Motor Speech: Dysarthrias Flashcards
Flaccid dysarthria affects what parts of speech?
resonance, prosody, articulation, phonation, respiration
Flaccid Dysarthria caused by
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
Flaccid dysarthria symptoms
paralysis, weakness, hypotonicity, atrophy, and hypoactive reflexes of involved speech subsystem musculature
Flaccid dysarthria speech characteristics
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
Flaccid Resonancy deficits
- hypernasality=MOST NOTICIBLE
- Nasal emission
- Weak pressure consonants
- Shortened phrases
Flaccid Artic deficits
- Imprecise consonant production
- Damage to trigeminal nerve= difficulties elevating jaw
Flaccid phonation deficits
- Phonatory incompetence
- Breathy voice quality or whisper
Flaccid respiration deficits
- Weakened respiration may or may not be a component
- Reduced loudness shortened phrase length, strained vocal quality, monoloudness, monopitch
Flaccid prosody deficits
- Monopitch & mono loudness
- Not unique to flaccid dysarthria
Key evaluation tasks for flaccid dysarthria
- 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
Treatment for flaccid
- 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
Spastic dysarthria affects what parts of speech?
articulation, phonation, resonance, prosody
Spastic dys cause by?
- 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
Spastic speech characteristics
- Weak/slow skilled movements- due to pyramidal system damage
- Weakness, increased muscle tone (spasticity), and abnormal reflexes- due to extrapyramidal system damage
Characteristics seen in spastic
- Pseudobulbar affect: uncontrollable crying or laughing due to damage ofo UMNs
- Drooling: due to impaired oral control of saliva or less frequent swallowing
Spastic artic deficits
- Very common is spastic
- Imprecise consonant production=MOST COMMON
- Vowel distortions
Spastic phonation deficits
- Harsh vocal quality=MOST COMMON
- strained/strangled vocal quality
- Low pitch
Spastic resonance deficits
Hypernasality
Spastic prosody deficits
- Monopitch
- Monoloudness
- Short phrases
- Slow rate of pitch
Key evaluation tasks for spastic
- Conversational speech and reading
—–Assesses resonance, articulation, and prosody - Speech alternatemotion rates (AMRs)
——Demonstrates slow rate of phoneme production - Vowel prolongations
—–Evokes phonatory deficits
Treatment for spastic
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)
Unilateral Upper Motor Neuron Dysarthria affects what parts of speech?
Articulation
UUMN caused by?
- 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
Differences between spastic and UUMN
- 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
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
Key evaluation tasks for UUMN
- Medical records
- Conversational speech or reading paragraph
- AMR tasks
- Provlonged vowel
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
Ataxic dysarthria affects what parts of speech
Articulation and prosody
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
Ataxic speech characteristics
- Movements appear poorly coordinated
- Problems controlling timing/force
- slurred , monotonous articulation
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
Ataxic artic deficits
- Imprecise consonant production
- Distorted vowels
- Irregular articulatory breakdowns
- Decomposition of movement (distinct and jerky)
Ataxic prosody deficits
- Equal and excess stress: distinguishing characteristics
- Prolonged phonemes and prolonged intervals between phonemes
- Monopitch & monoloudness
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)
Hypokinetic dysarthria affects what parts of speech
phonation, articulation and prosody
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
Hypokinetic speech characteristics
- Harsh vocal quality
- reduced stress
- monoloudness
- imprecise consonants
hypokinetic distinctive characteristics
- Festinating speech: increased rate
- Resting tremor
- Bradykinesia- slow, reduced movement
- Rigidity- spasticity
- Akinesia- delay in initiation of movements
- Postural reflexes
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
Hypokinetic deficits in prosody
- Monopitch
- Reduced stress
- Monoloudness
hypokinetic deficits in articulation
- Imprecise consonants
- Repeatedphonemes
- Palilalia- stuttering-like features
hypokinetic deficits in phonation
- harsh/breathy quality
- Aphonia
- Low pitch
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)
Hyperkinetic dysarthria affects what parts of speech
articulation, prosody, phonation
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
Speech characteristics of hyperkinetic
- Imprecise consonants
- distorted vowels
- Irregular artic breakdowns
- monopitch/monoloudness
- Inappropriate silences
- Harsh vocal quality
- Excess loudness variation
Key evaluation tasks for hyperkinetic dysarthria
- Vowel prolongations
- AMRs
- Conversational speech and reading
- Careful observation of associated involuntary movements
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
Mixed dysarthria caused by
- Any combination of pure dysarthrias
- Strokes
- Brain tumors
- TBIs
- Degenerative diseases
- Infectious diseases
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
treatment of mixed dysarthria
- Very difficult bc so many deficits and pairs of dysarthrias
- First treat component most severely affecting speech production
- AAC
Apraxia of Speech affects what parts of speech
Motor timing and sequencing
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
What are the 2 different types of apraxia?
- Ideational apraxia
- Ideomotor apraxia
Ideational apraxia
uncommon; disturbance in conception of object or gesture
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
Speech characteristics of apraxia
- Primarily disorder of artic and prosody
- Slow, labored, halting speech
- Instances of groping
- Inconsistent speech errors
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
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
Ways to rule out other conditions that cause movement difficulties similar to those seen in apraxia
- Muscle weakness
- Sensory l oss
- Comprehension deficit
- Incoordination
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
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
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
