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msd final - new content > neurogenic speech disturbances > Flashcards

neurogenic speech disturbances Flashcards

1
Q

mutism etiologies

A
  • Severe dysarthria
  • Laryngectomy
  • Apraxia of speech
  • Aphasia
  • Disorders of arousal or consciousness
  • Postictal
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2
Q

anarthria

A
  • Speechlessness resulting from severe loss of neuromuscular control over speech
    (AoS or dysarthria in its most severe form)
  • Language and cognitive abilities may be intact
  • May be end stage of dysarthria for degenerative diseases:
    Amyotrophic lateral sclerosis (ALS), Multiple system atrophy (MSA), Progressive supranuclear palsy syndrome (PSPS), Corticobasal syndrome (CBS)
  • Spastic and hypokinetic dysarthria types most likely to lead to anarthria
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3
Q

locked-in syndrome

A
  • Mutism
  • Quadriplegia
  • Preserved consciousness and vertical eye movements or blinking
  • Severe spastic or mixed spastic-flaccid type dysarthria
  • Usually severe dysphagia
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4
Q

AOS with mutism

A
  • Only lasts a few days if stroke is etiology
  • Usually have concomitant non-verbal oral apraxia
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5
Q

aphasia with mutism

A
  • May be present initially
  • Usually transforms into transcortical motor aphasia
  • Prosody may be flat
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6
Q

Disorders of arousal, responsiveness, and diffuse cortical functions

A
  • coma
  • vegetative state
  • minimally conscious state
  • akinetic mutism
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7
Q

coma

A
  • Unarousable unresponsiveness and absence of sleep/wake cycles on EEG
  • Typically caused by diffuse bilateral cerebral hemisphere damage, brainstem injury, or both
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8
Q

vegetative state

A
  • Wakeful unawareness often associated with severe bilateral cerebral hemisphere involvement without brainstem involvement
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9
Q

minimally conscious state

A

Have a degree of awareness and responsiveness; may not be entirely mute

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10
Q

akinetic mutism

A
  • Reduced motivation (abulia) to speak, difficulty initiating and sustaining the cognitive and motor effort required for speech
  • Massive bifrontal lobe damage
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11
Q

Etiology-specific neurogenic mutism

A
  • Speech arrest: Following seizure (ictal, post-ictal state)
  • Drug-induced mutism
  • Mutism after corpus callosotomy
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12
Q

Rancho Los Amigos levels of cognitive functioning

A

I. No Response: Total Assistance
II. Generalized Response: Total Assistance
III. Generalized Response: Total Assistance
IV. Confused/Agitated: Maximal Assistance
V. Confused, Inappropriate Non-Agitated: Maximal Assistance
VI. Confused, Appropriate: Moderate Assistance
VII. Automatic, Appropriate: Minimal Assistance for Daily Living Skills
VIII. Purposeful, Appropriate: Stand-By Assistance
IX: Purposeful, Appropriate: Stand-By Assistance on Request
X. Purposeful, Appropriate: Modified Independent

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13
Q

acquired neurogenic stuttering

A

dysfluent speech acquired as a direct result of neurologic disease

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14
Q

acquired neurogenic stuttering - etiologies

A
  • Stroke and closed head injury most common
  • Parkinson’s disease, PSPS, MS, dementia, corticobasal syndrome, multiple system atrophy, seizure disorders, dialysis dementia, brain tumor, anoxia, bilateral thalamotomy, thalamic or globus pallidus deep brain stimulation, drug toxicity or abuse
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15
Q

acquired neurogenic stuttering - characterisitcs

A
  • sound/syllable repetitions, prolongations, and blocking/hesitation
  • May not be restricted to initial syllables
  • Can occur within content and function words
  • Awareness of dysfluencies but without significant anxiety or secondary struggle behavior
  • May not demonstrate an adaptation effect or improvement with choral reading or singing
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16
Q

acquired neurogenic stuttering- possible associated deficits

A
  • Aphasia
  • Apraxia of speech
  • Dysarthrias (hypokinetic more than other types)
17
Q

palilalia

A

compulsive repetition of words and phrases

18
Q

palilalia - etiologies

A
  • Parkinson’s disease/parkinsonism, Alzheimer’s disease and other dementias, progressive supranuclear palsy syndrome, closed head injury, stroke, tumor, multiple sclerosis, Tourette’s syndrome, post thalamotomy
  • bilateral basal ganglia pathology
19
Q

palilalia- characteristics

A
  • Repetitions of words or phrases
  • Increased rate and decreased loudness with successive repetitions (not invariable)
  • Most prominent during spontaneous and elicited speech; tends to be reduced during reading, repetition, and automatic speech tasks
  • Most common toward end of utterances but can occur anywhere
    adaptation effect uncommon
  • Awareness of deficit possible but no anxiety or secondary struggle
  • Reiterations can be inhibited temporarily, with effort
20
Q

echolalia - types

A
  • Mitigated
  • Ambient
  • Effortful
  • Silent, simultaneous
21
Q

echolalia

A

unsolicited repetition of another’s utterances

22
Q

echolalia-etiologies

A

Stroke, Alzheimer’s disease, Pick’s disease and other dementias, PSPS, corticobasal syndrome, carbon monoxide poisoning, Tourette’s syndrome, status epilepticus, schizophrenia, mental retardation, ASD, post emergence from coma

23
Q

echolalia- characteristics

A
  • Unsolicited repetition of others’ utterances
  • Compulsive, parrot-like quality
  • Repetition may be complete or partial, sometimes with spontaneous correction of syntax
24
Q

echolalia- associated deficits

A
  • aphasia
  • diffuse cognitive deficits
25
Q

attenuation of speech- etiologies

A

common: closed head injuries (CHI)

26
Q

attenuation of speech- characteristics

A

reduced speed of verbal responding , reduced linguistic and cognitive complexity of content, reduced vocal loudness and incomplete phonation, and flattened prosody

27
Q

attenuation of speech- associated deficits

A
  • cognitive and affective impairments
  • Dysphonia/aphonia associated with postintubation, psychogenic
28
Q

disinhibited vocalizations- characteristics

A

e.g. verbal or vocal tics, repetitive grunting, groaning, humming, or lip smacking

29
Q

disinhibited vocalizations - associated deficits

A

Diffuse cognitive impairment

30
Q

disinhibited vocalizations- etiologies

A

Alzheimer’s disease, Tourette’s syndrome

31
Q

FAS

A
  • Neurologic speech disorder in which articulatory and prosodic characteristics are perceived as a foreign accent (A.K.A. pseudoforeign accent)
  • Unreliability among listeners regarding the specific accent perceived
32
Q

FAS- devient speech characteristics

A
  • Vowel changes-diphthongization; distortions and prolongations, omissions of unstressed vowels, epenthesis
  • Consonant changes-alterations in voicing, place, and manner features, leading to perception of substitutions
  • Prosodic changes-alterations in stress, rhythm, and intonation
33
Q

FAS- etiologies

A

Stroke, CHI, MS, brain tumor, dementia, and primary progressive aphasia

34
Q

FAS- associated deficits

A
  • aphasia
  • AOS
  • nonverbal oral apraxia
35
Q

aprosodia

A
  • Disturbances in the prosodic components of speech that are tied to the expression of attitudes, emotion, and emphasis
  • Require an ability to manipulate speech planning, programming and, monitoring for pragmatic/social purposes
36
Q

aprosodia- patient complaints

A
  • Voice does not convey felt emotions
  • Altered pitch, either lower or higher
  • Reduced pitch range
  • Reduced loudness
37
Q

aprosodia- perceptual characteristics

A
  • Flattened, robot like spontaneous prosody
  • Reduced pitch and loudness variation
  • Reduced or abnormal intonational range
  • Reduced affect, expression, and emotion; indifferent
  • Tendency to equalize stress
  • Poor expression of irony and sarcasm
  • Poor projection of voice
  • Lack of emphasis
  • Abnormal quality to emotional crying and laughter
38
Q

aprosodia- accompanying deficits

A
  • Paucity of spontaneous emotional and propositional gestures
  • Left-sided neglect
  • Visuoperceptual disturbances
    cognitive-communicative deficits
  • Left central facial weakness
  • Dysarthria (unilateral UMN)
  • Left hemiparesis
39
Q

aprosodia - etiologies

A

stroke most common but can include any process that damages right or nondominant hemisphere

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