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UoP NEURO 1 > Motor Speech Disorders > Flashcards

Motor Speech Disorders Flashcards

1
Q

MSD

A

breakdown in control over muscular speech movements as a consequence of CNS or PNS damage

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2
Q

Two classes of MSD

A

Dysarthria, Apraxia of Speech

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3
Q

Dysarthria

A

any disorder where respiration, phonation, articulation, resonation, or prosody is affected.

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4
Q

Defective voice and articulation from abnormal muscular control while…

A

speaker’s language and knowledge of how to produce sounds are normal.

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5
Q

Apraxia aka

A

cortical dysarthria and phonetic disintegration

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6
Q

apraxia may occur…

A

alone or as part of Broca’s or motor aphasia

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7
Q

Muscle strength in apraxia

A

intact, but loss of knowledge of correct placement of articulators for production of phonemes

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8
Q

Apraxia, instead of distortions, one hears…

A

substitutions, additions, omissions, reversals of sounds

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9
Q

T/F in Apraxia, trial and error movements can be present

A

TRUE

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10
Q

FD-Flaccid dysphonia

A

secondary to unilateral VF paralysis owing to lesion to RLN unilaterally

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11
Q

FD-Flaccid dysarthria

A

caused by flaccid paralysis of phonatory, resonatory, articulatory musculature owing to multiple CN lesions bilaterally

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12
Q

FD-Spastic dysarthria

A

resulting from spasticity of the peripheral speech musculature because of bilateral UMN lesions

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13
Q

FD-Ataxic dysarthria

A

muscular incoordination from a lesion in the cerebellum

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14
Q

FD-Hypokinetic dysarthria

A

in Parkinsons from rigidity of peripheral speech musculature caused by lesion in the basal ganglia.

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15
Q

HD-Hyperkinetic dysarthria-chorea

A

quick, spontaneous, uncontrolled movements from lesion in basal ganglia

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16
Q

HD-Hyperkinetic dysarthria-distonia

A

slow, continuous, uncontrolled movements from a lesion in the basal ganglia

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17
Q

HD-Hyperkinetic dyarthria-organic voice tremor

A

spontaneous rhythmic movement of laryngeal musculature from lesion of undetermined origin

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18
Q

HD-Hyperkinetic dyarthria-Paloatopharyngolaryngeal Myoclonus

A

spontaneous clonic muscular movementof larynx, pharynx, soft palate from lesion in brainstem.

19
Q

HD-Hyperkinetic dyarthria-Gilles de la Tourette’s Syndrome

A

uncontrolled barking and coperlalia from lesion of undetermined origin

20
Q

MD-Mixed dysarthria-amyotrophic lateral sclerosis (ALS)

A

spastic and flaccid simultaneous, caused by degenerative lesions of UMN and LMN systems

21
Q

MD-Mixed dysarthria-Multiple Sclerosis (MS)

A

ataxic and spastic simultaneous, demylenization of UMN and cerebellar motor neurons

22
Q

MD-Mixed dysarthria-Wilson’s Disease

A

ataxic, spastic, hypokinetic dysarthria occur due to excess copper deposits in neurons of cerebellum, pyramidal system, and basal ganglia

23
Q

MD-Apraxia of Speech

A

inability to produce or sequence sounds in absence of significant paralysis

24
Q

3 quick diagnostic activities

A
  1. contextual speech sample from reading standard paragraph
  2. prolongation of vowel
  3. repetition of “puh” “tuh” “kuh”
25
Q

Diadokinetic rates

A

Repetition of puhduhkuh as fast and evenly as possible. Evaluates rate, regularity, and duration of alternate movements of the articulators.

26
Q

Prolongation of vowel

A

Evaluate quality, loudness, duration, steadiness of phonatory control

27
Q

Speech sample from paragraph

A

evaluate integration of respiratory, phonatory, resonatory, articulatory, prosodic elements of contextual speech.

28
Q

QUICK Ataxic Dysarthria

A

Results from damage to the cerebellar system. It is characterized predominantly by articulation and prosody problems.

29
Q

QUICK Flaccid Dysarthria

A

Results from damage to the motor units of cranial or spinal nerves that supply speech muscles. Depending on the nerves involved, it may be characterized by respiratory, phonatory, articulatory, prosodic or resonance disorders.

30
Q

QUICK Hyperkinetic Dysarthria

A

Develops due to damage to basal ganglia circuitry

Causes extraneous, involuntary movement of speech musculature. Prosodic disturbances are dominant.

31
Q

QUICK Hypokinetic Dysarthria

A

damage to the basal ganglia; often seen in parkinson’s disease; hypertoned and rigid muscles; resting tremor that disappears with voluntary movement; accelerated movements and short rushes of speech; monopitch and loudness

32
Q

QUICK Spastic Dysarthria

A

Results from bilateral damage to the upper motor neurons (UMN). Increased muscle tone with spasticity in various muscles of the vocal tract resulting in weakness, reduced range of motion, decreased fine motor control.
Laryngeal muscles and velum are most affected

33
Q

QUICK Mixed Dysarthrias

A

A combination of two or more pure dysarthrias. The most common are flaccid-spastic dysarthria and ataxic-spastic dysarthria.

34
Q

QUICK Unilateral Upper Motor Neuron Dysarthria

A

Dysarthria due to damage to the pathway that supply cranial or spinal nerves involved in speech production. Characterized by poor control of facial muscles and articulation difficulty.

35
Q

How do you evaluate respiration?

A

Listen to volume of speech, ask pt to count from 1-20 on one breath, ask pt to produce /a/ from soft to loud, listen to conv.
If you hear – it may mean…
Reduced overall loudness, monoloudness, short phrases – Weakness of muscles
Reduced overall loudness, monoloudness, impaired loudness control – Abnormal tone
Sudden forced inspiration or expiration, speaking on low air – In-coordination of respiratory muscles

36
Q

How do you evaluate phonation?

A

Listen to spontaneous cough to judge strength of closure, Ask pt to produce /a/ and hold it and listen for tremor, Ask pt to grunt (produce glottal stop), Ask pt to sing a few notes up and down to determine control of laryngeal movement, Listen to reading or conversation.
If you hear – it may mean…
Breathiness, hoarseness, monopitch, decreased loudness, short phrases, audible inspiration – Weakness in laryngeal muscles
Breathiness, hoarseness, monotone, decreased
loudness, low pitch – Reduced tone
Strained, strangled dysphonia, harshness,
low/high pitch, monoloudness, pitch breaks – Increased tone
Inappropriate pitch changes, inconsistent hoarseness,voicing errors, tremors, excessive loudness variations, audible inspiration – Incoordination of laryngeal muscles.

37
Q

How do you evaluate resonance?

A

Ask pt to say /i/ and occlude nose and release (if no problem with resonance, there will be no change is quality. If pt is hypernasal, there will be a change in quality; Repeat nasal vs non-nasal sentence (Please pat the pretty puppy. My mom made many more.) Place mirror under nose if nasal emission is suspected, Observe movement of soft palate.
If you hear – it may mean…
Hypernasality and/or nasal emission – Weakness of velopharyngeal muscles.
Hypernasality – Increased tone.

38
Q

How do you evaluate articulation?

A

Assess oral motor movements unrelated to speech, diadochokinesis (alternate/sequential), word/phrase repetition, word/sentence/passage reading, conversation.
If you hear – it may mean…
Certain sounds consistently misarticulated – Indicates dysarthria vs. apraxia
Slow alternative motion rates (AMR) and sequential motion rates (SMR) – many types of dysarthria
AMRs and SMRs irregular in rhythm – Hypokinetic and some types of Hyperkinetic dysarthria.

39
Q

What is prosody?

A

Results from the appropriate use of the respiratory, phonatory and articulatory sub-systems. Prosody is stress, intonation, rate and rhythm.

40
Q

How do you evaluate prosody?

A

Stress: Get perception of syllable emphasis (word/sentence level), contrastive stress drills, signaled by pitch, loudness and duration
Intonation: Get perception of changes in fundamental frequency during speech, repetition of 8 basic word -level patterns, Declarative/interrogative sentence repetition, ask pt to repeat a sentence with different meanings,
Rate and Rhythm: Rate is artic time and pause time.
Rhythm is a durational relationship between artic time and pause time. Listen to conversational speech.
Tips to calculate normal rate:
130-220 words per minute
3-5 syllables per second
12-20 syllables per breath

41
Q

Etiology and types of dysarthria

A

Tumors rarely cause hyperkinetic dysarthria.
Toxic and metabolic disturbances rarely cause flaccid and unilateral upper motor neuron dysarthria.
Infectious and inflammatory conditions do not often cause dysarthria of any type.
Demyelinating diseases may cause any type of dysarthria, but rarely hypokinetic.
Anatomic malformations are usually associated with flaccid dysarthria.
Neuromuscular junction disorders, muscle disease, and neuropathy cause flaccid dysarthria.
Hypernasal - Nasal emission usually doesn’t occur with spastic dysarthria.
Hyponasal - Dysarthria does not cause hyponasality.

42
Q

Differential Diagnosis: Dysarthria Types

A

Spastic: Strained, strangled phonation with hypernasality, imprecise consonants and impaired stress.
Flaccid: Typically breathy, hypernasal, and imprecise consonants, but depends on site of lesion.
Hypokinetic: Increased rate with imprecise consonants and decreased loudness.
Hyperkinetic: Typically strained phonation with hypernasality, imprecise consonants, and variable rate (but depends on etiology).
Unilateral Upper Motor Neuron: Harsh phonation, imprecise consonants with irregular articulatory breakdowns
Ataxic: Excessive loudness variations, irregular articulatory breakdowns, impaired prosody

43
Q

cognitive-linguistic processes

A

thoughts, feelings, emotions are converted into verbal symbols through language. Where the desire to move may originate

44
Q

motor speech planning and programming

A

neuromuscular organization of verbal messages which activate speech muscles at appropriate times.

UoP NEURO 1 (1 decks)

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