WSU SLP 5300 motor speech disorders & dysphagia

dysarthria

a group of speech disorders caused by paralysis, weakness, or incoordination of the speech muscles; 6 different types categorized by the types of motor movement problems they have (involuntary movements, spastic or flaccid muscles)

dysarthria treatment

surgical intervention, pharmaceutical intervention to alleviate cause, speech therapy

dysarthria speech therapy

work to decrease speech rate, relaxation exercises for hyperadduction of VFs, over-articulating speech sounds, increasing respiratory support by improving posture/strength, augmented/alternative communication options

apraxia of speech

impairment in the planning, coordination, & timed execution of movement patterns for speech; often very severe impairment

apraxia treatment

sequenced production of speech sounds (/p/ words, /t/ words, /s/ words); alternative & augmented communication options for patients who do not respond to verbal treatment

dysphagia

swallowing disorder characterized by difficulty in oral preparation for the swallow or the movement of material (bolus) from the mouth to the stomach

four phases of swallowing

oral preparatory phase, oral phase, pharyngeal phase, esophageal phase

oral preparatory phase

variable duration, preparing food to be swallowed, conscious awareness of food or drink, bring food/drink to and into mouth, position & chew food in mouth, lip closure, creates a bolus

oral phase

1 second long, begins when chewing stops, tongue motion propels the bolus posteriorly, swallowing reflex begins when bolus reaches the anterior faucial pillars, food pulled toward pharynx, soft palate moves up to prevent nasal reflux which ends this phase

pharyngeal phase

1 second long, closure of soft palate, peristaltic motion of the pharyngeal constrictors, elevation & closure of larynx, epiglottis covers opening into larynx, vocal folds adduct tightly

esophageal phase

8-20 seconds, this peristaltic motion carries the bolus through the esophagus, esophageal sphincter opens to the stomach

oral preparatory phase problems

decreased cognition, impulsivity, weakness

oral phase problems

poor lip sealing/drooling, premature spillage, lingual weakness

pharyngeal phase problems

delayed swallow response, weakness in soft palate, larynx, and vocal folds, diminished laryngeal sensation leading to silent aspiration

esophageal phase problems

upper & lower sphincter problems, slow or absent esophageal peristalsis

peristalsis

a series of involuntary, wave-like contractions of the muscles in the digestive tract that propel food and other substances along the gastrointestinal tract

patients w dysphagia at risk for

aspiration of food or liquid passing into larynx, trachea, or lungs below the level of the true vocal folds; aspiration pneumonia/acute inflammation of lungs in reaction to aspirated food, liquid, or other foreign material

modified barium swallow study

dysphagia diagnosis tool; ‘gold standard’ instrumental evaluation, video recording of movement of liquid from entering mouth to entering stomach, performed by radiologist & SLP, barium put in liquid of different consistencies, patient x-rayed while swallowing (videofluoroscopy)

grandfather passage

reading passage that has all the phonemes in it in different positions, allows you to decide if speech is easy to understand or if there are issues

fiberoptic endoscopic evaluation of swallowing (FEES)

dysphagia diagnosis tool that provides info about pharyngeal phase, flexible endoscope w light source passed through nasal passageway into nasopharynx, various textures of blue/green-dyed foods chewed & swallowed, laryngopharynx observed to identify problems like incomplete problems or aspiration

dysphagia treatment

long-term functional goal based on patient’s prognosis, compensatory techniques like posture correction & food placement/bolus size, strengthening & ROM improvement for oral structures, change of food consistencies, NPO (nothing by mouth) nasogastric or gastric tube for feeding

dysarthria causes

thrombotic, embolic, or hemorrhagic strokes, open or closed head injuries, toxic/metabolic metals or drugs, Parkinson’s disease, Myasthenia gravis, ALS, MS; same etiologies as aphasia & cognitive disorders but sometimes no cause is found

speech characteristics of dysarthria

may sound hoarse, breathy, strained, or nasal; sounds may be distorted or difficult to produce accurately; slower or faster speech rate that’s difficult to understand; articulatory breakdowns; monotone speech; reduced loudness; audible inhalation; problems with intonation & stress; prolonged intervals between words or phrases

speech characteristics of apraxia

inability to select and program the positioning of speech muscles causing inconsistent errors, inability to sequence speech sounds, pts make many errors of articulation & recognize the errors, make repeated attempts to correct the errors, but each attempt may result in a different type of error

diadochokinesis (DDK)

refers to the ability to perform rapid, alternating articulation movements; used to assess the rate and regularity of repetitive movements of the oral articulators

oral mechanism examination

observe anatomy & physiology of articulatory structures, noting symmetry & range of motion, volitional movements, coordination, & strength; observe swallowing of various foods & liquids

causes of apraxia of speech

stroke, brain trauma, brain tumors, cranial nerve damage, degenerative diseases

causes of dysphagia

same neurological causes as language, motor speech, & cognitive disorders in children & adults; cancers in the head & neck, cancer treatments like surgeries, radiation, & chemotherapy