Motor Speech Disorders Final, Practice

Flaccid Lesion

lower motor neuron (cranial or spinal nerves)

Flaccid Primary Finding

Weakness; reduced strength or force

Flaccid Best Distinguishing Features

• C.N. V: jaw weakness, reduced sensation from face, jaw, lips, tongue.

-Articulatory imprecision

• C.N. VII: Unilateral facial weakness.

-Mild Articulatory distortions

• C.N. X: weakness of velopharyngeal and laryngeal muscles

-Hypernasality, nasal emission, breathiness

• C.N. XII: tongue weakness

-Imprecise articulation

• Spinal respiratory Nerves: reduced respiratory support for speech

Flaccid Confirmatory Sign

Fasciculations

Spastic Lesion

bilateral upper motor neuron

Spastic Primary Finding

Resistance to movement

Spastic Best Distinguishing Features

Spasticity, increased tone
Slow speech rate
Slow, regular AMR’s
Reduced variability of pitch and loudness
Harsh, strained-strangled vocal quality
Reduced range of movements

Spastic Confirmatory Sign

Spasticity of other body parts
Hyperactive reflexes
Emotional lability
Drooling
Suck and snout reflexes

Ataxic Lesion

cerebellar

Ataxic Primary Findings

Discoordination of movement

Ataxic Best Distinguishing Feature

Irregular & transient articulatory breakdowns
Irregular AMR’s
Vowel distortions
Prolonged phonemes
Excess & equal stress
Excess loudness variations
Dysprosody
Poor coordination of breathing with speech

Ataxic confirmatory sign

Slow voluntary movements
Intention or terminal tremor
Slurred, “drunken” quality of speech

Unilateral UMN Lesion

unilateral upper motor neuron

Unilateral UMN Primary Finding

Weakness and perhaps incoordination

Unilateral UMN Best Distinguishing Feature

Imprecise consonants
Slow rate
Irregular articulatory breakdown
Slow and sometimes irregular AMR’s
Usually only mild to moderate dysarthria
Loudness may be reduced
Voice may be harsh/hoarse
May accompany aphasia, apraxia, non-dom.,
or cognitive deficits

Unilateral UPN Confirmatory Sign

Hemiparesis
Unilateral lower facial weakness
Unilateral tongue weakness (no
fasciculations or atrophy)

Hypokinetic Lesion

Basal ganglia control circuit; extrapyramidal (prototype-Parkinson’s)

Hypokinetic Primary Finding

Rigidity and reduced range of motion

Hypokinetic Best Distinguishing Feature

Fast rate
Rapid, “blurred” AMR’s
Reduced stress
Monopitch and loudness
Inappropriate silences
Breathiness
Reduced loudness

Hypokinetic Confirmatory Sign

Resting tremor
Masked facies
Pill rolling (movement between thumb and
forefinger)
Bradykinesia (delays or false starts)
Writing may be micrographic
Festinating gait

Hyperkinetic Lesion

basal ganglia control circuit; extrapyramidal

Hyperkinetic Primary Finding

Abnormal rhythmic or irregular & unpredictable, rapid or slow involuntary movements

Hyperkinetic Examples

Action Myoclonus – very quick movements,
arrhythmic fine or course jerking of a
muscle or group of muscles in disorderly
fashion. Cannot be inhibited willfully.
Chorea – rapid, sustained, unpredictable
movements. Sudden forced inspiration
or expiration, excess loudness variations,
strained-strangled voice, voice
stoppages, slow irregular AMR’s.
articulatory distortions.
Dystonia – waxing and waning or near
constant character. Relatively slow,
writhing movements. Speech
characteristics similar to chorea. Can
volitionally control temporarily. Effortful
speech.

Spasmodic dysphonia – relatively isolated
voice disorder characterized by strained
or breathy voice quality resulting from
adductor or abductor laryngospasm. May
be neurogenic or psychogenic. Voice
may be intermittently strained and
breathy.
Tics – (prototype-Gilles de la Tourette’s
Syndrome) multiple tics, one or more
voice tics, onset before age 21. May
include throat clearing, sniffing, and
corprolalia
Organic Voice Tremor – onset usually
gradual, worsens with fatigue/stress, often
accompanied by head tremor. Rhythmic,
vertical laryngeal movements.
Palatopharyngeal myoclonus – abrupt
rhythmic or semirhythmic unilateral or
bilateral movements of palate, pharynx, or
larynx

Mixed Dysarthria Examples

ALS – spastic-flaccid
Multiple Sclerosis – spastic-ataxic most
common
Wilson’s Disease – hypokinetic, spastic, and
ataxic
Shy-Drager – hypokinetic, spastic, ataxic,
and flaccid
Progressive supranuclear palsy – can
include hypokinetic, spastic, ataxic
Hypoxic Encephalopathy – ataxic,
hypokinetic, hyperkinetic

Apraxia of Speech

•  A slow rate of speech resulting in lengthened sound segments and intersegment durations

• Speech-sound errors such as sound distortions and/or distorted sound substitutions

• Errors that are relatively consistent in type (i.e., distortion) and location (i.e., within a word)

• Disturbed prosody: many pauses, reduced pitch/intonation contours