiratory and laryngeal muscles
Speak Immediately on Exhalation
Avoids speaking on residual air and prevents harsh vocal quality, decreased loudness, and increased rate of speech. Teach patient to end an utterance before they run out of breath.
Stop Phonation Early
teaches patient how many syllables or words can be said clearly on one full inhalation. Once baseline is determined, patient will work on increasing the length of breath group with deeper inhalations, more controlled exhalations, or beginning phonations immediately on exhalation
Optimal Breath Group
Intensive physical exercise for speech by increasing volume and teaching a healthy voice through increased complexity, intensity, and repetition of voice tasks
LSVT
Form of Neuromuscular Electrical Stimulation to reeducate muscles and improve swallowing by sending current from electrodes to the tissue used with traditional exercises, better with most severe dysphagia
Vital Stim
Tool that measures lingual and labial strength and endurance with bulb against hard palate
IOWA
