Motor Speech Flashcards
Main features of apraxia (5)
- Difficulty transitioning between sounds (turning voice on and off)
- Issues with prosody
- Articulatory groping
- Difficulty with initiation
- Increased sound errors with increase in length
Apraxia of speech is due to a defecit in:
a) programming
b) planning
c) execution
d) all of the above
e) a and b only
d) a and c only
e) programming and planning
Main features of dysarthria
Abnormality in strength, speed, range, steadiness, and tone of movement required for speech
What is oral apraxia?
Difficulty planning volitional movement of oral structures for non-speech tasks
Ideomotor apraxia
Unable to follow commands or imitate gestures
Ideational apraxia
Able to do individual tasks but can’t plan out a longer sequence/action (e.g.
What is the most common cause of AOS?
Degenerative disease + stroke
If a person with AOS complained of chewing/swallowing difficulties, what should you do?
Assess for dysarthria
Protocol for AOS when it comes to potential aphasia
All AOS patients should be considered aphasic until comprehensive language ax has been completed because AOS frequently occurs with Broca’s
AOS is nearly always the result of abnormality in the _____ cerebral
hemisphere
Left (dominant)
T/F: Dysarthria is often associated with aphasia
False - AOS is very often associated wth aphasia but Dysarthria is NOT
Differential dx of dysarthria and AOS
Dysarthria vs AOS
- All speech systems vs. artic + prosody
- Consistent errors vs. inconsistent
- More distortions (makes speech easier) vs. more substitutions (making it harder)
- Weakness vs. no change in strength/tone
- Keeps rhythm of SMRs but reduced range/speed/force vs. trouble with the rhythm/sequence
Ataxic dysarthria and AOS SIMILARITIES
- Poor motor control/coordination
- Irregular artic errors
- Most prominent difficulties are with articulation and prosody
- Oral mec findings can be normal
Differential dx of ataxic dysarthria and AOS
- AMRs worse in ataxic while SMRs worse in AOS
- Don’t usually grope to correct vs. do
- Substitutions not as frequent in ataxic compared to AOS
- Dysarthria doesn’t improve with automaticity while AOS can
What are some tx goals for RESTORATION when confronted with MSDs?
- Increase maximum phonation time
- Strengthen muscles of exhalation
- Increase intelligibility
- Increase participation/comm. effectiveness
What are some tx goals for COMPENSATION when confronted with MSDs?
- Use extra effort to increase loudness
- Use palatal lift/nasal obturator
What are some tx goals for SUPPLEMENTATION when confronted with MSDs?
- Alphabet board to indicate first letter of word
- AAC device when natural speech profoundly affected
Flaccid dysarthrias come from an injury to the:
a) Upper Motor Neuron
b) Lower Motor Neuron
c) Both
B) Lower Motor Neuron
Why do bilateral UMN lesions cause spastic dysarthria?
UMN sends the signal to muscles to relax; when impaired, it’s not giving that signal and so ++ stretch reflex, ++tonicity
In spastic dysarthria, the bias of the muscle tone in the larynx is usually toward
a) hyperadduction
b) hypoadduction
a) hyperadduction
Perceptual voice/speech characteristics of spastic dysarthria
- Slow, deliberate pace
- Equal + excess stress; monotone
- Strained/strangled vocal quality
- Hypernasal
- Imprecise artic (sluggish tongue mvmt)
What does a person with PD having mixed spastic-ataxic dysarthria indicate?
Either they don’t have PD or they have something else going on as well because PD shouldn’t be associated with ataxia
What kinds of dysarthrias could we expect from ALS?
++ Flaccid
++ Spastic
(often mixed of the two)
What kinds of dysarthrias could we expect from MS?
+ Flaccid (sometimes present but not nec. typical)
++ Spastic
++ Ataxic
+ Hypokinetic
+ Hyperkinetic
+ UUMN
What is Sound Production Treatment used for? What is it?
Apraxia of Speech
https://www.youtube.com/watch?v=DdA1_PADaHw
- Target sound/word/minimal pair/phrase; model and ask for repetition
- Written letter + reminder; repeat 1
- Watch me, listen to me, and then say it with me w/ max number of attempts
- Provide specific placement cues
- Reduce step (e.g. sound instead of word)
- If wrong, move on to next target
Ataxic dysarthria is caused by damage to the ____ system
Cerebellar
Which type of dysarthria is described as giving the impression of “druken speech”?
Ataxic dysarthria
Which type of dysarthria is associated with festination of gait?
Hypokinetic (trait of Parkinson’s)
Which is the only type of dysarthria where a fast rate of speech can be observed?
Hypokinetic
T/F: pushing, pulling, and other effortful closure techniques to enhance vocal fold adduction are usually beneficial for spastic dysarthria
False - hyperadduction is generally already a problem for someone with spastic dysarthria
Vigorous nonspeech exercise is generally contraindicated in _______.
Rapidly degenerative disease and
myasthenia gravis.
Traditional approaches to articulation therapy with dysarthria + apraxia pts
- Integral stimulation
- Phonetic placement cues
- Phonetic derivation
- Exaggeration
- Minimal pairs/contrastive drills
- Referential tasks
What types of dysarthria would be contraindicated for a hand tapping to control rate?
Hypokinetic PD patients –> accelerate the rate
Ataxic –> most likely too uncoordinated
T/F: Working on prosody can have beneficial effects on rate control
True
Spasticity is associated with a lesion to what site, probably?
UMN
A strained/strangled vocal quality is associated with what lesion site? What cranial nerve?
UMN
Vagus nerve
Variable range is associated with what dysarthrias?
Ataxic
Hyperkinetic
Reduced range of movement associated with what dysarthrias?
Flaccid
Spastic
Hypokinetic
Increased rate is associated with what dysarthria?
Hypokinetic
Tongue fasciculations, slow and slurred DDKs and a breathy vocal quality are all signs of what type of dysarthria?
Flaccid
True/False: Those who can easily imitate productions have a better prognosis
True
T/F: In patients with progressive dysarthria, listeners’ perceptions are more accurate than the patients’
True - not as sensitive to early changes; able to offer more accurate ax of communication effectiveness
Patient has:
- Reduced palatal movement
- Reduced pharyngeal wall movement
- Incomplete glottal closure
Signs of what dysarthria?
Flaccid
Patient has:
- Reduced lip and jaw amplitude
- Lip rigidity
- Bowed vocal folds
Signs of what dysarthria?
Hypokinetic
Patient has:
- Reduced inhalatory/exhalatory volume
- Slow velopharyngeal movement
- Reduced tongue strength
- Incomplete lingual artic. contact
Signs of what dysarthria?
Spastic
T/F: The UMN is contained within the CNS?
True
Individual client factors that may influence compensatory strategies
o Presence + severity of co-occurring conditions
o Presence + severity of motor impairment
o Awareness of communication limitations
o Capacity to repair breakdowns
o Patient and care partner preference (capacity for support)
Populations with weak respiratory support
Flaccid dysarthria
Hypokinetic dysarthria
Children with spastic CP
Which dysarthria is associated with Pseudobulbar Palsy?
Spastic
Lombard effect
involuntary tendency to increase vocal effort when speaking in loud noise
Why should we not assume that reduced air pressure in dysarthria is caused by respiratory weakness/incoordination?
Could be caused by
- Velopharyngeal mechanism
- Impairment in larynx
- Insufficient articulatory closure
Why does sustained vowel not reflect breath support?
- Pts inhale a greater amount
- Reflects max lung capacity
- Does not represent demands of speaking for 4-5 seconds at a conversational loudness and quality
Lack of vocal flexibility (pitch variation) seen in what dysarthria?
Generally associated with hypokinetic (PD) but can be found in all types
Dysarthrias associated with LMN lesion?
Flaccid dysarthria
