Intro to CMDS Exam 3

What is Dysfluent Speech?

Involuntary repetitions of sounds/syllables, sound prolongations, blocks

Developmental Stuttering

Most common type of stuttering that begins during preschool years

Neurogenic Stuttering

Associated with neurological disease or trauma, Acquired after childhood

Cluttering

Abnormal rapid/irregular rate of speech.

Excessive interjections, filled words, revisions.

“Slushy quality”, syllables may be omitted, words run together

Speech follows train of thought, Person unaware of difficulty

Co-occurs with ADHD & ASD

Covert Stuttering

• Little to no observable stuttering

• Person works to conceal behaviors (word choices, avoid trigger situations)

• Impact quality of life

Associated Symptoms of disfluency

• Fear/avoidance of speaking, Dread

• Word substitutions

• Attempt to control environment

• Avoid trigger words

• Blocks

• See self as “person who stutters”

• Reduced self-esteem

Fluency Shaping Techniques

1. Prolonged Speech: Reducing Speech rate

2. Light Articulatory Contacts: Speaker uses less pressure/tension in articulators (stop consonants)

3. Easy Onset Speech:Tension-free onset of voicing gradually builds in intensity, gradually engage vocal folds

4. Voluntary Stuttering: Stuttering on purpose, allows a person to feel more in control of stuttering, focus on easy/light stuttering

Causes of motor speech disorders

• Weakness/Paralysis of muscles

• Neurologic Disease

• Brain injury/Stroke

• Cerebral Palsy

Dysarthria vs. Apraxia

Dysarthria:

• Neuromotor impairment

• Weakness, spasticity, discoordination

• Affects respiration, phonation, resonation, articulation

Apraxia

• Neuromotor impairment

• Impaired ability to plan/program motor speech control

• Affects articulation, prosody

Flaccid vs. Spastic Dysarthria

Flaccid:

• Damage to Lower Motor Neurons

• Hypotonia: Weak, Low Muscle tone

• Quick to fatigue (vocally)

• Reduced respiration for speech breathing

• Breathy, quiet, monopitch, hypernasal, imprecise

Spastic:

• Damage to Upper Motor Neurons

• Hyperactive reflexes-VFs even adduct excessively

• Muscle tone increased at rest

• Articulators: Move slowly, ↓Force/ROM

• Spacticity→Strained-Strangled voice quality

Functional Voice Disorder

Occurs when there is no physical/structural problem, but the vocal mechanism is not being used in an efficient manner.

Psychogenic Voice Disorder

A rare condition that occurs when there is not a structural/neurological reason for the vocal problem, but it is instead a result of psychological stressors (in which case referral to a mental health professional may be necessary).

Organic Voice Disorder

Results from an underlying physical or neurological cause, such as the growth of a vocal nodule or a tremor that results from problems with innervation of the larynx.

Dysphonia

The term for the altered vocal quality, pitch, or loudness that characterize voice disorders.

Presbyphonia

A voice disorder associated with changes in pitch, volume, and vocal quality as a result of aging.

SLPs with adequate training can conduct instrumental assessment of voice production (e.g. videoendoscopy, videostroboscopy), but a physician is the only professional qualified to give a medical diagnosis of laryngeal pathology.

True

In children, voice disorders are more common in males.

True

In adults, voice disorders are more common in males.

False, More common in females.

What are the aspects of voice that can be implicated in a voice disorder?

1. Voice Quality

2. Pitch

3. Volume/Loudness

Stuttering

An interruption in the flow of speaking characterized by sound- and syllable-repetitions, sound prolongations, and blocks.

Covert Stuttering

A person who is experiencing covert stuttering may achieve fluent-sounding speech due to the use of avoidance behaviors (such as avoiding sounds or words that tend to trigger disfluencies). However, the person's quality of life may still be adversely impacted by their efforts to conceal their stuttering behaviors.

Cluttering

A type of fluency disorder characterized by rapid and/or irregular speech rate, atypical pauses while speaking, unclear speech due to omitted or "collapsed" syllables, and often limited awareness of the communication breakdowns that are occurring.  

Fluent Speech

Defined as the effortless, smooth, forward-flowing production of speech.

Secondary Behaviors

A person who stutters sometimes develops secondary behaviors, which can include facial grimacing, facial tension, body movements (e.g. head movements, eye-blinking, arm or shoulder movements), or production of extraneous sounds, such as throat-clearing.

A person who stops voicing in the middle of speaking and seems unable to begin voicing again is exhibiting what type of disfluency?

Block

"Ssssssarah is at home" is an example of what type of disfluency?

Sound Prolongation

"He-he-he-he lost a tooth" is an example of what type of disfluency?

Word Repetition

"P-p-p-put it on the table" is an example of what type of disfluency?

Sound Repetition

A preschool-aged child who stutters should always receive direct speech-language intervention.

False

Which speech subsystem is most likely implicated when a person with dysarthria displays a very soft voice (i.e. low vocal volume)?

Respiratory System

Which speech subsystem is most likely implicated when a person with dysarthria displays difficulties with vocal pitch (i.e. either a higher or lower pitch than normal, an overly monotonous pitch, or breaks in pitch)?

Laryngeal System

Which speech subsystem is most likely implicated when a person with dysarthria displays imprecise production of speech sounds that are difficult for others to understand?

Articulatory and Resonatory Subsystem

Dysarthria is disordered speech production due to:

• Weakness or paralysis of muscles needed for speech production

• Neurologic disease, such as Huntington's disease, Parkinson's disease, Multiple sclerosis, or Amyotrophic Lateral Sclerosis (ALS)

• Brain injury or stroke

One characteristic that is present in dysarthria but not in apraxia of speech (AOS) is:

Muscle Weakness

The specific type of dysarthria is usually diagnosed based on the perceptual attributes of the person's speech, as well as: 

The neurologic landmarks associated with that type of deficit (e.g. upper/lower motor neuron system), cerebrum, basal ganglia

_____ interventions attempt to maximize a person's ability to functionally communicate by finding alternative communication methods beyond verbal speech (e.g. speech-generating device, letter board), modifying the communication environment, and increasing the skills of the communication partner to support the person with the communication impairment.

Compensatory

_____ interventions attempt to increase speech intelligibility by improving the function of the speech subsystems

Restorative

Speech errors in dysarthria tend to be more consistent and less variable, as compared to speech errors related to apraxia of speech.

True

Several speech subsystems (respiratory, laryngeal, articulatory/resonatory) can be impacted for a person with dysarthria, as opposed to apraxia of speech, which usually primarily affect the articulatory subsystem and prosody.

True