S&R: MSC Flashcards
What are the two types of motor speech disorder?
Dysarthria
Apraxia / Dyspraxia
What is dysarthria? Basis? Effect?
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Motor disorder affected speech
There are issues with the movement which affects speech. There is a neurological basis which affects the motor movements of the articulators
Can reduce control of any or all of the speech subsystems (artic, phonation, resonation, respiration) and coordination
What are the main subtypes of dysarthria for the pediatric population?
- Childhood dysarthria of Cerebral palsy (UMN)
- Childhood dysarthria of the LMN (flaccid dysarthria)
LMN Dysarthria? Signs?
- articulation?
- muscles?
- resonance?
- pitch?
- NAE?
- Less common than UMN
- Imprecise consonants/misarticulations
- Weak, hypotonic, and easily fatigable
- Hypernasality is often the major sign
- NAE (Nasal air emission)
- Monopitch/monoloudness
Types of UMN Dysarthria
Spastic
Dyskinetic
Ataxic
Mixed
What is spastic dysarthria? What are its characteristics?
OPM?
More severe in which structure?
Muscles?
Artic Errors?
- This is the most common
- OPM movement is slow
- Movement trajectories are variable → the movement of the articulators are not the same all the time
- Unlike spasticity in the limbs, OPM problems in spastic CP are not related to hypertonicity of the OPM.
- Tongue is usually more severe
- There is muscle weakness and instability
- Inaccurate in reaching articulation targets and weakness
- There is poor control of velum = hypernasality
- Aphonia - Articulatory errors
- omission was more frequent than substitution– more errors in omission
- More errors of manner than place
What are the expected characteristics of spastic dysarthria in terms of respiration?
- Reduced ERV–expiratory reserve volume (x thoracic and abdominals)
- Lower vital capacity = Poor respiratory support → shorter utterances
What are the expected characteristics of spastic dysarthria in terms of prosody?
Monopitch, monoloudness
CASE1: A 5-year old child demonstrates articulatory errors, specifically he would have difficulty producing plosive, affricate, fricative, and velar sounds. The child is only able to produce short utterances and would exhibit monopitch and monoloudness in terms of prosody. He was also observed to substitute /m, n, ŋ/ for different sounds due to poor coordination, muscle weakness, and muscle control, causing issues with velopharyngeal closure. What type of dysarthria does this patient have?
Spastic dysarthria
Hallmarks: Hypernasality, difficulty with manner, short utterances → poor respiratory support. Monopitch & Monoloudness. There are problems. Problems with manner (e.g., plosives, affricates, fricatives, and velar sounds).
What is dyskinetic–athetoid dysarthria?
- Slow movements with tremors
- Large ranges of jaw motion → affects tongue movement
- Long transition times for OPM movement
- Reduced lingual range of movement
- Difficulty fine–shaping the tongue
- Vocal folds hyperadduction → strained or strangled voice
- Nature of OPM difficulties seems to be similar to limbs (i.e., dyskinetic)
- Disruption of normal sensorimotor feedback
- Slower and unstable velar movement → resonance issues
Meron din unstable involuntary movements and madalas placing na related sa tongue yung issue
CASE2: A 6-year-old child demonstrates variable and involuntary movements of the face and mouth, which seem to worsen during speech attempts. The child exhibits difficulty with precise control of speech muscles, leading to inconsistent articulation errors, particularly with velar, palatal, and alveolar sounds. Speech is characterized by irregular pitch and loudness variations, giving it a strained, jerky quality. The child also shows a tendency toward prolonged vowel sounds and involuntary movements of the tongue and jaw. Despite the speech irregularities, the child’s language comprehension appears intact. There are also observed involuntary grimacing and lip pursing during rest and speaking.
Dyskinetic-athetoid dysarthria
Hallmarks: Involuntary movements → tremors, Irregular pitch and loudness, involuntary movements of the OPM. Reduced lingual motion → difficulties with the following speech sounds: alveolar, palatal, and velar sounds. There are prolonged vowel sounds and involuntary movements of the tongue and jaw.
What is ataxic dysarthria?
- Likely similar to adult ataxic dysarthria
- Inconsistency of substitutions and omissions
- Generally mild
- Scanning speech and dysrhythmia (“drunk” and uncoordinated)
- Problems with intonation and stress
- Severity may be more related to general intellectual levels than severity of oromotor problems → language and cognition problems
- Difficult to separate from typical developmental phonological issues
CASE3: A 9-year-old child presents with slurred, imprecise speech that worsens with fatigue or prolonged speaking. The child’s speech is marked by a noticeable monotone quality, with irregular rhythm and timing. There is a distinct pattern of prolonged pauses between syllables and words, giving their speech a scanning quality. Upon assessment, the child demonstrates difficulty coordinating movements of the lips, tongue, and jaw, leading to imprecise articulation of consonants, especially alveolar and velar sounds. Their voice has a harsh, breathy quality, and pitch and loudness tend to fluctuate unpredictably. Motor coordination difficulties extend beyond speech to other fine motor tasks, such as writing and buttoning clothes. Neurological examination reveals signs of cerebellar involvement, including issues with balance and wide-based gait. The child was also observed to have problems with language and cognition.
Ataxic dysarthria
Hallmarks: Irregular rhythm and timing. There is a distinct pattern of prolonged pauses between syllables and words, giving their speech a scanning quality → Problems with intonation and stress. Uncoordinated movements of the lips, tongue and jaw. Cerebellar involvement, including issues with balance and wide-based gait.
Apraxia in general has two subtypes. What are they?
Ideational
Ideomotor
What is an ideational motor plan?
- The known purpose of the movement is already lost because of the sequence of individual gestures of movement.
X Carrying out motor plan
x involuntary
x voluntary
What is ideomotor apraxia? Sample subtype?
- Disturbance in the performance
- Apraxia of speech is a subtype
- Voluntary movements are more affected
- Pantomiming is harder than object manipulation
- Verbal commands are harder than gestural commands
- Can co occur or be separate with ideational apraxia
What is nonverbal oral apraxia? Damage in?
- Common for left hemisphere damage
- Often co occurs with aphasia
- Puzzling and distressing
- Little clinical significance
Issues only occur with commands pero hindi naman affected ang ‘functional’ movements
What are the characteristics of apraxia of speech? Damage?
- Issues with selecting and sequencing motor commands
- They will have difficulty with positions articulators correctly (vs. nonverbal oral where the patient will have difficulty with licking, blowing, etc.,)
- They can co occur or be separate
- Caused by acquired left frontal lobe damage
- Isolated cases at pure apraxia only is rare
- Common comorbidities: aphasia, and unilateral UMN lesion
What is the difference between apraxia and dysarthria?
Muscle tone, strength, range are unaffected – there is no weakness/paralysis for a person with Apraxia.
Respiration, phonation, and resonance most unaffected→ Apraxia
Apraxia is common with language issues due to the lesion at the left hemisphere
Inconsistent errors for apraxia of speech–there is more variation in errors
Omission, substitution, repetition, and prolongation for AOS
Trial and error “groping” and self correction → Apraxia
Dysarthria
- issues with all speech subsystem
- tone strength, range
- relatively consistent errors
Apraxia
- inconsistent errors
- related with language deficits (left hemisphere lesion)
- mostly articulation errors
What area is damaged with AoS? What are the most common causes of apraxia of speech?
Perisylvian area of the left hemisphere damage
Due to: Stroke, degenerative diseases, traumatic brain injury
What is childhood apraxia of speech?
- Argued that is a unique diagnosis
- Does not have neurological basis, there is no neurological lesion
- It is neurological but there is no neurological basis, childhood speech sound disorder, in the absence of neuromuscular deficit
Causes: known neuro impairment, in association with neurobehavioral disorder (e.g., autism spectrum disorder, adhd) or idiopathic neurogenic.
What are the articulator issues that a clinician can expect with childhood apraxia of speech?
- Presence of vowel errors
- Substitution > Omission, distortion, addition
- Placement substitution are most common
- Voiceless for voiced
- Issues with voluntary movement in comparison to automatic/reactive movements
- Variations in error production → for the same sound, the child will produce different error productions
- Farther the distance of articulator contact = more errors
- Longer utterances = more errors
- Affricates/fricatives > stops, nasal, semivowels, vowels
What are the characteristics in prosody in terms of childhood apraxia of speech?
- Slower speech rate
- Monostress
- Pauses
- Reduced pitch/loudness variation
