Motor Speech Disorders Flashcards
Motor Speech Disorders
speech disorders resulting from neurologic
impairments affecting planning, programming, control, and execution of speech
The nervous system is comprised of
CNS
PNS
Brain is composed of…
cerebral hemispheres
brainstem
cerebellm
Cerebral hemispheres contain…
gray and white matter
UMN originate in the _________ and course downward to the brainstem via the _____________.
primary motor area
corticobulbar tracts
UMN terminate and synapse at the _________.
LMN
cerebellum
with coordination of voluntary movement,
Apraxia of Speech (AOS)
neurogenic speech disorder resulting from the
impairment of the capacity to plan/program the sequence of sensorimotor movements
required for volitional speech.
What is AOS characterized by?
-distortions
.-substitutions,
-groping articulatory postures
-initiation difficulties
Oral apraxia or nonverbal oral apraxia
difficulty with imitation or with
volitional non-speech movements of oral structures like the lips, tongue and that
difficulty not secondary to paresis or incoordination)
Phonatory apraxia,
inability to produce
voluntary phonation
AOS speech sound
sequencing errors
- Anticipatory or regressive errors
- Reiterative or preservative errors
- Transposition or metathesis errors
No normed tests for AOS, but there are 2 commercially available
evaluation protocols:
Apraxia BAttery for Adults
Comprehensive Apraxia Test
Treatment for phonatory apraxia-
training blowing as a method to gain voluntary control over oral airflow.
-next-try adding honation
Treatment for oral apraxia
- include imitation of oral postures
- use of mirror
Anticipatory or regressive errors
grappoper‘ for frasshopper
Reiterative or preservative errors
dred for dress
Transposition or metathesis errors
tefelone for telephone
large or small amount of
drill work?
large
how frequently to treat the patient?
no evidence
constant (blocked) or variable (random) presentation?
blocked practice initially produces more correct/accurate but has poorer generalization
Blocked practices involves what?
targeting/drilling a specific/single sound, syllable,
word, or phrase repeatedly before presenting the next sound/syllable/word/phrase for the patient to produce
frequency/timing of feedback
intermittently
about 60% of the time
specific treatment techniques for AOS
- Integral Stimulation/8 Step Task Continuum
- Sound Production Treatment
- Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT)
- Melodic Intonation Therapy (MIT)
- Multiple Input Phonemic Therapy (MIPT)
- Voluntary Control of Involuntary Utterances (VCIU)
- Other techniques for severe AOS
PROMPT
uses tactile-
kinesthetic cues to facilitate correct production.
Sound Production Treatment
incorporates portions of the integral stimulation techniques into a more
structured hierarchy while targeting specific sounds contained in words.
8 Step Task Continuum
most widely used approaches of treatment with speech repetition is at its core.
Melodic Intonational Therapy
uses a singing-like combined with hand-
tapping, then gradual fading of the singing/tapping quality
Multiple Input Phoneme Therapy
shapes the stereotypic utterance into various alternative utterances
(e.g. two-two-two shaped into two-tea-tie shaped into two-one shaped into two-one-two-three shaped into one-two-
three-four-five).
Voluntary Control of Involuntary Utterances
- write down any intelligible word or phrase that the patient produces
- see if patient can read it aloud
- repeatedly drill it
With low level apraxic speakers techniques such. as…..
rote speech tass,
sentence completions,
singing
intoning a phrase
Palilalia
-̳disorder of speech
-compulsive repetition of a phrase or word which the patient reiterates with increasing rapidity
and with a decrescendo of voice volume‘
Treatment for neurogenic stuttering tends to focus on what?
rate reduction
Are speech errors consistenten with sydarthria?
yes
Does dysarthric speech improve with volitional speech tasks?
How about AOS?
no
Yes
–Flaccid: damage?
LMN
Spastic damage location?
bilaterial UMN
Ataxic damage location?
cerebellum
Hypokinetic damage?
basal ganglia
Hyoerkinetic damage?
basal ganglia
Myasthenia Gravis
- chronic autoimmune disease affecting neuromuscular junction through destruction of acetylcholine receptors of the muscles.
- increasing fatigue/muscular weakness with repeated use
Guillian-Barre Syndrome
- a demyelinating disease that affects peripheral and cranial nerves.
- paralysis but can recover
- can produce dysarthria/dysphagia
Bell’s Palsy
-causes acute, unilateral, peripheral
lower motor neuron CN VII paralysis
-causes both upper and lower unilateral facial
weakness.
intention tremor
-begins during a visually guided target-directed movement
- increases in amplitude towards the end of the movement
—there is no resting tremor present
dysmetria
past-pointing, inability to control the range/trajectory of a movement,
e.g. when ask to touch their nose the patient will undershoot/overshoot the target
Babinski reflex
occurs after the sole of the foot has been firmly stroked.
bradykinesia
(slowness of movement)
hypokinesia
reduced range of movement
akinesia
lack of movement/difficulty initiating movement
athetosis
slow, writhing purposeless movements
ballism
rapid contractions of the muscles of the extremities that can produce flailing
chorea
rapid, involuntary, random, purposeless movements of a body part which may be subtle or obvious),
Mixed Dysarthria can result from:
- degenerative neurologic diseases
- metabolic diseases,
- multiple strokes
- TBI
- hypoxic encephalopathy
- brain tumor
- infectious/autoimmune diseases
Motor neuron diseased
- ALS
- Progressive bulbar palsy
- primary lateral scleross
- progressive muscular atropy
- postpolio syndrome
MS
- demyelinating autoimmune disease of the central nervous system.
- partial loss of vision
- abnormal sensation (numbness
- difficulty walking.
What is being examined in an oral facial exam?
-structural integrity
-strength, muscle tone,
-ROM, direction, speed and coordination of movement
-sensory
all of tongue, jaw, lips, velum, and oral cavity
Spasticity/rigidity translate into what?
slowness of moevemnt
Unilateral brainstem damage above the decussation of the pyramids may produce what?
limb parlysis on one side of body
Gag reflex:
sensory component is CN 9 maybe some 7
motor components are CN 9, 5, 10.
Prosody of speech refers to rate
- Rate of speech
- stress patterns
- phrasing patterns/length
- Pauses
The 2 most common commercial instruments for dysarthria are what?
-Assessment of Intelligibility in Dysarthric
Speakers
-Frenchay Dysarthria Assessment
Goals of treatment for various dysarthric speakers are to….?
- maximize speech intelligibility
- provide alternative means of communication when necessary.
Frequently used verbal communication strategies include:
- Heightening the awareness of deficits
- slower rate
- exaggeration of pronunciation
- other compensatory strategies
variable practice schedule
randomly treating several different
sounds/syllables/words/phrases
Or treating rate slowing/loudness with a random
Motor Learning Principles in the Dysarthrias
Consistent with the principles of motor learning speech tasks not non-speech tasks should be the focus of treatment for most patients.
Why treat Respiration for dysarthric patients?
May influence loudness of speech and phrase length
Expiratory Muscle Strength Training (EMST)
- utilizes a device that provides controlled, increasable resistance to expiration in order to strengthen the muscles of respiration.
Treatment for unilateral or bilateral vocal fold paralysis/paresis may include what?
VF adduction exercises (pushing/pulling)
- lateral digital pressure on thyroid cartilage
- head turning
- vocal fold medialization surgery
- collagen injections
- amplification.
Treatment for Resonance Disorders Hypernasality
- prosthetic appliances
- surgery
- behavioral techniqes (not really supported) but only for those who weakness ratherthan structure
palatal lift
prosthetic appliance that
pushes (lifts) the velum upward and back.
Treatment of Articulation for dysarthria
- Slowing the rate of speech
- slightly exaggerated pronunciation
The cerebellum acts in conjunction with the ___________to adjust/refine
movements.
basal ganglia
In general the output of the cerebellum is more _______________, while the output of the basal ganglia is_____________.
excitatory (enhances movements)
inhibitory (puts the brakes‘ on movements)
Damage to the cerebellum can cause what?
ataxic gait
nystagmus
The output of the cerebellum
- is excitatory
- helps coordinate the sequence of muscle movements
there cerebellum recieves ________ and sends _________ to the ________.
sensory
output
thalamus
Is CN 12 motor, sensory or both?
motor
direct activation pathways go directly from the _____________ to the ________________ or the __________________ and _________.
motor cortex
motor nuclei
brainstem
spinal cord
Damage to the basal ganglia control circuit can
influence muscle tone
result in involuntary/extraneous movements
What type of error best describes an apraxic speaker saying “ra-ra-razor” for razor
syllable repetition
the majority of the cranial nerve nuclei receive __________ cortical innervation
bilertal
cranial nerve nuclei are found in the
midbrain,
pons,
medulla
when treating apraxia of speech, shorter intensive treatment is better than less intensive treatment over a longer period of time
False
___________ may facilitate more accurate/better speech in an apraxic speaker because is facilitates relearning of submovements necessary for correct production
rate slowing
Dysarthria may be attributed to
incoordination of movements
muscle weakness
2 things that can be associated with CN (cranial nerve) 5 involvement/damage
jaw weakness
decreased facial sensation
Bilateral facial weakness can be caused by
bilateral damage (right and left) to the facial region of the primary motor areas
During an oral-facial exam you observed that the patient has atrophy on the right half of their tongue. Which of the following do you suspect
damage to the left side of the medulla
damage to the left primary motor cortex
According to the lecture notes, a patient with progressive supranuclear palsy could present with what type of dysarthria
mixed of hypokinetic ataxic, spastic
causes of hyperkinetic dysarthria (not location of damage)
lupus
anti-psych meds
What disease processes can result in some degree of a voice disorder
ALS
multiple sclerosis (MS)
corticobasilar degeneration
During an oral-facial exam you notice that the left side of the velum does not attempt to elevate. Which of the following likely accounts for this
damage to left CN 10 nucleus
CPAP treatment for hypernasality
it may be effective for hypernasality associated with weakness of the velopharyngeal musculature
T/F
Gaze paralysis and a lower motor neuron-based dysarthria are associated with progressive supranuclear palsy
False
T/F
According to your textbook a sucking reflex in an adult is a sign of lower motor neuron damage
Flase
According to the lecture notes pitch range in normal conversational speech is between one to 1 ½ octaves.
True
