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comps > Motor Speech: Dysarthrias > Flashcards

Motor Speech: Dysarthrias Flashcards

1
Q

Flaccid dysarthria affects what parts of speech?

A

resonance, prosody, articulation, phonation, respiration

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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

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3
Q

Flaccid dysarthria symptoms

A

paralysis, weakness, hypotonicity, atrophy, and hypoactive reflexes of involved speech subsystem musculature

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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

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5
Q

Flaccid Resonancy deficits

A
  • hypernasality=MOST NOTICIBLE
  • Nasal emission
  • Weak pressure consonants
  • Shortened phrases
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6
Q

Flaccid Artic deficits

A
  • Imprecise consonant production
  • Damage to trigeminal nerve= difficulties elevating jaw
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7
Q

Flaccid phonation deficits

A
  • Phonatory incompetence
  • Breathy voice quality or whisper
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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
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9
Q

Flaccid prosody deficits

A
  • Monopitch & mono loudness
  • Not unique to flaccid dysarthria
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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
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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
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12
Q

Spastic dysarthria affects what parts of speech?

A

articulation, phonation, resonance, prosody

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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
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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
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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
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16
Q

Spastic artic deficits

A
  • Very common is spastic
  • Imprecise consonant production=MOST COMMON
  • Vowel distortions
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17
Q

Spastic phonation deficits

A
  • Harsh vocal quality=MOST COMMON
  • strained/strangled vocal quality
  • Low pitch
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18
Q

Spastic resonance deficits

A

Hypernasality

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19
Q

Spastic prosody deficits

A
  • Monopitch
  • Monoloudness
  • Short phrases
  • Slow rate of pitch
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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
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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)

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22
Q

Unilateral Upper Motor Neuron Dysarthria affects what parts of speech?

A

Articulation

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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
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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
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25
Q

UUMN artic deficits

A
  • 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
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26
Q

Key evaluation tasks for UUMN

A
  • Medical records
  • Conversational speech or reading paragraph
  • AMR tasks
  • Provlonged vowel
27
Q

Treatment for UUMN

A
  • 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
Q

Ataxic dysarthria affects what parts of speech

A

Articulation and prosody

29
Q

Ataxic dysarthria caused by?

A
  • 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
Q

Ataxic speech characteristics

A
  • Movements appear poorly coordinated
  • Problems controlling timing/force
  • slurred , monotonous articulation
31
Q

Specific characteristics of Ataxic

A

Scanning speech: term used to describe ataxia dysarthria, describing slow, deliberate production of syllables, with each syllable in word receiving equal stress

32
Q

Ataxic artic deficits

A
  • Imprecise consonant production
  • Distorted vowels
  • Irregular articulatory breakdowns
  • Decomposition of movement (distinct and jerky)
33
Q

Ataxic prosody deficits

A
  • Equal and excess stress: distinguishing characteristics
  • Prolonged phonemes and prolonged intervals between phonemes
  • Monopitch & monoloudness
34
Q

Treatment for Ataxic dysarthria

A
  • 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
Q

Hypokinetic dysarthria affects what parts of speech

A

phonation, articulation and prosody

36
Q

Hypokinetic dysarthria caused by

A
  • Any process that damages the basal gamglia (extrapyramidal system)
  • Parkinsonism, idiopathic parkinsons, neuroleptic parinsons, TBI, toxic metal poisoning, stroke
  • Not enough dopamine
37
Q

Hypokinetic speech characteristics

A
  • Harsh vocal quality
  • reduced stress
  • monoloudness
  • imprecise consonants
38
Q

hypokinetic distinctive characteristics

A
  • Festinating speech: increased rate
  • Resting tremor
  • Bradykinesia- slow, reduced movement
  • Rigidity- spasticity
  • Akinesia- delay in initiation of movements
  • Postural reflexes
39
Q

Key evaluation tasks for hypokinetic dysarthria

A
  • Conversational speech and reading- detect short rushes
  • Speech alternate motion rates- highlight artic errors
  • Vowel prolongations- assess vocal quality
40
Q

Hypokinetic deficits in prosody

A
  • Monopitch
  • Reduced stress
  • Monoloudness
41
Q

hypokinetic deficits in articulation

A
  • Imprecise consonants
  • Repeatedphonemes
  • Palilalia- stuttering-like features
42
Q

hypokinetic deficits in phonation

A
  • harsh/breathy quality
  • Aphonia
  • Low pitch
43
Q

Treatment for hypokinetic

A
  • 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
Q

Hyperkinetic dysarthria affects what parts of speech

A

articulation, prosody, phonation

45
Q

Hyperkinetic dysarthria caused by

A
  • 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
Q

Speech characteristics of hyperkinetic

A
  • Imprecise consonants
  • distorted vowels
  • Irregular artic breakdowns
  • monopitch/monoloudness
  • Inappropriate silences
  • Harsh vocal quality
  • Excess loudness variation
47
Q

Key evaluation tasks for hyperkinetic dysarthria

A
  • Vowel prolongations
  • AMRs
  • Conversational speech and reading
  • Careful observation of associated involuntary movements
48
Q

Treatment for hyperkinetic dysarthria

A
  • 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
Q

Mixed dysarthria caused by

A
  • Any combination of pure dysarthrias
  • Strokes
  • Brain tumors
  • TBIs
  • Degenerative diseases
  • Infectious diseases
50
Q

examples of mixed dysarthrias

A
  • 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
Q

treatment of mixed dysarthria

A
  • Very difficult bc so many deficits and pairs of dysarthrias
  • First treat component most severely affecting speech production
  • AAC
52
Q

Apraxia of Speech affects what parts of speech

A

Motor timing and sequencing

53
Q

Apraxia caused by

A
  • 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
Q

What are the 2 different types of apraxia?

A
  • Ideational apraxia
  • Ideomotor apraxia
55
Q

Ideational apraxia

A

uncommon; disturbance in conception of object or gesture

56
Q

Ideomotor apraxia

A
  • 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
Q

Speech characteristics of apraxia

A
  • Primarily disorder of artic and prosody
  • Slow, labored, halting speech
  • Instances of groping
  • Inconsistent speech errors
58
Q

Key evaluation tasks of apraxia

A
  • 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
Q

4 categories of behaviors determine the correct diagnosis of apraxia

A
  • Primary clinical characteristics
  • Nondiscriminative clinical characteristics
  • Behaviors usually found in disorders other than apraxia
  • Behaviors that rule out presence of apraxia of speech
60
Q

Ways to rule out other conditions that cause movement difficulties similar to those seen in apraxia

A
  • Muscle weakness
  • Sensory l oss
  • Comprehension deficit
  • Incoordination
61
Q

Differentiating between apraxia and aphasia

A
  • 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
Q

Treatment for apraxia

A
  • 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
Q

Specific treatments for apraxia

A
  • 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

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