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Organic & Neurogenic Comm Disorders > Motor Speech Disorders > Flashcards

Motor Speech Disorders Flashcards

1
Q

Motor Speech Overview

A

Speech is a sensory and motor process
-Requires coordination of respiration, phonation, resonance, and articulation

Damage to the central (CNS) or peripheral (PNS) nervous systems can cause neurospeech disorders

  • Apraxia
  • Dysarthria
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2
Q

Cortex

A
  • contains motor and sensory regions responsible for voluntary movement
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3
Q

Broca’s area

A
  • Motor planning area for speech
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4
Q

Supplementary motor cortex

A
  • Works with the premotor area to send motor planning info to the primary motor cortex
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5
Q

Premotor area

A
  • Assists the motor strip in integrating and refining motor movements
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6
Q

Primary motor cortex (motor strip)

A
  • Precentral gyrus located in frontal lobe (have this in left and right hemisphere)
  • Homunculus
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7
Q

Cortical motor regions

A

involved in planning motor movements

Receive information on the motor ‘plans’ from cortical and subcortical structures

Important cortical motor regions:

  • primary moto cortex (motor strip)
  • premotor area
  • supplementary motor cortex
  • broca’s area
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8
Q

Direct Activation Pathway

A

Pyramidal tract

Upper motor neuron system-cortex, brainstem, & spinal cord

Divided into two tracts:

  • Corticobulbar
  • Corticospinal

Origin- cerebral cortex
Destination-cranial or spinal nerve nuclei
Function-voluntary, skilled movements

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9
Q

Indirect Activation Pathway

A

Extrapyramidal tract

Upper motor neuron system

Includes:

  • Red nucleus-works with cortex for movement of upper limbs (midbrain)
  • Reticular Nuclei-Postural set (pons & medulla)
  • Vestibular nuclei-balance (floor of 4th ventricle-pons & medulla)

Origin- Cerebral cortex
Destination-Cranial and spinal nerve nuclei
Function-controls posture, tone, & movements supportive of voluntary movement

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10
Q

Control Circuits

A

Basal Ganglia & Cerebellum

Give their input to cortex
Cortex sends the information down the direct and indirect pathways

They do NOT talk to the lower motor neurons (cranial and spinal nerves)

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11
Q

Cerebellum

Functions:

A

Coordination
Planning
Maintenance of muscle tone

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12
Q

Basal Ganglia Functions:

A

Functions:
Helps cortex select the right motor plan
Inhibits unnecessary movements

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13
Q

Lower Motor Neurons

A

The workers

Origin-brainstem and spinal cord

Destination-Muscle

Functions-
Carry out voluntary movement commands sent from UMNs

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14
Q

Cranial nerves

A

12 pairs; 7 pairs involved in speech production

Provide motor and sensory information to the muscles of respiration, phonation, resonance, and articulation (face and neck)

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15
Q

Spinal nerves

A

31 pairs of spinal nerves

Provide motor and sensory information to the muscles of the body (NOT including face and neck)

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16
Q

Apraxia

A

Error in Motor Planning- Difficulty planning the motor movements for speech

Lesions:
Left frontal lobe
Left parietal lobe
Parts of basal ganglia
Insula
Causes:
CNS degenerative diseases
Trauma
Tumor
Stroke

More likely to co-occur with Broca’s Aphasia

Characteristics:

  • Inconsistent articulatory errors
  • Errors increase as word complexity and length increase
  • Groping movements of the articulators
  • Difficulty initiating speech
  • Inaccurate syllable stress
  • Slow rate of speech

Apraxia in adults is an acquired disorder
Childhood apraxia of speech is a developmental problem

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17
Q

Dysarthria

A

– a group of neuromotor speech disorders that result in muscle weakness or loss of muscle control

Site of lesion and respiratory, phonatory, resonance, and articulation characteristics

18
Q

Flaccid Dysarthria

A

Site of lesion – lower motor neuron (LMN)
Resulting in muscle weakness or paralysis

Deficits may be seen in 1 or more speech subsystems:

  • Respiration
  • Reduced vital capacity (can’t take deep breath for speech)
  • Shallowing breathing
  • Phonation
  • Breathy voice or aphonia
  • Hoarse voice
  • Reduced pitch or loudness
  • Monotone & monoloudness

Resonance: Hypernasal
Articulation:
-Imprecise consonants – articulation errors

Associated diseases:
-Moebius syndrome – atypical development of brainstem
-Bell’s palsy – Facial nerve (VII) disorder
Guillian-Barre syndrome- viral infection causes muscle paralysis
-Myasthenia gravis – Loss of synapses resulting rapid weakening of muscles
-Muscular dystrophies – muscles affected by various diseases

19
Q

Unilateral Upper Motor Neuron Dysarthria (UUMN)

A

Site of Lesion – Unilateral UMN damage

Cleft hemisphere damage- can co-occur with apraxia or aphasia
Right hemisphere damage- can co-occur with cognitive deficits or prosody deficits

Speech deficits are usually mild and temporary

Face & tongue weakness is on opposite side of lesion

Phonation:

  • Harsh vocal quality
  • Articulation
  • Imprecise consonants
  • Slow rate of speech
  • Associated disorders:
  • Trauma
  • Stroke
20
Q

Spastic Dysarthria

A

Site of lesion – Bilateral UMN damage

Phonation:

  • Monopitch
  • Low pitch
  • Reduced stress
  • Harsh vocal quality’ “strained-strangled”
  • Monoloudness
  • Articulation
  • Imprecise consonants
  • Slow rate of speech
  • Effortful
  • Jerky movements

Resonance:
Hypernasality

Associated diseases/disorders:

  • Bilateral damage to UMNs
  • Stroke
  • Trauma
  • Degenerative diseases
21
Q

Ataxic Dysarthria

A

Site of lesion – Cerebellum

Articulation:

  • Irregular articulatory breakdowns
  • Phonation
  • Inappropriate loudness
  • Poor pitch control
  • Drunken speech (Duffy, 2005)

Associated Diseases/Disorders:

  • Cerebral palsy
  • Degenerative diseases
  • Friedrich’s ataxia
  • Stroke
  • Tumor
  • Trauma
  • Alcohol abuse
  • Drug toxicity
22
Q

Hyperkinetic Dysarthria

A

Site of lesion – basal ganglia

Reduced inhibitory control; results in hyperkinetic (too much) movements

Site of lesion – Cerebellum

Reduced coordination, timing, and rate of movements

Speech characteristics are variable

  • Articulation
  • Imprecise consonants
  • Prolonged speech sounds or long pauses

Phonation:

  • Harsh vocal quality
  • Excessive loudness
  • Monopitch
  • Resonance
  • Hypernasality
  • Associated disorders/diseases:
  • Huntington’s disease
  • Dystonias
23
Q

Movement disorders associated with hyperkinetic dysarthria

A

Tremor

  • Resting
  • Intention

Tics – rapid, repetitive, stereotyped, involuntary movements
-Can be suppressed for short periods of time

Can be movement (e.g., jumping or hitting) or vocal (e.g., screeching or barking)

Chorea – quick, random, involuntary writhing movements

  • Can be anywhere on the body
  • Interfere with voluntary movements

Dystonia – random involuntary movements

  • Interfere with voluntary movements
  • Movements are slow, sustained, and writhing
24
Q

Hypokinetic Dysarthria

A

Site of lesion – basal ganglia

Associated disease:
Parkinson’s disease

Phonation:

  • Reduced loudness
  • Monopitch
  • Hoarse voice
  • Breathy voice
  • Articulation
  • Imprecise consonants
  • Fast rate of speech- short rushes of speech
25
Q

Hypokinetic Dyarthria Movement Disorders:

A

Bradykinesia – difficulty and/or slowness in initiating movements (including speech)

Akinesia – reduced movement (e.g., eye blinking, speech, head, and/or swallowing)

Microagraphia – small handwriting

Resting tremor – pill rolling and other parts of body

26
Q

Mixed Dysarthria

A

Site of lesion – Damage to two or more divisions of the nervous system

  • This type of dysarthria is relatively common
  • Affects multiple components of the motor system for speech
  • Results in a combination of two or more types of dysarthria

Associated Diseases/Disorders:
-Amyotrophic lateral sclerosis (ALS)- affects UMNs and LMNs
Can present with spastic-flaccid dysarthria

-Multiple sclerosis – diffuse demyelization
Can present with spastic, ataxic, or mixed dysarthria

27
Q

Cerebral Palsy

A

3 major types of CP

Spastic CP – most common motor impairments in CP
-Associated with low birth weight, reduced oxygen and reduced blood flow in premature infants

4 profiles

28
Q

Spastic hemiplegia

A

arm and leg on one side have weakness

Mild dysarthria

29
Q

Spastic paraplegia

A

(rare)- weakness of both legs

No dysarthria

30
Q

Spastic diplegia

A

weakness of all 4 extremities (legs weakest)

Respiratory muscles may be compromised

31
Q

Spastic quadriplegia

A
  • equal weakness in all 4 extremities

May affect respiratory, laryngeal, articulatory, and palatopharyngeal muscles

Children with bilateral corticobulbar damage

Spastic dysarthria (diplegia or quadriplegia)

32
Q

Dyskinetic CP

A
  • Associated with mother-child incompatible blood types

Characteristics:
Respiratory issues- result in pitch and loudness problems
Laryngeal dysfunction- difficulty closing vocal folds
Strained vocal quality, monopitch, hypernasality, and imprecise consonants

33
Q

Ataxia CP

A

least common type of CP

Damage to cerebellum or cerebellar controls

Ataxic dysarthria
Mixed ataxic-spastic

34
Q

Tracheostomy & Ventilation

A

Tracheostomy – an alternative means of respiration

A tube is placed in the larynx which allows the individual to breath (ASHA, n.d.)

A tracheostomy can be temporary or long-term
Reasons for a tracheostomy include damage, obstruction, or dysfunction of larynx such as laryngectomy, tracheomalacia, & laryngeal injury (John Hopkins Medicine, n.d.)

Ventilator – a machine that provides the gases needed for respiration

The ventilator is attached to the tracheostomy

Valves can be placed on a tracheostomy to allow the individual to speak (ASHA, n.d.)

Valves allow air to pass through the vocal folds and larynx

As long as a ventilator patient has a tracheostomy with a valve, they can speak (ASHA, n.d.)

Speech occurs on the expiratory cycle of the machine

35
Q

Motor/Speech Disorder Assessment

A

Purpose is to assess:
Phonation, respiration, resonance, and articulation
Impact of motor speech disorder on quality of life

Differential diagnosis
Apraxia vs. dysarthria
Apraxia vs. aphasia
Dysarthria vs. aphasia

36
Q

Water Glass Manometer

A

used to measure respiratory pressure for speech

Drinking glass filled with 12 cm of water
Straw is paper clipped to glass
Patient is asked to blow bubbles in the water

Must be able to sustain bubbles for 5 seconds with
straw at a given depth

37
Q

Key Elemetrics Visi-Pitch

A

measures acoustic properties of voice signal including:

fundamental frequency (pitch)
intensity (loudness)
Hz and dB measurements
38
Q

Videofluoroscopy

A

used to assess velopharynx (resonance)

Requires SLP and radiologist to interpret results

39
Q

Apraxia Treatment

A

Goals: “facilitating the efficiency, effectiveness, and naturalness of communication by
Improving speech production and intelligibility” (ASHA, 2007)

When necessary, introducing augmentative-alternative communication (AAC) (ASHA, 2007)

Restorative treatment – re-establish motor plans for speech

  • Typically drill based activities
  • Activities are hierarchically structured
  • Require adequate auditory comprehension and self-monitoring abilities

Compensatory treatment – compensate for persistent speech deficits
-AAC

40
Q

Dysarthria Treatment

A

Treatment plans will be based on many factors including:

  • Testing/assessment results
  • Prognosis
  • Communication environments and partners
  • Health status

EARLY INTERVENTION IS KEY – for both children and adults

Medical treatment

  • Pharmacology
  • Surgery

Prosthetics

  • Palatal lift
  • AAC

Restorative treatments

  • Drill – systematic and repetitive practice
  • Feedback
  • Self-monitor

Subsystems approach – improve the impaired subsystem

  • Respiration
  • Phonation
  • Articulation
  • Resonance

Organic & Neurogenic Comm Disorders (10 decks)

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