MSD exam 2

where is the damage in hypokinetic dysarthria?

basal ganglia control circuit pathology (dopamine depeltion issue)

what are the most affected speech characteristics of hypokinetic dysarthria

voice, articulation, and prosody

what are the physical symptoms hypokinetic dysarthria?

rigidity and reduced forced and range of movement

what conditions can cause Parkinson’s

all kinds of Parkinson’s Pick’s disease (type of dementia) (frontal/temporal lobe), toxic/metabolic conditions that affect the basal ganglia, Wilson’s disease (copper), vascular conditions, trauma, and infections conditions like AIDS

Clinical Characteristics of hypokinetic dysarthria

resting tremor that decreases during voluntary movement, bradykinesia, rigidity, festination (slow, short, walking), and stooped posture

complaints of patients with hypokinetic dysarthria

fast and quiet speech that is hard to initiate, fatigue on speech, drooling, and swallowing issues

NONSPEECH oral mech findings in hypokinetic dysarthria

reduced blinking, expressionless face, reduced chest abdom movement during quiet breathing, infrequent swallowing w/ saliva/drooling, dysphagia, shaking of jaw/lips/tongue at rest

SPEECH findings in hypokinetic dysarthria

inappropriate silence, harshness/breathiness/reduced loudness, rapid speech rate, repetition of words and phrases with increasing rate and decreasing loudness (palilalia)

important speech tasks in hypokinetic dysarthria

conversational speech/reading (prosody), speech AMRs (range of movement and abnormalities in rate), and vowel prolongation (isolates phonatory characteristics like loudness and quality)

Prosody insufficiency in hypokinetic dysarthria

monopitch and monoloudness, reduced stress, short phrases, short rushes of speech, imprecise consonants, turns into flat attenuated speech quality

acoustic/physiological findings of hypokinetic: respiratory

reduced vital capacity, amp of chest wall movements, max vowel duration, and fewer syllables per breath group

acoustic/physiological findings of hypokinetic: laryngeal

decreased intensity, increased jitter + shimmer, voice tremors (in throat)

acoustic/physiological findings of hypokinetic: velopharyngeal

increased nasal airflow and reduced movement in this area

acoustic/physiological findings of hypokinetic: artic rate and prosody

reduced speech rate, inability to increase rate, increase frequency and duration of pauses during connected speech

etiology of hyperkinetic dysarthria

damage to basal ganglia, cerebellar control circuit, and IAP with normal orofacial, head, and respiratory movements

toxic metabolic conditions (drugs/TD/chorea), degenerative diseases (huntington), AIDS, and tumors

clinical characteristics of hyperkinetic dysarthria

abnormal involuntary movements in times when steadiness is expected (at rest),

hyperkinesia (abnormal/excess involuntary movements + voluntary movements are slow in body parts affected by the hyperkinesia),

dyskinesia such as orofacial dyskinesia or TD (akathisia [restlessness)

Myoclonus (involuntary single/brief repetitive lightning jerks of body parts)

tics + chorea

athetosis (slow writing, purposeless movement)

dystonia

Spasm

tremor

patient perception/complaints of hyperkinetic

depends on type of movement disorder + extent to which speech is affected

slurred, slow, hard to get out speech

inability to maintain steady jaw, face, + tongue posture

chewing/swallowing complaints

shaky voice/shortness of breath

tightness in affected structures + inability to control abnormal movements(when limited structures)

Chorea NONSPEECH oral mech: hyperkinetic

normal size, strength, + symmetry of jaw, face, tongue, + palate

normal gag reflex

drooling

motor unsteadiness

quick unpredictable movements when face is at rest

chorea SPEECH tasks/observations in hyperkinetic dysarthria

unpredictable breakdowns of artic and abnormalities in rate and prosody

vowel prolongation (fluctuations in state of vowels)

Visual observations confirm abnormal movements, involuntary movements disrupt direction/rhythm, slow rate of movement, + excessive muscle tone

chorea SPEECH characteristics: respiration

sudden, forced, involuntary inspiration/expiration

chorea SPEECH characteristics: resonance

hypernasal

chorea SPEECH characteristics: articulation

imprecise artic, distorted vowels, and irregular breakdowns

chorea SPEECH characteristics: phonation

harsh voice quality, strangled voice, excess loudness variations, abnormal F0, phonatory stenosis, instability of laryngeal movements during speech

chorea SPEECH characteristics: prosody

prosody disturbances/excess/insufficiency (monopitch/loudness/excess and equal stress)

chorea distinguishing features

hypernasal, strained harshness, artic breakdowns, loudness variations, excessive or insufficient stress patterns

dystonia NONSPEECH characteristics:

normal oral mech + resources

drooling

chewing/swallowing problems

dystonic movements at rest and when maintaining steady facial postures

dystonia speech tasks/observations in hyperkinetic dysarthria

convo speech or reading, AMRs, vowel prolongation, careful visual observation, direction and rhythm of movement and rate is slow

reduced range of individual and repetitive movements

Dystonia SPEECH characteristics: respiration

excessive loudness variation and abnormal respiratory movements

Dystonia SPEECH characteristics: resonance

mildly nasal

Dystonia SPEECH characteristics: phonation

harsh and strangled quality, excess loudness variations, short phrases, voice tremor

Dystonia SPEECH characteristics: articulation

artic inaccuracy (distorted vowels, irregular breakdown, imprecise consonants)

Dystonia SPEECH characteristics: prosody

monopitch/loudness

excess and equals stress

short phrases

inappropriate silences

Dystonia distinguishing features

imprecise and irregular breakdowns, inappropriate variability of loudness/rate, strained harshness, audible inspiration, excess/insufficient stress patterns

spasmodic torticollis (hyperkinetic)

cervical neck muscles

speech may be affected

palatopharyngeal myoclonus: NONSPEECH oral mech

ear clicks (eus tube opening and closing), clicking sensation in larynx, myoclonic movements of lips, nares, and tongue

palatopharyngeal myoclonus: speech

vowel prolongation

essential tremor

occasional hypernasal

inappropriate silence

action myoclonus

not present at rest

nonspeech oral can be normal a rest

affects artic and phonation

quicky jerky oral facial movement during speech

organic/essential vocal tremor NONSPEECH oral mech

lingual tremor on rest/protrusion

tremulous movements of the jaw

palatal + pharyngeal tremor on sustained phonation

organic/essential vocal tremor SPEECH

voice tremor (duh)

reduced speed rate

AMR rates are reduced

what is mixed dysarthria?

combo of two or more dysarthria types

etiologies of mixed dysarthria

degenerative diseases, toxic metabolic conditions (Wilson’s), vascular disorders, trauma, tumors,

mixed dysarthria caused by ALS

prosody issues all around, resonatory and phonation incompetence, hypernasal, slow rate, monopitch, short phrases, excess and equal stress, and distorted vowels

mixed dysarthria caused by MS

artic imprecision, impaired loudness control, harshness, breathiness, suddent artic breakdown

mixed dysarthria caused by Friedreich’s ataxia

harsh and breathy, monopitch, strangled voice quality, abnormal rate, excess and equal stress

mixed dysarthria caused by progressive supranuclear palsy

monopitch/loudness, nasal emission, excess + equal stress, slow rate, imprecise artic

mixed dysarthria caused by

hypernasal, strangled voice, strained voice, prolonged silences, slow rate, excess + equal stress, irregular artic breakdownsm low pitch

what is apraxia?

motor disorder of speech production from a brain injury that inhibits commands and movements with muscle structures that help with normal speech.

etiology of apraxia od speech

usually a stroke but can be CNS degenerative disease, MS, or primary progressive aphasia

T/F Apraxia and Broca’s commonly go hand in hand

true!!

patient complaints with apraxia

“i know what I want to say but I can’t say it!”

misarticulations and mispronunciations

Oral mech of apraxia

normal structures. May have some UMN signs in face and tongue

speech testing for apraxia

conversational speech is revealing

SMRs

imitation of multisyllabic words and sentences

apraxia is consistent problems in

artic, rate, prosody, and fluency

apraxia presents with

physical and audible groping, errors on consonants, inconsistent and pervasive errors

NONSPEECH characteristics of Apraxia

right-sided weakness and spasticity, sensory deficits, possible limb apraxia or nonverbal oral apraxia

IF CORTICOBULBAR PATHWAYS ARE FINE: dysphagia features may be normal and maybe no evidence of unilateral/linguistic weakness

nonverbal oral apraxia

inability to imitate or follow commands to perform volitional movements

general characteristics of AOS

slower and more variable speech, deficits are motor and phonetic—not linguistic, prosody, rate, and fluency are affected, artic breakdowns usually substitutions and omissions, inconsistent errors

articulatory characteristics of AOS

SODA + repetitions over other errors, harder to produce consonant clusters, consonants, intial words, (af)fricatives, and infrequent sounds

Rate and prosody in AOS

slow rate with prolonged consonants and vowels and equal stress on all syllables

Fluency in AOS

false starts and repetitive attempts and groping

AOS vs. Dsyarthria

AOS has more groping, subs, additions, less consistency, normal CN examination, and infrequent respiratory, phonation, and resonance problems

treating respiratory impairment

do maximum vowel prolongation activities to target duration and loudness. give feedback girl!

exhale at a steady rate for several seconds to be able to be able to produce several syllables on exhalation and increase respiratory capacity

pulling, pushing, and bearing down during speech tasks

adjusting posture (needs on this one can vary by type of dysarthria)

prothetics like a binder

management of laryngeal impairment

surgical procedures

prosthetics (artificial larynx, cervical collars)

effort closure procedure

initiatie phonation at beginning of exhalation

deveoping voluntary phonation

management of velopharyngeal dysfunction

surgery/prosthetics

modify pattern of speaking

resistance treatment during speech

feedback

nonspeech velopharyngeal movement

management of articulation

surgery/prosthetics (bite block)

strengthening (OME)

relaxation (if rigid or spastic)

stretching

instrumental biofeedback

imitation/phonetic placement/minimal contrasts/intelligibility drills

treatment research for AOS

integral stimulation (“watch me”)

^ and client imitates after a delay

^ but no visual cue

clinician says an utterance and client required to repeat it several times consecutively with no cue

written stimuli and simultaneous production

written stimuli and delayed production

role playing a situation

management of rate

prosthetic (pacing/alphabet board)

hand/finger tapping

visual feedback

rhythmic cueing

management of prosody and naturalness

contrastive stress tasks

referential tasks (reading with random stress they don’t know prior)

management for SPECIFICALLY spastic dysarthria

effort closure techniques, relaxation techniques,

management of pseudobulbar affect (affects verbal communication)

behavior mod or pharmacologic treatment

management for SPECIFICALLY flaccid dysarthria

goal is to increase strength/reduce weakness by improving resonance + velophrayngeal function

patients with MG behavior speech is contraindicated

management for SPECIFICALLY hypokinetic dysarthria

primary surgery and pharamlogic as pathophysiology isn’t under voluntary control

mostly focused on temporary relief

LSVT

management for SPECIFICALLY UUMN dysarthria

behavioral focuses on rate, prosody, and artic

compensatory strats can be used with a focus on more speech oriented than nonspeech ones

management for SPECIFICALLY apraxia

teach a slow dilberate speaking rate paired with motor/gesture stimuli with speech attempts

evoke automatic-reactive speech

use melodic intonation techniques to stimulate speech output

focus on artic imprecision

phonetic training with short re-duplicating utterances and work to increase length and complexity

NO MEDICAL INTERVENTION NEEDED IF JUST AOS

can have AAC or prosthetics

techniques for speechless apraxics

auto speech tasks (counting

predicatable phr