Motor Speech Test 1

Weeks 1-6

What are the characteristics of flaccid dysarthria related myasthenia gravis?

muscle weakness and fatigue that can recover with rest, affecdts voluntary muscles of the body, deterioration in articulation, dysphonia, poor loudness, hypernasality, continues until client is unintellible.

What is spastic dysarthria caused by?

Bilateral UMN lesions (damage to the motor cortex and/or its descending projections), stroke, MS, TBI, MND, cerebral palsy etc.

Damage to UMN results in an imbalance between what?

excitatory and inhibitory inpot to lower motor neurons

What are the clinical signs of spastic dysarthria?

weakness, spasticity (hypertonia), slowness of movement, reduced range of movement, no muscle atrophy, pseudobulbar effect, bilateral facial palsy, bilateral hemiparesis

Unilateral Upper Motor Neuron Dysarthria (UUMN) symptoms present where?

physical signs and symptoms present on the ipsilateral side (opposite side)

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The upper face is innervated ______, the lower face is innervated ------

bilaterally, unilaterally

Ataxic dysarthria is associated with damage where?

In the cerebellum/cerebellar control circuit

What are the causes of ataxic dysarthria?

Demyelination (MS), stroke, trauma, tumour

What is ataxia?

uncoordinated, ‘broken’ movements

What are the impacts of ataxic dysarthria on speech?

imprecise articulation, slurrig, stress is excess and equal, irregular AMRs

problems with cognitive linguistic processing

Aphasia

sensorimotor planning

Apraxia of Speech (AOS)

neuromuscular execution

Dysarthria

What are the two main functions that are affected by AOS?

articulation and prosody

What are the different types of Dysarthria?

Spastic, Flaccis, Ataxic, Hypokinetic, Hyperkinetric, Mixed

MSD’s arise from damage at many sites of the nervous system. True or False?

True

Hypo/Hyperkinetic Dysaarthria are associated with damage to which site in the nervous system?

Basal ganglia

Ataxic dysarthria is associated with damage to which part of the nervous system?

Cerebellum

Damage to the cerebral cortex is associated with which type of MSDs?

Apraxia of Speech (AOS), Spastic dysarthria and Upper Motor Neuron dysarthria.

Flaccid dysarthria is associated with damage to which nervous system site?

Cranial and spinal nerves.

Flaccid dysarthria is associated upper or lower MN lesions?

Lower Motor Neuron lesions (LMN)

Which type of dysarthria is associated with lesions somewhere between the brainstem/spinal cord and muscles of speech? (LMNs)

Flaccid dysarthria

What are the signs of Lower Motor Neuron lesions?

Muscle weakness, flaccid/hypotonic muscles, loss of muscle reflexes, muscle atrophy, fasciculations

Damage to the cell body of the LMN can be caused by…

Brainstem strokes, neuroplasms/tumours, MND (motor neuron disease i.e. ALS)

Damage to the axon of the LMN can be caused be/associated with…

Bell’s Palsy

Impaired nerve impluse transmission at the neuromuscular junction (LMN) is associated with what kind of dysarthria and what other condition?

Flaccid dysarthria, myasenthia gravis

What are the speech features of flaccid dysarthria?

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What is muscle atrophy?

The degredation of muscle tissue

What are the characteristics of hypotonia?

Not enough muscle tone (weakness), associated with flaccid dysarthria, LMN involvement

What are the characteristics of bradykinesia?

slow muscle movements, slow in initiation and execution of muscle movements, associated with Parkinson’s diseases and hypokinesia

What are the characteristics of the pseudobulbar effect?

sudden, uncontrollable emotions like laughter or crying, emotional lability, associated with unilateral UMN dysarthria and spastic dysarthria

What is spasticity?

Too much muscle tone. Associated with hypertonia, spastic dysarthria and UMN damage

Flaccid dysarthria with bilateral CNV (trigeminal) involvement results in…

Bilateral jaw movement difficulties - resulting in poor articulation

Flaccid dysarthria with bilateral CNVII (facial) involvement results in…

Bilateral lip movement difficulties - resulting in poor articulation of plosives, labial sounds

Flaccid dysarthria with bilateral CNXII (hypoglossal) involvement results in…

Bilateral tongue movement difficulties - articulation issues due to weakness etc.

What is the most severe form of flaccid dysarthria?

multiple cranial nerve lesions (bulbar palsy)

What are the characteristics off flaccid dysarthria associated bulbar palsy?

several cranial nerves involved, so all speech components affected (articulation, hypernasality, breathiness, monoloudness etc.)

What are the kinesic problems associated with basal ganglia circuit issues?

Hypokinesia, hyperkinesia

What is dopamine important for (in terms of movement)?

executing movements

Hypokinetic dysarthria is what?

Lesions in the basal ganglia control circuit where there is TOO MUCH inhibition/not enough excitation

What is the cause of hypokinetic dysarthria?

Parkinson’s Disease

What are the speech characteristics of hypokinetic dysarthria?

low volume, monotonous voice, very fast speech rate

What is hyperkinetic dysarthria?

too little inhibition, dopaminergic hyperfunction, increased excitation of motor cortex

What is dystonia?

sustained movements over 5 secs (still a jerky movement but lasts longer in the position)

What are the speech characteristics of hyperkinetic dysarthria?

slurred speech, strained, tight, hypernasality, inappropriate loudness, unpredictable

Apraxia of Speech is problems with what?

constructing a motor plan for speech

What is the most common cause of AOS?

Left MCA stroke

What happens to someone with AOS when they try to speak?

imprecise articulators, visible groping, awake of mistakes, consonant and vowel distortions, perseverative subsititutions, anticipatory substitutions, blurring of voiced and voiceless boundaries.

What is AOS' impact on speech prosody?

Slower rate, silent pauses, equal stress, monopitch and monoloudness

What is usually spared with AOS (might not be with severe cases)

automatic speech

Is AOS or dysarthria concerned with execution of movement?

dysarthria

Does AOS or dysarthria benefit from cueing strategies?

AOS