Motor speech disorders outline one

Nervous system

consists of the brain and spinal cord

Motor system

portion of the nervous system responsible for voluntary and involuntary body movements.

Dysarthria

impaired production of speech because of disturbances in the muscular control of the speech mechanism.

Apraxia

motor speech disorder in which a deficit is noted in the ability to smoothly sequence and place the tongue, lips, and jaw during speech; a deficit in the ability to sequence the correct movements needed to carry out a familiar action.

Hippocratic Corpus

70 volumes of text that describe numerous medicines, diseases, and treatments of the earliest speech and language disorders that were observed by Greek physicians; although it contains his name, Hippocrates was not the sole write of this collection. It is thought that numerous writers contributed to this collection over 100 years and most likely were physicians who were a part of a medical school founded by Hippocrates.

Aphasia

acquired language deficit that affects verbal production, auditory comprehension, reading, and writing

Flaccid dysarthria

dysarthria in which there is damage to the lower motor neurons

Spastic dysarthria

dysarthria that is associated with bilateral upper motor neuron damage to the pyramidal and extrapyramidal tracts

Mixed dysarthria

dysarthria in which there is both upper and lower motor neuron

Ataxic dysarthria

dysarthria in which there is damage to the cerebellum or to the neural tracts that connect the cerebellum to the central nervous system

Hypokinetic dysarthria

dysarthria caused by dysfunction in the basal ganglia usually with idiopathic parkinson’s disease

Hyperkinetic dysarthia

dysarthria cause by involuntary movements that interfere with speech

Cerebrum

the largest and most prominent part of the brain; is split into 2 hemispheres (right and left) by the longitudinal fissure; and contains 4 lobes below along with these other characteristics:

Frontal

anterior part of the cerebrum; critical for speech and language production bc it contains the primary motor cortex for speech production; also contains Broca’s area.

Temporal

lower part of the cerebrum; under frontal lobe and in front of the occipital lobe; contains the primary auditory cortex; also contains Wernicke’s area.

Parietal

upper side of the cerebrum and behind frontal lobe; considered the somatic sensory area responsible for pressure, pain, temperature, and touch.

Occipital

behind the parietal lobe above the cerebellum; and contains the primary visual cortex which is especially important reading, writing, and interpreting body/facial expressions during interactions.

Midbrain (mesencephalon)

first portion of the brainstem; controls many motor and sensory functions such as postural reflexes, visual reflexes, eye movement, and vestibular generated eye and head movements.

Pons (metencephalon)

round, bulgy structure in the middle of the brainstem; above medulla; involved in controlling hearing, respiration, eye movement, facial expressions, sensation, and balance; also houses nuclei for cranial nerves 5 (trigeminal) and 7 (facial) which are significantly important to speech production and chewing/swallowing.

Medulla (myelencephalon)

final portion of the brainstem; begins the upper portion of the spinal cord; houses nuclei for many cranial nerves 8-12; helps control breathing, cardiac function, digestion, heart rate, blood pressure, swallowing, and speech production.

Motor Neurons

a.     – transmits motor impulses AWAY from the CNS; responsible for movement in the body.

Sensory Neurons

transmits sensory impulses TO the CNS; helps elicit sensations such as temperature, touch, pain, and itching.

inter Neurons

most common neuron; these link neurons with other neurons; play a role in controlling movement as well.

Afferent Neurons

transmit their neural info TO the CNS; work in conjunction with the sensory neurons.

Glial Cells

provide the supporting structure of the nervous system; holds neurons in place; supply nutrients and oxygen to the neurons; help insulate the neurons from one another; help clean up dead neurons; these are found in the CNS.

Schwann Cells

glial cells of the PNS; help provide a myelin sheath (fatty) covering around the axons of the PNS; this myelin sheath insulates the axon resulting in faster conduction.

Microglia

these cells act as a scavenger to remove dead cells and other waste.

Oligodendroglia

these cells form the myelin around axons in the CNS.

Astrocytes

These make up the connective tissue of CNS

temporal association cortex

responsible for processing sound and forming memories.

frontal association cortex

responsible for planning the initiation of movement.

Parietal association cortex

responsible for eye-hand coordination; problems here result in difficulties manipulating objects, sensory difficulties, and reading/writing difficulties

Parts of the Basal Ganglia

caudate nucleus, putamen, globus pallidus

striatum

caudate nucleus and putamen

Substantia niagra

1.     which is connected to the striatum and is considered a neural tract between these areas.

2.     This neural tract produces large amounts of neurons that produce the neurotransmitter dopamine.

Results from low dopamine

hypokinetic dysarthria, parkinson’s disease

Hyperkinetic dysarthria

results from damage to the basal ganglia with characteristics of rapid, involuntary movements of the face, limbs, and tongue.

Diencephalon

structure deep within the basal ganglia and located between the brainstem and the cerebral hemispheres and contains:

Diencephalon

1. Thalamus

2. Hypothalamus

3. Epithalamus

Thalamus

the largest of the diencephalon structures; integrates sensory experiences (hearing, sight, touch, taste) and relays them to the cortical areas; every sensory impulse from the body travels through the thalamus to the cortex.

Hypothalamus

regulates body temperature

Epithalamus

Regulates sleep and optic reflexes

CN5 Trigeminal

mixed nerve; face/sensory; jaw/motor.

CN7 Facial

mixed nerve; tongue/sensory; face/motor

CN 8:  Acoustic

Sensory nerve; hearing and balance

CN9 Glossopharyngeal

mixed nerve; tongue and pharynx/sensory; pharynx only/motor.

CN10 Vagus

mixed nerve; larynx, respiratory, cardiac, and gastrointestinal systems/all sensory and motor.

CN11 Spinal Accessory

motor nerve; shoulder, arm, and throat movements

CN12 Hypoglossal

motor nerve; tongue movements

31 Pairs of Spinal Nerves

outside of the brain and spinal cord and are attached to the spinal cord; divided into segments according to the region of the spinal cord in which they are attached

Pairs of cervical spinal nerves

8

Pairs of thoracic spinal nerves

12

Pairs of Lumbar spinal nerves

5

Pairs of sacral spinal nerves

5

Coccygeal spinal nerves

1

An accurate diagnosis requires the clinician to

listen closely, pay attention, and determine which of the patient’s disorders are most characteristic of a true motor speech disorder

Once the diagnostic/proper evaluation has been completed, you can most likely decide on the most affected areas, and therefore

narrow it down to the most common characteristics of dysarthria.

Instrumental analysis

advanced devices that objectively measure the components of speech production.

Nasal and oral airflow—Assesses

palatal function and hyper– and hyponasality status to determine certain characteristics of dysarthria

Normal format frequencies for males

80-175 Hz

Normal formant frequency for females

165-255 Hz

Dysarthria

All processes of speech are affected including respiration, phonation, resonance, articulation, and prosody

Dysarthria

Change in muscle tone secondary to neurological involvement that results in difficulty with voluntary and involuntary motor tasks such as swallowing, chewing, and licking

Dysarthria

Speech errors result from a disruption in muscular control of the central and peripheral nervous systems

Dysarthria

errors of speech are consistent and predictable with no islands of clear speech

Dysarthria

Articulatory errors are primarily distortions and omissions

Dysarthria

Consonant productions are consistently imprecise, vowels may be neurtralized

Dysarthria

The speech rate may be slow and labored; strain tension, and poor breath support may be apparent

Dysarthria

speech intelligibility is often reduced as the speaking rate increased

Dysarthria

Increases in word/phrase complexity result in poorer articulatory performance

Apraxia

The speech process for artic is primarily affected, prosody may also be abnormal

Apraxia

There is a change in motor programming for speech secondary to neurological involvement but muscle tone is not affected. Involuntary motor tasks typically are not affected

Apraxia

speech errors result from a disruption of the message from the motor cortex to the oral musculature

Apraxia

errors of speech are inconsistent and unpredictable, islands of clear well articulated speech exist

apraxia

Articulatory errors are primarily substitutions, repetition, additions, transpositions, prolongations, omissions, and distortions. Most errors are close approximations of the targeted phoneme.

Apraxia

Consonants are more difficult than vowels blend are more difficult than singletons; initial consonants are more difficult than final consonants; fricatives and affricates are the most difficult consonants. Errors increase as the complexity of the motor pattern increases

Apraxia

a prosodic disorder may occur due to compensatory behaviors

Apraxia

Speech intelligibility sometimes increases as the speaking rate increases

Apraxia

increases in word phrase complexity result in poorer articulatory performance

These are the areas in which an SLP would be analyzing:

dysarthria, apraxia, respiration, phonation, resonance, articulation, prosody

The following areas should be evaluated concerning oral motor function

1. Muscular strength and control of the labial, lingual, palatal, and respiratory musculature

2. Speed of movement including AMR

3. Range of movement/range of motion

4. Respiratory sufficiency