Motor Speech

What are some perceptual speech characteristics of flaccidity (5)?

• Breathiness -> short phrases, rapid deterioration

• Diplophonia

• Audible inspiration/stridor

• Nasal air emission, nasality

• Imprecise AMRs

What are some perceptual speech characteristics of spasticity (4)?

• Slow speech rate

• Strained or harsh vocal quality

• Pitch breaks

• Slow and regular AMRs

What are some perceptual speech characteristics of ataxic dysarthria (5)?

• Irregular articulatory breakdowns

• Excess and equal stress

• Distorted vowels

• Excessive loudness variation

• Irregular AMRs

What are some perceptual speech characteristics of hypokinetic dysarthria (5)?

• Monopitch, monoloudness

• OR reduced loudness and stress

• Tendency for rapid/accelerated rate, rapidly repeated phonemes

• Inappropriate silences

• Rapid blurred AMRs

What are some perceptual speech characteristics of hyperkinetic dysarthria (6)?

• Sudden forced inspiration/expiration

• Transient breathiness, vocal strain or harshness

• Voice stoppages/arrests and/or tremors

• Intermittent hypernaslity

• Distorted vowels

• Slow and irregular AMRs

What are some perceptual speech characteristics of unilateral upper motor neuron dysarthria (5)?

• Slow rate of speech

• Imprecise articulation

• Irregular articulatory breakdowns

• Strained voice

• Reduced loudness

What are some distinguishing physical characterstics of flaccid dysarthria (5)?

• Muscular weakness, flaccidity or atrophy

• Muscular fasciculations

• Nasal backflow when swallowing

• Facial myokymia

• Synkesis

What is myokymia?

Involuntary muscle quivering/rippling of muscle fibers, seen through the skin

What is synkesis?

When voluntary movement in one part of the face causes involuntary movement in another part of the face (due to misdirected nerve regeneration)

What are some distinguishing physical characteristics of spastic dysarthria (3)?

• Pathologic oral reflexes (sucking, snout, jaw jerk)

• Hyperactive gag reflex

• Hypertonia

What is hypertonia?

An abnormal increase in muscle tone, which causes muscle to stiffen and become difficult to move

What are some distinguishing physical characteristics of ataxic dysarthria (2)?

• Dysmetric jaw, face and tongue in AMRs

• Head tremor

What does dysmetric mean?

A lack of coordination of movement

What are some distinguishing physical characteristics of hypokinetic dysarthria (4)?

• Masked facial expression

• Tremulous jaw, lips, tongue/resting tremor

• Reduced range of motion on AMR tasks

• Rigidity

What are some distinguishing physical characteristics of hyperkinetic dysarthria (3)?

• Involuntary movements and motor tics (such as myoclonus or tremors)

• Relatively sustained deviation of head position

• Facial grimacing

What is a tremor?

Rhythmic oscillations caused by intermittent muscle contractions

What is chorea?

Involuntary, irregular or unpredictable muscle movements

What is Hemiballismus?

Wild, large-amplitude, flinging movements on one side of the body, commonly affecting proximal limb muscles but can also affect the trunk

What is Dystonia?

Sustained or repetitious muscular contractions, often produces abnormal posture

What is a Tic?

A habitual spasmodic contraction of the muscles, most often in the face - suppressible for a while

What is Athetosis?

Writhing movements, mostly of arms and hands. Often slow

What is the role of the substantia nigra? What motor disease is it related to?

Substantia nigra = 'black substance'

A dark-coloured brain structure (due to neuromelanin) located in the basal ganglia of the midbrain that is crucial for motor control, reward functions (dopamine production), and cognition

Deficiency of dopamine made by substantia nigra leads to Parkinson's disease

What is the globus pallidus (GP)? What motor disorders is it linked with?

• Part of the basal ganglia

• Controls conscious, voluntary movements -> allows for SMOOTH, CONTROLLED actions by balancing excitatory signals of the cerebellum

• Linked with Parkinson's Disease and Huntington's disease

Which cranial nerves are bilaterally innervated?

CN V

CN VII (upper face)

CN IX and X

CN XII (apart from genioglossus - muscle of protrusion)

What are the two facial cranial nerves that will be impacted by unilateral brain damage?

CN VII -> lower

CN XII -> genioglossus (muscle of protrusion)

What is the genioglossus muscle?

The muscle of protrusion for the tongue

What sort of phonemes would be impacted by unilateral brain damage?

Sounds at the FRONT of the mouth (as they require protrusion)

E.g. /l, s, t/ and interdental sounds /th/

Requiring lip closure: /f, v/

What DDK sound would be difficult for a unilateral brain damage client to make?

/t/ because it requires tip of the tongue. /p, k/ would not be impacted as much as they are back of the tongue sounds

What do we mean by laminal distortion?

/s, th, t/ caused by tongue protrusion difficulties