Motor speech and dysphagia Flashcards
what are the characteristics of AOS
- slower rate of speech
- distorted speech sound substitutions
- syllable segmentation
- articulatory groping, false starts and restarts
- prosodic impairment
- more errors on longer utterances
what are the characteristics of AOS in adults
unimpaired reflex and automatic acts. The difficulty is with voluntary movement
what does AOS typically associate with
- aphasia, especially Brocas
2. less frequently with unilateral uppermotor neuron dysarthria
what is primary progressive apraxia of speech
- when AOS is the only dominant symptom in primary progressive aphasia or dysarthria
- insidious onset and slow progress as compared to stroke induced AOS which is sudden with some improvement then stabilized
what is the neuropathology of AOS
- most often from a single left hemisphere stroke
- progressive AOS may be caused by degenerative diseases that cause primary progressive aphasia
- can be caused by left hemisphere trauma
what are the general symptoms of AOS
- impaired oral sensation in some
- language disorders may coexist if aphasia present
- if dysarthria coexists, facial and lingual weakness
what are the communication deficits in AOS
- auditory processing deficits
- have general awareness of speech problem which causes frustration
- slow or delayed initiation of speech
- may use compensatory strategy of reduced rate
- speech production errors
- prosodic problems
what are the speech production errors seen in AOS
- problems in volitional or spontaneous sequencing of movements with unaffected automatic speech
- high variability of speech errors that change on repeated attempts
- speech sound substitutions more common that distortions and omissions
- voicing errors (voiceless for voiced)
- more difficulty with consonants than vowels
- regressive assimilation
- progressive assimilatio
- metathetic errors ( switched positions of phonemes)
- insertion of schwa into consonant clusters
- increased frequency of errors on longer words
- trial and error groping
- greater difficulty with word initial sounds
- attempts at self repair
what prosodic problems are associated with AOS
- slower rate with difficulty changing the rate when requested
- impaired intonation becuse of increased duration of consonants
- even stress and restricted range of loudness, limited pitch
- fluency problems (silent pauses especially at initiation
How is AOS assessed
- check for aphasia when the patient shows coexisting signs
- tape record speech sample and transcribe. Note groping, self correction, repetition, dysfluencies, facial grimacing etc.
- evoke imitation of speech sounds
- diadochokinesis
- imitate progressively longer words, phrases, sentences
- evoke counting
- picture description
- oral reading
- check for oral apraxia or dysarthri
- assess limb apraxia
- standardized test: Apraxia Battery for Adults
How is AOS treated
behavioral treatment
- treatment should include instructions, demonstration, modeling, shaping, phonetic placement, frequent cueing, use of rhythm, immediate positive or corrective feedback
- treatment targets include artic accuracy, slower rate, systematic practice, gradual increase in rate, and normal prosody
- more difficult words promote better generalization
- include practice with a variety of sounds and sound combinatins
- repeated trials on same target response necessary to start
- cueing includes tactile cues for artic placement, simultaneous production, modeling, delayed imitation
- contrastive stress, phonetic cotrasts, carrier phrases, and singing may be useful
- push on abdomen to get vocal fold closure
- metronome or pacing board may be useful
- emphasize total communication
- teach self monitoring
- teach family members to speak slower when client is focused and use total communication
what is SPT or sound production treatment
minimal contrast therapy
what is the pathology of ataxic dysarthria
- appears only during movement
- will be manifested in other motor movements
- neuropathology is bilateral or generalized cerebellar lesions
- Friedreich’s ataxia is a degenerative form
- ataxic gait, nystagmus, and dysmetria may be present
what is dysmetria
undershooting and overshooting a target
what are the characteristics of ataxic dysarthria
- gait disturbance
- movement disorder (overshoot, undershoot, jerky, etc)
- respiratory disorder: exaggerated and paradoxical movement during speech
- artic disorders:imprecise consonants, irregular artic breakdown, distorted vowels
- prosodic disorder: excessive and even stress, prolonged phonemes, intervals between wors or syllables, slow rate
- phonatory disorder: monopitch, monoloudness, harshness
- speech quality: sounds drunk
- resonance disorder: intermittent hyponasality on some
what is flaccid dysarthria
- damage to LMN for volitional and nonvolitional movement
- characterized by hypotonia
- can be caused by degenerative disease (ALS),motor neuron disease, progressive bulbar disease, MS
what are the major characteristics of flaccid dysarthria
- muscular disorders: weakness, hypotonia, atrophy, diminished reflexes, fasiculations, fibrillations, rapid and progressive weakness with use
- respiratory weakness: reduced subglottic air pressure, weak inhalation
- phonatory disorder: breathy voice, audible inspiration
- resonance disorder: hypernasality, nasal emission
- artic disorder: imprecise consonants, weak pressure consonants
- cluster: phonatory incompetence, resonatory incompetence, phonatory-prosodic insufficiency
what is the etiology of hyperkinetic dysarthria
- results from damage to the basal ganglia
- produces variable muscle tone and involuntary movement
- commonly caused by degenerative disease (Huntington’s), vascular disease (brainstem stroke), trauma, toxic condition,
what are the major characteristics of hyperkinetic dysarthria
- orofacial dyskinesia: abnormal, involuntary, movement of orofacial muscles
- myoclonus: involuntary jerks of body
- tics: patterned, rapid, commonly of face and shoulders
- chorea: purposeless, random, involuntary
- athetosis: slow, writing,
- Ballism: bilateral, involutary movement of extremities
- hemiballism: unilateral ballism
- dystonia: contractions of antagonistic muscles that cause abnormal postures
- respiratory problems: audible inspiration, forced sudden inspiration not typical of other dysarthrias
- phonatory disorder: voice tremor, strained voice, voice stoppage, vocal noise
- resonance disorders: hypernasality
- artic problems: impreise consonant production with distorted vowels and slow rate
- prosodic problems: prolonged interword intervals, inappropriate silent periods, phoneme prolongations, excess and equal stress
what are the characteristics of hypokinetic dysarthria
- resting tremors
- mask face with infrequent blinking, no smiling
- micrographic writing
- walking disorder
- postural disturbances
- decreased swallowing: drooling
- respiratory problems: reduced vital capacity, irregular breathing
- phonatory disorders: monopitch, low pitch, harsh and breathy voice
- prosodic disorder: reduced stress, inappropriate silent intervals, short rushes of speech
- artic disorders: imprecise or distorted consonants, stops sound like fricatives
what is the etiology of spastic dysarthria
bilateral damage to upper motor neuron
- most commonly caused by multiple strokes that damage both the pyramidal and extrapyramidal systems
- Cerebral palsy in children
what are the characteristics of spastic dysarthria
- spasticity and weakness
- movement disorder: reduced range, force, and speed, loss of fine and skilled movement, increased muscle tone
- artic: imprecise consonants and distorted vowels
- prosody: excess and equal stress, slow rate, reduced stress, short phrases
- phonatory: hyperadduction of folds,
- resonance disorder: predominant hypernasality due to inadequate closure of velopharyngeal port
what are the most common mixed forms of dysarthria
- flaccid-spastic: associated with ALS
2. ataxic-spastic: associated with MS
what is the etiology of UUMN dysarthria
- purely anatomical
2. most common cause is stroke