Motor Speech: Dysarthrias Flashcards
1
Q
Flaccid dysarthria affects what parts of speech?
A
resonance, prosody, articulation, phonation, respiration
2
Q
Flaccid Dysarthria caused by
A
impairments of lower motor neurons in cranial or spinal nerve (damage to the PNS
- Anything that disrupts the flow of motor impulses to muscles of speech production
- Physical trauma (surgical accident), brainstem stroke, myasthenia gravis, guillain-barre syndrome, and polio
- Tumors, muscular dystrophy, progressive bulbar palsy
3
Q
Flaccid dysarthria symptoms
A
paralysis, weakness, hypotonicity, atrophy, and hypoactive reflexes of involved speech subsystem musculature
4
Q
Flaccid dysarthria speech characteristics
A
slow-labored articulation, marked degrees of hypernasal resonance, hoarse-breathy phonation
- Not all individuals demonstrate deficits in all areas
- Severity level within area will vary
5
Q
Flaccid Resonancy deficits
A
- hypernasality=MOST NOTICIBLE
- Nasal emission
- Weak pressure consonants
- Shortened phrases
6
Q
Flaccid Artic deficits
A
- Imprecise consonant production
- Damage to trigeminal nerve= difficulties elevating jaw
7
Q
Flaccid phonation deficits
A
- Phonatory incompetence
- Breathy voice quality or whisper
8
Q
Flaccid respiration deficits
A
- Weakened respiration may or may not be a component
- Reduced loudness shortened phrase length, strained vocal quality, monoloudness, monopitch
9
Q
Flaccid prosody deficits
A
- Monopitch & mono loudness
- Not unique to flaccid dysarthria
10
Q
Key evaluation tasks for flaccid dysarthria
A
- Conversational speech and reading
—–Evoke many errors of resonance, articulation, respirations, and prosody - Speech alternate motion rates (AMRs)
——Will highlight a slowed rate of phoneme production - Prolonged vowel
- Speech stress test
11
Q
Treatment for flaccid
A
- Depend on/ are spefcific to the deficits of the individuals
- Work towards generalization
- Non-speech oral strenth exercises (open to question)
- Strengthening weakened muscles
- Work on strategies that concentrate on intelligibility of speech
12
Q
Spastic dysarthria affects what parts of speech?
A
articulation, phonation, resonance, prosody
13
Q
Spastic dys cause by?
A
- BILATERAL damage to the upper motor neuron tracts (CNS) including both pyramidal and extrapyramidal systems
- Strokes (most common), degenerative diseases, TBI, infections, Tumors
- Other: brainstem tumor, cerebral anoxia, viral infection in cerebral tissue, bacterial infection in cerebral tissue
14
Q
Spastic speech characteristics
A
- Weak/slow skilled movements- due to pyramidal system damage
- Weakness, increased muscle tone (spasticity), and abnormal reflexes- due to extrapyramidal system damage
15
Q
Characteristics seen in spastic
A
- Pseudobulbar affect: uncontrollable crying or laughing due to damage ofo UMNs
- Drooling: due to impaired oral control of saliva or less frequent swallowing
16
Q
Spastic artic deficits
A
- Very common is spastic
- Imprecise consonant production=MOST COMMON
- Vowel distortions
17
Q
Spastic phonation deficits
A
- Harsh vocal quality=MOST COMMON
- strained/strangled vocal quality
- Low pitch
18
Q
Spastic resonance deficits
A
Hypernasality
19
Q
Spastic prosody deficits
A
- Monopitch
- Monoloudness
- Short phrases
- Slow rate of pitch
20
Q
Key evaluation tasks for spastic
A
- Conversational speech and reading
—–Assesses resonance, articulation, and prosody - Speech alternatemotion rates (AMRs)
——Demonstrates slow rate of phoneme production - Vowel prolongations
—–Evokes phonatory deficits
21
Q
Treatment for spastic
A
Patient specific
Target most affected deficit 1st
–Phonation-stretching exercises; tongue & lips; traditional arctic
–Articulation- intelligibillity drills, phonetic placements, exaggerated consonants, minimal contrast drills
–Prosody- pitch range, intonation profiles, contrastive dress drills, chinking
–Resonance- surgical/prosthetic treatments
–Visual feedback, increase loudness(BEST)
22
Q
Unilateral Upper Motor Neuron Dysarthria affects what parts of speech?
A
Articulation
23
Q
UUMN caused by?
A
- Any conditionthat damages UMNs on one side of brain either left or right hemisphere
- Focal lesions are most common
- Stroke (MOST COMMON)
- Left hemisphere damage= co-occurs w/aphasia and apraxia
- Right hemisphere damage=co-occurs with visual and cognitive deficits associated w/injury to that side of brain
24
Q
Differences between spastic and UUMN
A
- UUMN is on one side and less severe than bilateral damage
- Most cranial nerves serving speech muscles (except lower face and tongue) receive bilateral innervation from upper motor neurons
- Unilateral damage to UMN can cause obvious speech deficits
——Damage to muscles of lower face and tongue
——Sever cases of unilateral damage
25
UUMN artic deficits
- UUMN dysarthria primarily a disorder of articulation
- Affects tongue & lower face much more than any other speech structure
- Causes of articulation deficits due to
------Weakness, reduced ROM, decreased fine motor control of tongue
- Imprecise consonant production: primary difficulty
- Irregular articulatory breakdowns
- Slow/irregular AMRs
26
Key evaluation tasks for UUMN
- Medical records
- Conversational speech or reading paragraph
- AMR tasks
- Provlonged vowel
27
Treatment for UUMN
- Often other coexisting deficits are allotted bulk of treatment time
- Articulation is the key deficit so arctic therapy
- Intelligibility drills, phonetic placement, exaggerating consonants, minimal contrast drills
28
Ataxic dysarthria affects what parts of speech
Articulation and prosody
29
Ataxic dysarthria caused by?
- to cerebellum or its nural pathways that connect cerebellum to other parts of CNS
- Cerebellum coordinates timing and force of muscular contractions=processes sensory info into execution of movement
- Ataxia: widespread incoordination “lack of order”
- Cerebellar ataxia: movement of deficits of timing, force, range, and direction
- Degenerative diseases, stroke, toxic conditions, TBI, tumors, infections
30
Ataxic speech characteristics
- Movements appear poorly coordinated
- Problems controlling timing/force
- slurred , monotonous articulation
31
Specific characteristics of Ataxic
Scanning speech: term used to describe ataxia dysarthria, describing slow, deliberate production of syllables, with each syllable in word receiving equal stress
32
Ataxic artic deficits
- Imprecise consonant production
- Distorted vowels
- Irregular articulatory breakdowns
- Decomposition of movement (distinct and jerky)
33
Ataxic prosody deficits
- Equal and excess stress: distinguishing characteristics
- Prolonged phonemes and prolonged intervals between phonemes
- Monopitch & monoloudness
34
Treatment for Ataxic dysarthria
- Damage affects speech, force, and timing of movements of articulators, resulting in uncoordinated movement
- Most evident speech errors related to arctic and prosody
- Rate control (hand tapping, metronome), stress & intonation (contrastive stress drills, pitch range exercises)
35
Hypokinetic dysarthria affects what parts of speech
phonation, articulation and prosody
36
Hypokinetic dysarthria caused by
- Any process that damages the basal gamglia (extrapyramidal system)
- Parkinsonism, idiopathic parkinsons, neuroleptic parinsons, TBI, toxic metal poisoning, stroke
- Not enough dopamine
37
Hypokinetic speech characteristics
- Harsh vocal quality
- reduced stress
- monoloudness
- imprecise consonants
38
hypokinetic distinctive characteristics
- Festinating speech: increased rate
- Resting tremor
- Bradykinesia- slow, reduced movement
- Rigidity- spasticity
- Akinesia- delay in initiation of movements
- Postural reflexes
39
Key evaluation tasks for hypokinetic dysarthria
- Conversational speech and reading- detect short rushes
- Speech alternate motion rates- highlight artic errors
- Vowel prolongations- assess vocal quality
40
Hypokinetic deficits in prosody
- Monopitch
- Reduced stress
- Monoloudness
41
hypokinetic deficits in articulation
- Imprecise consonants
- Repeatedphonemes
- Palilalia- stuttering-like features
42
hypokinetic deficits in phonation
- harsh/breathy quality
- Aphonia
- Low pitch
43
Treatment for hypokinetic
- Pharmacologic: most commonly used
- Surgical: deep brain stimulation
- Behavioral: speech therapy– (therapy to fully adduct VF- glottal attack, Lee Silverman vt; slow rate of speech, intonation profiles, contrastive stress drills, chunking utterances)
44
Hyperkinetic dysarthria affects what parts of speech
articulation, prosody, phonation
45
Hyperkinetic dysarthria caused by
- Damage to basal ganglia damage
- Chorea- involuntary random movement of limbs, trunk, head, and neck
- Myoclonus-brief contractions of muscles
- Essential tremor-tremulous movements
- Dystonia- prolonged muscle contractions
- Degenerative diseases
- TBI
- Stroke
- Infections
- Too much dopamine
46
Speech characteristics of hyperkinetic
- Imprecise consonants
- distorted vowels
- Irregular artic breakdowns
- monopitch/monoloudness
- Inappropriate silences
- Harsh vocal quality
- Excess loudness variation
47
Key evaluation tasks for hyperkinetic dysarthria
- Vowel prolongations
- AMRs
- Conversational speech and reading
- Careful observation of associated involuntary movements
48
Treatment for hyperkinetic dysarthria
- Medical: botox=most successful , drugs that suppress movements, deep brainstimulation
- Behavioral:
------Huntingtons:rate of speech, speaking on exhalation, individuals deteriorate very quickly
------Dystonia: strategies to suppress involuntary movements, bit blocks- stabilize jaw during speech, easy onset phonation
-----Tic disorders- habit reversal, relaxation therapy, exposure response prevention
49
Mixed dysarthria caused by
- Any combination of pure dysarthrias
- Strokes
- Brain tumors
- TBIs
- Degenerative diseases
- Infectious diseases
50
examples of mixed dysarthrias
- Multiple sclerosis: ataxic-spastic– progressivedemyelinating disease
- Amyotrophic lateral sclerosis: spastic-flaccid–progressive degeneration of any 4 areas of motor neurons
- Wilson’s disease: ataxic-spastic-hypokinetic–rare hereditary, copper gets built up in liver and eye
- Friedrch’s ataxia: ataxic-spastic–inherited progressive disorder caused by neural degeneration in cerebellum, brainstem, and spinal cord, untreatable and fatal
51
treatment of mixed dysarthria
- Very difficult bc so many deficits and pairs of dysarthrias
- First treat component most severely affecting speech production
- AAC
52
Apraxia of Speech affects what parts of speech
Motor timing and sequencing
53
Apraxia caused by
- Damage is caused in or around Broca’s area and is frequently paired with Broca’s aphasia
- Supplementary motor cortex is impacted
------Planning-sequencing sounds and syllables
------Programming- giving specific demands, ROM, and speed
- Stroke, degenerative diseases, trauma, tumor
54
What are the 2 different types of apraxia?
- Ideational apraxia
- Ideomotor apraxia
55
Ideational apraxia
uncommon; disturbance in conception of object or gesture
56
Ideomotor apraxia
- disturbance in performance of movements needed to use object - make gestures, sequence movements
- typically affects voluntary movements
- subcategories: limb apraxia, nonverbal oral apraxia, apraxia of speech
57
Speech characteristics of apraxia
- Primarily disorder of artic and prosody
- Slow, labored, halting speech
- Instances of groping
- Inconsistent speech errors
58
Key evaluation tasks of apraxia
- Sequential motor rate tasks
- Conversational speech and reading
- Repeating words of increasing length
- Reading or repeating low-frequency, multisyllabic words in isolation or sentence
59
4 categories of behaviors determine the correct diagnosis of apraxia
- Primary clinical characteristics
- Nondiscriminative clinical characteristics
- Behaviors usually found in disorders other than apraxia
- Behaviors that rule out presence of apraxia of speech
60
Ways to rule out other conditions that cause movement difficulties similar to those seen in apraxia
- Muscle weakness
- Sensory l oss
- Comprehension deficit
- Incoordination
61
Differentiating between apraxia and aphasia
- Speech errors in apraxia increase as word length and complexity increase while errors of dysarthria are fairly consistent
- Muscle ROM, tone, coordination, and strength are within normal limits in apraxia while at least one muscle quality in impaired in nearly all dysarthrias
62
Treatment for apraxia
- Mostly behavioral based on procedures to help select and sequence speech sounds
- PROMPT- promoting reorganization of oral muscular phonetic targets
- Sequenced to maintain success
- Repetitive and intensive drill
- Patients learn to self-monitor
- Concentrate on functional words
63
Specific treatments for apraxia
- Articulatory kinematic treatments- improve timing, placement, positioning and repetitions of articulatory movements
- Rate and rhythm procedures- timing errors
- Alternative and augmentative communication- for limited verbal communication
- Intersystemic facilitation and reorganization treatment- strengths used to assist verbal speech
