Motor Speech Disorders

Dysarthria

Group of disorders associated with an impairment to motor speech control and execution due to damage to the CNS or PNS

What are the speech subsystems affected by MSD

Respiratory, Phonatory, Resonatory, Articulatory, Prosody

Lesion location & neuromuscular condition of flaccid dysarthria

lower motor neuron, weakness

Lesion location & neuromuscular condition of spastic dysarthria

bilateral upper motor neurons, spasticity

Lesion location & neuromuscular condition of ataxic dysarthria

cerebellum, incoordination

Lesion location & neuromuscular condition of hypokinetic dysarthria

basal ganglia, rigidity

Lesion location & neuromuscular condition of hyperkinetic dysarthria

basal ganglia, involuntary movements

Lesion location & neuromuscular condition of unilateral upper motor neuron dysarthria

unilateral upper motor neurons, weakness & incoordination and spasticity

Lesion location & neuromuscular condition of mixed dysarthria

more than one location, more than one neuromuscular conditions

Phonatory deficits of Flaccid Dysarthria

- Breathy vocal quality

- Harsh vocal quality

- Monopitch

Resonatory deficits of Flaccid Dysarthria

- Hypernasality

- Nasal emission

Respiratory deficits of Flaccid Dysarthria

- Audible inspiration

- Monoloudness

- Short phrases

Articulatory deficits of Flaccid Dysarthria

-Imprecise consonants

Prosodic deficits of Flaccid Dysarthria

N/A

Phonatory deficits of Spastic Dysarthria

- Breathy

- Harsh

- Low pitch

- monopitch

- pitch breaks

- strained- strangled

Phonatory deficits of Ataxic Dysarthria

- harsh

- monopitch

- voice tremor

Phonatory deficits of Hypokinetic Dysarthria

- breathy

- harsh

- low pitch

- monopitch

Phonatory deficits of Hyperkinetic Dysarthria

- harsh

- monopitch

- strained-strangled

- transient breathy

Phonatory deficits of UUMN Dysarthria

- harsh

- hoarse

Resonatory deficits of Spastic Dysarthria

Hypernasal

Resonatory deficits of Hyperkinetic Dysarthria

Hypernasal

Resonatory deficits of UUMN Dysarthria

Hypernasal

Respiratory deficits of Spastic Dysarthria

- monoloudness

- short phrases

Respiratory deficits of Ataxic Dysarthria

- excess loudness variations

- monoloudness

Respiratory deficits of Hypokinetic Dysarthria

- monoloudness

Respiratory deficits of Hyper Dysarthria

- excess loudness variations

- monoloudness

- short phrases

- sudden forced inspirations

Respiratory deficits of UUMN Dysarthria

Decreased loudness

Articulatory deficits of Spastic Dysarthria

Distorted vowels

Imprecise consonants

Slow rate of speech

Articulatory deficits of Ataxic Dysarthria

Distorted vowels

Slow rate of speech

Prolonged phonemes

Irregular articulatory breakdowns

Articulatory deficits of Hypokinetic Dysarthria

Imprecise consonants

Short rushes of speech

Repeated phonemes

Variable rate of speech

Articulatory deficits of Hyperkinetic Dysarthria

Distorted vowels

Imprecise consonants

Irregular articulatory breakdowns

Variable rate of speech

Prolonged phonemes

Articulatory deficits of UUMN Dysarthria

Imprecise consonants

Slow rate of speech

Irregular articulatory breakdowns

Prosodic deficits of Spastic Dysarthria

Prosodic deficits of Ataxic Dysarthria

Excess and equal stress

Prolonged intervals

Prosodic deficits of Hypokinetic Dysarthria

Inappropriate silences

Overall increased rate of speech

Reduced stress

Prosodic deficits of Hyperkinetic Dysarthria

Excess and equal stress

Prolonged intervals

Inappropriate Silences

Reduced stress

Prosodic deficits of UUMN Dysarthria

N/A

Developmental Dysarthria

Dysarthria occurs prior to acquisition of speech

Childhood Dysarthria

Used to depict the onset of dysarthria during childhood

Omission, distortion errors and Impaired prosody

Apraxia of speech

Neurogenic speech disorder associated with impairment to motor planning or programming

Etiology of AOS

Most common is Stroke and neurodegenerative diseases

Lesion Location of AOS

Lesion is frontal or parietal lobe of the left cerebral hemisphere

What is AOS commonly co-occurrent with?

Aphasia and Dysarthria

Childhood Apraxia of Speech

neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits. Accounts for 3 to 5% of all SSD

Speech characteristics of CAS

Inconsistent articulation errors

Consonantal distortions

Lengthened speech segments

Speech sound substitutuons

Articulatory groping behaviors

Initiation difficulties

Sequencing Characteristics of CAS

Slow rate of speech

Increase errors with utterance length/complexity

Better with automatic speech

What is CAS commonly co-occurrent with?

Language delay

Motor speech assessment points

Naturalness

Speech intelligibility

Speaking rate

Efficiency

Articulation

Apraxia of Speech standardized assessments

Apraxia Battery for Adults (ABA-2)

Apraxia of Speech Rating Scale (ASRS)

Childhood Apraxia of Speech Standardized assessments

Dynamic Evaluation of Motor Speech Skills (DEMSS)

Kaufman Speech Praxis Text for Children (KSPT)

Screening Test for Developmental Apraxia of Speech (STDAS-2)

Verbal Motor Production Assessment for Children (VMPAC)

The Apraxia Profile

What is the ICF model?

International Classification of Functioning, Disability, and Health

What are the components of the ICF model

Health Condition: Body function/structure, Speech activity and Participation

Contextual factors: Environmental and Personal

Treatment for Respiratory Deficits

Breathing exercises (Maximum inhalation/Exhalation)

Body positioning techniques

Biofeedback of respiratory function

Treatment for Phonatory Deficits: Hypoadduction Treatment

Effortful closure

Posture adjustment

Physical manipulation: Pressure on thyroid lamina

Lee Silverman Voice Treatment (LSVT): Typically used for Parkinson's/ Hypokinetic Dysarthria, targets vocal quality, intensity, vocal fold adduction

Treatment for Phonatory Deficits: Hyperadduction Treatment

Relaxation Techniques

Biofeedback of airflow/muscle activity

Yawn-Sign method to ease tension

Head positioning

AAC-Electrolarynx, Vocal intensity, Portable amplifier

Treatment for Velopharyngeal Deficits

Surgery

Prosthetic: Palatal lift to reduce velopharyngeal weakness (flaccid dysarthria)

Treatment for Articulatory Deficits

Integral stimulation: Clinician says utterance, client watches, listens and repeats

Phonetic placement: Clinician provided visual of artic placement and tactile cues

Phonetic derivation: Nonspeech sounds to build and mold into production of target.

Surgery: Neural anastomosis

Botox (Spastic Dysarthria)

Treatment for Prosody Deficits

Referential task: Produce target feature demonstrated by clinician

Contrastive Stress: Same sentences, said differently each time

Delayed Auditory Feedback

Rhythmic Cueing

Rigid rate: Hand/finger tapping, metronome

What subsystems does CAS affect?

Articulation and Prosody

Treatment for AOS

- Articulatory Kinematic: Focus on spatial and temporal aspects of artic movement

- Rate/Rhythm: restore tempotal control

- AAC: Severe AOS

- Intersystemic facilitation: facilitate impaired system (speech) with intact modality (limb movement)

Treatment for CAS

- Dynamic Temporal & Tactile Cueing (DTTC)

- Nuffield Centre Dyspraxia Programme- Based on hierarchy, isolated sounds to conversational speech

- Rapid Syllable Transition Treatment (ReST)- Multisyllabic Psuedowords

- Melodic Intonation Therapy (MIT)

- Prompts for restructuring oral muscular phonetic targets

- AAC/PECS

respiration

breathing

phonation

voice production

resonation

sound quality

articulation

sound formation

what degenerative disease is associated with flaccid dysarthria

myasthenia gravis

what degenerative disease is associated with spastic dysarthria

multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS

what degenerative disease is associated with ataxic dysarthria

Cerebellar degeneration, Fredrich's ataxia

what degenerative disease is associated with hypokinetic dysarthria

Parkinson's disease

what degenerative disease is associated with hyperkinetic dysarthria

Huntington's disease

what degenerative disease is associated with UUMN dysarthria

Multiple sclerosis (MS)

what degenerative disease is associated with mixed dysarthria

Wilson's disease, Fredrich's ataxia