Motor Speech Disorders 2

Bilateral UMN

Lesion site for spastic dysarthria

LMN

Lesion site of flaccid dysarthria

Weakness

A common feature of flaccid dysarthria is

Myasthenia gravis

Disease associated with flaccid dysarthria

Incoordination

A common feature of ataxic dysarthria is

Cerebellar circuits

Lesion site of ataxic dysarthria

Rigidity, reduced ROM

Common feature of hypokinetic dysarthria

Basal ganglia circuit

Lesion site of hypokinetic dysarthria

Parkinson's disease

Hypokinetic dysarthria is associated with this disease

involuntary movement

Common feature of hyperkinetic dysarthria

Basal ganglia circuit

Site of lesion of hyperkinetic dysarthria

Huntington's disease, dystonia

Hyperkinetic dysarthria is associated with this disease

Mild or transient weakness/spasticity

Common feature of UUMN dysarthria

unilateral UMN

Site of lesion of UUMN dysarthria

irregular articulatory breakdowns, prolonged phonemes, excessive loudness variation, and equal and excess stress

Ataxic dysarthria speech characteristics:

audible inspiration, hypernasality with nasal emission

Flaccid dysarthria speech characteristics:

inappropriate silences, prolonged phonemes, prolonged intervals, variable rate, transient breathiness, voice stoppages, excess loudness variation, sudden forced inspiration or expiration

Hyperkinetic (chorea) dysarthria speech characteristics

voice tremor, irregular articulatory breakdowns, inappropriate silences, distorted vowels, harsh voice, strained-strangled, excess loudness variation, audible inspiration

Hyperkinetic (dystonia) dysarthria speech characteristics

short rushes of speech, inappropriate silences, repeated phonemes, increased rate, monopitch/monoloud, reduced stress

Hypokinetic dysarthria speech characteristics

imprecise consonants, slow rate, strained-strangled voice, low pitch

Spastic dysarthria speech characteristics:

Guillan-Barre, Myasthenia gravis, chiari malformations

Diseases associated with flaccid dysarthria

flaccid

Myasthenia gravis is associated with ____ dysarthria.

Degenerative disease

_________ is the most common etiology of flaccid dysarthria.

imprecise or distorted consonants; slow rate of speech (along with inhalatory stridor, breathiness, hypernasality w/ nasal emission)

If damage to CN V & VII results in flaccid dysarthria, you are likely to observe

short phrases, weak pressure consonants, aphonia, reduced loudness/pitch, hoarseness (along with inhalatory stridor, breathiness, hypernasality w/ nasal emission)

If damage to CN X results in flaccid dysarthria, you are likely to observe

Reduced loudness, pitch

short phrases (gasping for air, shallow breathing) (along with inhalatory stridor, breathiness, hypernasality w/ nasal emission)

If damage to spinal nerves results in flaccid dysarthria, you are likely to observe

Mixed spastic-flaccid

ALS is associated with ____ dysarthria

spastic

Cerebral palsy is associated with _____ dysarthria.

spastic

Pseudobulbar palsy is associated with ______ dysarthria.

Degenerative disease

_________ is the most common etiology of spastic dysarthria.

Slow rate

Increased effort to speak

Fatigue when speaking

Chewing/swallowing difficulty

Poor control of emotion

Speaker complaints of spastic dysarthria

strained-strangled voice

A hallmark voice characteristic of spastic dysarthria is

breath support

A person with spastic dysarthria will likely have intact...

Pseudobulbar Palsy (UMN)

Inability to control facial movements (chewing and speaking) caused by a neurological disorder.

Difficulty chewing, swallowing, speaking, hyperactive reflexes, spasticity

Symptoms of pseudobulbar palsy include

bilateral damage (degeneration) to the corticobulbar tract

The cause of pseudobulbar palsy is

Pseudobulbar affect

Uncontrolled crying or laughter.

Only partially or not at all under voluntary control

In exaggerated response to emotion or out of context.

unknown - theoretically, bilateral lesions in descending corticobulbar tracts cause failure of voluntary control of emotion

The cause of pseudobulbar affect is

TBI, Dementia, ALS, MS, Parkinson's, Tumors, Pseudobulbar palsy

Pseudobulbar affect is associated with these diseases:

Ataxic Cerebral Palsy

A congenital disease that can cause ataxic dysarthria is

ataxic

Multiple sclerosis is associated with _____ dysarthria.

degenerative disease

Most common etiology of ataxic dysarthria is

"drunk" or intoxicated speech

Stumbling over words

biting tongue or cheek when speaking or eating

Deterioration of speech with alcohol

Poor coordination of speech while breathing

Speaker complaints of ataxic dysarthria include

Intermittent disintegration of articulation, dysrhythmia and irregularities of pitch and loudness during DDK

One pattern of perceptual features of ataxic dysarthria is characterized by

Altered prosody, prolongations of sounds, equalization of syllabic stress (putting stress on normally unstressed syllables), prolonged intervals between syllables and words.

The other pattern of perceptual features of ataxic dysarthria is characterized by

gait disturbance, nystagmus, dysmetria, halting/imprecise/jerky movement

Nonspeech characteristics associated with ataxic dysarthria include

Nystagmus

rapid back and forth eye movements

Ataxic movement

halting, imprecise, jerky, poorly coordinated, and lacking in speed and fluidity

hypokinetic

Parkinson’s disease is associated with ______ dysarthria.

hypokinetic

CTE is associated with what kind of dysarthria?

short rushes of speech

Hallmark characteristic of hypokinetic dysarthria

reduced loudness, rapid rate, mumbling or stuttering, difficulty initiating speech, stiff lip

Speaker complaints of hypokinetic dysarthria

Parkinsonism

general syndrome with a constellation of symptoms - tremor, rigidity, akinesia, postural instability (TRAP).

loss of dopaminergic neurons in substantia nigra

Underlying cause of PD

Hypernasality

A minority of people with PD have

hyperkinetic

Huntington’s disease is associated with ______ dysarthria.

hyperkinetic

Spasmodic dysphonia is associated with ______ dysarthria.

dystonia (spasmodic dysphonia, generalized dystonia), Tourette's syndrome, myoclonic epilepsy, essential tremor, familiar tremor

Other causes of hyperkinetic dysarthria are

irregular, regular/predictable

Chorea is defined as _____________ movement, while tremor is defined as __________.

undetermined

The most common etiology of hyperkinetic dysarthria is

dyskinesia

general term for an impairment in voluntary movement, often results in fragmented or jerky motions

myoclonus

quick muscle jerk

tics

repeated, rapid involuntary muscle contraction

chorea

abrupt, irregular, jerky, uncontrolled movements

ballismus

jerking, flinging movements of extremities

athetosis

slow, flowing, writhing movements

Acquired Apraxia of Speech (AOS)

an impairment in motor planning/programming for directing movements for speech production

articulation, prosody; resonance, phonation, respiration

Speech characteristics of AOS often reflect impairments in _______ and ________, rather than ________, ________, or _________

Neurological damage (stroke, TBI, tumor, degenerative disease, etc.) to the left hemisphere near the third frontal convolution (Broca’s area)

AOS is caused by…

motor execution; motor planning/programming

Dysarthria arises from impairment of _____ ______, while AOS arises from impairment of _____ ______.

motor planning

a general plan about what is needed to accurately achieve a speech production goal (can be used over and over)

motor programming

the procedure of adding specific details to the plan about how to achieve the goal (details about muscle tone, force, and range; articulatory posture; transition movements; speech rate and prosody)

the individual needing to construct programs each time for each sound/syllable

A theory surrounding AOS is that it could reflect problems with the access or use of pre-programmed subroutines, resulting in…

oral reflexes will likely be WNL (normal OME)

If the lesion causing AOS did not damage corticobulbar pathways, …

right central facial weakness, right lingual weakness, impaired oral sensation

If the lesion causing AOS is large enough to have damaged corticobulbar pathways, you may observe…

Non-verbal oral apraxia

inability to follow commands to perform volitional movements of specific structures

off target, effortful, inconsistent, movements can often be performed spontaneously

A person with non-verbal oral apraxia will like have responses that are…

spontaneously; voluntarily

If a person has non-verbal oral apraxia, they may be able to perform some movements __________, but not __________

I have the words I want to say, they won’t come out

I’m not as fluent as I was before

I mispronounce words

I’m stuttering

I have to work hard to prevent errors

AOS patient complaints

articulatory distortions dominated by consonant distortion, slow overall rate, errors of stress assignment, multiple self-correction attempts, trial and error groping, effortful

Salient speech characteristics of AOS include…

perseverative substitutions (nanana for banana)

anticipatory substitutions (popado for potato)

additions, sound prolongations, voicing errors

Specific articulatory distortions you may observe with clients with AOS include

slow overall rate

prolonged but variable vowels and interword intervals

syllable segregation

errors of stress assignment, equalized stress - decreased accuracy as rate increases

Rate and prosody errors you may observe in a person with AOS include…

multiple self-correcting attempts - false starts and restarts

visible trial and error groping for articulatory postures

sound and syllable repetitions (speech can look effortful)

Fluency errors you may observe in a person with AOS include…

increase

As linguistic complexity increases, symptoms of AOS ______

variable and inconsistent; consistent across contexts

A key difference between AOS and dysarthria is that AOS speech sound errors are ___________, while dysarthria errors are __________.

imprecision; substitution

Speech sound errors associated with dysarthria are characterized by _______, while speech sound errors associated with AOS are characterized by ______.

Alternating Motion Rate (AMR)

single syllable repeated at maximum rate (e.g., papapapapa, tatatata, kakakakaka)

Sequential Motion Rate (SMR)

sequence of syllables repeated at maximum rate (“pataka”)

same; different

In a client with dysarthria, you should observe the ____ degree of difficulty with AMR and SMR tasks. In a client with AOS, you should observe _____ degree of difficulty with AMR and SMR.

AMR; SMR; SMR

A person with AOS may perform typically on the ____ task but display difficulty on the _____ task. This is because ____ requires more planning and transition.

slow (~3.8); slightly faster (~4), slower

Ataxic dysarthria is associated with a _____ AMR rate. Spastic dysarthria has a ____ _____ AMR rate, but is still ____ than the average adult (~6).

mild to moderately slow, regular

Spastic Dysarthria AMR

mildly slow, regular

Mixed Spastic-Flaccid AMR

irregular

Ataxic AMR

irregular

Hyperkinetic AMR

rapid, regular; or galloping

Hypokinetic AMR

imprecise

Flaccid AMR

hypokinetic

If a client displays short rushes of speech or abnormally fast speaking rate, they likely have _____ dysarthria.

flaccid

If a client displays audible inhalation and hypernasality with nasal emission, they likely have _____ dysarthria.

hyperkinetic (dystonia)

If the client displays a rhythmic, consistent tremor, they likely have _____ dysarthria.