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Neurogenic Speech Disorders > Overview of Dysarthria & Apraxia > Flashcards

Overview of Dysarthria & Apraxia Flashcards

0
Q

Dysarthria can be congenital or acquired. T/F

A

T

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1
Q

A speech disorder resulting from a disturbance in muscular control. Results in weakness, slowness, in-coordination of speech musculature due to damage of CNS, PNS, or both.

A

Dysarthria

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2
Q

Speech systems that can be affected by dysarthria

A 
Respiration
Phonation
Resonance
Articulation
Prosody
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3
Q

An articulatory disorder resulting from impairments as a result of brain damage of the capacity to program the positioning of speech muscles and the sequencing of muscle movements for the volitional production of phonemes.

A

Apraxia

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4
Q

Absence of weakness, absence of slowness & in coordination during automatic speech or as part of a reflex, and prosodic alterations may be present in…..

A

Apraxia

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5
Q

Consistent errors, volitional vs spontaneous speech makes no difference, therapy targets strengthening systems, systems of speech may be affected….best describes

A

Dysarthria

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6
Q

Inconsistent errors, the ability to say a word spontaneously but not volitionally, therapy targets burning in the motor program, articulation difficulty…..best describes

A

Apraxia

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7
Q

Four parts of speech motor system

A

Final common pathway
Direct activation pathway
Indirect activation pathway
Control circuits

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8
Q

Another name for final common pathway

A

Lower motor neuron

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9
Q

The LMN (FCP) is the ….

A

Mechanism through which all motor activity is mediated, the last link in the chain.

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10
Q

Damage to LMN prevents

A

Normal activations muscle fibers

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11
Q

Damage to LMN can result in

A

Weakness/ paresis or paralysis

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12
Q

Over time, when damage to LMN has occurred, you will see

A

Atrophy due to loss of inner action

Fasiculations

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13
Q

Spontaneous motor discharges are called

A

Fasiculations

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14
Q

What type of dysarthria is associated with LMN damage?

A

Flaccid

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15
Q

What cranial nerves does the LMN contain?

A 
Trigeminal V
Facial VII
Glossopharyngeal IX
Vagus X
Accessory XI
Hypoglossal XII
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16
Q

Another name for the direct activation pathway

A

Pyramidal tract or direct motor system

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17
Q

The DAP is part of the ________ nervous system and provides a direct route from cortex to a direct synapse with the LMN.

A

Central

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18
Q

What tract in the DAP is of interest to SLPs?

A

Corticobulbar tract

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19
Q

Crucial to voluntary, controlled, discrete and rapid motor activity; movements generated by cognitive activity that may involve complex planning; mediates the complex planning, programming of speech muscles……best describes the function of the

A

DAP

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20
Q

Areas of origination in the cortex of each hemisphere for the DAP include…

A

Primary motor cortex
Premotor cortex
Supplementary motor area
Secondary motor area (post central gyrus)

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21
Q

Damage to the DAP may result in what types of dysarthria?

A

Spastic (ONLY if bi-lateral)

Unilateral upper motor neuron dysarthria

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22
Q

Function & route complex, poorly understood; difficult to separate completely from basal ganglia & cerebellar control circuits; sends input directly to the LMN, control circuits do not…best describes

A

Indirect activation pathway

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23
Q

Another name for indirect activation pathway is

A

Extra pyramidal tract. Or indirect route (due to multiple synapses)

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24
Q

The IAP is considered part of the UMN and is contained within the _____?

A

CNS

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25
Q

Damage to IAP causes what kind of dysarthria?

A

Unilateral upper motor neuron

Dysarthria or spastic dysarthria.

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26
Q

Regulates reflexes, maintains posture & tone, provides framework for the direct pathway to accomplish its discrete fine motor movements…best describes the function of

A

The IAP

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27
Q

Damage to ______ can affect muscle tone & reflexes, increased muscle tone or spasticity, hyperactive reflexes, pathological reflexes, excessive emotion

A

IAP

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28
Q

Pseudo bulbar palsy (chatacterized by excessive emotion) indicated damage to the _______

A

IAP

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29
Q

Contained within CNS, made up of nerve tracts from DAP & IAP, spastic paralysis, hypertonic, increased reflexes, no atrophy/ fasiculations…..best describes….

A

UMN

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30
Q

Peripheral nervous system, cranial & spinal nerves, flaccid paralysis, hypotonia, diminished reflexes, marked atrophy and fasiculations….best describes…

A

LMN

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31
Q

No direct contact with LMN, integrate or control the impulses of the direct and indirect motor pathways….best describe….

A

Control circuits

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32
Q

Two control circuits are the

A

Basal ganglia & cerebellum

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33
Q

Normal posture, maintaining tone of muscles for fine motor movements, amplitude and velocity of movement, damping effect on cortical discharges, and learning new movements all are believed to be functions of the…

A

Basal ganglia

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34
Q

Damage to BG results in two movement disorders…

A

Hypokinesia

Hyperkinesia

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35
Q

Reduced mobility, dopamine deficiency, increase in muscle tone and rigidity, Parkinson disease are associated with the movement disorder…

A

Hypokinesia

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36
Q

Involuntary movements, excessive activity in dopamine rigid nerve fibers reduce the damping effect, Huntington’s chorea are associated with the movement disorder…

A

Hyperkinesia

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37
Q

Preliminary info from the cortex re: movement, monitors integrity of movement, influences subsequent movement based on feedback it gives to the cortex, inhibits/ filters signals from cortex, “air traffic controller” of the human body best describe the functions of the ….

A

Cerebellum

38
Q

Ataxia, decomposition of movement, dysmetria, dysdiadochokinesia, clumsiness, hypotonia, and tremor are signs of dysfunction of the …

A

Cerebellar

39
Q

Name 7 Types of dysarthria

A 
Spastic
Flaccid
Ataxic
Hypokinetic
Hyperkinetic
Unilateral upper motor neuron
Mixed
40
Q

The purpose of motor speech assessment is…

A 
description of speech (pt & clinician's)
Problem detection
Establish dx possibilities 
Establishing dx
Implications for localization
Specifying severity
41
Q

5 parts of Motor Speech Exam

A 
Pt Hx
Oral motor exercises
Perceptual speech characteristics
Intelligibility 
Acoustic/ physiologic analysis ***

***optional

42
Q

Tools for motor speech exam

A 
Flashlight
Gloves
Tape recorder
Tongue blade
Stopwatch/ timer
43
Q

What to ask when collecting pt Hx

A 
Introduction/ goal setting 
Pt perception
Basic info
Onset/course
Associated deficits
Pt awareness of dx/disorder 
Consequences of disorder
Does speech sound abnormal
Pt self management
44
Q

During oral motor exam (your own or purchased) be thorough and look at speech musculature during….

A

Sustained postures
Rest
Movement

45
Q

When the face is at rest, look for ___

A

symmetry

46
Q

Observe the face during sustained postures of…

A

lip retraction, rounding, pursing, puffing cheeks, mouth open

47
Q

Observe the face during movement via the following…

A

pursing and retracting (oo-ee),
opening/closing mouth,
reflexive smiling,
observe uncontrolled crying/laughing

48
Q

When the jaw is at rest, look for

A

hang lower than normal, inability to close, clenching, temor

49
Q

Observe the jaw during sustained postures and look for…

A

deviation, limited excursion (chewing motion), resistance to opening/closing

50
Q

Observe the jaw during movement and look for…

A

symmetry, rapid/open close

51
Q

When the tongue is at rest, look for…

A

fasiculations (muscle twitching)-only at rest in the mouth, extraneous, large movements, normal in size, full, symmetric

52
Q

When the tongue is in a sustained posture, look for…

A

protrusion, deviation, resistance forward and in the cheek

53
Q

During tongue movement, look for…

A

lateralization

54
Q

When the velopharynx is at rest, look for…

A

palate hanging low, rests on tongue, palatal arches symmetry, and myoclonus (involuntary jerking of muscles)

55
Q

Check movement of velopharynx via…

A

prolong ‘ah’- checking for nasal air flow on mirror during vowel prolongation or pressure sounds

56
Q

Check the function of larynx via…

A

glottal coup (cough)–checking for vocal chords coming together, or sustain ‘ah’

57
Q

Observe respiration by assessing…

A

normal posture, SOB (shortness of breath), irregular/shallow or labored breathing

58
Q

Reflexes to test (optional)…

A

gag (only significant if assymetry stimulation observed), jaw, snout, suck

59
Q

Assessment of Perceptual Characteristics consists of…

A

vowel prolongation, AMRs-alternation motion rates(pa, pa, pa/ ta, ta, ta), SMRs-sequential motion rates (pa,da,ka,pa,da, ka,) contextual speech, stress testing (counting 1-100) , and apraxia screening

60
Q

Inappropriate response to reflex stimuli indicates

A

upper motor neuron damage

61
Q

AMRs stands for

A

alternating motion rates

pa, pa, pa; ta, ta, ta; ka, ka, ka

62
Q

When preforming speech stress testing, if someone’s speech deteriorates, it may indicate______which indicates____ damage

A

myasthenia gravis (more exercise weakens)

lower motor neuron damage

63
Q

Frenchay Dysarthria Assessment

A

published test, the only standardized assessment, no opportunity for perceptual analysis/bit confusing

64
Q

Dysarthria Profile

A

no longer in print, singing scales, need own case hx, additional ineligibility test needed

65
Q

Duffy Dysarthria Assessment (in book)

A

includes screening for apraxia

66
Q

Hartman-Dworkin Dysarthria assessment

A

screening

67
Q

Dysarthria Examination Battery

A

-assessment without instrumentation is diffcult, add case hx, intelligibility, and perceptual assessment…more like a voice assessment

68
Q

Assessment of Intelligibility (Yorkston and Beukelman 81)

A
  • pt needs to be literate
  • only a test on intelligibility
  • 50 words/12 choices each
  • sentences 5-15 words in length
  • *professor recommends having this for intelligibility testing–“very good”
69
Q

Apraxia Battery for Adults (Davul 79)

A

-6 subtests (5 speech, 1 limb/oral)

70
Q

Comprehensive Apraxia Test

A

-6 subtests (5 speech, 1 non-oral/postures & movements

71
Q

Salient features for Speech DX

A

strength, speed, range of motion, steadiness, tone, accuracy

72
Q

Confirmatory signs for dx

A 
(additional clues, other than deviant speech characteristics, regarding the location of pathology)
fasiculations (muscle twitching)
pathologic reflexes
atrophy
difficulty w/ initiation of movement
flat affect
73
Q

When establishing a dx…

A

address all reasonable possibilities, rule out what is it NOT, if ambiguous state why, always try to differentiate dx and report the type of dysarthria and implications for localization

74
Q

Why is it important to specify severity?

A

measures can be measures against the pt’s perception, influences prognosis and decision making, baseline data to compare change/improvement

75
Q

A disorder of volitional movement, not due to weakness, paralysis, incoordination, comprehension deficits, or memory loss is….

A

apraxia

76
Q

Where is the lesion located in apraxia?

A

motor association areas and association pathways

77
Q

Is apraxia a language disorder?

A

NO—it is a speech disorder (motor planning)

78
Q

What language disorder is apraxia often confused with?

A

Broca’s aphasia

79
Q

What disorder are the following symptoms associated with? telegrammatic speech, jargon/phonologic errors, syntactical/semantic errors, language deficits, AMRs wnl,variable self monitoring

A

Brocas’ Aphasia

80
Q

What disorder are the following symptoms associated with? well constructed sentences, absence of phonologic errors, grammatical construction wnl, language wnl, irregular AMRs, good self monitoring

A

Apraxia

81
Q

When listening for apraxia, what are some key things to listen for?

A

false articulatory starts (stutter-like), inconsistent artic errors, sound and syllable repetitions, altered rate and prosody

82
Q

Salient features for dx apraxia

A

audibly and visually groping for sounds and articulatory postures, automatic speech generally WNL (unless severe), slow labored speech, variable phonetic errors, increase in errors as utterances increase in length & complexity, sound transpositions

83
Q

Other types of apraxia,

A

nonverbal oral apraxia, limb apraxia, contrustional apraxia

84
Q

Nonverbal oral apraxia

A

impaired volitional oral motor movements (nonspeech)

85
Q

Limb apraxia

A

use of limbs for volitional acts is impaired

86
Q

Constructional apraxia

A

difficulty with visual-spatial tasks, inability to copy simple designs

87
Q

How to treat apraxia

A

1 on 1, “listen & watch me,” NO mirror, burn in motor program-repetition/reauditorization, automoatic speech tasks, focus on self-monitoring, slow deliberate speaking rate, paire external temporal pacing stimuli with speech attempts, melodic intonation techniques to stimulate speech, begin training with short re-duplication utterances increasing length and complexity as warranted

88
Q

Muteness that may be present for 1-2 weeks, limited repertoire of speech sounds, no difference between automatic and volitional speech, likely accompained with aphasia is descriptive of

A

severe apraxics

89
Q

T or F: Return to functional speech is unlikely for severe apraxics

A

TRUE

90
Q

Treatment with severe apraxics

A 
AAC- (gestures, pix boards, low tech),
work on aphasia,
stimulate speech (automatic speech & imitating vowels),
multiple input phoneme therapy,
counseling
91
Q

Treatment with mod apraxics

A

work on aphasia, try slow rate of speech and reauditorization, artic drills & prosodic aids, AAC as needed, counseling

92
Q

Treatment with mild apraxics

A

work on aphasia, artic drills, reinforce speech w/writing, work on artic w/ oral reading, encouarge self-monitoring, counseling

Neurogenic Speech Disorders (4 decks)

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