LECTURE #13 - neurogenic communication disorders 2 Flashcards
what is the most common dysarthria type ?
mixed dysarthria
what is mixed dysarthria ?
two or more pure dysarthria types
what are the causes of mixed dysarthria ?
- More diffuse damage than other dysarthrias
– Commonly associated with degenerative disorders (e.g., ALS, MS)
how many dysarthria types ?
6
what are the dysarthria types ?
- hyperkinetic
- hypokinetic
- spastic
- flaccid
- ataxic
- mixed
what is the two acquired speech disorders
dysarthria and aphasia
what is dysarthria ?
is a speech problem. It makes it hard to control the muscles needed for speaking, which can result in slurred or unclear speech. It’s caused by damage to the nerves or muscles that control speech.
what is aphasia ?
is a language problem. It affects your ability to understand or produce words, but the muscles used for speaking are fine. It’s usually caused by brain damage (most commonly from a stroke).
FILL IN THE BLANK
_______ affects what you say, while _________ affects how you say it.
aphasia affects what you say, while dysarthria affects how you say it
what is apraxia ?
Acquired neurological impairment in motor speech
planning and programming
what does apraxia lead to the inability of ?
Inability to voluntarily select and program skilled
motor movements for speech
TRUE OR FALSE
apraxia is related to weakness, slowness, paralysis
FALSE
Unrelated to weakness, slowness, paralysis
what term is used to describe a problem to plan and program (not muscle weakness) ?
apraxia
what are some speech characteristics of apraxia ?
- Groping attempts and great variability
- Repeated attempts to correct errors
- Complex, long words are difficult
how many purposes of assessment of dysarthria are there ?
5
what are the 5 purposes of assessment of dysarthria ?
– Determine if speech is abnormal
– Evaluate nature/severity of difficulties
– Determine cause of difficulties
– Determine need for intervention
– Identify directions for treatment
what does MSE stand for ?
motor speech exmaination
what is motor speech exmaination ?
is a key part of the assessment for dysarthria, focusing on how well the muscles and motor control systems involved in speech are functioning.
what is the goal of MSE ?
is to identify the specific type of dysarthria and the areas of speech production that are most affected
about how much % of the distribution of acquired motor speech disorders is apraxia ?
8%
in regards to the distribution of acquired motor speech disorders is majority apraxia or dysarthria ?
dysarthria
how many things do we look for in the assesment of dysarthria ; motor speech examination ?
5
what are the 5 things we look for during a motor speech examination ?
- Respiration
- Phonation
- Resonance
- Articulation
- Intelligibility
TRUE OR FALSE
during a MSE, only 1 factor at a time can be present?
FALSE
all 5 can be present
factor #1 : respiration
what is the respiration portion of MSE ?
– Observe posture and general appearance
– Observe rate of respiration
– Sustained phonation of
open vowels
– Measure respiratory
pressure/flow (manometer)
why is posture important in respiration ?
it gives breath support to produce speech (breath support)
when observing rate of respiration, what is a typical rate ?
12-20 breaths cycle per minute
what is a manometer ?
tube with fluid and measure how much breath support there is
factor #2 : phonation
what is the phonation portion of MSE ?
– Laryngeal mechanics
– Phonation time and voice quality
– Vocal flexibility and coordination
what is an example of something you may do to assess the laryngeal mechanics ?
ask to cough and grunt to see if larynx is working
what is an example of something you may do to assess the phonation time and voice quality of an individual ?
- ask them to perform the sound “aaaaaa” for a long time
- can they hold it ?
- how can they phonate in different contents
if you ask someone to cough or grunt and its quiet or you can hear them inhalling with difficulty… what will this show us ?
that their vocal folds are not fully properly apart like they are supposed to be
factor #3 : VP function and resonance
what is the phonation portion of MSE ?
– Velopharyngeal mechanics
* Visual assessment of resting palate
* Observe palate during repeated /ah/
– Resonance
* Perceptual evaluation of hypernasality and distorted consonants
what does VP stand for ?
velopharyngeal mechanics
what is resonance ?
is the quality of sound produced by the vocal cords as it travels through the throat, mouth, and nose. It affects how rich or nasal the voice sounds
where is the Velopharyngeal area located ?
is located at the back of the mouth and the upper part of the throat, specifically between the soft palate (velum) and the pharynx.
what does the velopharyngeal area control ?
the opening and closing of the passage between the nose and mouth, allowing air to flow either through the nose or mouth, which affects speech resonance and nasal sounds.
factor #4 : articulation
what is the articulation portion of MSE ?
– Articulatory mechanics (oral mech examination)
– Speech movements
* Syllable and phrase repetitions
* Puh-tuh-kuh
* Multisyllabic words
– Samples of speech in several contexts
what is the oral mech examination ?
looking at how articulators function
is it better to get more than one sample of speech or only one ?
better to perform more than one as people perform different in different contexts
factor #5 : intelligibility
what is the intelligibility portion of MSE ?
– Observation in multiple contexts
– Perceptual rating scales and measures
– e.g., Assessment of Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981)
* % Intelligibility
* Speech rate for sentences (words/minute)
* Intelligible words/minute
* Unintelligible words/minute
what does intelligibility mean in simplest terms ?
means how easily someone can understand what you are saying
what are 3 indirect activities and compensatory strategies for intervention for dysarthria ?
- sensory stimulation
- muscle strengthening
- posture and speaking position
explain “sensory stimulation” :
This involves using touch, sound, or other senses to help improve the control of muscles needed for speech. It’s sometimes debated whether it works well for everyone.
explain “muscle strengthening” :
This includes exercises to make the muscles used for breathing, voice production, speaking, and resonance (sound quality) stronger. Some experts are not sure how effective it is for speech issues.
explain “posture and speaking position” :
Changing how a person sits or stands can help improve speech. This may involve working with an occupational therapist or doctor to find the best position for clearer speaking.
which 1 out of 3 indirect activities and compensatory strategies for intervention for dysarthria are NOT contreversial ?
posture and speaking position
which of the three indirect activities and compensatory strategies for intervention for dysarthria “exercises to improve respiration, phonation, articulation and resonance” ?
muscle strengthening
which of the three indirect activities and compensatory strategies for intervention for dysarthria “increases motor control”. ?
sensory stimulation
what are some examples of direct interventions for dysarthria ?
- Rate reduction therapy
- Amplification devices
- Delayed auditory feedback device
- LSVT (lee silverman voice therapy)
what is rate reduction therapy ?
This involves teaching the person to speak more slowly. Speaking at a slower pace can make speech clearer and easier to understand.
what are amplification devices ?
These are devices, like microphones, that help make the person’s voice louder, which can be helpful if they have a weak or soft voice.
what are delayed auditory feedback devices ?
This device plays the person’s voice back to them with a slight delay. It helps them hear their speech and improve control, making it clearer.
what is the Lee Silverman Voice Therapy ?
This is a specialized therapy designed to help people with speech difficulties, especially those with Parkinson’s disease.
what does the Lee Silverman Voice Therapy focus on ?
It focuses on increasing the loudness of the voice by teaching the person to speak more loudly and clearly. The idea is that louder speech helps improve overall communication and voice strength.
what does changing the environment mean; as a form of intervention ?
This means making adjustments to the person’s surroundings to make it easier for them to communicate. For example, reducing background noise, improving lighting, or making sure the person has a quiet space to talk can help them be better understood.
what does LSVT stand for ?
Lee Silverman Voice Therapy
what is the intensive therapy for Parkinson speech ?
Lee Silverman Voice Therapy
what does the Lee Silverman Voice Therapy focus on ?
Focus on laryngeal adduction, increased vocal effort, and recalibration of intended intensity
what training is involved in changing the environment; as a form of intervention for dysarthria patients ?
- Training patient and caregivers to minimize environmental impact on speech intelligibility
- Train patient to monitor listeners’ comprehension
- Train listeners to advise when they don’t understand
in regards to intervention for dysarthria; what is its focus ?
Focus on improvement of speech clarity and
naturalness
TRUE OR FALSE
Type of intervention, course, and prognosis vary with dysarthria type
TRUE
what may some treatments for dysarthria include ?
– Indirect activities or compensatory strategies
– Direct interventions
– Changes to the environment
– Augmentative and Alternative Communication (AAC)
which indirect intervention of dysarthria include applying vibration to articulators to try to stimulate motor movement / brushing on weaker articulators to try and stimulate ?
sensory stimulation
which indirect intervention of dysarthria act as a “physio but for speech” ?
muscle strengthing
TRUE OR FALSE
better posture = better speech
TRUE
in regards to direct interventions, what do people prefer ?
am[lification devices
TRUE OR FALSE
parkinsons causes to talk less
TRUE
a focus on laryngeal adduction, increased vocal effort, and recalibration of intended intensity does what?
leads to a big improvement on quality and loudness
what are AAC devices ?
are tools that help people with speech or communication difficulties express themselves. These devices can range from simple picture boards to high-tech speech-generating devices that produce spoken words. AAC devices are used when a person can’t communicate effectively with speech alone, allowing them to use symbols, text, or voice output to communicate their needs, thoughts, and feelings.
what do AAC devices stand for ?
Augmentative and Alternative Communication
what are the 2 identifying characteristics of assessment for apraxia ?
(1) articulatory error patterns and (2) consistency of errors
define : “Articulatory error patterns” :
- substitution, distortion errors common
- ommiting sounds are less common
- looking for errors “are they consistent” ?
define : “Consistency of errors” :
- Phonemes are correct in one instance and incorrect at other times
- Related to variations in context
- Typically more consistent in natural settings
- usually inconsistent
- error in one context can be natirally conducted in another context
how many assessments of apraxia are there ?
5
what are the 5 assessments of apraxia ?
- Non-speech oral motor movements (stick out tongue and puff out cheeks)
- Non-speech movement sequences (kiss & smile movement)
- Repetition of syllables ““puh-tuh-kuh”)
- Repetition of words (give words & see where they break down)
- Repetition of phrases (give phrases for them to repeat and see where they break down)