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1 CETP > Motor Speech > Flashcards

Motor Speech Flashcards

1
Q

the term motor speech disorders includes which more specific diagnoses
(2)

A
  • dysarthrias (affects neuromuscular execution/control)
  • verbal apraxia (affects motor programming - no weakness/slowness/discoordination of speech musculature when used for reflexes/automatisms)
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2
Q

systems of speech that can be affected by dysarthrias

5

A
  • respiration
  • phonation
  • articulation
  • prosody
  • resonance
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3
Q

neuromuscular caracteristics of speech

6

A
  • rate
  • strength
  • range of motion
  • rhythm/steadiness (tremors/involuntary movements)
  • precision
  • tone
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4
Q

3 general types of apraxia (and 2 subtypes)

A
  • verbal apraxia
  • oral apraxia
  • limb apraxia (ideomotor and ideational)
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5
Q

which motor speech disorder affects motor planning? neuromuscular execution/control?

A

motor planning?
- apraxia

neuromuscular execution/control?
- dysarthrias

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6
Q

which 2 main motor systems are the ones affected by verbal apraxia?

A
  • articulation

- prosody

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7
Q

difference between 2 types of limb apraxia (ideomotor and ideational)

A

Ideomotor
- cannot execute motor commands on request/imitation, but able to execute spontaneously

Ideational

  • unable to plan complex act of series of movements.
  • can do individual movements, but cannot sequence them.
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8
Q

3 methods to assess motor speech disorders

A
  • perceptual
  • acoustic
  • physiological
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9
Q

of the 3 methods to assess motor speech disorders (perceptual, acoustic, physiological), which provides the DAB dysarthria classification

A

perceptual (Darley, Aronson, Brown classification)

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10
Q

what component of speech do tremors affect the most?

A

phonation

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11
Q

how do variations in tonus affect spasticity? rigidity? hyperkinesia? hypotonus?

A

spasticity: excessive tone (clasp-knife - increased resistance at start of movement)
rigidity: excessive tone with intermittent variations (cogwheel - lead pipe phenomenon (entire movement is rigid))
hyperkinesia: irregular variable tone
hypotonus: reduced tone

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12
Q

main steps of motor speech assessment

4

A
  • case history
  • oral motor exam
  • perceptual assessment
  • intelligibility assessment
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13
Q

during an oral mech exam, observations are made in which 4 task contexts

A
  • at rest
  • in movement
  • held positions
  • reflexes
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14
Q

what does presence of a pathologic reflex indicate? absence of a normal reflex?

A

presence of a pathologic reflex - central nervous system lesion (UMN)

absence of a normal reflex
- peripheral nervous system lesion (LMN)

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15
Q

perceptual indications of respiratory impacts of MSD

7

A
  • inhale speed (slow or fast)
  • reduced utterance length (lack of respiratory control or support)
  • speaking on residual air
  • compensatory movements (i.e. raising shoulders)
  • inability to maintain phonation (lack of control of expiration)
  • reduced maximum phonation time
  • reduced intensity of phonation
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16
Q

perceptual indications of phonation impacts of MSD

A

(assess in speech and with /a/)

  • voice quality
  • tonality
  • tonality changes
  • phonation stability (tremors; phonation breaks)
  • intensity (loudness outbursts; reduced intensity)
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17
Q

how to differentiate between phonatory and respiratory deficits

A

glottal stop vs cough

if cough is weak but glottal stop is strong, suggests respiratory weakness
(since glottal coup does not require respiratory effort)

if both glottal coup and cough are weak, could be either laryngeal or respiratory weakness

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18
Q

how to use speech AMRs/SMRs to differentiate between apraxia/dysarthria

A

apraxia - difficulty with maintaining the sequence

dysarthria - no difficulty with sequence, but signs of their particular dysarthria

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19
Q

names of the 7 main types of dysarthrias

A
  • flaccid
  • spastic
  • hypokinetic
  • hyperkinetic
  • ataxic
  • mixed
  • unilateral upper motor neuron
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20
Q

distinctive motor features of flaccid dysarthria

1 + 4

A
  • LMN lesion

weakness; reduced tone; atrophy; fasciculations

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21
Q

distinctive motor features of spastic dysarthria

1 + 4

A
  • bilateral UMN lesion

weakness; spasticity; reduced ROM; slowed movements + pseudobulbar signs

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22
Q

distinctive motor features of unilateral upper motor neuron dysarthria
1 + 3

A
  • unilateral UMN lesion of low face (VII) and tongue (XII)

(weakness; spasticity; reduced ROM - controlateral of lesion

23
Q

distinctive motor features of ataxic dysarthria

1 + 4

A
  • cerebellar control circuit dysfunction

imprecision; slowing; dysmetric/decomposed movements; terminal tremor

24
Q

distinctive motor features of hypokinetic dysarthria

1 + 5

A
  • extrapyramidal system lesion (dopamine system - substantia nigra)
    (rigidity AND spasticity; reduced ROM; festination; resting tremor; palilalia)
25
Q

distinctive motor features of hyperkinetic dysarthria

1 + 3

A
  • extrapyramidal system lesion (basal ganglia)

abnormal/unpredictable movements - can be regular/irregular or fast/slow

26
Q

which two Dx are most frequent examples of mixed dysarthria

A
  • ALS (spastic-flaccid)

- MS (most often spastic-ataxic)

27
Q

3 goals of intervention in motor speech disorder intervention

A
  • restore
  • compensate
  • adjust
    (RCA)
28
Q

interventions to improve respiration in MSD

4 categories

A
  • improve respiratory support (MPT; ESMT; constant pressure w manometer; optimal respiratory group; control expiration)
  • postural adjustments
  • respiratory protheses
  • behavioral compensation
29
Q

interventions to improve resonance in MSD

3 categories

A
  • surgery (pharyngeal flap – injection)
  • prosthesis (palatal lift)
  • behavioral Tx
30
Q

interventions to improve phonation in MSD

3 categories

A

medical approach (laryngoplastie ; injection ; resection of recurrent laryngeal nerve ; botox)

prosthetic approach (portable amplification system ; artificial larynx ; neck collar)

behavioral approach (LSVT ; push-pull `voice quality modification)

31
Q

interventions to improve articulation in MSD

2 categories

A

behavioral approaches (bite block ; muscle training; relaxation ; stretching)

traditional approaches (consonant exaggeration ; compensatory articulatory movements ; minimal pairs)

32
Q

specific interventions to improve pacing in MSD

5

A

DAF ; pacing board ; alphabet board ; tapping ; rhythmic cues

33
Q

benefits of speaking valve for trach

4

A
  • oral communication
  • taste and smell
  • control of secretions and reduction of aspiration (allows coughing)
  • helps swallowing (+ comfort; + laryngeal elevation; + laryngeal reflexes; + muscle coordination, etc.)
34
Q

why never speaking valve with trach cuff inflated?

A

bc Pt couldn’t breathe (no way to exhale)

35
Q

features of verbal apraxia

5

A
  • no weakness / slowness / discoordination of speech musculature when used for reflexes / automatisms
  • awareness of errors leading to self-correction attempts, effort, trial and error, groping.
  • attempts to control all aspects of speech lead to slow pace, even accentuation, monotonous speech.
  • variability in productions
  • starting utterances often difficult
36
Q

difference in performance in speech AMRs/SMRs for verbal appraxia

A
  • no difficulty in speech AMRs (/papapa/)

- difficulty with speech SMRs (/pataka/) (substitutions/ omissions/ distorsions, etc.

37
Q

3 main goals in apraxia therapy

A
  • maximize output and naturalness of communication
  • no attempt to improve physiological support (vs dysarthria)
  • reestablishing motor programs
38
Q

which dysarthria can be harder to distinguish from verbal apraxia?

A

ataxic dysarthria (bc slow scanning speech)

39
Q

how to distinguish errors related to aphasia (phonemic paraphasias) from errors related to verbal apraxia?
(4)

A

apraxia

  • errors are closer to target
  • phonemes not in Pt’s language (due to distorsions)
  • prosody affected
  • a lot of self-correction attempts

phonemic paraphasias

  • errors can be very off target
  • phonemes always in Pt’s language
  • prosody preserved
  • effortless articulation
40
Q

5 examples of assessments tasks for verbal apraxia

A
  • repeating same word (checking for variations)
  • words of increasing length
  • multisyllabic words
  • automatic speech vs voluntary (1 to 20 forward vs backwards)
  • non-verbal oral apraxia tasks
41
Q

types of errors in apraxia of speech

A

“distorted substitutions” - sounds like substitutions, but is really more like distortions

  • voicing errors (due to errors in VOT)
  • assimilation errors (anticipatory / perseveratory); metathesis; addition
  • errors on consonant groups
42
Q

motor learning concepts utilized in apraxia of speech therapy
(4)

A
  • drill (intensive + systematic)
  • self-monitoring/ self-cueing
  • bloc vs variable practice
  • slow pace for precision, then increase pace maintaining precision
43
Q

categories of therapies for apraxia treatment

A

sensory approach

  • auditory (self-monitor)
  • tactile-kinesthetic (articulatory placement cues)
  • visual (mirror)

articulatory /kinematic approach

rate/pace approaches

44
Q

what does “integral stimulation” refer to in apraxia of speech therapy?

A
  • combining all sensory approaches for treatment (“look at me, listen to me, and speak with me”), increasing awareness of auditory, tactile and visual aspects of articulatory movements.
45
Q

MSD associated with bulbar palsy? pseudobulbar palsy?

A

bulbar palsy:
- UMN lesions, spastic dysarthria

pseudobulbar palsy:
- LMN lesions, flaccid dysarthria

46
Q

distinctive speech features of flaccid dysarthria

5

A
  • hypernasality (velopharyngeal weakness)
  • nasal emissions (velopharyngeal weakness)
  • breathy voice quality (laryngeal/VF weakness)
  • audible inspiration (stridor) (laryngeal/VF weakness)
  • imprecise consonants (weakness of articulators)
47
Q

distinctive speech features of flaccid dysarthria

4

A
  • strain/struggle vocal quality (laryngeal spasticity)
  • imprecise articulation
  • slow pace
  • effortful speech
48
Q

distinctive speech features of ataxic dysarthria

5

A
  • irregular and transitory articulatory breaks
  • irregular DDK rhythm (speech AMRs, SMRs)
  • vowel distorsion
  • scanning speech (excessive and even accentuation)
  • pitch and loudness outbursts
49
Q

distinctive speech features of hypokinetic

7

A
  • breathy voice quality
  • reduced variability in tonality and intensity
  • reduced intensity
  • imprecise articulation due to incomplete movements
  • anomalies in prosody caused by inappropriate pauses
  • variable pace with brief flows of speech

** only dysarthria where fast pace is heard (festination)

50
Q

distinctive speech features of hyperkinetic

2

A
  • involuntary, sudden and out of control speech blockages (sounds like hiccups)
  • excessive and exaggerated (imprecise) articulatory movements
51
Q

why is “bulbar” an important term to note for speech

A

bc bulb (lower half of pons and medulla together) is the site for most cranial nerves for speech (IX, X, XI, XII)

  • associated with LMN lesion / flaccid dysarthria
52
Q

link between dopamine and Parkinson

A

reduction of dopamine (produced by substantia nigra and transmitted to striatum - part of basal ganglia) = reduction of tone inhibition = increase of tone = rigidity = hypokinesia

53
Q

link between acetylcholine (ACh) and hyperkinesia

A

decrease in Ach = decrease in control of movements = hyperkinesia

54
Q

6 cranial nerves involved in speech production

A

V
- muscles of mastication

VII (not bi-lat for lower face)
- muscles of face

IX
- motor for stylopharyngeous; but mainly sensory

X
- muscles of soft palate, pharynx, larynx.

XI
- SCM + trapezius

XII (not bi-lat for genioglossus)
- muscles of tongue

1 CETP (7 decks)

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