Motor 2 - Aphasia, Flaccid, Spastic, and UUMN Dysarthria Flashcards
1
Q
What part of speech is: produced w/ a relatively open vocal tract?
A
Vowels
2
Q
stops
A
Formed by completely occluding vocal tract at some point between the vocal tract and lips, and may be followed by a burst of air called stop release
3
Q
nasal
A
occlusion of vocal tract in same way as stops BUT VP port is open and sound goes through the nasal cavity
4
Q
fricatives
A
Air forced through narrow constriction, vocal tract narrowed at some point, produces sustained “frication”, Noisy, hissing quality, and paired w/ stops as obstruents
5
Q
affricates
A
Two-phase: stop followed by brief fricative, and production is represented by a combination of two symbols
6
Q
obstruents
A
stops, fricatives, affricates (there’s an obstruction)
7
Q
glides and liquids
A
Also called approximants, articulators not close enough to produce a stop or fricative, grouped w/ nasals as sonorants, and pronounced “resonant” quality
8
Q
glides
A
the gradual movement of articulators, is sometimes called “semi-vowels” because of its similarity to vowels
9
Q
liquids
A
Faster articulatory movement than glides, and is sometimes produced w/ a “retroflex” place of artic., tongue tip curled behind alveolar ridge
10
Q
/b/
A
voiced bilabial stop
lowercase b
11
Q
/p/
A
voiceless bilabial stop
lowercase p
12
Q
/d/
A
voiced alveolar stop
lowercase d
13
Q
/t/
A
voiceless alveolar stop
lowercase t
14
Q
/k/
A
voiceless velar stop
lowercase k
15
Q
/g/
A
voiced velar stop
lowercase g
16
Q
/m/
A
(voiced) bilabial nasal
lowercase m
17
Q
/n/
A
(voiced) alveolar nasal
lowercase n
18
Q
/ŋ/
A
(voiced) velar nasal
“eng” or “engma”
19
Q
/v/
A
voiced labio-dental fricative
lowercase v
20
Q
/f/
A
voiceless labio-dental fricative
lowercase f
21
Q
/ð/
A
voiced interdental fricative
“eth+”
22
Q
/θ/
A
voiceless interdental fricative
“theta”
23
Q
/z/
A
voiced alveolar fricative
lowercase z
24
Q
/s/
A
voiceless alveolar fricative
lowercase s
25
/ʒ/
voiced palatal fricative
"ezh" or "long z" or "tailed z"
26
/ʃ/
voiceless palatal fricative
"esh" or "long s"
27
/h/
voiceless glottal fricative
lowercase h
28
/j/
palatal approximant
lowercase j
29
/w/
labial-velar approximant
lowercase w
30
/r/
rhotic liquid or retroflex approximant
lowercase r
31
/l/
lateral liquid or lateral approximant
lowercase l
32
What is relatively unaffected in AOS?
Reflexive and automatic speech are relatively unaffected
33
Ideomotor apraxia
type of apraxia where the client has the idea of what to do but they need help with the planning
34
Ideational apraxia
type of apraxia where the client forgets what to do with the object/item/task
35
Limb apraxia
type of apraxia characterized by the inability to sequence movements of limbs during a voluntary action; issues with brushing teeth, writing a letter, combing hair
36
Nonverbal Oral Apraxia
Affects nonverbal, voluntary movements of tongue, lips, jaw, etc.; Groping, Hesitations, Incomplete or incorrect movements, Extra movements, Not usually seen in spontaneous or reflexive movements, Often co-occurs with AOS; issues with whistling, puffing cheeks
37
AOS definition
Inability to accurately sequence motor commands needed to correctly position the articulators during voluntary production of phonemes; often occurs with (Broca’s) aphasia and/or dysarthria (UUMN); SOL is left frontal lobe, perisylvian region
38
Etiologies of AOS
Stroke - 58%
Degenerative diseases - 16%
TBI - 15% (usually surgical trauma)
39
Speech characteristics of AOS
Primarily articulation and prosody
Speech is labored and halting
Articulatory groping
Inconsistent errors
May be nearly mute in severe cases
40
Anticipatory
Back of the word to front coarticulation - “lelo” for yellow
41
Perseverative
Bababa for banana
42
Metathetic
Two consonants are transposed - e.g. hitsory for history
43
Articulation errors - stay away from (AOS)
Stay away from clusters; fricatives and affricates are difficult; errors are common in initial position; low-frequency and nonsense words are more difficult; the more of a distance in oral cavity the harder it is
44
Prosody (AOS)
Slow speech rate (hesitations, prolonged phonemes), equal syllable stress, silent pauses before or between syllables, reduced pitch and loudness variability
45
Evaluation of AOS: specific tasks
1. Repetition of words & sentences
2. Count from 1 to 20
3. Count backward from 20 to 1
4. Picture description (cookie theft from BDAE)
46
MIT Candidates
1. Left CVA
2. Restricted verbal output
3. Good auditory comprehension
4. Poor articulation
5. Poor repetition abilities
6. Good motivation and attention span
47
MIT steps
Phase 1 - unison with fading
Phase 2 - delay of 6 secs
Phase 3 - introduce Sprechgesang
48
Darley, Aronson & Brown
Initiating speech activities, using automatic responses, phonemic drill
49
Initiating speech activities
begin with /ɑ/ vowel using cough or sigh, then train /m/ and put into syllables
50
What are the easiest places of articulation
labial and lingualveolar
51
Standardized test used to assess AOS
ABA (apraxia battery for adults)
52
AOS evaluation tasks
word and sentence repetition, counting 1-20, counting backward 20-1, picture description
53
treatment of AOS is primarily behavioral. T/F
True
54
AOS treatment session
time intensive, repetitive, highly structured
55
Automatic responses examples
counting, days of the week, nursery rhymes, prayers, songs
56
phonemic drill steps
1. choose phoneme
2. CV word
3. CV words reduplicated
4. CVC (target sound x2)
5. CVC (different final consonant)
6. two word phrases with target sound initial position
7. two word phrases with target sound final position
8. target sound in initial for 1st word and final for 2nd word
9. phrases with multisyllabic words
ex:
1. /m/
2. my, may, me, etc.
3. me-me, my-my
4. mom, mime, etc.
5. more, mine, men, etc.
6. my mom, more mail
7. come home, name him
8. my home
9. moment by moment
57
UMN or LMN: descending motor fibers in the CNS?
UMN
58
UMN or LMN: Which synapses with motor neurons in the PNS?
UMN
59
UMN or LMN: Which is motor fibers in the CNS?
UMN
60
UMN or LMN: Motor fibers in the PNS?
LMN
61
What is the cranial nerve nuclei?
The point at which CNs attach to the brainstem
62
What is the movement chain?
UMN > CN nuclei > LMN > muscles
63
What are the motor neurons in the PNS called?
Final common pathway
64
What is the term for reduced strength due to reduced mass/bulk?
atrophy
65
T/F: Flaccid and spastic muscles are considered weak?
True
66
What are the etiologies of Flaccid dysarthria?
Physical trauma (surgery, TBI), brainstem stroke, Myasthenia Gravis, tumors, Moebius Syndrome, Bell's Palsy
67
A stroke in what location is the only place that can cause flaccidity?
Near the CN nuclei
68
Myasthenia Gravis characteristics; etiologies
affects neuromuscular junction, rapid fatigue of muscle contractions, improvement after rest (allow for ACH receptors to unclog); tumors
69
Moebius Syndrome etiology characteristics
CN VII absence or underdevelopment, swallowing issues, open mouth posture, the "smile operation" surgery
70
What are the resonance characteristics associated with Flaccid dysarthria?
hypernasality (vowels), nasal emissions (consonants), weak pressure consonants, shortened phrases
71
What are the articulatory characteristics associated with Flaccid dysarthria?
imprecise consonants, unintelligible to mildly intelligible
72
What are the phonation characteristics associated with Flaccid dysarthria?
breathiness (continuous), mono-pitch, monoloudness, inhalatory stridor, harsh quality
73
What are the respiration characteristics associated with Flaccid dysarthria
reduced loudness, monopitch, monoloudness, harsh voice quality, shortened phrase length
74
What are the prosody characteristics associated with Flaccid dysarthria
mono pitch, mono loudness
75
What are the 3 key evaluation tasks for Flaccid and Spastic dysarthria?
1. Conversational speech and reading, 2. AMRs, 3. Vowel prolongation
76
How could you treat damage to CN VII?
Lip muscle stengthening
77
Damage to CN X leads to deficits in what and how can it be treated?
deficits in resonance; treatment to increase loudness with SPL or visipitch, reduce speech rate, exaggerated mouth opening
78
Biofeedback is only successful IF the patient is anatomically and physiologically capable of:
achieving adequate VP closure
79
What is used to replace or improve the appearance of teeth & orofacial structures?
Prosthetic devices
80
What prosthetic device can be used when a patient has: severe hypernasality, no deteriorating medical condition, adequate dentition, No hyperactive gag reflex or spasticity, Motivation to use/care for prosthetic, and the ability to see prosthodontist and SLP?
Palatal lift or speech bulb
81
What is reduction therapy in prosthodontics
continually making the prosthetic structure smaller
82
What is a technique for hypernasality?
tactile-kinesthetic training (raise/lower velum during vowels, tongue blade to raise velum), lower back of the tongue (think yawn)
83
What is a technique for nasal emission?
visual feedback - see scape, air paddle
84
What does the cul-de-sac technique involve?
occluding nose during pressure consonants to feel air out of the mouth
85
What drills are used when damage to CN X causes prosody deficits?
lexical stress drills, sentence stress drills
86
What is used when there is damage to CN XII?
tongue strengthening, articulation treatment
87
Treatment for respiration weakness in flaccid dysarthria
Cueing for complete inhalation, Speaking immediately on exhalation, Starting with a vowel in isolation, and Adding final consonants for a word
88
UMN damage >
spasticity
89
Unilateral UMN damage >
UUMN dysarthria
90
Bilateral UMN damage >
spastic dysarthria
91
LMN damage >
flaccidity, flaccid dysarthria
92
What is the direct activation pathway?
the pyramidal system
93
What tract serves speech muscles?
corticobulbar
94
Bilateral damage of the pyramidal system =
weakness and slowness of speech muscles on both sides
95
Where do fibers originate in the extrapyramidal system?
cortex and brainstem
96
What is the indirect activation pathway?
the extrapyramidal system
97
Signs of UMN lesions
weakness, slow movements, spasticity, hyperreflexia, and spastic paralysis
98
Etiologies of spastic dysarthria
stroke, TBI, tumors, cerebral anoxia, meningitis
99
What are the phonation characteristics associated with spastic dysarthria
harsh voice quality, strained-strangled, low pitch, hypernasality
100
What are the articulation characteristics associated with spastic dysarthria
Imprecise consonants, incomplete articulatory contacts, incomplete clusters, vowel distortions
101
What are the prosody characteristics of spastic dysarthria?
monopitch, monoloudness, short phrases, slow speech rate
102
A Positive Babinski sign (the big toe juts out and other toes fan out) is a sign of what?
UMN damage
103
What are treatments for phonatory deficits in Spastic dysarthria?
Easy-onset, yawn sigh
104
What does Traditional Articulation Treatment for Spastic Dysarthria consist of?
Intelligibility drills, phonetic placement, overarticulation of consonants, minimal contrast drills
105
What is the treatment for resonance deficits in Spactic dysarthria?
increase loudness
106
Where does unilateral upper motor damage mainly affect?
muscles of the contralateral lower face and tongue (NOT jaw)
107
What are the etiologies of upper motor neuron damage of the left hemisphere?
aphasia and AOS
108
What are the etiologies of upper motor neuron damage of the right hemisphere?
RHS - right hemisphere syndrome
109
What is the most common cause of UUMN?
Stroke (91%)
110
What are the articulation characteristics of UUMN damage?
imprecise consonants, weakness, reduced ROM, decreased fine motor control of tongue & lips
111
What are the prosody characteristics of UUMN?
Slow speech rate (reduced speed of articulators, reduced ROM, weakness)
112
What are additional characteristics of spastic Dysarthria?
Drooling, a positive Babinski sign (bilaterally), pseudo bulbar effect (emotionally labile)
113
What are additional characteristics of UUMN Dysarthria?
Drooling on one side of the mouth, a positive Babinski sign (contralateral to lesion), pseudo bulbar effect (emotionally labile)
114
What are the 3 key evaluation tasks for UUMN dysarthria?
1. Conversational speech and reading, 2. AMRs, 3. Prolonged vowels (4. medical records to look at SOL)
115
What does Traditional Articulation Treatment for UUMN target?
Phonetic placement, overarticulation of consonants, minimal contrast drills
116
Rosenbek's 8-step continuum
1. client and clinician say target word in unison
2. clinician silently mouths word, client says it aloud
3. client repeats word after clinician
4. client repeats word several times
5. client says word while looking at written stimulus
6. clinician present written stimulus, removes stimulus, client says word
7. client responds to probe questions (cue with cloze)
8. role play using target word
(Coffee example with Autumn)
117
Sound production treatment
1. Produce target word or phrase following verbal model
2. Repeat Step 1, but with a written cue
3. Produce target word w/ integral stim. (up to three attempts allowed)
4. Produce target word w / placement cues & modeling
5. Produce target sound in isolation w/ a model
6. Next item
ex:
1. “Mutt” following verbal model. If correct > next item
2. Like Step 1 but use large card with “M”. If correct > repeat “mutt” (step 1)
3. Produce "mutt" in unison. If correct > step 1
4. Produce "mutt" w/ placement cues & modeling, in unison. If correct > step 1
5. Produce /m/ in isolation w/ a model > step 1
6. Next item
118
groping
trial and error searching behaviors
