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Motor Speech Disorders > Motor 2 - Aphasia, Flaccid, Spastic, and UUMN Dysarthria > Flashcards

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

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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

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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

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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

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5
Q

affricates

A

Two-phase: stop followed by brief fricative, and production is represented by a combination of two symbols

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6
Q

obstruents

A

stops, fricatives, affricates (there’s an obstruction)

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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

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8
Q

glides

A

the gradual movement of articulators, is sometimes called “semi-vowels” because of its similarity to vowels

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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

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10
Q

/b/

A

voiced bilabial stop
lowercase b

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11
Q

/p/

A

voiceless bilabial stop
lowercase p

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12
Q

/d/

A

voiced alveolar stop
lowercase d

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13
Q

/t/

A

voiceless alveolar stop
lowercase t

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14
Q

/k/

A

voiceless velar stop
lowercase k

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15
Q

/g/

A

voiced velar stop
lowercase g

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16
Q

/m/

A

(voiced) bilabial nasal
lowercase m

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17
Q

/n/

A

(voiced) alveolar nasal
lowercase n

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18
Q

/ŋ/

A

(voiced) velar nasal
“eng” or “engma”

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19
Q

/v/

A

voiced labio-dental fricative
lowercase v

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20
Q

/f/

A

voiceless labio-dental fricative
lowercase f

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21
Q

/ð/

A

voiced interdental fricative
“eth+”

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22
Q

/θ/

A

voiceless interdental fricative
“theta”

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23
Q

/z/

A

voiced alveolar fricative
lowercase z

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24
Q

/s/

A

voiceless alveolar fricative
lowercase s

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25
Q

/ʒ/

A

voiced palatal fricative
“ezh” or “long z” or “tailed z”

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26
Q

/ʃ/

A

voiceless palatal fricative
“esh” or “long s”

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27
Q

/h/

A

voiceless glottal fricative
lowercase h

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28
Q

/j/

A

palatal approximant
lowercase j

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29
Q

/w/

A

labial-velar approximant
lowercase w

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30
Q

/r/

A

rhotic liquid or retroflex approximant
lowercase r

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31
Q

/l/

A

lateral liquid or lateral approximant
lowercase l

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32
Q

What is relatively unaffected in AOS?

A

Reflexive and automatic speech are relatively unaffected

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33
Q

Ideomotor apraxia

A

type of apraxia where the client has the idea of what to do but they need help with the planning

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34
Q

Ideational apraxia

A

type of apraxia where the client forgets what to do with the object/item/task

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35
Q

Limb apraxia

A

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

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36
Q

Nonverbal Oral Apraxia

A

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

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37
Q

AOS definition

A

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

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38
Q

Etiologies of AOS

A

Stroke - 58%
Degenerative diseases - 16%
TBI - 15% (usually surgical trauma)

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39
Q

Speech characteristics of AOS

A

Primarily articulation and prosody
Speech is labored and halting
Articulatory groping
Inconsistent errors
May be nearly mute in severe cases

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40
Q

Anticipatory

A

Back of the word to front coarticulation - “lelo” for yellow

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41
Q

Perseverative

A

Bababa for banana

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42
Q

Metathetic

A

Two consonants are transposed - e.g. hitsory for history

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43
Q

Articulation errors - stay away from (AOS)

A

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

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44
Q

Prosody (AOS)

A

Slow speech rate (hesitations, prolonged phonemes), equal syllable stress, silent pauses before or between syllables, reduced pitch and loudness variability

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45
Q

Evaluation of AOS: specific tasks

A
  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)
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46
Q

MIT Candidates

A
  1. Left CVA
  2. Restricted verbal output
  3. Good auditory comprehension
  4. Poor articulation
  5. Poor repetition abilities
  6. Good motivation and attention span
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47
Q

MIT steps

A

Phase 1 - unison with fading
Phase 2 - delay of 6 secs
Phase 3 - introduce Sprechgesang

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48
Q

Darley, Aronson & Brown

A

Initiating speech activities, using automatic responses, phonemic drill

49
Q

Initiating speech activities

A

begin with /ɑ/ vowel using cough or sigh, then train /m/ and put into syllables

50
Q

What are the easiest places of articulation

A

labial and lingualveolar

51
Q

Standardized test used to assess AOS

A

ABA (apraxia battery for adults)

52
Q

AOS evaluation tasks

A

word and sentence repetition, counting 1-20, counting backward 20-1, picture description

53
Q

treatment of AOS is primarily behavioral. T/F

A

True

54
Q

AOS treatment session

A

time intensive, repetitive, highly structured

55
Q

Automatic responses examples

A

counting, days of the week, nursery rhymes, prayers, songs

56
Q

phonemic drill steps

A
  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
Q

UMN or LMN: descending motor fibers in the CNS?

A

UMN

58
Q

UMN or LMN: Which synapses with motor neurons in the PNS?

A

UMN

59
Q

UMN or LMN: Which is motor fibers in the CNS?

A

UMN

60
Q

UMN or LMN: Motor fibers in the PNS?

A

LMN

61
Q

What is the cranial nerve nuclei?

A

The point at which CNs attach to the brainstem

62
Q

What is the movement chain?

A

UMN > CN nuclei > LMN > muscles

63
Q

What are the motor neurons in the PNS called?

A

Final common pathway

64
Q

What is the term for reduced strength due to reduced mass/bulk?

A

atrophy

65
Q

T/F: Flaccid and spastic muscles are considered weak?

A

True

66
Q

What are the etiologies of Flaccid dysarthria?

A

Physical trauma (surgery, TBI), brainstem stroke, Myasthenia Gravis, tumors, Moebius Syndrome, Bell’s Palsy

67
Q

A stroke in what location is the only place that can cause flaccidity?

A

Near the CN nuclei

68
Q

Myasthenia Gravis characteristics; etiologies

A

affects neuromuscular junction, rapid fatigue of muscle contractions, improvement after rest (allow for ACH receptors to unclog); tumors

69
Q

Moebius Syndrome etiology characteristics

A

CN VII absence or underdevelopment, swallowing issues, open mouth posture, the “smile operation” surgery

70
Q

What are the resonance characteristics associated with Flaccid dysarthria?

A

hypernasality (vowels), nasal emissions (consonants), weak pressure consonants, shortened phrases

71
Q

What are the articulatory characteristics associated with Flaccid dysarthria?

A

imprecise consonants, unintelligible to mildly intelligible

72
Q

What are the phonation characteristics associated with Flaccid dysarthria?

A

breathiness (continuous), mono-pitch, monoloudness, inhalatory stridor, harsh quality

73
Q

What are the respiration characteristics associated with Flaccid dysarthria

A

reduced loudness, monopitch, monoloudness, harsh voice quality, shortened phrase length

74
Q

What are the prosody characteristics associated with Flaccid dysarthria

A

mono pitch, mono loudness

75
Q

What are the 3 key evaluation tasks for Flaccid and Spastic dysarthria?

A
  1. Conversational speech and reading, 2. AMRs, 3. Vowel prolongation
76
Q

How could you treat damage to CN VII?

A

Lip muscle stengthening

77
Q

Damage to CN X leads to deficits in what and how can it be treated?

A

deficits in resonance; treatment to increase loudness with SPL or visipitch, reduce speech rate, exaggerated mouth opening

78
Q

Biofeedback is only successful IF the patient is anatomically and physiologically capable of:

A

achieving adequate VP closure

79
Q

What is used to replace or improve the appearance of teeth & orofacial structures?

A

Prosthetic devices

80
Q

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?

A

Palatal lift or speech bulb

81
Q

What is reduction therapy in prosthodontics

A

continually making the prosthetic structure smaller

82
Q

What is a technique for hypernasality?

A

tactile-kinesthetic training (raise/lower velum during vowels, tongue blade to raise velum), lower back of the tongue (think yawn)

83
Q

What is a technique for nasal emission?

A

visual feedback - see scape, air paddle

84
Q

What does the cul-de-sac technique involve?

A

occluding nose during pressure consonants to feel air out of the mouth

85
Q

What drills are used when damage to CN X causes prosody deficits?

A

lexical stress drills, sentence stress drills

86
Q

What is used when there is damage to CN XII?

A

tongue strengthening, articulation treatment

87
Q

Treatment for respiration weakness in flaccid dysarthria

A

Cueing for complete inhalation, Speaking immediately on exhalation, Starting with a vowel in isolation, and Adding final consonants for a word

88
Q

UMN damage >

A

spasticity

89
Q

Unilateral UMN damage >

A

UUMN dysarthria

90
Q

Bilateral UMN damage >

A

spastic dysarthria

91
Q

LMN damage >

A

flaccidity, flaccid dysarthria

92
Q

What is the direct activation pathway?

A

the pyramidal system

93
Q

What tract serves speech muscles?

A

corticobulbar

94
Q

Bilateral damage of the pyramidal system =

A

weakness and slowness of speech muscles on both sides

95
Q

Where do fibers originate in the extrapyramidal system?

A

cortex and brainstem

96
Q

What is the indirect activation pathway?

A

the extrapyramidal system

97
Q

Signs of UMN lesions

A

weakness, slow movements, spasticity, hyperreflexia, and spastic paralysis

98
Q

Etiologies of spastic dysarthria

A

stroke, TBI, tumors, cerebral anoxia, meningitis

99
Q

What are the phonation characteristics associated with spastic dysarthria

A

harsh voice quality, strained-strangled, low pitch, hypernasality

100
Q

What are the articulation characteristics associated with spastic dysarthria

A

Imprecise consonants, incomplete articulatory contacts, incomplete clusters, vowel distortions

101
Q

What are the prosody characteristics of spastic dysarthria?

A

monopitch, monoloudness, short phrases, slow speech rate

102
Q

A Positive Babinski sign (the big toe juts out and other toes fan out) is a sign of what?

A

UMN damage

103
Q

What are treatments for phonatory deficits in Spastic dysarthria?

A

Easy-onset, yawn sigh

104
Q

What does Traditional Articulation Treatment for Spastic Dysarthria consist of?

A

Intelligibility drills, phonetic placement, overarticulation of consonants, minimal contrast drills

105
Q

What is the treatment for resonance deficits in Spactic dysarthria?

A

increase loudness

106
Q

Where does unilateral upper motor damage mainly affect?

A

muscles of the contralateral lower face and tongue (NOT jaw)

107
Q

What are the etiologies of upper motor neuron damage of the left hemisphere?

A

aphasia and AOS

108
Q

What are the etiologies of upper motor neuron damage of the right hemisphere?

A

RHS - right hemisphere syndrome

109
Q

What is the most common cause of UUMN?

A

Stroke (91%)

110
Q

What are the articulation characteristics of UUMN damage?

A

imprecise consonants, weakness, reduced ROM, decreased fine motor control of tongue & lips

111
Q

What are the prosody characteristics of UUMN?

A

Slow speech rate (reduced speed of articulators, reduced ROM, weakness)

112
Q

What are additional characteristics of spastic Dysarthria?

A

Drooling, a positive Babinski sign (bilaterally), pseudo bulbar effect (emotionally labile)

113
Q

What are additional characteristics of UUMN Dysarthria?

A

Drooling on one side of the mouth, a positive Babinski sign (contralateral to lesion), pseudo bulbar effect (emotionally labile)

114
Q

What are the 3 key evaluation tasks for UUMN dysarthria?

A
  1. Conversational speech and reading, 2. AMRs, 3. Prolonged vowels (4. medical records to look at SOL)
115
Q

What does Traditional Articulation Treatment for UUMN target?

A

Phonetic placement, overarticulation of consonants, minimal contrast drills

116
Q

Rosenbek’s 8-step continuum

A
  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
Q

Sound production treatment

A
  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
Q

groping

A

trial and error searching behaviors

Motor Speech Disorders (2 decks)

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