Motor Speech Disorders_ Exam 1

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What is a motor speech disorder?

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What is a motor speech disorder?

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

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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.

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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.

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What are the six cranial nerves that directly influence speech?

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

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

Dopamine

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

Acetylcholine

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

True

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The peripheral nervous system consists of?

Cranial Nerves Spinal Nerves Spinal Cord

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

Toxic metabolic

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

Degenerative

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The Direct Activation Pathway is also known as?

  1. Direct Motor System

  2. Pyramidal System

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The indirect activation pathway is also known as?

  1. Extrapyramidal Tract

  2. Brainstem Motor System

  3. Brainstem Motor Pathway

  4. Indirect Motor System

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What does the cerebellar control circuit do?

Coordination and timing of movement

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What does the basal ganglia control circuit do?

motor control executive function emotion motor control posture tone

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

Upper

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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

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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

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There are ____ cranial nerves involved in speech production.

6

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The final common pathway includes the following:

Paired Cranial Nerves Paired Spinal Nerves

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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

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

Direct activation pathway

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What are some neurologic speech disturbances?

Acquired neurogenic stuttering Palilia Echolalia Foreign Accent Syndrome Aprosodia Mutism

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What are some functional and nonorganic speech disorders?

Certain mental health conditions: Schizophrenia Depression Conversion Disorder

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What are some cognitive- linguistic deficits?

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

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What changes in speech occur due to age?

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

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What are some differences in speech due to sex?

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

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How can sensory deficits impact MSDs?

Hearing loss can result in degradation of speech.

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What are some musculoskeletal defects that impact speech?

Injury Disease Congenital abnormality Surgical removal Cleft palate

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

Personality Emotional state Speaking role

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What are examples nonneurologic/ nonpsychogenic voice disorders?

Dysphonia Vocal abuse Hormonal Disturbances

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What characteristics do perceptual methods evaluate?

Pitch Loudness Voice Quality Resonance Respiration Prosody Articulation

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Why is training in perceptual methods important?

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

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How do acoustic methods evaluate speech?

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

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What value do physiologic methods help when evaluating speech?

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

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What are some pros to physiologic methods of evaluation?

Helps quantify characteristics.

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What are some forms of physiologic evaluations?

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

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What are some examples of visual imaging?

Videofluoroscopy Nasoendoscopy Laryngoscopy Videostroboscopy

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How do we categorize motor speech disorders?

Course Age Lesion Onset Neurologic Diagnosis Pathophysiology

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What is the importance of age of onset?

Age can influence prognosis and treatment/ management decisions

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How does site of lesion impact diagnosis?

Biggest goal in diagnosis Can predict deficits therefore prognosis and treatment

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Localization of Flaccid Dysarthria?

LMN- Final Common Pathway

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Neuromotor bases of Flaccid Dysarthria?

Execution

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Neurologic bases of Flaccid Dysarthria?

Weakness

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Localization of Spastic Dysarthria?

Bilateral UMN- indirect & direct pathways

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Neuromotor bases of Spastic Dysarthria?

Execution

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Neurologic bases of Spastic Dysarthria?

Spasticity

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Localization of Ataxic Dysarthria?

Cerebellum Cerebellar control circuit

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Neuromotor bases of Ataxic Dysarthria?

Control

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Neurologic bases of Ataxic Dysarthria?

Incoordination

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Localization of Hypokinetic Dysarthria?

Basal ganglia control circuit extrapyramidal

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Neuromotor bases of Hypokinetic Dysarthria?

Control

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Neurologic control of Hypokinetic Dysarthria?

Rigidity Reduced range of movement scaling problems

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Localization of Hyperkinetic Dysarthria?

Basal ganglia control circuit extrapyramidal

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Neuromotor bases of Hyperkinetic Dysarthria?

Control

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Neurologic bases of Hyperkinetic Dysarthria?

Involuntary movements

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Localization of Unilateral UMN Dysarthria?

Unilateral upper motor neuron

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Neuromotor bases of Unilateral UMN Dysarthria?

Execution/ control

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Neurologic bases of Unilateral UMN Dysarthria?

UMN weakness Incoordination Spasticity

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Localization of Mixed Dysarthria?

Many locations

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Neuromotor bases of Mixed Dysarthria?

Execution and/or control

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Neurologic bases of Mixed Dysarthria?

More than one

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Undetermined Dysarthria

Unknown location, neuromotor and neurologic bases

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Localization of Apraxia of Speech?

Left (dominant) hemisphere

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Neuromotor bases of Apraxia of Speech?

Motor Planning Motor Programing

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Neurologic bases of Apraxia of Speech?

Planning and programming errors

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Perceptual speech characteristics of Flaccid Dysarthria?

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

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Physical characteristics of Flaccid Dysarthria?

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

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Perceptual speech characteristics of spastic dysarthria?

Slow rate Strained/ harsh Pitch breaks Slow but regular AMRs

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Physical characteristics of spastic dysarthria?

Pathologic oral reflexes Lability of affect Hypertonia Hyperactive gag reflex

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Perceptual speech characteristics of ataxic dysarthria?

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

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Physical characteristics of ataxic dysarthria?

Dysmetric jaw, face, tongue Head tremors

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Perceptual speech characteristics of hypokinetic dysarthria?

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

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Physical speech characteristics of hypokinetic dysarthria?

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

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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

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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

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Perceptual speech characteristics of unilateral UMN dysarthria?

Slow rate imprecise articulation irregular articulation errors strained voice reduced loudness

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Physical characteristics of unilateral UMN dysarthria?

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

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What are the 4 anatomic levels?

Supratentorial Posterior Fossa Spinal Peripheral

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What structures are in the supratentorial level?

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

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What MSDs occur in the supratentorial level?

Apraxia Spastic Unilateral UMN Hyperkinetic Hypokinetic

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What structures are in the posterior fossa level?

Brainstem Cerebellum CN III-XII Spinal Nerves Tectum Tegmentum

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Where and what is the tectum?

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

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Where and what is the tegmentum?

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

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

PNS

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