Types of dysarthria Flashcards
LMN Flaccid Dysarthria
characteristics:
- nasal emission
- short phrases
- breathiness
- inhalatory stridor
- hypernasal
motor problems:
- weakness
- hypotonia
- fasciculations (b/c of muscle death)
- hyporelflexia: volitional and reflexive movements lost
- slow rate only if severe
-damage to any part of 1 or more CNs
- tx: increase strength or compensate for weakness
- increase respiratory support: pushing pulling exercises, deep inhalation, controlled exhalation, postural adjustments (Sapienza)
Unilateral Upper Motor Neuron
-usually mild, temporary, due to stroke
speech characteristics:
- similar to flaccid and spastic
- facial weakness to lower 1/2 of face and tongue
- imprecise artic, slow rate, reduced loudness
- damage to direct/pyramidal pathway.. loss of fine, controlled, skilled movements, hypotonia, weakness
- cerebral hemispheres –> usually internal capsule
treatment: articulation- intelligibility drills and phonetic placement (Yorkston)
Spastic Dysarhtria
- bilateral UMN damage
- usually damage to pyramidal and extrapyramidal tracts
- extrayramidal tract usually dominates (increased tone/spasticity)
speech characteristics:
- harshness
- low pitch
- slow rate
- strained/strangled quality
- pitch breaks
- slow & regular AMRs
-Pseudobulbar affects: lack of inhibition of emotional display d/t extrapyramidal tract damage)
physiologic impairments:
- slow
- increased tone
- hyperreflexic
- loss of fine motor control agility/precision
motor deficits:
-reduced strength, reduced range, slow, excess tone
tx:
- relaxation exercises to reduce spasticity (Weismer,2000)
- breathy/easy onsets (Yorkston)
- manage pseudobulbar affect with meds
Hypokinetic Dysarthria
Speech Characteristics
- -monopitch
- monoloud
- variable rate
- rapid “blurred” AMRs
- short rushes of speech
- reduced stress
physiologic impairmentS:
- bradykinesia (slow movement)
- hypokinesia (limited range of movement)
- rigidity
- rest and action tremor
- neurologic damage:
- to BG circuit in extrapyramidal pathway
- PD is disease of SN.. deficiency of dopamine causes excess cortical motor output becuase BG is not longer inhibiting cortex
Tx:
- LSVT to increase loudness and self-awareness (Ramig)
- voice amplifiers/DAF (yorkston)
- pacing boards
Hyperkinetic Dysarthria
speech characteristics
- slow/irregular AMRs
- distored vowels
- prolonged intervals
- voice tremor
- transient breathiness
-dyskinesias: myoclonus, tics, chorea, dystonia, athetosis, ballismus, spasm, tremor
physiologic impairments
- quick or slow involuntary movements that interfere with voluntary movements
- slow
- variable or increased muscle tone
neurologic impairment
-problem in BG… excess dopamine causes atrophy of striatum and reduced inhibition of cortical activity
tx:
- botox injections for dystonia (SD)
- bite blocks to inhibit excess jaw movements
- postural abnormalities
- rate reduction strategies (yorkston)
- respiration/relaxation exercises
- AAC when severe
ataxic dysarthria
Speech Characteristics -irregular articulartory breakdowns -prosodic excess -prolongation of phonemes -irrgular AMRs -excessive loudness variation major impairment in artic and prosody -3 Hx tremor
neurologic impairments:
- damage to cerebellar circuit
- unilateral cerebellar damage not likely to cause dysarthria, bilateral is
- affects fine motor control, rapid timing of movements, spatial, coordination of muscle sequencing
tx:
- pacing boards for rate control (Yorkston)
- target loudness and pith control
Stroke and dysarthria
Vertebrobasilar artery stroke:
-UMN damage–> spastic dysarthria
ICA stroke (MCA/ACA)–> UUMN flaccid or spastic if bilateral
AOS
damage:
- LH/cortical, or BG damage
- usually LH stroke or degenerative disease
- common artic errors: substitutions, distortions, some deletions
- disorder of skilled volitional speech movement, planning deficit
- lesion is at PHONOLOGICAL OUTPUT BUFFER
-speech characteristics
-slow rate
-sound distortions and substitutions
-prosodic abnormalities
-more errors on longer words
-artic groping
initiation difficulties
-error awareness, attempts at self-correction
exclusionary criteria:
-normal rate, fast rate, normal prosody
8 Step Continuum
Integral stimulation: 8 Step continuum (Rosenbek)
**most commonly used method for moderate-severe apraxia, clinician provides auditory and visual model (watch me, listen to me)
**imitative and focuses on multiple input modes
**gestures can be used to cue
8 steps:
-start with easiest speech sounds, increases to more
-initial target words should begin with nasals, vowels, stops
-gradually increase length of target words to more complex SS
-choose high-frequency words
-clinician says “watch me and listen to me” then says the target word/phrases, then they say it in unison
-client imitates target word then repeats it several times independently
-clinician presents target words on paper, patient says word
-patient says word in response to question
-role-playing with clinician, family, friends with target used
Melodic Intonation Therapy
(Sparks, Helm, Albert 1973)
- prosodic method for apraxia
- based on premise that singing accesses undamaged right hemisphere
- originally developed for BROCA’s
- tap out rhythms to emphasize intonation
- have person sing words and then work towards more natural prosody
- tapping cues fade
- prosodic aspects facilitate improvement in motor planning and programming
Contrastive Stress
- Wertz 1984)
- AOS tx
- most effective with mild-moderate AOS
- use prosodic cues and stress patterns to improve speech production and prosody
- focus on producing utterance with primary stress on particular word
- example: clinician- are you going out? client- no I am going out TOMORROW
- articulatory skill for stimuli must be demonstrated before starting
