MWF 10 - 2 Flashcards
What is needed for successful speech production?
- Create a Plan
- Refine the Plan
- Transmit the Plan
- Carry out the Plan
True or False: When there’s a pattern of breakdown along the way, the patient has a motor speech disorder
True
What are some differences in speech for a person who has a Motor Speech Disorder?
-Fumbling
-Inconsistent
-Halting
-Slurred
-Unintelligible
-Weak
-Harsh
What is a key characteristic of speech in a Motor Speech Disorder?
Weakness in speech
What are the two types of Motor Speech Disorders?
- Apraxia
- Dysarthria
True or False: Apraxia is a disorder of motor execution
False; disorder of motor PLANNING
What is Dysarthria?
a disorder of execution, in which motor plans are distorted or disrupted
What are the subtypes of Apraxia?
-Apraxia of Speech
-Oral Apraxia
-Limb Apraxia
-Ideomotor Apraxia
-Ideational Apraxia
What is Apraxia of Speech?
speech is affected but can still do nonverbal tasks
What is Oral Apraxia?
oral tasks in general are affected
inability to move tongue around
affects verbal and nonverbal functioning
What is Limb Apraxia?
affects both arms and legs and the plan to carry out limb movement
What is Ideomotor Apraxia?
understands what’s being asked of them, but cannot complete task
What is Ideational Apraxia?
difficulty with spontaneous and requested actions, may not understand what’s being asked of them
What are some causes of Acquired Apraxia?
Injury to:
-Motor Strip
-Broca’s Area
-Basal Ganglia
- Cerebellum
-Supplementary Motor Area
Where are the most common lesion sites for Acquired Apraxia?
-Left Hemisphere damage
-Often to posterior portion of frontal cortex
What are some symptoms of Acquired Apraxia?
-Groping Behaviors
-Inconsistent error patterns
- Islands of intact speech
-Requested action < Voluntary action
-Slow rate
-Artic errors
-Atypical prosody
-Impaired initiation
What are the three key symptoms of Acquired Apraxia?
*Groping behaviors
*Inconsistent errors, with islands of intact speech
*Voluntary action preferred over Requested action
What are the four patterns of Articulation Errors?
-Metatheses
-Sound Substitutions
-Syllable Repetitions
-Epentheses
What is the definition of Metatheses?
initial sound and medial sound gets transposed or switched
What is the definition of Epentheses?
inserting an extra sound where it doesn’t belong
ex: /bʌlu/ “buhloo” instead of /blu/ “blue”
What are the three Apraxia therapy treatments?
-PROMPT
-MIT
-Biofeedback
What is PROMPT?
an Apraxia therapy treatment where clinicians specifically cue each speech movement with use of their hands on the clients mouth to form speech sounds
What does PROMPT stand for?
Prompts for Restructuring Oral Muscular Phonetic Targets
What is Melodic Intonation Therapy (MIT)?
an Apraxia therapy treatment where clinicians use rhythmic cues to invoke a phrase said by the client in a singing voice
What is Biofeedback?
an Apraxia therapy treatment that utilizes a symptom of approaches intended to show where the articulators are making sounds then correcting the placement
What is the definition of Dysarthria?
a group of speech disturbances caused by a disruption of motor control through the CNS and PNS that may affect respiration, phonation, articulation, resonation, and/or prosody
What are the causes by the Flaccid Dysarthria?
Caused by lower motor neuron damage and trauma, surgical error, tumor, brainstem stroke, degenerative diseases, neuromuscular disease, anatomical anomalies, infectious diseases, idiopathic conditions
What is damaged in Flaccid Dysarthria?
Damage to the recurrent laryngeal nerve
What are the Hallmark symptoms of Flaccid Dysarthria?
Hypotonia and Muscle Weakness
What are the symptoms of Flaccid Dysarthria?
Hypotonia
Muscle weakness
Hypernasality, Nasal Emissions
Audible inspiration, Inhalatory Phonation
Breathiness, Short Phrases
Diplophonia
What causes Spastic Dysarthria?
caused by bilateral upper motor neuron damage
Brainstem stroke
Trauma
Primary Lateral Sclerosis
Leukoencephalitis
What are the Hallmark features of Spastic Dysarthria?
Bilateral Spasticity and Hypertonia
What are the symptoms of Spastic Dysarthria?
Bilateral Spasticity
Hypertonia
Harsh, strained, strangled voice
Low pitch, pitch breaks
Slow, effortful, fatiguing speech
Drooling
What the causes of Unilateral Upper Motor Neuron Dysarthria?
Stroke, overwhelmingly*
Tumor
Neurosurgery
What are the symptoms of UUMN Dysarthria?
Milder than other forms
Slurred, slow speech
Fatigue exasterbates symptoms
Often accompanied by hemiplegia, hemiparesis, or unilateral sensory impairment; limb or facial
What causes Hypokinetic Dysarthria?
Caused by disruption of the basal ganglia control circuits
Parkinsons and related degenerative diseases
Stroke affecting basal ganglia
Toxin exposure
TBI
Encephalitis
What are symptoms of Hypokinetic Dysarthria?
Decreased Rate of Movement
Rigidity, tremor at rest
Masked facies
Monopitch, Monoloudness
Reduced loudness driven by faulty self-perception
Short bursts of speech, increased speech rate overall, rapid AMR’s
Palilalia
What are the causes of Hyperkinetic Dysarthria?
Caused by damage to the basal ganglia control circuit
Idiopathic
Toxic, including Tardive Dyskinesia
Degenerative, including Huntington’s disease
Trauma
Stroke
What is considered a subtype of Hyperkinetic Dysarthria?
Spasmodic Dysphonia
Types: Abductor, Adductor, Tremor
What are the Hallmark Features of Hyperkinetic Dysarthria?
unpredictable involuntary movement
What are the associated features of Hyperkinetic Dysarthria?
unpredictable involuntary movement
intermittent breathiness or harshness or aphonia
tense vowel prolongation, irregular/slow AMR’s
intrusive phonation
Echolalia/Coprolalia
Sudden intrusive respiration
What are the causes of Ataxic Dysarthria?
Caused by damage to the cerebellar control circuits
Degenerative disease
Demyelination
Stroke
TBI
Tumor
Toxin exposure, including alcohol/drug abuse
Idiopathic
What are the hallmark features of Ataxic Dysarthria?
Sounds drunk; slurred speech
Gait/stance effects
What are the features of Ataxic Dysarthria?
Slurred speech
Gait/Stance
Irregular AMR’s
Primary effects on artic and prosody
Excess and equal stress
Excess loudness variation
Vowel distortions and phoneme prolongations
What is the #1 cause of Hypokinetic Dysarthria?
Parkinson’s disease
What is the definition of Echolalia?
when one repeats things that they hear, unrelated to the topic at hand
What is the definition of Coprolalia?
sudden bursts of profanity or inappropriate
What is the definition of Palilalia?
repeat themselves and is contextually inappropriate in tone and message
What is Bradykinesia?
slowed movement
What is common between Tremor, Chorea, Dystonia, and Dyskinesia?
All refer to unwanted movement that is involuntary
What is Leukoencephalitis?
white matter inflammation causing the brain to swell
What is Muscular Dystrophy?
muscles are not able to respond, contractible muscles become connective tissue, causing inability to create new muscle tissue and stiffening of the muscles
What is Guillan-Barre?
autoimmune issue, particular target is myelin sheathe, signal between the brain and its muscles is impaired
What causes Mixed Dysarthria?
Caused by lesions affecting different neurological structures will result in different clinical presentation
- Degenerative disease
- Stroke
- Trauma
- Tumor
- Metabolic (hypothyroidism, Wilson’s Disease)
- Encephalopathy
What are the approaches to treat Dysarthria?
- Restorative Approaches
- Compensatory Approaches
What are the Restorative Approaches used to treat Dysarthria?
- Improve flexibility
- Improve strength
- Promote optimal medical management
What are the Compensatory Approaches used to treat Dysarthria?
- Optimize speech
- Support AAC selection/implementation
What is Aprosodia?
where a person cannot pick up on tone meanings
What are some Communication Impairments that are caused by a Right Hemisphere Stroke?
- Aprosodia
- Paralinguistic cues, such as facial expressions
- Pragmatics
- Figurative Language
- Drawing Inferences
What is Hemianopsia?
a visual field cut; patient cannot see
What is Neglect?
a persistent attention problem; patient doesn’t see
What are the subtypes of neglect?
- Personal
- Peripersonal
- Extrapersonal
- Viewer-centered
- Object-centered
What is the Personal subtype of neglect?
neglect is confined to body, person doesn’t perceive left side of her body
What is the Peripersonal subtype of neglect?
neglect is within arms reach; outside of body and within reach
What is the Extrapersonal subtype of neglect?
neglect is beyond arms reach; outside body and outside of reach
What is the Viewer-centered subtype of neglect?
the neglected region shifts with self-movement
What is the Object-centered subtype of neglect?
the person neglects left side of objects, even in rightfield
What is Topological Disorientation?
inability to navigate to familiar places
What is Prosopagnosia?
facial blindness; hard to recognize familiar faces
What is Capgras Delusion?
recognizes familiar faces, but believes they are an impostor
What is Anosognosia?
person doesn’t know they have an illness or deficits
What is Alexia?
an acquired impairment of reading
What is Sensory Agnosia?
person hears a noise, but doesn’t know what it means; touches things and doesn’t know what it means, how to solve problems
What is Autotopagnosia?
inability to recognize one’s body parts
What is Phonagnosia?
inability to recognize a familiar voice
What is Achromatopsia?
disruption of color vision
What is Amusia?
inability to enjoy music; sees music as noise
What is Simultagnosia?
unable to see the meaning behind images; only sees the individual parts of an image
What are the three mechanisms of brain injury?
- Primary
- Secondary (acute)
- Secondary (chronic)
What are the components of a Primary Brain Injury?
- Skull Fracture
- Contusions
- Hematomas
- Lacerations
- Diffuse Axonal Injury (DAI)
What is a Diffuse Axonal Injury?
the shearing (tearing) of the brain’s long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull. DAI usually causes coma and injury to many different parts of the brain.
What are the components of an Acute Secondary Brain Injury?
- Ischemia/Hypoxia
- Cerebral Edema
- Increased intracranial pressure
- Herniation
- Intracranial infection
- Excitotoxicity
- Hypercapnia
- Acidosis
What is Herniation?
a devastating rearrangement of brain tissue
What is Excitotoxicity?
neurotransmitters causing cell damage??????
What is Hypercapnia?
too much CO2;
What is Acidosis?
abnormally low pH
What are the components of Chronic Secondary Brain Injury?
- Epilepsy
- Hydrocephalus
What are the causes of Pediatric TBI/ABI?
- Child abuse/neglect
- Accidents
- Asphyxia
- Sports injuries
What is Barotrauma?
an injury caused by exposure to rapidly changing pressure
What is Polytrauma?
multiple types of trauma arising from a single incident
PTSD and its implications for Military personnel and TBI
re-entry can be significantly complicated by psychological effects of an injury
What is a Coma?
a state of deep unconsciousness in response to a grave injury to the brain
What is Anterograde Amnesia?
loss of the ability to form new memories
What is Retrograde Amnesia?
loss of pre-existing memories
What is Disinhibition?
loss of the ability to act appropriately in social contexts
What is Confabulation?
the production of inaccurate stories, presented as true and often contain factual elements that may reflect problems with “time-tagging”
What are the areas of deficit for Brain Injury?
- Pragmatics
- Cognition
What are the pragmatic deficit patterns for Brain Injury?
- Topic Maintenance
- Tendency to dominate conversations, repeat stories
- Potential problems with indirect requests, sarcasm, metaphor
What are the cognitive deficit patterns for Brain Injury?
- Impulsivity
- Planning and judgement
- Awareness of problem areas
What are Long-term needs of those with Brain Injury?
- Self-cuing strategies
- Advocacy/education
What are the Assessment strategies for those with Brain Injury?
- Orientation
- Behavior
- Language
- Cognition
What are the treatment strategies for those with Brain Injury?
- Coma stim
- Memory strategies (compensatory/restorative)
- Cognitive Rehabilitation Therapy (CRT)
What is Coma Stim?
focusing on simply getting a general response to sensory stimulation. This can include touching the patient’s hand, talking loudly into the ear, or even letting the patient smell an object or food
What is required for someone to be declared as being in a coma?
Needs to be unconscious for more than 6 hours; if it lasts for more than 4 weeks, probability of recovery is significantly less
What is the Rancho Los Amigos Scale?
used to track progress of a person out of a coma; Level 1 - 8 higher the level, more functional
What is the Glasgow Coma Scale?
used to assess those in a coma on their verbal, visual, and motor skills
What is a Decerebrate Response?
abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward; first, before decorticate response
What is a Decorticate Response?
