neurogenic speech disturbances Flashcards
mutism etiologies
- Severe dysarthria
- Laryngectomy
- Apraxia of speech
- Aphasia
- Disorders of arousal or consciousness
- Postictal
anarthria
- 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
locked-in syndrome
- Mutism
- Quadriplegia
- Preserved consciousness and vertical eye movements or blinking
- Severe spastic or mixed spastic-flaccid type dysarthria
- Usually severe dysphagia
AOS with mutism
- Only lasts a few days if stroke is etiology
- Usually have concomitant non-verbal oral apraxia
aphasia with mutism
- May be present initially
- Usually transforms into transcortical motor aphasia
- Prosody may be flat
Disorders of arousal, responsiveness, and diffuse cortical functions
- coma
- vegetative state
- minimally conscious state
- akinetic mutism
coma
- Unarousable unresponsiveness and absence of sleep/wake cycles on EEG
- Typically caused by diffuse bilateral cerebral hemisphere damage, brainstem injury, or both
vegetative state
- Wakeful unawareness often associated with severe bilateral cerebral hemisphere involvement without brainstem involvement
minimally conscious state
Have a degree of awareness and responsiveness; may not be entirely mute
akinetic mutism
- Reduced motivation (abulia) to speak, difficulty initiating and sustaining the cognitive and motor effort required for speech
- Massive bifrontal lobe damage
Etiology-specific neurogenic mutism
- Speech arrest: Following seizure (ictal, post-ictal state)
- Drug-induced mutism
- Mutism after corpus callosotomy
Rancho Los Amigos levels of cognitive functioning
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
acquired neurogenic stuttering
dysfluent speech acquired as a direct result of neurologic disease
acquired neurogenic stuttering - etiologies
- 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
acquired neurogenic stuttering - characterisitcs
- 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
acquired neurogenic stuttering- possible associated deficits
- Aphasia
- Apraxia of speech
- Dysarthrias (hypokinetic more than other types)
palilalia
compulsive repetition of words and phrases
palilalia - etiologies
- 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
palilalia- characteristics
- 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
echolalia - types
- Mitigated
- Ambient
- Effortful
- Silent, simultaneous
echolalia
unsolicited repetition of another’s utterances
echolalia-etiologies
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
echolalia- characteristics
- Unsolicited repetition of others’ utterances
- Compulsive, parrot-like quality
- Repetition may be complete or partial, sometimes with spontaneous correction of syntax
echolalia- associated deficits
- aphasia
- diffuse cognitive deficits
attenuation of speech- etiologies
common: closed head injuries (CHI)
attenuation of speech- characteristics
reduced speed of verbal responding , reduced linguistic and cognitive complexity of content, reduced vocal loudness and incomplete phonation, and flattened prosody
attenuation of speech- associated deficits
- cognitive and affective impairments
- Dysphonia/aphonia associated with postintubation, psychogenic
disinhibited vocalizations- characteristics
e.g. verbal or vocal tics, repetitive grunting, groaning, humming, or lip smacking
disinhibited vocalizations - associated deficits
Diffuse cognitive impairment
disinhibited vocalizations- etiologies
Alzheimer’s disease, Tourette’s syndrome
FAS
- 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
FAS- devient speech characteristics
- 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
FAS- etiologies
Stroke, CHI, MS, brain tumor, dementia, and primary progressive aphasia
FAS- associated deficits
- aphasia
- AOS
- nonverbal oral apraxia
aprosodia
- 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
aprosodia- patient complaints
- Voice does not convey felt emotions
- Altered pitch, either lower or higher
- Reduced pitch range
- Reduced loudness
aprosodia- perceptual characteristics
- 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
aprosodia- accompanying deficits
- Paucity of spontaneous emotional and propositional gestures
- Left-sided neglect
- Visuoperceptual disturbances
cognitive-communicative deficits - Left central facial weakness
- Dysarthria (unilateral UMN)
- Left hemiparesis
aprosodia - etiologies
stroke most common but can include any process that damages right or nondominant hemisphere
