Week 1 Readings- Ch. 1

Question 1

Define: cognitive-linguistic process

Answer 1

intent to verbally communicate (based on thoughts/feelings) must be converted into a code that abides by the rules of language

Question 2

Define: neuromuscular execution

Answer 2

neural and neuromuscular transmission of and subsequent muscle contractions and movements of speech structures

Question 3

Define: Motor speech planning, programming, and control

Answer 3

Selections, sequencing, and regulation of sensorimotor “programs” that activate speech muscles at appropriate coarticulated times, durations, and intensities.

Question 4

Changes in speech may be a harbinger of ___________

Answer 4

neurologic disease

Question 5

Recognizing and understanding predictable patterns of speech and their underlying neurophysiologic bases are valuable for what 4 reasons?

Answer 5

1. Understanding nervous system organization for speech motor control
2. Differential diagnosis and location of neurologic disease
3. Prevalence (common and chronic)
4. Management (identification and localization)

Question 6

Define: motor speech disorders

Answer 6

speech disorders resulting from neurologic impairments affecting the planning, programming, control, or execution of speech

Question 7

Define: Dysarthria

Answer 7

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

Question 8

Sensorimotor abnormalities associated with dysarthria

Answer 8

weakness, spasticity, incoordination, involuntary movements, or excessive, reduced, or variable muscle tone

Question 9

3 implications of dysarthria as defined

Answer 9

1. Dysarthria is neurologic in origin
2. It is a disorder of movement
3. Categorized into different types that are characterized by distinguishable perceptual characteristics and differing underlying neuropathophysiology

Question 10

Define: apraxia of speech

Answer 10

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

Question 11

Apraxia of speech’s distinctive clinical manifestions frequently are buried within categories of _______ or _______.

Answer 11

Aphasia or dysarthria

Question 12

6 other neurologic speech disturbances

Answer 12

acquired neurogenic stuttering, palilalia, echolalia, some forms of mutism, foreign accent syndrome, and aprosodia associated with right hemisphere dysfunction.

Question 13

It is important to think of motor speech processes and disorders as _______ and not just ______ in nature.

Answer 13

sensorimotor, motor

Question 14

3 normal variations in speech production

Answer 14

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)

Question 15

Prevalence of motor speech disorders

Answer 15

Dysarthria- 53%, Non-aphasic cognitive communication disorders- 16.8%
aphasia- 25/8%
Other neurogenic speech disorders- 0.4%
Apraxia of speech- 3.9%

Question 16

5 methods of studying motor speech disorders

Answer 16

Perceptual, instrumental, acoustic, physiologic, visual imaging

Question 17

________ methods are the gold standard for clinical differential diagnosis, judgments of severity, many decisions about management, and the assessment of meaningful temporal change.

Answer 17

Perceptual methods

Question 18

Define: perceptual methods

Answer 18

rely primarily on the auditory perceptual attributes of speech

Question 19

Why are instrumental methods not widely used in the clinical evaluation and management of MSD’s?

Answer 19

Lack of widely accepted standards and normative data for speech tasks and methods and parameters for instrumental measurement

Question 20

Define: acoustic methods

Answer 20

visually display and numerically quantify frequency, intensity, and temporal components of the speech signal- tightly linked to auditory perceptual judgments of speech

Question 21

Define: rhythm metrics

Answer 21

metrics based on acoustic measures of vocalic and consonantal segment duration

Question 22

Defone: envelope modulation spectra

Answer 22

automated analysis of the rhythmicity of speech

Question 23

Define: physiologic methods

Answer 23

move “upstream” towards the sources of activity that generate and control speech

Question 24

5 things physiologic methods focus on

Answer 24

1. Muscle contractions that generate movement
2. Movements of speech structures and air
3. Relationships among movements at different levels of the musculoskeletal speech system
4. Temporal parameters and relationships among central and peripheral neural and biomechanical activity
5. Temporal relationships among activities in central nervous system structures and networks during the planning, programming, and control of speech.

Question 25

The 3 most commonly used physiologic methods used to study the movement of air and peripheral structures associated with MSD’s

Answer 25

electromyography, kinematic measures, and aerodynamic measures

Question 26

Most commonly used physiologic imaging

Answer 26

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)

Question 27

Most commonly used visual imaging methods

Answer 27

Videofluoroscopy, nasoendoscopy, laryngoscopy, videostroboscopy

Question 28

3 facts/beliefs that support the emphasis on perceptual assessment

Answer 28

1. Evaluation begins with perceptual assessment; if diagnostic/descriptive errors are made diagnosis and management may be misguided and misleading
2. Established usefulness relative to its contribution to localization and diagnosis of neurologic disease
3. Standard for judging functional outcome is based on perceptual judgments of speech intelligibility, comprehensibility, and efficiency

Question 29

5 variables relevant to neurologic and etiologic perspectives

Answer 29

Age at onset, course, site of lesion, neurologic diagnosis, pathophysiology

Question 30

3 variables relevant to the speech disorders themselves

Answer 30

Speech components involved, severity, perceptual characteristics

Question 31

5 types of course

Answer 31

congenital, chronic/stationary (plateau), improving (spontaneous recovery), progressive/degenerative, exacerbating-remitting

Question 32

_________ over time may actually help establish the course of the disease or help eliminate diagnoses incompatible with with a particular course

Answer 32

Monitoring

Question 33

Potential lesion locations

Answer 33

neuromuscular junction, peripheral and cranial nerves, brainstem, cerebellum, basal ganglia, pyramidal or extrapyramidal pathways, cerebral cortex

Question 34

Knowledge of the lesion can predict _______, whereas incompatibility of speech with presumed lesion location can raise doubts about ________

Answer 34

certain speech deficits, presence of additional lesions or different diseases

Question 35

4 speech components

Answer 35

breathing, phonation, resonance, articulation

Question 36

Speech characteristics that suggest profound weakness are usually accompanied by physical findings that (confirm, deny) the weakness

Answer 36

confirm

Question 37

L&NB chart- Flaccid dysarthria

Answer 37

Localization- lower motor neuron (final common pathway, motor unit)

NB general- execution
NB specific- weakness

Question 38

L&NB chart- spastic dysarthria

Answer 38

Localization- bilateral upper motor neuron (direct and indirect activation pathways)

NB general-execution
NB specific- spasticity

Question 39

L& NB chart- Ataxic dysarthria

Answer 39

Localization- cerebellum (cerebellar control circuit)

NB general- control
NB specific- incoordination

Question 40

L&NB chart- hypokinetic dysarthria

Answer 40

Localization- basal ganglia control circuit (extrapyramidal)
NB general- control
NB specific- rigidity, reduced range of movement, scaling problems

Question 41

L&NB chart- hyperkinetic dysarthria

Answer 41

Localization- basal ganglia control circuit (extrapyramidal)
NB general- control
NB specific- involuntary movements

Question 42

L&NB chart- unilateral upper motor neuron

Answer 42

Localization- unilateral upper motor neuron
NB general- execution/control
NB specific- upper motor neuron weakness, incoordination, or spasticity

Question 43

L&NB chart- mixed

Answer 43

Localization- more than one
NB general- execution and/or control
NB specific- more than one

Question 44

L&NB chart- Apraxia of speech

Answer 44

Localization- left (dominant) hemisphere
NB general- motor planning/programming
NB specific- planning/programming errors

Question 45

Define: control

Answer 45

modulatory motor programming activities that occur before or during the execution of motor speech units

Question 46

L&NB chart- undetermined dysarthria

Answer 46

Localization- ?
NB general- ?
NB specific-?

Question 47

Prevalence of different dysarthria types

Answer 47

Mixed- 28%, Hyperkinetic- 19%, Hypokinetic- 9%, Unilateral- 8%, Ataxic- 9%, Spastic- 7%, Flaccid-8%, AOS-7%, Undetermind dys-4%, Anarthria- 1%