Motor Speech Disorders_ Exam 1

What is a motor speech disorder?

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

What is dysarthria?

Collective name to reflect abnormalities in strength, speed, range, steadiness, tone, or accuracy of movements required for the breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production.

What is apraxia of speech?

Impaired capacity to plan or program the commands necessary for directing movements in accurate speech productions: can occur in absence of: disturbances associated with dysarthria and disturbances in any component of language.

What are the six cranial nerves that directly influence speech?

V- Trigeminal
VII- Facial
IX- Glossopharyngeal
X- Vagus
XI- Accessory
XII- Hypoglossal

Which neurotransmitter plays a role in movement, motivation and reward, cognition and learning, attention, mood, and sleep?

Dopamine

Which neurotransmitter leads to movement but inducing contraction of muscle fibers?

Acetylcholine

The supratentorial, posterior fossa, spinal, and peripheral make up the major anatomic levels of the nervous system. True or False

True

The peripheral nervous system consists of?

Cranial Nerves
Spinal Nerves
Spinal Cord

What type of disease with diffuse effects could occur due to complications of kidney and liver disease?

Toxic metabolic

Which type of disease is typically chronic, progressive, and diffuse?

Degenerative

The Direct Activation Pathway is also known as?

1. Direct Motor System
2. Pyramidal System

The indirect activation pathway is also known as?

1. Extrapyramidal Tract
2. Brainstem Motor System
3. Brainstem Motor Pathway
4. Indirect Motor System

What does the cerebellar control circuit do?

Coordination and timing of movement

What does the basal ganglia control circuit do?

motor control
executive function
emotion
motor control
posture
tone

The direct and indirect activation pathways are part of the ____ motor neuron system.

Upper

The following divisions are part of the speech motor system:

The control circuits
The indirect activation pathway
The final common pathway
The direct activation pathway

The major anatomic levels of the nervous system include the supratentorial, posterior fossa, spinal, and peripheral level. The 10 of the 12 paired cranial nerves originate in the brainstem which is part of the ____ level.

Posterior Fossa

There are ____ cranial nerves involved in speech production.

6

The final common pathway includes the following:

Paired Cranial Nerves
Paired Spinal Nerves

When describing or determining the specific pathologic process, the physician may refer to the course or temporal time line of the disease as acute, subacute, or chronic. If the symptoms developed within minutes, the condition would be considered

Acute

The pyramidal tract or direct motor system is referred to as the

Direct activation pathway

What are some neurologic speech disturbances?

Acquired neurogenic stuttering
Palilia
Echolalia
Foreign Accent Syndrome
Aprosodia
Mutism

What are some functional and nonorganic speech disorders?

Certain mental health conditions:
Schizophrenia
Depression
Conversion Disorder

What are some cognitive- linguistic deficits?

Changes in verbal expression
Aphasia
Akinetic mutism
Can co-occur with MSDs

What changes in speech occur due to age?

Pitch
Voice quality
Stability
Loudness
Speech Breathing Patterns
Rate
Fluency
Prosodic Variations
Fine motor control

What are some differences in speech due to sex?

Difference seen in acoustical analysis.
Different norms for men and women.

How can sensory deficits impact MSDs?

Hearing loss can result in degradation of speech.

What are some musculoskeletal defects that impact speech?

Injury
Disease
Congenital abnormality
Surgical removal
Cleft palate

What are some other factors that can impact speech based on the individual?

Personality
Emotional state
Speaking role

What are examples nonneurologic/ nonpsychogenic voice disorders?

Dysphonia
Vocal abuse
Hormonal Disturbances

What characteristics do perceptual methods evaluate?

Pitch
Loudness
Voice Quality
Resonance
Respiration
Prosody
Articulation

Why is training in perceptual methods important?

It is the gold standard.
Requires lots of practice to train your ear.

How do acoustic methods evaluate speech?

Visually displays and helps quantify characteristics such as frequency, intensity, and temporal components.

What value do physiologic methods help when evaluating speech?

This includes visual imaging.
Can help create a relationship between speech produced and the pathophysiology.

What are some pros to physiologic methods of evaluation?

Helps quantify characteristics.

What are some forms of physiologic evaluations?

kinematic measures- electroglottography, magnetometry
aerodynamic measures- spirometry, nasal accelerometry

What are some examples of visual imaging?

Videofluoroscopy
Nasoendoscopy
Laryngoscopy
Videostroboscopy

How do we categorize motor speech disorders?

Course
Age
Lesion
Onset
Neurologic Diagnosis
Pathophysiology

What is the importance of age of onset?

Age can influence prognosis and treatment/ management decisions

How does site of lesion impact diagnosis?

Biggest goal in diagnosis
Can predict deficits therefore prognosis and treatment

Localization of Flaccid Dysarthria?

LMN- Final Common Pathway

Neuromotor bases of Flaccid Dysarthria?

Execution

Neurologic bases of Flaccid Dysarthria?

Weakness

Localization of Spastic Dysarthria?

Bilateral UMN- indirect & direct pathways

Neuromotor bases of Spastic Dysarthria?

Execution

Neurologic bases of Spastic Dysarthria?

Spasticity

Localization of Ataxic Dysarthria?

Cerebellum
Cerebellar control circuit

Neuromotor bases of Ataxic Dysarthria?

Control

Neurologic bases of Ataxic Dysarthria?

Incoordination

Localization of Hypokinetic Dysarthria?

Basal ganglia control circuit
extrapyramidal

Neuromotor bases of Hypokinetic Dysarthria?

Control

Neurologic control of Hypokinetic Dysarthria?

Rigidity
Reduced range of movement
scaling problems

Localization of Hyperkinetic Dysarthria?

Basal ganglia control circuit
extrapyramidal

Neuromotor bases of Hyperkinetic Dysarthria?

Control

Neurologic bases of Hyperkinetic Dysarthria?

Involuntary movements

Localization of Unilateral UMN Dysarthria?

Unilateral upper motor neuron

Neuromotor bases of Unilateral UMN Dysarthria?

Execution/ control

Neurologic bases of Unilateral UMN Dysarthria?

UMN weakness
Incoordination
Spasticity

Localization of Mixed Dysarthria?

Many locations

Neuromotor bases of Mixed Dysarthria?

Execution and/or control

Neurologic bases of Mixed Dysarthria?

More than one

Undetermined Dysarthria

Unknown location, neuromotor and neurologic bases

Localization of Apraxia of Speech?

Left (dominant) hemisphere

Neuromotor bases of Apraxia of Speech?

Motor Planning
Motor Programing

Neurologic bases of Apraxia of Speech?

Planning and programming errors

Perceptual speech characteristics of Flaccid Dysarthria?

Continuous
Breathy
Diplophonia?
Audible inspiration
Nasal emissions
Short phrases
Hypernasality
Rapid deterioration & recovery
Imprecise AMRs

Physical characteristics of Flaccid Dysarthria?

Weakness
Atrophy
Fasciculations
Hypoactive gag reflex
Facial myokmia
Rapid deterioration & recovery
Synkinesis
Nasal backflow when swallow

Perceptual speech characteristics of spastic dysarthria?

Slow rate
Strained/ harsh
Pitch breaks
Slow but regular AMRs

Physical characteristics of spastic dysarthria?

Pathologic oral reflexes
Lability of affect
Hypertonia
Hyperactive gag reflex

Perceptual speech characteristics of ataxic dysarthria?

Irregular articulatory breakdowns
Excess but equally placed stress
Distorted vowels
Excessive loudness variation
Irregular AMRs

Physical characteristics of ataxic dysarthria?

Dysmetric jaw, face, tongue
Head tremors

Perceptual speech characteristics of hypokinetic dysarthria?

Monopitch
Monoloudness
Reduced loudness/ stress
Rapid/ accelerated rate
Inappropriate silence
Rapidly repeated phonemes
palilalia
Fast & blurred AMRs

Physical speech characteristics of hypokinetic dysarthria?

Masked faces
Tremors in jaw, lips, tongue
Reduced range of motion AMR
Resting tremor
Rigidity

Perceptual speech characteristics of hyperkinetic dysarthria?

Prolonged intervals
Sudden forced breathing
Transient breathiness
Transient vocal strain/ harshness
Voice stops/ arrests
Voice tremor
Myoclonic vowel prolongation
Intermittent hypernasality
Deterioration with faster rate
Inappropriate vocal noises
Distorted vowels
Excessive loudness variation
Slow & irregular AMRs

Physical characteristics of hyperkinetic dysarthria?

Involuntary movement of facial/articulatory structures
Sustained deviation of head position
Motor tics
Myoclonus of plate, pharynx, lips, etc
Tremor of jaw, lip, tongue, etc
Grimace during speech

Perceptual speech characteristics of unilateral UMN dysarthria?

Slow rate
imprecise articulation
irregular articulation errors
strained voice
reduced loudness

Physical characteristics of unilateral UMN dysarthria?

Unilateral lower face weakness
Unilateral lingual weakness (no atrophy/ fasciculations)
Nonverbal oral apraxia

What are the 4 anatomic levels?

Supratentorial
Posterior Fossa
Spinal
Peripheral

What structures are in the supratentorial level?

Surface of cerebellum
4 Lobes
Basal ganglia
Thalamus
Hypothalamus
CN I & II

What MSDs occur in the supratentorial level?

Apraxia
Spastic
Unilateral UMN
Hyperkinetic
Hypokinetic

What structures are in the posterior fossa level?

Brainstem
Cerebellum
CN III-XII
Spinal Nerves
Tectum
Tegmentum

Where and what is the tectum?

Posterior Fossa level
Dorsal to aqueduct of Sylvius
Inferior and superior colliculli (copora quadrigemina)
Auditory and visual systems

Where and what is the tegmentum?

Posterior Fossa level
Ventral to aqueduct of Sylvius & 4th ventricle
White matter pathways and reticular formation

Are CN that deal with speech part of CNS or PNS?

PNS

What structures are in the spinal level?

Vertebrae
spinal nerves

How many vertebrae are there?

7 cervical
12 thoracic
5 lumbar

How many pairs of spinal nerves?

31

What structures are found in the peripheral level

Cranial Nerves
Spinal Nerves

Explain the roots of spinal nerves.

Contain dorsal and ventral roots that emerge from the vertebral column to their respective muscles.

What are the types of clinicopathologic correlations?

Localization
Development
Evolution

What are the types of localizations?

Focal- one area/ one group of structures
Multifocal- many areas/ groups of structures
Diffuse- affecting bilateral groups of the NS

What are the types of development?

Acute- minutes
Subacute- days
Chronic- months

What are types of evolution?

Transient: symptoms resolved
Improving: severity is reduced
Progressive: Worsen over time
Exacerbating- remitting: Cycles of relapse/ remission
Stationary/ Chronic: Stay the same over time

What are the broad categories of etiology?

Degenerative
Inflammatory
CNS
Toxic-Metabolic
Neoplastic
Trauma
Vascular

Define and give an example of a degenerative disease.

Disease worsens over time.
Parkinson's Disease

Define and give an example of an inflammatory disease.

Caused by chemicals, immune response, disease
Meningitis
Arthritis

Define and give an example of a toxic-metabolic disease.

When the body is unable to process different toxins, causes in too much of a toxin or lack of a nutrient.
Drug toxicity
Hypoglycemia

Define and give an example of neoplastic disease.

Abnormal cell growth- tumor
Leptomeninges

Define and give an example of a traumatic disease.

Physical injury
TBI
Subdural hematoma

What are the types of TBI?

Pentrating- gun shot
Closed head: coup or contrecoup, diffuse axonal injury, hypoxia