Week 1 Readings- Ch. 1 Flashcards
Define: cognitive-linguistic process
intent to verbally communicate (based on thoughts/feelings) must be converted into a code that abides by the rules of language
Define: neuromuscular execution
neural and neuromuscular transmission of and subsequent muscle contractions and movements of speech structures
Define: Motor speech planning, programming, and control
Selections, sequencing, and regulation of sensorimotor “programs” that activate speech muscles at appropriate coarticulated times, durations, and intensities.
Changes in speech may be a harbinger of ___________
neurologic disease
Recognizing and understanding predictable patterns of speech and their underlying neurophysiologic bases are valuable for what 4 reasons?
- Understanding nervous system organization for speech motor control
- Differential diagnosis and location of neurologic disease
- Prevalence (common and chronic)
- Management (identification and localization)
Define: motor speech disorders
speech disorders resulting from neurologic impairments affecting the planning, programming, control, or execution of speech
Define: Dysarthria
collective name for a group of neurologic speech disorders that reflect abnormalities in the strength speed, range, steadiness, tone, or accuracy of movements required for the breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production
Sensorimotor abnormalities associated with dysarthria
weakness, spasticity, incoordination, involuntary movements, or excessive, reduced, or variable muscle tone
3 implications of dysarthria as defined
- Dysarthria is neurologic in origin
- It is a disorder of movement
- Categorized into different types that are characterized by distinguishable perceptual characteristics and differing underlying neuropathophysiology
Define: apraxia of speech
neurologic speech disorder that affects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech
Apraxia of speech’s distinctive clinical manifestions frequently are buried within categories of _______ or _______.
Aphasia or dysarthria
6 other neurologic speech disturbances
acquired neurogenic stuttering, palilalia, echolalia, some forms of mutism, foreign accent syndrome, and aprosodia associated with right hemisphere dysfunction.
It is important to think of motor speech processes and disorders as _______ and not just ______ in nature.
sensorimotor, motor
3 normal variations in speech production
age-related changes in speech (pitch, voice quality, stability, loudness, speech breathing patterns, rate, fluency, prosodic variation)
Gender (perceptually distinguishable, abnormalities may differ within the same disease)
Variations in style (personality, emotional state, speaking role)
Prevalence of motor speech disorders
Dysarthria- 53%, Non-aphasic cognitive communication disorders- 16.8%
aphasia- 25/8%
Other neurogenic speech disorders- 0.4%
Apraxia of speech- 3.9%
5 methods of studying motor speech disorders
Perceptual, instrumental, acoustic, physiologic, visual imaging
________ methods are the gold standard for clinical differential diagnosis, judgments of severity, many decisions about management, and the assessment of meaningful temporal change.
Perceptual methods
Define: perceptual methods
rely primarily on the auditory perceptual attributes of speech
Why are instrumental methods not widely used in the clinical evaluation and management of MSD’s?
Lack of widely accepted standards and normative data for speech tasks and methods and parameters for instrumental measurement
Define: acoustic methods
visually display and numerically quantify frequency, intensity, and temporal components of the speech signal- tightly linked to auditory perceptual judgments of speech
Define: rhythm metrics
metrics based on acoustic measures of vocalic and consonantal segment duration
Defone: envelope modulation spectra
automated analysis of the rhythmicity of speech
Define: physiologic methods
move “upstream” towards the sources of activity that generate and control speech
5 things physiologic methods focus on
- Muscle contractions that generate movement
- Movements of speech structures and air
- Relationships among movements at different levels of the musculoskeletal speech system
- Temporal parameters and relationships among central and peripheral neural and biomechanical activity
- Temporal relationships among activities in central nervous system structures and networks during the planning, programming, and control of speech.
The 3 most commonly used physiologic methods used to study the movement of air and peripheral structures associated with MSD’s
electromyography, kinematic measures, and aerodynamic measures
Most commonly used physiologic imaging
Functional magnetic resonance imaging (FMRI), positron emission topography (PET), single positron emission computed topography (SPECT), multichannel electroencephalography (EEG), transcranial magnetic stimulation (TMS), and magnetoencephalography (MEG)
Most commonly used visual imaging methods
Videofluoroscopy, nasoendoscopy, laryngoscopy, videostroboscopy
3 facts/beliefs that support the emphasis on perceptual assessment
- Evaluation begins with perceptual assessment; if diagnostic/descriptive errors are made diagnosis and management may be misguided and misleading
- Established usefulness relative to its contribution to localization and diagnosis of neurologic disease
- Standard for judging functional outcome is based on perceptual judgments of speech intelligibility, comprehensibility, and efficiency
5 variables relevant to neurologic and etiologic perspectives
Age at onset, course, site of lesion, neurologic diagnosis, pathophysiology
3 variables relevant to the speech disorders themselves
Speech components involved, severity, perceptual characteristics
5 types of course
congenital, chronic/stationary (plateau), improving (spontaneous recovery), progressive/degenerative, exacerbating-remitting
_________ over time may actually help establish the course of the disease or help eliminate diagnoses incompatible with with a particular course
Monitoring
Potential lesion locations
neuromuscular junction, peripheral and cranial nerves, brainstem, cerebellum, basal ganglia, pyramidal or extrapyramidal pathways, cerebral cortex
Knowledge of the lesion can predict _______, whereas incompatibility of speech with presumed lesion location can raise doubts about ________
certain speech deficits, presence of additional lesions or different diseases
4 speech components
breathing, phonation, resonance, articulation
Speech characteristics that suggest profound weakness are usually accompanied by physical findings that (confirm, deny) the weakness
confirm
L&NB chart- Flaccid dysarthria
Localization- lower motor neuron (final common pathway, motor unit)
NB general- execution
NB specific- weakness
L&NB chart- spastic dysarthria
Localization- bilateral upper motor neuron (direct and indirect activation pathways)
NB general-execution
NB specific- spasticity
L& NB chart- Ataxic dysarthria
Localization- cerebellum (cerebellar control circuit)
NB general- control
NB specific- incoordination
L&NB chart- hypokinetic dysarthria
Localization- basal ganglia control circuit (extrapyramidal)
NB general- control
NB specific- rigidity, reduced range of movement, scaling problems
L&NB chart- hyperkinetic dysarthria
Localization- basal ganglia control circuit (extrapyramidal)
NB general- control
NB specific- involuntary movements
L&NB chart- unilateral upper motor neuron
Localization- unilateral upper motor neuron
NB general- execution/control
NB specific- upper motor neuron weakness, incoordination, or spasticity
L&NB chart- mixed
Localization- more than one
NB general- execution and/or control
NB specific- more than one
L&NB chart- Apraxia of speech
Localization- left (dominant) hemisphere
NB general- motor planning/programming
NB specific- planning/programming errors
Define: control
modulatory motor programming activities that occur before or during the execution of motor speech units
L&NB chart- undetermined dysarthria
Localization- ?
NB general- ?
NB specific-?
Prevalence of different dysarthria types
Mixed- 28%, Hyperkinetic- 19%, Hypokinetic- 9%, Unilateral- 8%, Ataxic- 9%, Spastic- 7%, Flaccid-8%, AOS-7%, Undetermind dys-4%, Anarthria- 1%
