Speech Disorders Exam #3

• What is #1 on the diagram?

• What is its physiological function?

• Precentral gyrus (motor strip)

• controls voluntary movement

• What is #2 on the diagram?

• What is its physiological function?

• Frontal Lobe

• helps control thinking, planning, organizing, memory, and problem solving

• What is #3 on the diagram?

• What is its physiological function?

• Broca’s Area

• aids in language comprehension as well as motor-related activities (hand movements)

• What is #4 on the diagram?

• What is its physiological function?

• Temporal Lobe

• helps process information from your senses (smell, taste, sound), and aids in memory storage

• What is #5 on the diagram?

• What is its physiological function?

• Brain Stem

• contains nuclei for the cranial nerves; means that all cranial nerves originate in the brainstem and is most involved in our life sustaining functions

• What is #6 on the diagram?

• What is its physiological function?

• Pons

• Motor center involved with maintenance, posture, and gait (walking), also houses information for swallowing

• What is #7 on the diagram?

• What is its physiological function?

• Medulla Oblongata

• Basic life sustaining forces: control heart rate, blood pressure, breathing rate

• What is #8 on the diagram?

• What is its physiological function?

• Spinal Cord

• how the central nervous system communicates with the peripheral nervous system, important in breathing

• What is #9 on the diagram?

• What is its physiological function?

• Cerebellum

• compares sensory information to a motor plan, and provides corrective adaptations to the motor plan

• What is #10 on the diagram?

• What is its physiological function?

• Wernicke’s area

• aids in speech production as well as understanding spoken words

• What is #11 on the diagram?

• What is its physiological function?

• Occipital Lobe

• processes images and connects those images to ones stored in your memory

• What is #12 on the diagram?

• What is its physiological function?

• Parietal Lobe

• helps interpret feelings and processes taste, texture, and temperature

• What is #13 on the diagram?

• What is its physiological function?

• Post Central Gyrus

• responsible for sensory reception like touch, pressure, temperature, and pain

• What happens neurologically in our head when we produce speech?

• First we have nerve impulses —> muscle contractions —> ________ —> alter cavity shapes —> __________ —> that results in sound.

• Movements

• air pressure changes

Our Sense —> (Re-) Act function has both ________ information and _________ information.

• Sensory

  • from our environment processed in the brain; includes vision, hearing, touch, temperature, pain

• Motor

 What two controls are in the Intent —> Action function of our nervous system?

• Automatic Control

• Volitional Control

What is Automatic Control?

• responses/activation patterns that are involuntary or “automatic”

  • heart beating, breathing at rest, walking

What is Volitional Control?

• Responses that are characterized as voluntary behavior, thought to be under your cognitive control

  • driving, speaking to a class, writing notes

Our Central Nervous System is made up of the ________, ________, and __________.

The brain, brain stem, and spinal cord

Within our Central Nervous System we have the Cortex. What is the cortex?

• The cortex is the outer layer of our brain

• is made up of the occipital lobe, parietal lobe, frontal lobe, and temporal lobe

What is the primary motor cortex?

Involved in execution of motor gestures like breathing and adducting and abducting the VFs

Within our primary motor cortex we have the ________ _________ _________.

Direct Activation Pathway

What does the Direct Activation Pathway do?

communicates the movement to the rest of the body via upper and lower motor neurons

What does the Upper Motor Neuron do?

• starts communication and is part of the central nervous system

• goes from the brain (frontal lobe) down into the spinal cord

• known as the “1st leg” of the race

What does the Lower Motor Neuron do?

• initiates communication via the peripheral nervous system

• goes from the spinal cord and connects to a muscle outside of the spinal cord

• known as the '“2nd leg” of the race

What is the subcortex?

• deeper and lower brain structure

• involves the cerebellum, basal ganglia, brainstem (midbrain, pons, medulla), and the spinal cord

What is the Peripheral Nervous System?

• takes information from the brain and communicates it to the muscles of the body and vice versa

• involves the spinal nerves and cranial nerves

What are the Cranial Nerves important in speech?

• Trigeminal Nerve V (5)- muscles of the jaw (articulation of vowels/consonants & mastication), face sensation

• Facial Nerve VII (7)- all of the muscles in the face (articulation, mastication, smiling, and taste for front 2/3 of tongue)

• Glossopharyngeal IX (9) & Vagus X (10)- together we know they are involved with the velum, pharynx muscles (articulation & swallowing), laryngeal muscles (intrinsic), and communicates with our diaphragm

• Accessory XI (11)- unsure, know that it is integrated with speech though

• Hypoglossal XII (12)- intrinsic muscles of the tongue

Both Apraxia of Speech and Dysarthria have breakdowns within the ___________ Level of the Encoder’s Speech Chain.

Physiological

What is Apraxia of Speech?

• Neurogenic speech disorder due to impairment of the capacity to be able to program the commands for the positioning and movement of the muscles for speech

• the breakdown is in the programming part, in our head

What are some characteristics of Apraxia?

• Impaired Prosody, slowed speech rate, articulation errors that increase with speech complexity, Impaired fluency

What are the types of Apraxia’s?

• Developmental

  • Childhood- symptoms of motor planning/programming issues; difficult to tell from a severe phonological disorder

    • one sign that it is apraxia is when there are vowels involved; other motor symptoms include “articulatory groping”

    • No known cause

• Acquired

  • Acquired Apraxia- most common; usually caused by a stroke in the Lobo da Insula, and will occur at the same time as aphasia

  • Primary Progressive Apraxia- individual that acquires apraxia of speech and it gets worse over time; unknown cause

What is Dysrthria?

• result from disturbances in muscular control over the speech mechanism due to damage in the central or peripheral nervous system

• creates problems in oral communication due to paralysis, weakness, or incoordination of the speech musculature

• the breakdown is in the execution part, the muscles involved in articulation for speaking

What are some characteristics of Dysarthria?

• disturbances in muscle tone, reflexes, speed, range, accuracy, and steadiness

• Errors are more consistent

What are the types of Dysarthria’s?

• Flaccid- due to lower motor neuron damage or damage to cranial nerves

  • cause could be TBI or stroke

  • characteristics depend on what cranial nerve is damaged (if CN V is damaged, you would see difficulty producing vowels)

  • breathiness or hypernasality

• Spastic- due to upper motor neuron damage (affected bilaterally)

  • cause could be TBI or stroke

  • characteristics include strained voice quality, excess stress or equal stress

• Unilateral Upper Motor Neuron- due to upper motor neuron damage (unilaterally)

  • cause could be TBI or stroke

  • characteristics include reduced precision of articulators, harsh voice quality or reduced loudness

• Hypokinetic- due to Basal ganglia circuit damage

  • cause could be neurotoxins or stroke

  • characteristics include rapid bursts of speech with long pauses, reduced range of motion in articulators

• Hyperkinetic- due to Basal ganglia circuit damage

  • cause could be Huntington’s disease, but is more likely unknown

  • characteristics include hoarse or breathy voice quality, irregular precision of articulators

What are the 4 Assessment Procedures for Motor Speech Disorders?

1. Diagnostic Interview & Case History

2. Oral Mechanism Exam

3. Motor Speech Exam

4. Speech Programming Capacity (Apraxia Only)

What is done in an Oral Mechanism exam?

• testing cranial nerves

• looking at structures during rest, during movement, during sustained postures

What are the three parts to a Motor Speech Exam?

• Vowel Prolongation

  • assess duration, voice quality (pressed, strain, raspy), fundamental frequency, intensity, and stability

• Diadochokinetic Rates (DDKs)

  • speech-like tasks designed to see the general movements of the articulators

  • 2 types:

    • Alternating motion rates (AMRs)- One consonant and one vowel repeated (/pʌ pʌ pʌ/)

    • Sequential motion rates (SMRs)- combine three syllables together (/pʌtʌkʌ pʌtʌkʌ pʌtʌkʌ) to look at syllables per second

      • examines precision, regularity, range of motion

• Reading Passage and Conversation

  • fundamental frequency, intensity, stability, voice quality, rate and rhythm

If a patient complains of speech problems only when they are tired or stressed, what do we do?

• Stress/Fatigue the system

What is the #1 goal of treatment in dysarthria and apraxia?

Achieve the highest level of independent function for communication for participation in daily living

What are Restorative Approaches?

Approaches that focus on improving speech intelligibility, prosody and naturalness, and efficiancy

How do you pick what technique to use for treatment?

Pick based on the speech domain that is affected

What are the three Dysarthria treatments?

Respiratory techniques, Phonatory techniques, and Articulation techniques

What is included in the Respiratory techniques?

• Preparatory inhalation

• Controlled exhalation tasks

• Optimal breath groups

What is included in the Phonatory techniques?

• LSVT-LOUD --> Bob 1

• Effortful closure techniques

What is included in Articulation techniques?

• Phonetic placement techniques

• Clear speech

• Rate modification

What are Compensatory Approaches?

approaches that focus on increasing speaker's use of strategies, improving listener skills, and altering the communication environment

What are the Compensatory Approaches?

• Communication strategies training

• Environmental modification

• Augmentative and Alternate Communication (AAC)

• Listener Training

What are the treatments for the Apraxia’s?

• Articulatory-Kinematic- based in principles of motor programming/planning (sound production treatment)

• Sensory Cueing- incorporate sensory input to teach the movement sequences of speech (Integral Stimulation, Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT))

• Rate and Rhythm Control- uses intonation patterns to improve speech production (Metered Pacing treatment, Melodic intonation therapy)