Motor Speech Disorders

Name the 5 domains/systems of speech

respiratory, phonatory, resonance, articulation, prosody

What are 2 general types of motor speech disorders?

dysarthria, apraxia of speech

What are the 6 types of dysarthria?

flaccid, spastic, ataxic, hypokinetic, hyperkinetic, unilateral upper motor neuron

Where does the damage occur in flaccid dysarthria?

LMN (final common pathway, motor unit)

Where does the damage occur in spastic dysarthria?

bilateral UMN (direct and indirect activation pathways)

Where does the damage occur in ataxic dysarthria?

cerebellum (cerebellum control circuit)

Where does the damage occur in hypokinetic dysarthria?

basal ganglia control circuit (extrapyramidal)

Where does the damage occur in hyperkinetic dysarthria?

basal ganglia control circuit (extrapyramidal)

Where does the damage occur in unilateral upper motor neuron dysarthria?

in a unilateral upper motor neuron

What is the neurologic specific issue with flaccid dysarthria?

weakness

What is the neurologic specific issue with spastic dysarthria?

spasticity

What is the neurologic specific issue with ataxic dysarthria?

incoordination

What is the neurologic specific issue with hypokinetic dysarthria?

rigidity, reduced range of motion, scaling problems

What is the neurologic specific issue with hyperkinetic dysarthria?

involuntary movements

What is the neurologic specific issue with unilateral upper motor neuron dysarthria?

upper motor neuron weakness, spasticity, or incoordination

In motor speech disorder’s how is movement affected (RATSSS)?

range of motion, accuracy, tone, strength, speed, steadiness

What complications are associated with MSDs?

  - communication problems, social difficulty, quality of life (depression)

What are issues with audio-visual perceptual measures?

- Subject to unreliability of judgements among clinicians
- May be difficult to agree on severity
- Cannot directly test hypotheses about the pathophysiology underlying the perceived speech abnormalities
- Perceptual classification is hard because:
+ listeners must identify clinically significant features from a multidimensional acoustic signal.
+ Salient features are not invariant; any one individual can deviate from group similarities
+ It is possible that subgroups exist.

Apraxia

The motor speech disorder that results when there are problems with motor planning and programming:

Dysarthria

The motor speech disorder that results when there are problems with motor execution:

Trigeminal

CN V Name

Mixed

CN V Innervation

jaw movement, face/mouth/jaw sensation, chewing

CN V Function

Facial

CN VII Name

Mixed

CN VII Innervation

taste, facial movement, hyoid elevation, stapedius reflex, salivation, lacrimation

CN VII Function

Glossopharyngeal

CN IX Name

Mixed

CN IX Innervation

Pharyngeal swallow onset, taste, pharynx/tongue sensation

CN IX Function

Vagus

CN X Name

Mixed

CN X Innervation

Voicing, pharyngeal swallow, pharyngeal/palatal/laryngeal movement, visceral senation

CN X Function

Accessory

CN XI Name

Motor

CN XI Innervation

Neck and Shoulder Movement

CN XI Function

Hypoglossal

CN XII Name

motor

CN XII Innervation

tongue movement

CN XII Function

ALS

Name an example of a degenerative etiology:

encephalitis

Name an example of an inflammatory etiology:

drug toxicity/hypoglycemia

Name an example of a toxic-metabolic etiology:

Cancer (astrocytomas)

Name an example of a neoplastic etiology:

TBI

Name an example of a trauma etiology:

stroke

Name an example of a vascular etiology:

The pyramidal system (UMN system)

What is another name(s) for the direct activation pathway?

consciously controlled skilled voluntary movements

What does the direct activation pathway control?

primary motor cortex, premotor cortex, supplementary motor area, splits into corticobulbar (to the cranial nerves) and corticospinal (to the spinal nerves) tracts

What are the major structures of the direct activation pathway?

small lesions can have big effects (weakness/loss/reduction of skills movements), the UMNs innervate the LMNs on the opposite side of the body, some UMNs have bilateral innervation

What happens if the direct activation pathway is damaged?

The extrapyramidal system (UMN system)

What is another name(s) for the indirect activation pathway?

subconscious automatic muscle movements (posture, muscle tone, movements that support and accompany vol. movements)

What does the indirect activation pathway control?

basal ganglia, red nucleus, substantia nigra, reticular formation, cerebellum

What are the major structures of the indirect activation pathway?

Unilaterally: mild spasticity, slow movements, hyperadduction of vocal folds

Bilaterally: rigid muscle tone, hyperreflexia, dysphagia, disinhibition of facial expressions

What happens if the indirect activation pathway is damaged (unilateral & bilateral)

Integrates and coordinate execution of smooth, directed movements.

Describe the function of the cerebellum.

ataxic dysarthria

What happens if the cerebellum is damaged?

cerebellum, thalamus, cortex (part of the control circuits)

What are the major structures of the cerebellum?

Plans and programs postural and supportive components of motor activty

What is the function of the basal ganglia?

basal ganglia, substantia nigra, subthalamic nucleus, cortex

What are the major structures of the basal ganglia?

either hypokinetic dysarthria or hyperkinetic dysarthria

What happens if the basal ganglia is damaged?

degenerative diseases (ALS, motor neuron disease, Kennedy’s disease)

What is the most common condition grouping of flaccid dysarthria?

ALS

What is the most common motor neuron disease?

flaccid dysarthria

What type of dysarthia is commonly seen in ALS patients?

surgery in the brainstem, head, neck, or upper chest

What is the most common cause of vocal fold paralysis?

the brainstem

Where would a stroke need to occur to cause damage to cranial nerve nuclei (affecting LMNs, causing flaccid dysarthria)?

stroke-like symptoms, ptosis (drooping eye lids), facial weakness, flaccid dysarthria, dysphagia, sometimes dysphonia

What signs do patients with myasthenia gravis frequently present with?

they fatigue quickly and recover with rest

What role does movement and rest have in someone with myasthenia gravis?

Acute, inflammatory autoimmune disorder:
demyelinating, peripheral motor neuropathy

What is Guillain-Barre syndrome?

weeks to years

How long does it take to recover from Guillain-Barre?

No

Do cognitive deficits co-occur with flaccid dysarthria?

Degenerative (ALS, motor neuron disease, primary lateral sclerosis, unspecified degenerative CNS disease, progressive supranuclear palsy, corticobasal syndrome, multiple system atrophy, parkinsonism)

What is the most common condition grouping for spastic dysarthria?

vascular disorders

What general etiology category is found most frequently with spastic dysarthria (but not other types of dysarthria)?

internal carotid, MCA, PCA

Where would a stroke need to occur (arteries) in the brain to result in spastic dysarthria?

bc the R and L UMNs are closer together so one lesion can cause bilateral damage

Why is spastic dysarthria the likely type if there is damage to the brainstem?

spastic, flaccid, ataxic

What types of dysarthria could occur if there is damage to the brainstem?

vascular dementia (Binswanger’s disease)

Spastic Dysarthria is seen in which kind of dementia?

bc dysarthria is not common with degenerative cortical dementias like alzheimer’s or pick’s disease.

Why is it important to note that spastic dysarthria can occur in vascular dementia?

a chronic condition (ranging from mild to severe) CNS movement disorder caused by genetic or non-genetic issues before, during, or after birth by early childhood

What is cerebral palsy?

spastic-ataxia, and flaccid-spastic

What are two mixed dysarthria types seen in TBI populations?

YES

Are cognitive deficits common for individuals with spastic dysarthria?