motor speech disorders Flashcards
where is the primary motor cortex found?
frontal lobe
what are the 3 motor processes to produce speech?
planning
programming
execution
what happens in the “planning” process when producing speech?
sequencing of articulatory goals
what happens in the “programming” to produce speech?
preparing the flow of motor info across muscle, control timing, and force of movement.
what happens during the “execution” to produce speech?
activating the relevant muscles.
what are two major speech disorders?
apraxia
dysarthria
do people with apraxia and dysarthria have problems with writing?
no. these are only issues with motor processes.
What is the cause of motor speech disorders?
Neuromuscular and /or motor control system.
Where is the issue for apraxia ?
Planning and sequencing
Where is the issue for dysarthria?
Execution
Where is the disconnect for dysarthria?
Damage is on nervous system pathways. Disconnect between cerebellum and muscles
What can be affected from dysarthria?
Respiration
Phonation
Resonance
Articulation.
What is the cause of motor speech disorders?
Stroke
Head trauma
Progressive diseases
How is the hearing abilities of motor speech disorders?
Fine
Spastic:
Damage where?
Major symptom:
Other signs:
Upper motor neurons
Spasticity
Weakness, increases muscle tone, gagging, drooling, involuntary crying
Ataxic:
Damage where?
Major symptom:
Other signs:
Cerebellum
In coordination
Reduced muscle tone, “intoxicated speech”, wide based gait, tremors
Difficulty with properly planning, programming, and executing motor movements for speech
motor speech disorders.
what are the stages of word production (4)
concept/message
lexical-concept
phonological encoding
articulation
broca’s aphasia does not have writing impairments. t/f
false!
their writing matches their speech.
MSD has writing impairments. t/f
false. Their writing is fine.
MSD have deficits that result from impairment of ___________ and/or motor control system.
neuromuscular
MSD may co-occur with other language impairments, t/f
t
other oral movements (besides speech) may be impaired, including chewing and smiling. t/f
t
is MSD/s common among adults or children? what type?
adults.
46% dysarthria
What are the impaired mechanisms in MSDs?
planning/programming
execution
Apraxics have issues with what motor processes?
planning and programming
dysarthrics have issues with what motor processes?
execution
in general what does dysarthria impact? (4)
respiration
phonation
resonance
articulation
Speech disorder due to dysfunctional motor execution resulting in incoordinated, weak, and slow articulatory movements
dysarthria
what is the cause of dysarthria?
Damage to nervous system pathways results in inability to send proper message from brain to the muscles involved in speech
Typically occurs because of a progressive disease, stroke, or trauma
acquired dysarthria
what imposes control on movement initiated in primary motor cortex?
cerebellum
Group of cell nuclei in the medial part of the brain
Basal Ganglia
where do upper motor neurons originate?
primary motor cortex
where do lower motor neurons originate?
brainstem and spinal cord.
what receives information from upper motor neurons?
lower motor neurons
what part of the body is responsible for phonation?
vocal cords
what type of dysarthria; LMN damage weakness reduced muscle tone reduced reflexes atrophy fasiculations
flaccid
what type of dysarthria: UMN damage spasticity weakness reduced range of movement increased muscle tone hypertonia
spastic
what type of dysarthria: Non-speech deficits: Paresis/spasticity of other body parts Hyperactive reflexes (e.g., gag) Dysphagia, drooling Pseudobulbar affect (involuntary crying)
spastic
what type of dysarthria: Cerebellum damage Errors in force, speed, timing, range, & direction of movements i.e., incoordination Reduced muscle tone “intoxicated speech”
ataxic
what are the primary deficits of basal ganglia dysarthrias?
hypokinetic (parkinsons)
hyperkinetic (huntingtons)
symptoms associated with ?:
Chorea
Dystonias
Tremor
Palatopharyngolaryngeal myoclonustics (muscles spasms of vocal folds)
hyperkinetic
Relatively slow waxing/waning involuntary postures resulting from excessive muscles contracting
dystonia
Area of damage: primary motor cortex, white matter in frontal lobe, or brainstem
Major symptoms: Weakness Incoordination Spasticity central face weakness hemiparesis/plegia
unilateral upper motor neuron dysarthria
upper motor neuron damage will lead to :
spastic dysarthria
what are three ways to measure Dysarthria symptoms?
perceptual
acoustic
physiological (measuring muscle strength)
problems with apraxia deal mainly with?
sequencing
the main problem with dysarthria is?
execution
do apraxics have writing impairments?
no
what does an apraxic person sound similar to?
broca’s
dysarthria or apraxia? Speech distortions Consistent errors Little/no groping for sounds All speech affected Muscle weakness/rigidity
dysarthria
dysarthria or apraxia? Speech substitutions Inconsistent errors groping for sounds “Island of fluency” Automatic speech = ok No muscle weakness/rigidity
apraxia
Speech disorder or neurological origin characterized by inability to program or sequence articulatory movements for speech production
apraxia
what is the cause of apraxia?
Can be developmental or acquired
No known cause for developmental
acquired AOS means there is damage where?
only to Broca’s area. (left frontal corex)
Acquired AOS is due to :
stroke, brain injuries, illness, infections
Inability to transform an intact linguistic representation(idea in their head) into coordinated movements of the articulators(words)
acquired AOS
what does speech sound like for acquired AOS?
sound substitutions sound distortions prolonged durations of sounds reduced prosody difficulties initiating speech groping of articulators
what is the most common error type for AOS?
anticipation
what are three common error in AOS?
anticipations:(felephone)
perseverations (gave the goy)
exchanges (with this wing I do red)
if someone could not stick out their tongue or puff their cheeks they may have?
acquired AOS
2 non language symptoms of acquired AOS are:
oral motor apraxia
impaired oral sensation
treatment of apraxia includes?
speech therapy (awareness of articulators/exercises) AAC
what disorder involves deficits with processing and using language? including reading, writing, speaking, auditory.
aphasia
what disorder involves inability to execute speech movements, sequencing, disconnect between brain and articulators?
apraxia
inability to activate volitional movements for speech
apraxia
if a client has difficulty moving their tongue when given directions, this is an example of
apraxia
someone who drools or has poor speech due to facial weakness
dysarthria
someone that may have other weakness’ other than just speak may be
ataxic dysarthria
errors are consistent and predictable
dysarthria
errors are inconsistent and unpredicatable
apraxia
errors are many distortions and omissions
dysarthria
substitutions are most common type of error
apraxia
all aspects of speech are affected
dysarthria
mainly an articulation issue
apraxia
apraxia and dysarthria both may have swallowing issues. t/f
t
what is always a result from damage to the broca’s area?
apraxia
what is the result of damage to either the CNS or PNS?
dysarthria
dysarthria or apraxia?
speech substitutions
apraxia
dysarthria or apraxia?
speech distortions
dysarthria
dysarthria or apraxia?Little/no groping for sounds
dysarthria
dysarthria or apraxia?
Automatic speech = ok
apraxia
dysarthria or apraxia?All speech affected
dysarthria
dysarthria or apraxia?“Island of fluency”
apraxia
treatment for apraxia includes? (2)
speech therapy
aac
the patient has subcortical damage. What is most likely the outcome?
dysarthria
if cortical damage, it will be bilateral
the patients speech behavior has sound level distortions.
dysartharia
The patient’s speech has abnormal prosody.
aos
this patient has problems initiating speech and has phoneme substitutions.
aos
the patient has phoneme substitutions.
aos
the patient has infrequent metathetic errors.
aos
presence of paralysis, paresis, ataxia, involuntary movements. apraxia or dysarthria?
dysarthria
the longer the utterance the more errors are made. apraxia or dysarthria?
aos
prolonged durations of sound is typical for apraxia or dysarthria?
aos
where is the damage for flaccid?
lower motor neurons
where is the damage for spastic?
upper motor neurons
where is the damage for ataxic?
cerebellum
where is the damage for hypokinetic/hyperkinetic?
basal ganglia
what are the 2 control circuits relating to the motor system?
basal ganglia
cerebellar
what are the 2 execution pathways relating to the motor system?
upper
lower motor neurons.
what control circuit imposes control on movement initiated in primary motor cortex?
cerebellum
what part of the brain plays a major role in error correction based feedback?
cerebellum
group of cell nuclei in the medial part of the brain is the?
basal ganglia
where do upper motor neuron axons synapse?
cell bodies of lower motor neurons in the brainstem and spinal cord.
where do lower motor neurons originate where?
brain stem and spinal cord.
lower motor neuron axons synapse where?
muscle fibers
a patients primary deficit is weakness. what type of dysarthria and where is damage?
flaccid
lower motor
a patients primary deficit is spasticity. what type of dysarthria and where is damage?
spastic
upper motor
a patients primary deficit is incoordination. what type of dysarthria and where is damage?
ataxic
a patients primary deficit is involuntary movements. what type of dysarthria and where is damage?
basal ganglia
hyperkinetic
a patients primary deficit is rigidity. what type of dysarthria and where is damage?
hypokinetic
basal ganglia
a patient has weakness; incoordination; spasticity. what type of dysarthria and where is damage?
unilateral UMN
UMN
major deficit is: weakness other signs of this type of dysarthria: reduced muscle tone reduced reflexes atrophy fasciculations
flaccid
people with conduction aphasia make what type of errors with their speech?
phonological paraphasias
where is brain damage when the result is conduction aphasia?
cortex in the posterior superior temporal lobe.
why do conduction aphasics have a hard time repeating non-words?
this would require intact phonological processing; which they do not have.
harry has a large amount of right hemisphere damage. What would be a difficult task for him?
summarizing a paragraph that he read or summarizing a conversation he heard.
also, paying attention to information in their left visual field.
paying attention to information in the left visual field would be difficult for someone with …?
right hemisphere damage
t/f people with apraxia and dysarthria make the same errors consistently.
false
dysarthria makes consistent, but not apraxia
why does someone with apraxia have difficulty with saying fairly long words but does not have difficulty with simple sounds, such as “tatatata”?
because apraxia is a deficit in the planning and sequencing of motor sequences.
would an apraxic have difficulty with “tatatata” or “ta ba ka da”?
ta ba ka da
this requires motor sequencing which is impaired.
apraxia is a deficit in the processing that occurs before the motor movements are made. t/f
t
if the basal ganglia is not active enough, the patient might have….
hypokinetic dysarthria
what is an example of hypokinetic dysarthria?
parkinson
what is an example of hyperkinetic dysarthria
huntingtons
what is the one thing that all types of aphasia have in common ?
anomia
main symptom of hyperkinetic dysarthria.
involuntary movements
main symptom of hypokinetic dysarthria
rigidity, stiffness, and tightness
main symptom of spastic dysarthria
increased muscle tone, lack of inhibitory signals
main symptom of flaccid dysarthria
weakness
main symptom of ataxic dysarthria
“druken speech”, due to cerebellum damage
how is transcortical motor aphasia’s speech comprehension
good, no major deficits
how is broca’s aphasia speech comprehension?
good ,but difficulties with some complex syntactic constructions
how is wernickes aphasia speech comprehension?
very poor
how is global aphasia speech comprehension?
very poor
how is anomic aphasia speech comprehension?
good, no major deficits
Transcortical motor and Broca’s aphasias are mainly problems of speech production, not comprehension. One exception to this though is that Broca’s aphasics’ comprehension is ____________
agrammatic, meaning that they have difficulty understanding phrases or sentences in which the grammatical structure is needed to understand the sentence
which neurons are the neurons that have synapses with the muscles?
lower motor
where do UMN and LMN connect?
brain stem and spinal cord
do conduction aphasics have speech comprehension problems?
no
what is alexia?
ACQUIRED (dyslexia) inability to comprehend written language
what are the 3 routes used in reading?
- Grapheme to phoneme conversion (sound it out)
- whole word to phonology conversion (words activate the appropriate sound based representation, which then activates meaning)
- whole word meaning route (familiar words activate appropriate visual word form, which activates meaning)
Can you use the grapheme to phoneme conversion for irregular words?
no, only works for regular words.
why is grapheme to phoneme conversion not a route to depend on?
- it would take forever to read!
2. doesn’t work for irregular words.
which word route takes care of irregular word issues?
whole word to phonology conversion.
whole words activate the appropriate sound representation, which then activates meaning. However, what type of words still present a problem?
him vs. hymn
write vs. right
homophones
how would someone use the whole word to meaning route?
Words activate the appropriate visual representation which in turn activates meaning
why do people not use the whole word to meaning route all the time?
the words must be familiar!
what are the 3 routes needed in order to read normally?
- grapheme to phoneme
- whole word to phonology
- whole word to meaning
when reading is disrupted, what is it called?
acquired alexia
what are two ways to describe deficits with reading?
- neurological model
2. cognitive model
which model is used to explain the different types of alexia with agraphia a clinician might see?
cognitive model
when using the neurological model for pure alexia, what is the diagnosis?
a ‘disconnection’ syndrome, from left hemisphere word-recognition system
according to the neurological model, alexia with agraphia, has what deficits?
pure reading and writing
according to the neurological model, aphasic alexia, has what type of deficits?
reading deficits mirror language deficits
A patient with pure alexia would be able to do what?
write
read letter-by-letter
can a person with pure alexia read individual words?
sometimes, however when combining words they cannot access meaning.
what type of alexia is a disconnection of visual information from left hemisphere word-recognition system?
pure alexia
A patient is able to write normally, however they cannot read what they just wrote. This is an example of what type of alexia?
Pure alexia.
a patient is able to tell you what you spelled out. for example, “C-A-T”. they can tell you it says ‘cat”. this is an example of what type of alexia?
pure alexia
other symptoms of pure alexia are: (3)
- impaired ability to copy words.
- acalculia
- hemianopsia (blind in one visual field; usually the right)
what type of speech comprehension and production does a person with pure alexia have?
normal
what two parts of the brain must be damaged to cause Pure Alexia?
- left primary visual cortex
2. splenium
part of the corpus callosum that connects the right visual cortex to the left hemisphere.
splenium
where is the calcarine sulcus?
primary visual cortex
what is the etiology of pure alexia?
blocked splenium
why does a blocked splenium cause pure alexia?
Because visual information cannot get to the regions in the left hemisphere that process word forms
where is the splenium?
posterior part of the corpus callosum
which type of alexia is not affected by orthographical regularity?
pure alexia
what type of alexia has relatively pure reading/writing deficits, with no aphasia?
alexia with agraphia
a patient has a brain lesion on the angular gyrus in the left hemisphere. What type of alexia would they most likely suffer from?
alexia with agraphia
according to the neurological model, what two types of alexia do not have aphasia?
pure alexia
alexia with agraphia
the cognitive model, describes what 3 types of reading deficits?
surface dyslexia
phonological dyslexia
deep dyslexia
when the only route left is to “sound it out”, it is known as what type of dyslexia?
surface (visual form)
what patients typically exhibit surface dyslexia?
dementia
alzheimer
a patient cannot read non-words or new words and is unable to “sound it out”. what type of dyslexia?
phonological dyslexia (sound form)
where is there brain lesions when the result is phonological dyslexia?
superior temporal lobe, angular gyrus, and other nearby areas.
A patient is making semantic errors, has difficulty with abstract and function words. What type of dyslexia?
deep dyslexia
where is damage when the result is deep dyslexia?
large left hemisphere perisylvian lesion.
what type of patients typically have surface dyslexia?
dementia
what part of the brain is thought to be the central area involved in the processing of orthographic word forms?
angular gyrus
lesions to what part of the brain will result in alexia with agraphia?
angular gyrus
a patient is able to read and comprehend words, however cannot read pseudowords. What type of alexia?
phonological
a patient with phonological alexia might have damage to what areas of the brain?
temporal lobe and surrounding areas, as well as angular and supramarginal gyri
a patient is able to read words and pseudowords but has profound impairments with comprehension. What type of alexia?
semanti
a patient is supposed to read the word “soft” but verbalizes the word “hard”. The next word is “vegetable” and their response is “broccoli”. This is an example of what type of alexia?
deep
the disconnection between orthographical units and phonological units is representative of what type of alexia?
phonological
is the reading and comprehension preserved with phonological alexia?
yes
which type of alexia has problems with pseudo words?
phonological
a patient is a not able to use visual input to activate the orthographic unit therefore unable to read, although can recognize individual letters. What type of alexia?
pure
“groping” is a common characteristic for what type of patient?
apraxic
a patient is making inconsistent errors, such as substitutions, additions, repetitions and prolongation. What is the deficit?
apraxia
inability to transform graphemes into phonemes, and thus non-words are often read as real words they resemble.
phonological alexia
This type of dyslexia is similar to phonological dyslexia but in addition makes numerous semantic errors.
deep
