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Motor Speech Disorders Flashcards

1
Q

Motor Speech Disorders

A

speech disorders resulting from neurologic

impairments affecting planning, programming, control, and execution of speech

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2
Q

The nervous system is comprised of

A

CNS

PNS

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3
Q

Brain is composed of…

A

cerebral hemispheres
brainstem
cerebellm

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4
Q

Cerebral hemispheres contain…

A

gray and white matter

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5
Q

UMN originate in the _________ and course downward to the brainstem via the _____________.

A

primary motor area

corticobulbar tracts

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6
Q

UMN terminate and synapse at the _________.

A

LMN

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7
Q

cerebellum

A

with coordination of voluntary movement,

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8
Q

Apraxia of Speech (AOS)

A

neurogenic speech disorder resulting from the
impairment of the capacity to plan/program the sequence of sensorimotor movements
required for volitional speech.

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9
Q

What is AOS characterized by?

A

-distortions
.-substitutions,
-groping articulatory postures
-initiation difficulties

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10
Q

Oral apraxia or nonverbal oral apraxia

A

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)

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11
Q

Phonatory apraxia,

A

inability to produce

voluntary phonation

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12
Q

AOS speech sound

sequencing errors

A
  1. Anticipatory or regressive errors
  2. Reiterative or preservative errors
  3. Transposition or metathesis errors
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13
Q

No normed tests for AOS, but there are 2 commercially available
evaluation protocols:

A

Apraxia BAttery for Adults

Comprehensive Apraxia Test

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14
Q

Treatment for phonatory apraxia-

A

training blowing as a method to gain voluntary control over oral airflow.
-next-try adding honation

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15
Q

Treatment for oral apraxia

A
  • include imitation of oral postures

- use of mirror

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16
Q

Anticipatory or regressive errors

A

grappoper‘ for frasshopper

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17
Q

Reiterative or preservative errors

A

dred for dress

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18
Q

Transposition or metathesis errors

A

tefelone for telephone

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19
Q

large or small amount of

drill work?

A

large

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20
Q

how frequently to treat the patient?

A

no evidence

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21
Q

constant (blocked) or variable (random) presentation?

A

blocked practice initially produces more correct/accurate but has poorer generalization

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22
Q

Blocked practices involves what?

A

targeting/drilling a specific/single sound, syllable,

word, or phrase repeatedly before presenting the next sound/syllable/word/phrase for the patient to produce

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23
Q

frequency/timing of feedback

A

intermittently

about 60% of the time

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24
Q

specific treatment techniques for AOS

A
  1. Integral Stimulation/8 Step Task Continuum
  2. Sound Production Treatment
  3. Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT)
  4. Melodic Intonation Therapy (MIT)
  5. Multiple Input Phonemic Therapy (MIPT)
  6. Voluntary Control of Involuntary Utterances (VCIU)
  7. Other techniques for severe AOS
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25
Q

PROMPT

A

uses tactile-

kinesthetic cues to facilitate correct production.

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26
Q

Sound Production Treatment

A

incorporates portions of the integral stimulation techniques into a more
structured hierarchy while targeting specific sounds contained in words.

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27
Q

8 Step Task Continuum

A

most widely used approaches of treatment with speech repetition is at its core.

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28
Q

Melodic Intonational Therapy

A

uses a singing-like combined with hand-

tapping, then gradual fading of the singing/tapping quality

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29
Q

Multiple Input Phoneme Therapy

A

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).

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30
Q

Voluntary Control of Involuntary Utterances

A
  1. write down any intelligible word or phrase that the patient produces
  2. see if patient can read it aloud
  3. repeatedly drill it
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31
Q

With low level apraxic speakers techniques such. as…..

A

rote speech tass,
sentence completions,
singing
intoning a phrase

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32
Q

Palilalia

A

-̳disorder of speech
-compulsive repetition of a phrase or word which the patient reiterates with increasing rapidity
and with a decrescendo of voice volume‘

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33
Q

Treatment for neurogenic stuttering tends to focus on what?

A

rate reduction

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34
Q

Are speech errors consistenten with sydarthria?

A

yes

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35
Q

Does dysarthric speech improve with volitional speech tasks?

How about AOS?

A

no

Yes

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36
Q

–Flaccid: damage?

A

LMN

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37
Q

Spastic damage location?

A

bilaterial UMN

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38
Q

Ataxic damage location?

A

cerebellum

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39
Q

Hypokinetic damage?

A

basal ganglia

40
Q

Hyoerkinetic damage?

A

basal ganglia

41
Q

Myasthenia Gravis

A
  • chronic autoimmune disease affecting neuromuscular junction through destruction of acetylcholine receptors of the muscles.
  • increasing fatigue/muscular weakness with repeated use
42
Q

Guillian-Barre Syndrome

A
  • a demyelinating disease that affects peripheral and cranial nerves.
  • paralysis but can recover
  • can produce dysarthria/dysphagia
43
Q

Bell’s Palsy

A

-causes acute, unilateral, peripheral
lower motor neuron CN VII paralysis
-causes both upper and lower unilateral facial
weakness.

44
Q

intention tremor

A

-begins during a visually guided target-directed movement
- increases in amplitude towards the end of the movement
—there is no resting tremor present

45
Q

dysmetria

A

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

46
Q

Babinski reflex

A

occurs after the sole of the foot has been firmly stroked.

47
Q

bradykinesia

A

(slowness of movement)

48
Q

hypokinesia

A

reduced range of movement

49
Q

akinesia

A

lack of movement/difficulty initiating movement

50
Q

athetosis

A

slow, writhing purposeless movements

51
Q

ballism

A

rapid contractions of the muscles of the extremities that can produce flailing

52
Q

chorea

A

rapid, involuntary, random, purposeless movements of a body part which may be subtle or obvious),

53
Q

Mixed Dysarthria can result from:

A
  • degenerative neurologic diseases
  • metabolic diseases,
  • multiple strokes
  • TBI
  • hypoxic encephalopathy
  • brain tumor
  • infectious/autoimmune diseases
54
Q

Motor neuron diseased

A
  • ALS
  • Progressive bulbar palsy
  • primary lateral scleross
  • progressive muscular atropy
  • postpolio syndrome
55
Q

MS

A
  • demyelinating autoimmune disease of the central nervous system.
  • partial loss of vision
  • abnormal sensation (numbness
  • difficulty walking.
56
Q

What is being examined in an oral facial exam?

A

-structural integrity
-strength, muscle tone,
-ROM, direction, speed and coordination of movement
-sensory
all of tongue, jaw, lips, velum, and oral cavity

57
Q

Spasticity/rigidity translate into what?

A

slowness of moevemnt

58
Q

Unilateral brainstem damage above the decussation of the pyramids may produce what?

A

limb parlysis on one side of body

59
Q

Gag reflex:

A

sensory component is CN 9 maybe some 7

motor components are CN 9, 5, 10.

60
Q

Prosody of speech refers to rate

A
  1. Rate of speech
  2. stress patterns
  3. phrasing patterns/length
  4. Pauses
61
Q

The 2 most common commercial instruments for dysarthria are what?

A

-Assessment of Intelligibility in Dysarthric
Speakers
-Frenchay Dysarthria Assessment

62
Q

Goals of treatment for various dysarthric speakers are to….?

A
  • maximize speech intelligibility

- provide alternative means of communication when necessary.

63
Q

Frequently used verbal communication strategies include:

A
  1. Heightening the awareness of deficits
  2. slower rate
  3. exaggeration of pronunciation
  4. other compensatory strategies
64
Q

variable practice schedule

A

randomly treating several different
sounds/syllables/words/phrases

Or treating rate slowing/loudness with a random

65
Q

Motor Learning Principles in the Dysarthrias

A

Consistent with the principles of motor learning speech tasks not non-speech tasks should be the focus of treatment for most patients.

66
Q

Why treat Respiration for dysarthric patients?

A

May influence loudness of speech and phrase length

67
Q

Expiratory Muscle Strength Training (EMST)

A
  • utilizes a device that provides controlled, increasable resistance to expiration in order to strengthen the muscles of respiration.
68
Q

Treatment for unilateral or bilateral vocal fold paralysis/paresis may include what?

A

VF adduction exercises (pushing/pulling)

  • lateral digital pressure on thyroid cartilage
  • head turning
  • vocal fold medialization surgery
  • collagen injections
  • amplification.
69
Q

Treatment for Resonance Disorders Hypernasality

A
  1. prosthetic appliances
  2. surgery
  3. behavioral techniqes (not really supported) but only for those who weakness ratherthan structure
70
Q

palatal lift

A

prosthetic appliance that

pushes (lifts) the velum upward and back.

71
Q

Treatment of Articulation for dysarthria

A
  • Slowing the rate of speech

- slightly exaggerated pronunciation

72
Q

The cerebellum acts in conjunction with the ___________to adjust/refine
movements.

A

basal ganglia

73
Q

In general the output of the cerebellum is more _______________, while the output of the basal ganglia is_____________.

A

excitatory (enhances movements)

inhibitory (puts the brakes‘ on movements)

74
Q

Damage to the cerebellum can cause what?

A

ataxic gait

nystagmus

75
Q

The output of the cerebellum

A
  • is excitatory

- helps coordinate the sequence of muscle movements

76
Q

there cerebellum recieves ________ and sends _________ to the ________.

A

sensory
output
thalamus

77
Q

Is CN 12 motor, sensory or both?

A

motor

78
Q

direct activation pathways go directly from the _____________ to the ________________ or the __________________ and _________.

A

motor cortex
motor nuclei
brainstem
spinal cord

79
Q

Damage to the basal ganglia control circuit can

A

influence muscle tone

result in involuntary/extraneous movements

80
Q

What type of error best describes an apraxic speaker saying “ra-ra-razor” for razor

A

syllable repetition

81
Q

the majority of the cranial nerve nuclei receive __________ cortical innervation

A

bilertal

82
Q

cranial nerve nuclei are found in the

A

midbrain,
pons,
medulla

83
Q

when treating apraxia of speech, shorter intensive treatment is better than less intensive treatment over a longer period of time

A

False

84
Q

___________ may facilitate more accurate/better speech in an apraxic speaker because is facilitates relearning of submovements necessary for correct production

A

rate slowing

85
Q

Dysarthria may be attributed to

A

incoordination of movements

muscle weakness

86
Q

2 things that can be associated with CN (cranial nerve) 5 involvement/damage

A

jaw weakness

decreased facial sensation

87
Q

Bilateral facial weakness can be caused by

A

bilateral damage (right and left) to the facial region of the primary motor areas

88
Q

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

A

damage to the left side of the medulla

damage to the left primary motor cortex

89
Q

According to the lecture notes, a patient with progressive supranuclear palsy could present with what type of dysarthria

A

mixed of hypokinetic ataxic, spastic

90
Q

causes of hyperkinetic dysarthria (not location of damage)

A

lupus

anti-psych meds

91
Q

What disease processes can result in some degree of a voice disorder

A

ALS

multiple sclerosis (MS)

corticobasilar degeneration

92
Q

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

A

damage to left CN 10 nucleus

93
Q

CPAP treatment for hypernasality

A

it may be effective for hypernasality associated with weakness of the velopharyngeal musculature

94
Q

T/F

Gaze paralysis and a lower motor neuron-based dysarthria are associated with progressive supranuclear palsy

A

False

95
Q

T/F

According to your textbook a sucking reflex in an adult is a sign of lower motor neuron damage

A

Flase

96
Q

According to the lecture notes pitch range in normal conversational speech is between one to 1 ½ octaves.

A

True

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