Neurogenic Speech Disorders Flashcards
Neurogenic Speech Disorders
Causes of Neurogenic Speech Disorders
Cerebral Palsy
The Dysarthrias
Apraxia of Speech
Related to problems of movement can affect all speech processes
*Planning
*Coordination
*Timing
*Execution
Heterogeneous group of disorders.
Common causes
Common causes *Stroke
*TBI
*Anoxia
*Brain Tumors *Infections
*Toxins
*Diseases
Speech may vary widely
Cerebral palsy
Nonprogressive neurological difficulty
Brain injury early in fetal or infant
development
Affects
*Movement, communication, development, locomotion, learning and sensation
Over 500,000 individuals in the U.S. have CP
30-90% also have dysarthria
Hemiplegia
Hemiplegia: one side of the body, the right or left is paralyzed
Paraplegia
Paraplegia: only the legs and lower trunk are paralyzed
Monoplegia
Monoplegia: only one limb or a part thereof is paralyzed
Diplegia
Diplegia: either the two leg or the two arms are parlayzed
Quadriplegia
Quadriplegia (all four limbs are paralzed
Types of cerebral palsy
Spastic=-Hypertonia
Athetoid =Dyskinesia
Ataxic = Ataxia
Spastic
Spastic
-Hypertonia
-Movement is jerky, labored, slow
-Infantile Reflex patterns
-Motor cortex and/or pyramidal tract
Athetoid
Athetoid
-Dyskinesia
-Slow, involuntary writhing -Infantile Reflex patterns -Extrapyramidal tract, basal ganglia
Ataxic
Ataxic
-Ataxia
-Uncoordinated and disturbed balance
-Movements lack direction, adequate force and rate, direction control. -Injury to cerebellum
Motor Speech Problems with cerebral palsy
Motor Speech Problems
*All aspects of speech may be affected
*Swallowing/breathing affected
*Voice quality reflects hypotonia
*Resonance is hypernasal
*Articulation may be extremely difficult, possibly unintelligible
*Prosody monotonous, choppy, or non-fluent
*Additional complications
–Intellectual, auditory, processing, language impairments
Lifespan issues with cerebral palsy
Early Symptoms
*Irritability, weak crying/sucking, excessive sleeping, little interest in surroundings, persistence of primitive reflexes
*Motor delays are often the first sign
*Usually receive early intervention
-Focus on movement and communication
*Important to assess cognition
*May obtain higher education and hold employment
*May work or learn in special programs
Assessment for cerebral palsy
*TEAM
*Pediatrician
*Neurologist
*PhysicalTherapist
*Otolaryngologist
*Speech-Language-Pathologist
*OccupationalTherapist
Thoroughly assess oral mechanism and potential for AAC
Electropalatograph (EPG)
Intervention for cerebral palsy
Speech and language training
Systems approach
Prosthetic devices/intraoral surgery
Electopalatograph
AAC
Work with Physical Therapist to facilitate movement patterns
Consult with parents about expectations
The dysarthrias
A group of neuromuscular impairments that affect speed, range, direction, strength, and timing of motor speech movements.
*Result of paralysis, weakness, discoordination All speech processes may be affected
Motor movements
*Sloworrapid *Decreasedrangeofstrength *Poordirectionalityorcoordination
Intelligibility most affected by involvement of jaw, tongue, lips and soft palate
Types of Dysarthrias and Associated Etiologies
Types of Dysarthrias and Associated Etiologies
*Different types result from lesion location within the CNS
Flaccid
Spastic
Ataxic
Hyperkinetic
Hypokinetic
Flaccid Dysarthria
Hypotonia
Lesions in cranial/spinal nerves,
muscle unit
Reduced vital capacity, shallow breathing, breathy voice, aphonia
*Bulbar Palsy
*Myasthenia Gravis
*Muscular Dystrophy
Spastic dysarthria
Results of lesions in lower brain Bilateral lesions are more severe Speech characteristics
*Slow and jerky, imprecise articulation, reduced rapid alternating speech
Pseudobulbar palsy
Ataxic dysarthria
Damage to cerebellum
Result of breakdown in motor organization
and control
Affects accuracy, timing and direction
Speech Characteristics
*Shift in Fo, variability in moving between speech sounds, energy varies across syllables, respiration poorly coordinated, voicing/articulation imprecise
Hyperkinetic
Lesions in lower and mid brain Tremors, tics
Inaccurate articulation
Types
*Dystonia
Chorea Huntington Chorea
Hypokinetic
Lesions of mid and lower brain Decrease or lack of
appropriate movement Muscles become rigid and stiff Example:
Parkinson’sDisease
Mixed dysarthria
Symptoms or areas of brain that cross several dysarthrias
Diffuse brain damage
*Degenerative disorders, toxins, metabolic disorders, stroke, trauma, tumors, infectious disease
Example
*Amyotrophic Lateral Sclerosis
Lifespan issues
Acquired dysarthria mostly occurs in adults
Even slight speech imperfection can cause embarrassment
Reduced social interaction
Progressive disorders
*May be unable to care for themselves
AAC
Assessment for dysarthria
Purpose of Evaluation
*Determine if there is significant long-term
*Describe impairment
*Identify functions not impaired
*Establish goals and baseline for intervention
*Form prognosis
Oral Peripheral Exam and samples of speech in several contexts
Range, speed, and direction of oral movement
Standard Assessment
Intervention for dysarthria
Evidenced-based practice does not support non-speech oral motor treatments
Intervention may include
*Drill, progressively complex tasks, feedback
Exercises for respiration and hypernasality
LSVT for Parkinson’s disease
Speech and non-speech movements respond differently to neurosurgical, genetic, pharmacological intervention
Apraxia
Disorder in voluntary motor placement/sequencing, unrelated to weakness, slowness, paralysis
Oral Apraxia
Apraxia of Speech
*Problem of speech-sound articulation and prosody or rhythm
*Groping attempts and great variability
*Repeated attempts to correct errors
*Complex, long words are difficult
*Children can exhibit developmental apraxia of speech
Etiology for apraxia
Lesion of the central programming area for speech
Broca’s area
* Details and plans speech motor
movements
Most common causes
*Stroke
*Degenerative Disease
*Trauma
Assessment apraxia
Important aspects of assessment
*Imitation of single words of varying length
*Sentence Imitation
*Reading aloud
*Spontaneous speech
Rapid repetition of “puh”, “tuh”, “kuh” and “put-tuh-kuh”
Perform better with auditory-visual stimuli
Intervation for apraxia
Attempt to increase muscle tone and strength
Sensory bombardment
Imitation, simultaneous production, spontaneous speech
AAC
Electromagnetic articulography
Decrease speech rate
Frequently used phrases are practiced and incorporated in verbal repertoire
