Motor Speech Flashcards
What is the difference between AOS and dysarthria
Dysarthria- motor execution
AOS- motor planning
What do the lower motor neurons do?
They are the final common pathway
Carry impulses to muscle fibres
Include cranial nerves for speech
Damage to LMN would result in flaccid weakness
What do upper motor neurons do?
Include corticospinal and corticobulbar tracts
Damage results in spasticity
What aspects are used to describe dysarthric speech
Physiological- are the muscles moving
Neurological - where is it damaged
Acoustic- what effect does it have on the sound signal?
Perceptual- how does it sound
Name the 5 types of dysarthria
Flaccid Spastic Ataxic Hypokinetic Hyperkinetic
Name some features of flaccid dysarthria
Weakness
Lower motor neurons affected
Phonatory incompetence (breathiness, soft voice)
Resonatory incompetence (hypernasality, imprecise consonants)
Phonatory prosodic insufficiency (harsh voice, monoloudness, monopitch)
Features of spastic dysarthria
- prosodic excess (excess stress, slow rate)
- articulatory resonatory incompetence (imprecise consonants, hypernasal)
- phonatory stenosis (strained, harsh, low voice)
- prosodic insufficiency (monopitch, monoloudness)
Features of ataxic dysarthria
Articulatory inaccuracy (imprecise articulation, irregular breakdowns)
Prosodic excess (excess stress, slow rate)
Phonatory prosodic insuffiency (monoloudness, monopitch, harsh voice)
Mainly occurs with degenerative diseases
Features of hypokinetic dysarthria
Prosodic insufficiency (monoloudness, monopitch, low volume, increased rate) Often in Parkinson’s disease
Features of hyperkinetic
Unpredictable involuntary movements
- respiration- sudden inspiration
- phonation- strained quality
- resonance - hypernasal
- Articulation- imprecise
- prosody- variable rate
What is unilateral UMN dysarthria
Occurs in single lesion strokes Lower facial and tongue weakness Imprecise consonants Harsh voice, slow rate Drooling from affected side
Features of AOS
Occurs with dominant hemisphere damage Distorted articulation Slow effortful speech Groping Difficulty initiating
What features do you look for when completing an observation of a dysarthric client
Speech mechanisms (speed, range of movement, symmetry, tone, precision) Assess - respiration -phonation - articulation - resonance
How do you assess respiration
Posture normal? Sufficient breath support? Adequate loudness? Assess maximum exhalation of /s/ Alternating loudness on /s/
How do you assess phonation
Pitch level appropriate?
Voice quality normal?
Maximum phonation on /a/
Alternating pitch on /a/
How do you assess resonance
Is nasality normal?
Is there nasal emission?
Observe for symmetrical palatial elevation
Assessing articulation
Are consonants and vowels precise
Length of phoneme normal?
Irregular articulatory breakdowns?
How do you assess mvmt of oral structures
Frenchay
Observe lips, jaw, face, tongue
Diadochokinetic (DDK) rates
- /p/ /t/ /k/ as fast possible (altering rates of motion)
- /p-t-k/ as fast as possible (sequential rates of motion)
Name a scale used to rate severity of speech
Frenchay- 9point scale
Dysarthria profile- 5 point scale
Name some assessment tasks for AOS
Spontaneous vs repetition Automatic vs propositional (automatic better) AMR vs SMR (AMR better) Length complexity
What instrument measures muscle contraction.
Electromyography
What can be used to visualise oral structures
Ultrasounds/ videofluoroscopys
How do you measure respiratory volume
Spirometry
What records mvmt of articulators during speech
Electromagnetic articulograph
What is the difference between intelligibility and comprehensibility
Intelligibility- understanding acoustic signal
Comprehensibility - the same plus other information (eg gesture) that may contribute to understanding
How can you assess and quantify intelligibility
Visual analogue scale
% correct item identification by listener
ASSIDS ( identify word from set of options)
Transcription by listener
Frenchay intelligibility section
How can you assess a clients functional communication
Interview
Dysarthria impact profile
Communicative effectiveness survey (4 point scale)
What is the purpose of management of motor speech
Maximise-
Effectiveness of communication
Efficiency of communication
Naturalness of communication
What are the different approaches to management for motor speech
Medical Prosthetic AAC Counselling Behavioural
What are the two aspects to medical management of motor speech
Pharmacological - (medication eg in Parkinson’s, Botox injections)
Surgical -( thyroplasty for VF paralysis, deep brain stimulation but can worsen dysarthria)
Name some examples of prosthetic management
Palatal lift prosthesis
Voice amplifier
Pacing board
Delayed auditory feedback
What is considered in candidacy for AAC
Access (do they also have a physical impairment) Cognitive ability (attention, memory) Motivation Carer support Funding
What does the speaker oriented approach aim to do
Reduce impairment
Compensate for impairment
Management strategies for respiration
Direct- exhalation tasks, vowel prolongation, blowing into bottles
Compensation- postural adjustment, abdominal breathing, phrasing
Management strategies for phonation
Direct- lee Silverman voice treatment
16 sessions/ 4 weeks, starting with /a/ working to connected speech, works on perception of loudness
Management for resonance
Duffy 2013- non speech tasks eg blowing don’t help
Changing rate, overarticulation may help
Management for articulation
Integral stimulation (watch and listen imitation) Phonetic placement Contrastive tasks (minimal pairs) Intelligibility drills (help from listener)
Over articulation (improve clarity) Reduce rate (Duffy 2013 easiest to achieve)
Management for prosody
Contrastive stress tasks
Phrasing
Loudness and pitch control
What activities could you do to help AOS
Drill and repetition therapies
What evidence is there for LSVT
Yorkston et al (2007) effective to increase intelligibility
What evidence is there for Botox injections
Duffy and Yorkston (2003) improvement for spasmodic dysphonia
Evidence for AOS therapy
Morgan et al (2018) positive outcome after 1 month with Nuffield and rapid syllable transition treatment
Staging of dysarthria
1- no detectable dysarthria 2- dysarthria detectable 3- reduced intelligibility 4- need for speech supplementation 5- no useable speech
What type of dysarthria is most common in Parkinson’s
Hypokinetic
What type of dysarthria is most common in Huntington’s disease
Hyperkinetic (affects basal ganglia)
