COSI 357: Motor Speech Disorders/Swallowing Disorders

what are motor speech disorder?

• Motor speech disorders: disorders of speech resulting from neurologic impairments affecting the motor programming or neuromuscular execution of speech. They encompass:
  • Dysarthria
  • Apraxia

what is dysarthria?

• Dysarthria: Neurologic speech disorder; results in changes in strength, speed, range, steadiness, tone or accuracy of movements required from all the systems involved in speech production

  • Respiratory, phonatory, articulatory/resonace, and prosody

what is apraxia?

• Apraxia: Neurologic speech disorder; impaired capacity to plan or program sensorimotor commands necessary to carry out the act of speech production

What is the motor control hierarchy?

1. Association Cortex, Basal Ganglia, Cerebellum, thalamus

2. Upper Motor Neurons

3. Descending Spinal Tracts

4. Lower Motor Neurons

5. Peripheral nerve

6. Neuro Muscular Junction

7. Muscles

what are the hallmark clinical characteristics of flaccid dysarthria?

Hallmark clinical characteristics:
• Weakness
• Hypotonia
• Hyporeflexia
• Atrophy
• Fasciculations
• Fibrillations

what are the hallmark characteristics of spastic dysarthria?

Hallmark clinical characteristics:
• Strained- strangled vocal quality
• Slow rate and reduced range of motion
• Imprecise consonants
• Limited pitch range

what are the hallmark clinical characteristics of hypokinetic dysarthria?

Hallmark clinical characteristics:
• May manifest in any of the speech systems
• HOWEVER, most evident in voice, articulation, and
prosody
• Slow individual movements, fast and small repetitive movements
• Reduced range of motion
• Imprecise articulation
• Limited pitch variability

what are the hallmark clinical characteristics of hyperkinetic dysarthria?

Hallmark clinical characteristics:
• Abnormal involuntary movements
• Can occur at rest, during voluntary movements, or during static postures
• Not usually seen during sleep
• Exacerbated by anxiety or high emotions
• Hyper does not indicate speech of movement, only presences of extra movements
• Highly variable

what are the hallmark clinical characteristics of ataxic dysarthria?

Hallmark clinical characteristics:

• Si/sx can manifest itself in any or all the speech
  systems

• Articulation and prosody most noticeable

  • Overshooting or undershooting targets

    • Imprecise articulation

    • Difficulty with loudness control

    • Difficulty with pitch control

    • Variable phrase length

Discuss the complexity of swallowing.

• Human swallow is a complex sensori-motor event
• Required contraction and inhibition of the oral, pharyngeal, & laryngeal musculature

what % of oral pharyngeal dysphagia is caused by neurologic disease?

75%

What % of stroke patients present with dysphagia?

30-50%

What are the stages of swallowing?

1. oral prepatory phase

2. oral phase

3. pharyngeal phase

4. esophageal phase

describe the oral prepatory phase of swallowing

• stage 1 of swallowing

  • voluntary

  • preparation of bolus

describe the oral phase of swallowing

• stage 2 of swallowing

  • voluntary

  • movement of bolus to posterior tongue

describe the pharyngeal phase of swallowing

• stage 3 of swallowing

  • reflexive

  • pharyngeal and laryngeal muscles

  • suprahyoid muscles + base of tongue

describe the esophageal phase of swallowing.

• stage 4 of swallowing

  • automatic control

  • peristaltic movement

what cranial nerves are involved in swallowing?

CNs V, VII, IX, X, XI

what cortical areas control swallowing?

• lateral precentral gyrus

• supplementary motor area

• anterior cingulate cortex

• insula and frontal operculum

• primary sensory cortex and parietal cortex

• temporal cortex

what dysphagia characteristics do we see in the oral phase of swallowing?

• repetitive pumping movement of the tongue

• rocking-rolling festination movement of the tongue

• oral residue

• piecemeal swallow

• difficulty of bolus formation

• premature falling

what dysphagia characteristics do we see in the pharyngeal phase of swallowing?

• reduced tongue retraction and pharyngeal constriction

• regurgitation of food into the nasal cavity or upper pharynx

• difficulty in initiating and completing airway closure

• penetration/aspiration

• residue in valleculae and pyriform sinuses

• reduced pharyngeal and laryngeal sensitivity

what dysphagia characteristics do we see in the esophageal phase of swallowing?

• reduced esophageal peristalsis