Motor speech Flashcards
Apraxia of speech
caused by injury/damage to speech/motor programming areas in the dominant hemisphere. It is a motor PLANNING disorder. c/b slower rate of speech, distorted speech sounds substitutions and additions, syllable segmentation, artic groping, false starts and restarts, prosodic impairments. Longer utterances worse than shorter.
assessment of AOS
case hx
interview pt and family
speech samples and transcribe samples phonetically
evoke imitative production of speech
repetitive production of syllables (papapa, tatata)
progressively longer utterance
oral reading/picture discriptions
diadochokinetic tests (pataka)
assess limb movement
administer standardized testing
Treatment of AOS
-target more difficult words to promote better generalization
-tx concerned with speech movements (not non speech exercises)
-repeated trials/drills
-slower rate with gradual increase in rate and prosody
-treat co-existing aphasia
-a specific tx approach (SPT-sound production treatment) which has emphasis on teaching artic of words with minimal contrast has been found effective
Dysarthria
group of neuro based motor speech disorders attributed to peripheral or central nervous system pathology, resulting in paralysis, weakness, or incoordination of muscles of speech.
ataxic dysarthria
results from cerebellar damage
individuals with ataxic dysarthria will most likely also have ataxic gait
artic:
imprecise conanants and distortionof vowels
irregular artic breakdowns
prosody:
excessive and even stress
slow rate of speech
phonation:
monopitch, monoloud, and harshness
resonanance:
may have intermittent hyponasality
respiration:
exageratted and paradoxical movements during speech production
ataxia is distinguishing sx
flaccid dysarthria
lower motor neuron lesion (weakness and hypotonia)
artic: imprecise consonants
phonation:breathy, audible inspiration, harshess, monopich, monoloudness, short phrases
resonance: hypernasality, nasal emissions, short phrases
repirations: reduces subglottal air pressure, weak inhallation
characterized by hypotonia (low muscle tone) and weakness
hyperkinetic dysarthria
basal ganglia damage with abnormal or excessive movements.
artic: imprecise consonants, distorted vowels
prosody: slow rate of speech, inappropriate silent periods, phonemic prolongations, excess/equal stress, reduced stress, short phrases
phonotion: monopitch, monoloudness
resonance: hypernasality
respiration: audible inspiration and forced sudden inspiration or expiration
distinguishing characteristics: abnormal rhythmic movements, myoclonus (jerks of body parts), tics, athetosis (writhing movements), dystonia (contractions/abnormal postures), tremor
hypokinetic dysarthria
basal ganglia damage with reduced range of motion, ridigity, and reduced movement.
artic: impresice/distorted consonants, stops sound more like fricatives, mushy fricatives
prosody: reduced stress, inappropriate silent intervals, short rushes of speech, variable increased rate in segments, short phrases
phonotion: monopitch, monoloud, low pitch, harsh and continuously breahty
resonance: mild hypernasality (25% of cases)
respiration: reduced vital capacity, irregular breathing, faster rate of respiration
fluency: repeated phonemes
tremors, masklike face, micrographia, walking disorders*
**if sx are present due to BG damage and NOT to PD, they are referred to as parkinsonian.
spastic dysarthria
upper motor neuron (bilaterally): weakness and spasticity
artic: imprecise consonants/distorted vowels
prosody: excess and equal stress, reduced stress, slow rate, short phrases
phonation: hyperadduction of vocal folds, continuous breathy voice, harshness, low pitch, pitch breaks, strained/strangled vocal quality, monoloud, monopitch
resonanance: hypernasality
spasticity and weakness* CP in children have this
mixed dysarthria
damage to various parts of nervous system. combo of two or more pure dysarthrias. all combos are possible.
mixed flaccid-spastic: ALS
mixed ataxic-spastic: MS
unilateral upper motor neuron dysarthria
upper motor neuron damage (unilateral): weakness and spasticity
artic: imprecise consonants, irregular artic breakdowns, some vowel distortions, sound/syllable repetitions
prosody: slow rate, increased rate in segments, excess and equal stress, short phrases
phonation: harshess, strain, reduced loudness, wet hoarseness, breathiness, monopitch, monoloudness, low pitch
resonance: hypernasality, nasal emission, combo of hypernasality and nasal emission
Differentiating between AOS and Dysarthria
Dysarthria: neuromuscular weakness/slowness, affects voluntary and involuntary utterances, errors are consistent, errors are predictable and consistent, abnormal strength, tone, and range of movement in oral and pharyngeal muscles, will have diff performing oth non-speech and speech motor tasks
aos: no muscle weakness, all motor speech planning. unimpaired error free automatic utterances, longer utterances have more errors, inconsistent errors, can complete non speech oral mech exam.
Treatment of Dysarthrias
goals include modifying respiratory, phonatory, articulatory, resonatory, and prosodic problems and increasing pt’s ability to communicate funcationlly.
intensive, systemic, and extensive trials (drills) with SLP shaping and modeling and cueing pt for correct productions.
direct tx of swallowing
direct tx is designed to reduce problems that are evident in different stages of swallowing (compensatory strategies)
Indirect treatment of swallowing
does not involve food. Exercises and skill straining, designed to improve muscle strength and are practiced.
