Motor Speech Disorders Flashcards
Dysarthria
Neurologic speech disorder that results in:
- Weakness
- Spasticity
- Incoordination
- Involuntary movements
- Altered tone of muscles
Controlling various aspects of speech production
Flaccid Dysarthria
LMN damage (cranial/spinal nerves)
Patient complains of:
- Difficulty moving oral structures
- Heavy tongue, drooling
- Slurred speech
- Difficulty singing
Etiologies:
- Stroke (brain stem)
- Motor neuron disease
- MS/Guillain Barre
- Muscular dystrophy
- Surgical trauma
Motor:
- Hypotonia, atrophy, fasciculations, hyporeflexia
Speech:
- Breathy voice, nasal emission, imprecise consonants, stridor, diplophonia
Spastic Dysarthria
Bilateral UMN damage
Patient complains of:
- Difficulty controlling emotions
- Feeling tired after talking/takes a lot of effort
- Drool & trouble swallowing
Etiologies:
- Stroke
- TBI
- Toxicity
- Inflammatory (MS) or degenerative (ALS) disease
Motor:
- Hyperreflexia, bilateral face weakness, reduced ROM, pseudo bulbar affect, pathological reflexes
Speech:
- Strained-strangled, Slow speech, Slow/regular AMRs, low/harsh voice, excess/equal stress
Ataxic Dysarthria
Damage to cerebellum
Patient complains of:
- Slurred speech, sounding drunk
- Difficulty timing speaking/breathing
- Biting tongue/cheek
Etiologies:
- Cerebellar degeneration
- Friedrich’s Ataxia
- Stroke
- Trauma
- Toxicity
- Metabolic disease
Motor:
- Intention tremor
- Normal OME
- Irregular non-speech AMRs
- Hypotonia
- Uncoordinated motor movements
- Stumbling gate
Speech:
- Articulatory breakdowns/distortions
- Slow rate
- Prolonged phonemes/pauses
- Irregular AMRs and SMRs
Hyperkinetic Dysarthria
Huntington’s/Idiopathic
Patient complains of:
- Increased/inability to inhibit movement
- Slurred/slow speech
- Shaky, tired voice
Etiologies:
- Toxicity (psychotropic)
- Infection
- Stroke of basal ganglia
- Tumor (subcortical structures)
Motor:
- Hyperkinesia (involuntary movement)
- Myoclonus, tremor, athetosis
Speech:
- Effortful speech
- Voice stopping
- Variable rate
- Transient breathiness
- Prolonged phonemes
Hypokinetic Dysarthria
Dopamine production/basal ganglia (substantia nigra of midbrain)
98% = Parkinson’s
Patient complains of:
- Sounding quiet/work
- Speech is too fast
- Difficult to get started speaking
- Problems w/drooling/swallowing
Etiologies:
- Vascular
- Toxicity
- Trauma
- Infection
Motor:
- Hypokinesis (diminished motor activity)
- Abnormal OME (expressionless, immobile upper lip, decreased ROM)
Speech:
- Breathy voice, tremor
- Rapid AMRs
- Weak but rigid
- Short rushes/pauses
Apraxia of Speech
Patient complains of:
- Speech doesn’t come out right
- Aware of errors & experience frustration
Etiology:
- Damage to dominant hemisphere structures (e.g., stroke, tumor, TBI)
- Degenerative disease
Lesion:
- Motor planning/programming areas (premotor cortex, supplementary motor area, subcortical areas)
Motor:
- Right-sided weakness
- Limb apraxia, non-verbal oral apraxia
- Groping articulatory movements
Speech:
- Difficulty with sequencing of sounds
- Inconsistent errors on repeated attempts (substitutions, deletions, vowel errors)
- Slow rate of speech
- Self-correction attempts
- Abnormal SMRs/slow AMRs
What are the components of a motor speech disorder assessment?
- Case history
- Oral mech/cranial nerve exam
- Standardized assessment
- Asses respiration, voluntary/involuntary movements, reflexes
- Speech tasks: DDK rates, vowel prolongation, contextual speech
- Perceptual characteristics (intelligibility, comprehensibility, efficiency
What information should the SLP collect during the case history?
- Time course of complaints
- Premorbid function
- Management (other medical personnel, medications, previous eval/tx, etc.)
- Awareness of deficits
- Cooperation
- Visual/hearing aids
- Language & cognition
Assessment of reflexes includes…
Pathological oral reflexes: sucking, snout, palmomental reflex, jaw jerk
Normal reflexes: gag (stroke faucial arches)
What do DDK Rates measures? Types/How are they administered
Measures respiratory-phonatory coordination and speed of articulators
Alternating motion rates: /pa, pa, pa/
/ta, ta, ta/
/ka, ka, ka/
Sequential motion rates: /pa, ta, ka/
What does vowel prolongation measure? How do you administer?
Respiration, pitch, steadiness, intensity, and quality of voice
“Take a deep breath and say ‘ah’ for as long and as steadily as you can until you run out of air”
What does contextual speech measure? How can you collect a sample
Measures:
- Fatigue, precision, resonance
- Errors (SODA), self-corrections, groping behaviors
Read standard passage (Grandather or Rainbow)
What is the difference between intelligibility and comprehensibility?
Intelligibility: degree to which a listener understands the acoustic signal produced by a speaker
Comprehensibility: degree to which listener understands an acoustic signal produced by a speaker AND all other information that may contribute to understanding what has been said (e.g., gestures, topic, context, setting, orthographic cues etc)
