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Motor Speech Disorders > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Regions of the Brain

A 
Frontal Lobe
Parietal Lobe
Occipital Lobe
Temporal Lobe
Cerebellum
Brain Stem
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2
Q

Speech

A

Complex motor act:

  • Disproportionate cortical sensorimotor space allotted to the larynx, palate, tongue and lips (Homunculus)
  • Requires more motor fibers than any other mechanical behavior
  • Multimodal feedback
  • 140,000+ neuromuscular acts/second
  • Temporal precision about 10msec
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3
Q

Somatosensory and Motor Cortex

A

Somatosensory is anterior to Motor Cortex

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4
Q

Motor Speech Disorders (MSD)

A
  • An impairment caused by a lesion or dysfunction of the motor speech centers in either the PNS, CNS, or both.
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5
Q

MSD Result In…

A

An inability to regulate the movements required for speech:

  • Planning
  • Programming
  • Control
  • Execution of speech
  • Includes the dysarthrias and apraxia of speech
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6
Q

MSD May Be…

A
  • Congenital or acquired
  • Static, improving, or degenerative
  • Associated with lesions in various CNS and PNS structures
  • Caused by numerous diseases/condition
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7
Q

MSD Descriptive terms of SLPs vs. Neurologists

A
  • Weak/Slow vs. Paralysis
  • Unsteady vs. Tremor
  • Uncoordinated vs. Dymetria/Dyssergia
  • Decreased Tone vs. Hypotonic
  • Increased Tone vs. Hypertonic
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8
Q

Terms to Define Decrease in MSD Function

A
  • Paresis: partial or incomplete paralysis
  • Plegia: paralysis
  • Monoparesis/monoplegia: weakness/paralysis of one limb
  • Hemiparesis/hemiplegia: weakness/paralysis of one side of the body
  • Paraparesis/paraplegia: weakness/paralysis of both lower extremities
  • Quadriparesis/quadriplegia: weakness/paralysis of all four limbs
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9
Q

Two Major Categories of MSDs

A

Dysarthrias:
- In its extreme form also called anarthria
- Static, improving, degenerative

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10
Q

Childhood MSD

A

Terms vary/may be synonymous

  • childhood dysarthria (CD)
  • developmental verbal dyspraxia (DVD)
  • childhood apraxia of speech (CAS
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11
Q

Dysarthria Definition

A

Neurogenic speech disorder caused by dysfunction of CNS or PNS

Reflects abnormalities in movements required for breathing, phonatory, resonatory, articulatory or prosody of speech production:

  • strength
  • speed
  • range
  • steadiness
  • tone
  • accuracy
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12
Q

Dysarthria Types

A
  • Different types, each corresponding to damage to particular part(s) of the nervous system,
  • Each having different underlying neuropathophysiology
  • Each type has different auditory perceptual characteristics which can be distinguished clinically
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13
Q

Dysarthria Diagnosis

A
  • Made independently by neurologist and SLP
  • Can affect any of the speech production subsystems:
    • Respiration
    • Phonation
    • Resonance
    • Articulation
    • Prosody
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14
Q

Dysarthria Casues

A

Common causes:

  • Stroke (CVA)
  • Brain Injury (TBI)
  • Brain Tumor
  • Conditions that cause facial paralysis or weakness
  • Degenerative Disorders

Pharmacological Causes:

  • Sedatives
  • Narcotics
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15
Q

Dysarthria Clinical Challenges

A
  • Educational
  • Medical
  • In children: must be differentiated from other developmental CMD
  • Ind adults: must be differentiated from apraxia of speech, language and/or cognitive deficits
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16
Q

Dysarthria Types Definitions

A
  • Each type has an identifiable etiology corresponding to site of lesion
  • Each had a characteristic pattern
  • Each reflects a breakdown in the normally synchronous and coexisting subsystems of speech
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17
Q

Flaccid Dysarthria

A

Location: Lower motor neurons (LMN)
Primary Deficit: weakness
Common Cause: Myasthenia Gravis

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18
Q

Spastic Dysarthria

A

Location: Upper motor neurons (UMN)
Primary Deficit: spasticity
Common Cause: Unilateral Stroke

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19
Q

Ataxic Dysarthria

A

Location: cerebellar control circuit
Primary Deficit: incoordination
Common Cause: Fredrich’s Ataxia

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20
Q

Hypokinetic Dysarthria

A

Location: basal ganglia control circuit
Primary Deficit: rigidity and decreased ROM
Common Cause: Parkinson’s Disease

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21
Q

Hyperkinetic Dysarthria

A

Location: basal ganglia control circuit
Primary Deficit: involuntary movements
Common Cause: Huntington’s chorea

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22
Q

Unilateral UMN

A

Location: unilateral UMN

Primary Deficit: weakness, incoordination, spasticity

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23
Q

Mixed Dysathria

A

Location: more than one
Primary Deficit: more than one
Common Cause: ALS

24
Q

Apraxia Definition

A

Disruption in the ability to voluntarily sequence complex movements accurately

25
Q

Two Types of Apraxia

A
  • Nonverbal (Oral) Apraxia

- Verbal Apraxia

26
Q

Nonverbal (Oral) Apraxia

A

Disruption in the sequencing of oral movements that are non-verbal (smiling, puckering the lips, protruding the tongue)

  • May or may not coexist with apraxia of speech
  • AKA: Bucco-Facial apraxia in adults
  • ONLY in nonverbal tasks
27
Q

Nonverbal (Oral) Apraxia Characteristics

A
  • Hesitations, groping and revisions are displayed when attempting to perform nonverbal movements
  • Inability to coordinate and/or initiate movement of articulators on command such as:
    • Stick out your tongue
    • Whistle
    • Kiss a baby
    • Clear your throat
    • Blow out the candle
28
Q

Apraxia of Speech Definition

A

Disruption in the sequencing of voluntary movements for speech production

  • ONLY in speech production
29
Q

Apraxia of Speech Characteristics

A
  • Errors of sequencing are displayed when saying multisyllabic words
  • Errors include groping to position the articulators, transposition of syllables within a word and phoneme substitutions
  • Automatic and emotional words are free of apraxic errors
30
Q

Apraxia in Children

A
  • Impaired ability to execute voluntarily the expected motoric and programming gestures required for speech in the absence of a muscular disturbance of the speech mechanism
  • Disability of VOLUNTARY motor programming and sequencing of speech movements
  • AKA: Developmental Verbal Dyspraxia (DVD), Developmental Apraxia of Speech (DAS), and Childhood Apraxia of Speech (CAS)
31
Q

Apraxia in Adults (w/o CVA)

A
  • Non-dysarthric, non-aphasic sensorimotor disorder of articulation and prosody
  • Aphasia and dysarthria may coexist with apraxia but deficits in muscle strength and endurance do not account for specific errors
  • Apraxic errors are inconsistent, trial and error responses are prevalent
32
Q

Apraxia Continuum

A

Mild: Individual articulatory gestures are largely preserved

33
Q

Approaches to Studying MSDs

A
  • Psycholinguistic
  • Neurological
  • Social Constructionist
  • Motor Control System
34
Q

Psycholinguistic Approach

A
  • Does not concern itself with SOL
  • Psychological processes that underlie speech processing
  • Early stages of the model could be described as cognitive-linguistic
  • Planning and programming are a relatively early component of speech processing
  • Motor execution is at a later stage
  • Apraxia = disorder of planning and programming
  • Dysarthria = disorder of motor execution occurring at the later stages of motor speech processing
35
Q

Neurological Approach

A
  • Verbal apraxic disturbances = higher level cerebral functioning
  • Apraxia = lesions at the highest level of motor integration in the nervous system; in adults with apraxia are located in the left cerebral hemisphere
  • Dysarthria = more peripheral; result of disturbances in the lower level motor integration in the nervous system
36
Q

Social Approach

A
  • Associated with long-term conditions
  • A model of the consequences of a chronic disorder is helpful in developing a clinical perspective
37
Q

Social Approach Definitions of Impairment vs. Disability

A

Impairment – is the functional limitation within the individual caused by physical mental or sensory impairment

Disability – is the loss or limitation of opportunities to take part in the “normal” life of the community on an equal level with others due to physical and social barriers

38
Q

Social Approach Nature of Barriers

A
  • Information
  • Peer Support
  • Housing
  • Technical Aids
  • Personal Assistance
  • Transportation and mobility
  • Access
  • May be additional barriers that apply to speakers with MSD
39
Q

Social Approach Time Barriers

A
  • Not allowing enough time for the impaired person to express themselves
  • In a meeting or classroom time needs to be scheduled to ensure that all participants are enabled to participate
40
Q

Social Approach Organizational Barriers

A
  • Barriers to communicate would lead the patient to having un-equal access to service ex) being unable to communicate meal preferences
  • A school or university should ensure that sufficient time can be allocated to facilitate equality and ease in communication
  • Allowing time for fully listening
  • Be prepared to use a variety of communication aids and/or techniques
41
Q

Social Approach Identity and Self-Expression Barriers

A
  • Barriers to expressing one’s own sense of self development through interpersonal experiences
  • A person’s sense of self is constructed through interactions with others- type of experiences had
  • Dysarthric speech can often introduce an inequality in the interaction process, through its slow and unclear nature
  • Typical speech can gain dominance in confrontational and non confrontational interaction- problems in group setting
42
Q

Social Approach Personal Experiences

A
  • Deep internal frustration and this in turn would lead to terrible temper tantrums – becomes behavioral
  • Communication is noise in public spaces
43
Q

Social Approach Effects of Working Lives

A
  • Acceptance of AAC

- Limitations regarding job performance – teaching, telephone work, etc.

44
Q

Motor Control Systems Approach

A
  • Speech system is composed of sensory and motor regulators –monitoring system
  • Cognition, language and neural representations are not the emphasis
  • Theoretical basis from discussions that contrast the primate oral mechanism from the human oral mechanism.
  • Reflexes, valves, oscillators combine to produce speech
  • Different mechanisms control speech and vegetative movement
  • Practice is necessary to activate the specialized neuronal connections that control fine motor speech movements
45
Q

Motor Control Systems Approach Tx Implications

A
  • Based on how the regulators evolved for speech purposes
  • Speech systems is viewed as a finite set of interconnected functional units capable of fine motor movement
  • Movements are manifested by performance in strength, endurance, ROM and speech
  • Goal of SLP: to evaluate the functional resources of each component of the speech system
  • Critical points in the system were delineated
  • Function at any point can be measured – the subsystems of speech
46
Q

4 Subsystems of Speech Production

A
  • Respiratory: airflow
  • Phonatory: vocal production and intonation
  • Resonatory: vibration of the airflow
  • Articulatory: manipulation of airflow

The muscles and muscle groups in these subsystems must be coordinated in time and space

47
Q

Respiratory System

A
  • Speech production requires airflow
  • Pulmonary airstream mechanism; pushes air out of lungs through trachea to produce airflow
  • Ingressive: inhalation vs. Egressive: exhalation
  • Exhalation cycle – needs to be extended in time (for completion of utterance) and modulation (to reflect stress/intonation)
48
Q

Phonatory System

A
  • Includes various muscles and structures in the larynx, and regulates the production of voice and the intonational aspects of speech
  • Vocal folds are brought closely together (adduction), and airflow builds up (subglottal pressure) to set the vocal folds into vibration (undulation)
  • Vocal folds are stretched lengthwise to manipulate the frequency or pitch of the voice
    (longer the cords higher the pitch)
49
Q

Resonatory System

A
  • Regulates the vibration of the airflow as it moves from the pharynx into the oral and nasal cavity
  • Manipulates shape and size of vocal tract for maintaining normal sound quality
  • Manipulates the velopharyngeal port, (whether nasal cavity is used as a vibrating chamber) for determining nasality of sounds ex) oral vs. nasal sounds - /b/ and /p/ vs. /m/ and /n/
50
Q

Articulatory System

A
  • Control the articulators within the oral cavity to manipulate the outgoing airflow
  • Major structures: lower jaw, lips, tongue (most important)
  • Tongue:
    • intrinsic muscles (fine-tuned movements)
    • extrinsic muscles (coarse movements)
    • Protrusion, retraction, elevation and depression
  • Muscles contract to create constrictions in the oral cavity to produce varying sounds
51
Q

MSD Measurement Methods

A
  • Perceptual measures: judgments of intelligibility, accuracy and speech production (most common)
  • Acoustic measures: visual representation of speech sound wave (spectrogram) for more detailed and objective view of speech problems
  • Physiologic measures – measurement of physiologic aspects of speech motor system not easily perceived otherwise (muscle strength)
52
Q

The Nervous System

A

CNS:

  • includes brain and spinal cord
  • center of integration and control

PNS:

  • nervous system outside of CNS
  • includes 12 pairs of cranial nerves (CN) and 31 pairs of spinal nerves (SN)
  • CN carry info to and from the brain
  • SN carry to and from the spinal cord

Brain = roots
Spine = trunk
CNS + PNS = branches

53
Q

The Brain

A

Most complex part of the nervous system, where all activity originates or is ultimately processed

  • Composed of: wrinkled, pinkish gray tissue
  • Surface anatomy includes:
    • Cerebrum: cerebral hemispheres
    • Cerebellum
    • Brain Stem
54
Q

Cerebrum

A
  • Largest, most conspicuous portion
    of the brain.
  • 2 hemispheres connected by the corpus collosum
  • Outer cortex of gray matter
  • Interior that is mostly white matter, except for a few islands of grey matter
  • Surface is marked by ridges called gyri and separated by grooves called sulci
55
Q

Cerebral Cortex

A
  • Made of superficial gray matter; accounts for 40% of the mass of the brain
  • Consists of neuron cell bodies, dendrites, unmyelinated axons, no fiber tracts
  • Conscious mind
  • Enables sensation, communication, memory, understanding and voluntary movements
  • Hemispheres are not equal in function
56
Q

Lobes of Cerebrum

A
  • Four lobes: frontal lobe, parietal lobe, temporal lobe and occipital lobe; divided by deep sulci
  • Central sulcus: separates the frontal and parietal lobes
  • Precentral gyrus: primary motor area
  • Postcentral gyrus: primary somatosensory area
57
Q

3 Types of Functional Areas of Cerebral Cortex

A
  • Motor Areas: control voluntary movement
  • Sensory Areas: conscious awareness of sensation
  • Association Areas: integrate diverse information, bring info to major areas to be processed and responded to.

Motor Speech Disorders (1 decks)

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