Motor Speech Disorders Flashcards
dysarthria
speech disorder caused by neurologic damage
AOS
neurologically based motor programming disorder —difficulty producing the correct sounds in correct order
CN V function & change in speech
trigeminal
motor: mastication muscles
sensory: face & mucous surfaces of eyes, tongue, & parts of nasoapharyneal space
damage – imprecise consonants, distorted vowels, slow rate
CN VII function & change in speech
Facial
motor: facial muscles
sensory: ant 2/3 of tongue
damage: distortion of bilabial, labiodental sounds, slow rate
CN X function & change in speech
Vagus
motor & sensory to muscles of the soft palate, pharynx, and larynx
damage: breathiness, decreased loudness, short phrases, hyper nasality, nasal emission, weak plosives (possible hoarseness if unilateral)
CN XII function & change in speech
hypoglossal
innervation of tongue muscles
damage: mild-sever consonant imprecision vowel distortion
planning
selecting the sounds you want to say
programming
how to move from 1 sound to the next, fine movements
Langmore dysarthria eval components
- motor parameters
- speech parameters
- speech motor subsytem
Langmore’s motor parameters (7)
- symmetry
- tone
- steadiness
- strength
- range/amp
- rate
- coordination/accuracy/precision
Langmore’s speech parameters (4)
- phonation
- resonance
- articulation
- prosody
Langmore’s speech motor subsystem (4)
- respiratory
- laryngeal
- velopharyngeal
- orofacial
what to include in SUMMARY & FORMULATION on comps
- diagnosis
- severity
- describe the speech and motor impairments
- relate it to the neurological damage
- discuss the major limiting features
- prognosis and recommendations
Severity - Mild (Langmore)
- just barely dysarthric
- completely intelligible
- artic impaired <10% of words
- voice &/or resonance may be slightly impaired
Severity - Mild/Mod (Langmore)
- definitely dysarthric
- intelligible except for occasional words
- artic impaired 10-30% of words
- errors involving only a few consonants
- voice &/or resonance are impaired
Severity -Moderate (Langmore)
- speech sometimes difficult to understand
- artic impaired 30-50% of words
- errors involving many consonants & occasional words
- some combo of resonance, voice, speech, rate & prosody impaired
Severity - Mod/Severe (Langmore)
- speech is often difficult to understand
- atic impaired 50-70% of words
- Resonance, voice, speech rate, & prosody all affected
Severity - Severe (Langmore)
- speech is often unintelligible
- artic impaired 70-90% of words
- errors involving nearly all consonants and some vowels
- Resonance voice, speech rate, & prosody are all affected
Flaccid speech characteristics
- hypernasality
- nasal emission
- short phrases
- breathiness
- inhalatory stridor
Flaccid motor characteristics
- decreased muscle tone
- decreased/absent reflexes
- weak
- atrophy
- fasiculation
Flaccid dysarthria neuro damage
-damage to any part of 1 or more CNs (nucleus, axon, or jxn) or can result from muscle damage
Flaccid dysarthria common causes
- traumatic – surgical, CHI, neck injury
- neuropathies of 1 or more CN
- degenerative diseases
- CVA – rare
spastic dysarthria speech characteristics
- harshness
- low pitch
- slow rate
- strained/strangled quality
- pitch breaks
- slow & regular AMRs
Spastic motor characteristics
- increased muscle tone
- hyperactive reflexes
- slow
- loss of fine motor control & agility/precision
spastic neuro damage
- bilateral UMN damage
- usually damage to direct and indirect pathways (extrapyramidal & pyramidal pathway)
- *see pseudobulbar palsy/psuedobulbar affect in pt w/ bilateral UMN damage
- –displays lack of inhibition of emotional display(d/t extrapyramidal pathway damage)
spastic common causes
- degernerative diseases
- stroke (usually multiple strokes or UMN brainstem stroke)
hypokinetic speech
- monopitch
- monoloud
- variable rate
- rapid “blurred” AMRs
- short rushes of speech
- reduced stress
hypokinetic motor impairments
- rigidity
- bradykinesia
- akenesia (loss of automaticity)
- festination
- tremor
- excessive tone
Hypokinetic common causes
- degenerative diseases (PD, PSP)
- vascular strokes
hypokinetic neurological damage
- damage to the striatum in the BG
- deficiency of dopamine in the substania niagra
- leads to imbalanced cortical motor output to the LMN that causes the hypokinesia, rigidity, and tremors
ataxic dysarthria speech
**sounds like a drunk person
- irregular articulartory breakdowns
- prosodic excess
- prolongation of phonemes
- irrgular AMRs
- excessive loudness variation
ataxic motor
- reduced movements
- slow (esp repetitive movements)
- inaccurate/dysmetria
- incoordination/dysdiachochokinesis
- intention tremor
ataxic neuro
disruption to the cerebellar circuit
—-bilateral cerebellar damage is most likely to cause severe ataxic dysarthria
ataxic dysarthria causes
- degernerative diseases
- demyelinating diseases (MS)
- TBI
- Vascular
- cerebellar tumors
hyperkinetic speech
- slow/irregular AMRs
- distored vowels
- prolonged intervals
- voice tremor
- transient breathiness
hyperkinetic motor
- quick/slow involuntary muscle movements that interfere with voluntary muscle movements
- slow
- reduced force
- irregular rhythm
- dyskinesias
hyperkinetic neuro
- lack of GABA and excess dopamine with cortico-frontotemporal atrophy
- CNS dysfunction-GG circuits
hyperkinetic common causes
- -diseases of the BG control circuit
- majority is idiopathic
- spasmodic dysphonia
- organic voice tremor
- degenerative diseases (Huntingtons chorea)
unilateral upper motor neuron flaccid dysarthria speech
- similar characteristics of spastic and LMN flaccid but more variability depending on damage
- facial weakness –> lower 1/2 face and tongue
- imprecise articulation, slow rate, and reduced loudness
unilateral upper motor neuron flaccid dysarthria damage neuro damage
- cerebral hemispheres –> usually internal capsule
- damage to the direct/indirect pyramidal pathway (corticobulbar tract) which executes precise, skilled, discrete movements
….loss of fine, controlled skilled movements
hypotonia
weakness
Vertebobasilar artery stroke
UMN damage –> spastic dysarthria
VB arteries are further apart in cortical hemispheres so you need multiple strokes to cause spastic dysarthria
ICA stroke (Internal Carotid) – MCA, ACA
-may cause unilateral UMN flaccid dysarthria if an MCA stroke
spastic dysarthria if it is bilateral damage
…damage to primary motor cortex/subcortical structures —>may accompany AOS or aphasia if in LH, cognitive deficits likely present if in RH
Lacunar Strokes
- small infarcts from occlusions of branches in carotid or VB systems
- usually subcortical damage –BG, thalamus, internal capsule, direct/indirect pathways
multiple lacunar strokes –> dementia, parkinsonism
….can result in flaccid/spastic/hypokinetic dysarthria
dysarthria in parkinsons
hypokinetic
*look at hypo kinetic notecard
dyarthria in PSP
mixed hypo, spastic, and ataxic
dysarthria in MS
–ataxic & spastic
–due to demylination of the myelin sheath around neuron in the CNS of the white matter
Speech characteristics: irregularities and slowness
- syllables pronounced slowly and hesitantly
- harshness
- defective articulation
- …in general com pains of fatigue (psychical and cog sense)
dysarthria in ALS
*mixed spastic & flaccid
speech characteristics:
- severe harshness and strained-strangled squeezing of low-pitch tones, gurgle
- disrupted prosody
- prolonged intervals and phonemes
- appropriate silences
