Motor Speech Disorders

Question 1

Dysarthria is:

Answer 1

a collective name for a group of neurologic speech disorders resulting from abnormalities in the strength, speed, range, steadiness, tone or accuracy of movements required for control of the respiratory, phonatory, resonatory, articulatory, and prosodic aspects of speech.

Question 2

Match the following Dysarthrias with their area of lesion:
*some repeat*

1. Spastic Dysartrhria A. Mixed Lesion
2. Flaccid Dysarthria B. Basal Ganglia Lesion
3. Hypokinetic Dysarthria C. UMN Lesion
4. Hyperkinetic Dysarthria D. Cerebellar/Pathways
5. Ataxic Dysarthria E. LMN Lesion
6. Mixed Dysarthria

Answer 2

1. Spastic Dysarthria - UMN Lesion
2. Flaccid Dysarthria - LMN Lesion
3. Hypokinetic Dysarthria - Basal Ganglia Lesion
4. Hyperkinetic Dysarthria - Basal Ganglia Lesion
5. Ataxic Dysarthria - Cerebellar & Cerebellar Pathways
6. Mixed Dysarthria - Mixed Lesions

Question 3

The characteristics for UUMN (Unilateral Upper Motor Neuron) damage are:

A.) relative mildness of speech impediment

B.) Imprecise articulation

C.) harshness, reduced loudness, hypernasality and slow rate

D.) All of the above

Answer 3

D. ) All of the above

Question 4

Lesions of UUMN usually occurs in:

A.) One hemisphere

B.) Either hemisphere (motor cortex)

C.) Descending corticobulbar pathways

D.) Internal capsule/brainstem

E.) all of the above, except A

Answer 4

E. ) all of the above, except A

*either cerebral hemisphere (motor cortex), descending white matter pathways, internal capsule or brainstem

Question 5

The common oral-mech findings for UUMN are:

A.) Bilateral “central” facial weakness ipsilateral to the lesion

B.) Unilateral “central” facial weakness contralateral to the lesion

C.) Unilateral tongue weakness

D.) Jaw, palate and laryngeal weakness

E.) Only B & C

Answer 5

E. Only B & C

*unilateral “central” facial weakness (i.e. lower face) contralateral to the lesion

*unilateral tongue weakness (you see deviation of tongue on protrusion away from side of lesion)

*uncommon to see jaw, palate and laryngeal weakness since they are bilaterraly innervated

Question 6

What are some of the common characteristics to Spastic Dysarthria?

A.) Strained-harsh voice

B.) Slow rate of speech

C.) Slow and regular AMRs

D.) Reduced variability and loudness

E.) All of the above

Answer 6

E.) All of the above

*strained harsh voice, monopitch, monoloudness, and slow rate of speech

Question 7

AMR in Spastic Dysarthria is:

A.) Regular and Slow

B.) Irregular and Slow

C.) Irregular and Fast

D.) Regular and Fast

Answer 7

A.) Regular and slow

Question 8

Vowel prolongation in Spastic Dysarthria has:

Answer 8

strained vocal quality due to hypertonicity of intrinsic laryngeal musculature

Question 9

Connected speech in Spastic Dysarthria has a fast rate, hyponasality, multipitch, multiloudness, and unstrained vocal quality: True or False

Answer 9

False - has a slow rate, hypernasality, monopitch, monoloudness, and strained vocal quality

Question 10

Spastic Dysarthria is due to Bilateral LMN Damage:

True or False

Answer 10

False- is due to Bilateral UMN Damage

*can occur anywhere from the beginning of the pathways in the cerebral hemisphere, all the way down to the cranial nerve nuclei in the brainstem

*grey matter of the cerebral hemispheres, descending white matter at level of corona radiata or internal capsule, or before they synapse in the lower motor neuron nuclei

Question 11

Some oral-mech findings for Spastic Dysarthria are:

A.) Slow rate of orofacial movements

B.) Reduced range of motion

C.) Hyperactive gag reflex & pathologic oral reflex

D.) Pseudobulbar Affect

E.) All of the above

Answer 11

E.) All of the above

*slowness is due to damage to the indirect pathways
*both the indirect and direct are usually damaged due to the same origin (area of motor cortex)
*damage to the pathways you get increased muscle tone and hyperactive reflexes

*drooling and dysphagia is also common

Question 12

Some of the symptoms seen in Flaccid Dysarthria due to damage in CN V are:

A.) reduced jaw movement

B.) reduced jaw closure

C.) reduced articulatory contact of tongue, lips and teeth

D.) None of the above

E.) A, B, & C

Answer 12

E - Reduced jaw movement, jaw closure, and reduced articulatory contact of tongue, lips and teeth

Question 13

In Flaccid Dysarthria, due to damage of CN VII one can expect to see:

A.) imprecise articulation of sounds requiring facial movement

B.) unilateral paresis or mild-moderate bilateral weakness resulting in distortion of sounds

C.) bilateral paralysis preventing production of bilabials and labiodentals

D.) All of the above

Answer 13

D - All of the above

Question 14

Due to damage of CN X, Flaccid Dysarthria will manifest as:

A.) Voice and resonance changes

B.) hoarseness, breathiness, and diplphonia

C.) Vocal cord paralysis in paramedian position

D.) All of the above

Answer 14

D - All of the above

Question 15

Vowel prolongation in Flaccid Dysarthria, you will hear:

Answer 15

diplophonia and breathiness,

Question 16

Bilateral recurrent laryngeal nerve damage can result in:

Answer 16

breathiness and/or inhalatory stridor

*symptoms of Flaccid Dysarthria

*bilateral LMN damage where vocal cords are paralyzed in paramedian position

Question 17

Superior laryngeal nerve (bilateral) lesion can cause:

Answer 17

restriciton of vocal pitch

*superior laryngeal nerve innervates the cricothyroid muscle which is able to tense the vocal fold and raise pitch

*bilateral lesion can affect the ability to change pitch

Question 18

Unilateral Damage to the pharyngeal branch nerve (CN X) will cause:

Answer 18

mild to moderate hypernasality and nasal air flow during production of consonants requiring pressure build up in mouth

Question 19

Bilateral damage to pharyngeal branch will cause:

Answer 19

severe hypernasality, audible nasal emission, and weakness of sounds requiring intraoral pressure

Question 20

In connected speech for someone with Flaccid Dysarthria you hear:

Answer 20

breathy vocal quallity, hypernasality and weak production of pressure consonants

Question 21

Unilateral or bilateral lesions to CN XII will result:

Answer 21

weakness, atrophy and fasciculations of the tongue

*resulting in articulatory imprecision of all consonants requiring lingual movements

Question 22

Unilateral hypoglossal lesion will result in:

Answer 22

mild imprecision

*while bilateral lesion will result in articulatory imprecision and vowels as well

Question 23

Sites of lesion for Flaccid Dysarthria are located in:

Answer 23

cell bodies, axons, and or neuromuscular joints of the LMN that supply speech musculature

*usually CN V, VII, X, or XII and or cervical/thoracic spinal nerves innervating the diaphragm and other respiratory muscles.

Question 24

Non-speech oral mech findings for Flaccid Dysarthria are:

Answer 24

weakness and a loss of muscle tone, oral reflexes will be reduced or absent, atrophy of affected muscles and or fasciculations

*dependent which CN is damaged

Question 25

Characteristics seen in Ataxic Dysarthria are:

Answer 25

irregular breakdowns in articulation, distorted vowels, excess variation in loudness, slow speech rate, and excess or equal stress on each syllables

*unstead vowel prolongations

*AMRs are slow distinctively irregular

Question 26

Lesions that cause Ataxic Dysarthria are in:

Answer 26

cerebellum or cerebellar control circuits/pathways
*cerebellar speech functions are not well localized
*significant dysarthria is most often associated with bilateral or genralized cerebellar disease

Question 27

Non speech oral-mech findings for Ataxic Dysarthria are:

Answer 27

the size, strength, symmetry, and reflexes may be normal

*however, during non-speech AMRs, repetitive movements of the jaw, face, and tongue are performed slowly and irregularly

Question 28

Hypokinetic Dysarthria is characterized by:

Answer 28

accelerated speech rate and hypophonia
*only dysarthria where speech rate is accelerated
*articulation errors due to reduced range of motion
*AMRs are rapid and blurred with reduced range of articulatory movements

Question 29

Lesions in which cause Hypokinetic Dysarthria is located:

Answer 29

in the basal ganglia control circuit (bliaterally most likely)
*

Question 30

Nonspeech oral-mech findings for Hypokinetic Dysarthria are:

Answer 30

*masked or expressionless face at rest and lack animation during social interaction
*tremor or tremulousness may be apparent in jaw, face, or tongue at rest
*size, strength, and symmetry of jaw, face, and tongue may be normal, but reduced range of motion in AMR tasks

Question 31

This is the dysarthria that has a subtype:

A.) Ataxic Dysarthria

B.) Hypokinetic Dysarthria

C.) Flaccid Dysarthria

D.) Hyperkinetic Dysarthria

E.) None of the above

Answer 31

D - Hyperkinetic Dysarthria

Question 32

Speech characteristics for Hyperkinetic Dysarthria - Tremor:

Answer 32

vocal tremor - rhythmic, quavering, waxing, and waning character

*if severe tremor there may be abrupt voice arrests and speech rate rate may be slowed

*can affect all muscles of speech but is frequently isolated to the larynx

Question 33

Speech charcteristics of Hyperkinetic Dysarthria - Chorea are:

Answer 33

quick, unsustained and unpredictable movement

*may occur in the jaw, face, tongue, palate, larynx or respiratory system
*abnormal speech characteristics depending on structures affected
*voice arrests with strained quality
*mild hypernasality and nasal emission
*jerky prosody
*irregular AMRs and unsteady vowel prolongation

Question 34

Speech characteristics of Hyperkinetic Dysarthria - Dystonia are:

Answer 34

slow and sustained, may affect all or parts of speech system
*slow adventitious movements of lips, tongue, or jaw may be evident at rest
*can be confined to muscles for speech and swallowing and triggered only by act of speaking

Question 35

Hyperkinetic Dysarthria has two subtypes:

Answer 35

Adductor Spasmodic Dysarthria & Abductor Spasmodic Dysarthria

Question 36

Characteristics for Adductor Spasmodic Dysarthria:

Answer 36

intermittent, waxing, and waning, or constrained strained-harsh voice quality
*may have some hypernasality

Question 37

Characteristics for Abductor Spasmodic Dystonia:

Answer 37

intermittent breathy or aphonic segments of speech
*hypernasality may occur
*face, jaw and tongue dystonia can affect articulation

Question 38

Lesion that causes Hyperkinetic Dysarthria is:

Answer 38

damage to the basal ganglia circuits

Question 39

Nonspeech oral mech findings for Hyperkinetic Dysarthria are:

Answer 39

size, strength and symmetry is normal

*no hyper or hyporeflexia, no oral reflexes
*ivoluntary movements will be observed during oral motor exam

Question 40

Apraxia is _________

Answer 40

a disorder of learned movement, not caused by paralysis, weakness, or incoordination and cannot be accounted for by sensory loss, comprehension deficits, or inattention to commands

Question 41

Oral Apraxia, Nonverbal Oral Apraxia or (NVOA) is:

Answer 41

the difficulty carrying out volitional, oral non-speech movements

Question 42

Speech characteristics of AOS (Apraxia of Speech) are:

Answer 42

imprecise/distorted speech constituted with substitutions, omissions, or even addition of sounds
*errors are more on complex sounds and sound sequences
*slow speech rate, prolonged vowels, syllable by syllable speech production

Question 43

Site of lesion for Apraxia of Speech is in:

Answer 43

distribution of the middle cerebral artery and involves posterior portions of frontal lobe
*rarely seen in isolation, it co-occurs with aphasia and or unilateral upper motor neuron dysartrhia

Question 44

Nonspeech oral mech findings of Apraxia of Speech are:

Answer 44

size, strength, symmetry and reflexes of oral mechanism muscles may be normal
*right lower facial and tongue weakness is often present
*noverbal oral apraxia usually co-occurs but can have one and not the other