Speech Disorders Exam 3 - Motor Speech Disorders

Motor Speech Disorder

A disorder of speech resulting from neurologic impairment affecting the motor programming or neuromuscular execution of speech

Dysarthria

speech disorder resulting from weakness, paralysis, or incoordination of the muscles of the speech mechanism

Flaccid Dysarthria Cause

Lower motor neuron damage

Flaccid Dysarthria symptoms

muscle weakness, reduction of muscle reflexes, loss of muscle tone, atrophy of muscles, fasciculations

Spastic Dysarthria cause

Upper motor neuron damage

Spastic Dysarthria symptoms

Spastic paralysis (stiff, contracted muscles resistance to stretch), hyperactive and pathological muscle reflexes, strained/harsh voice, slow and labored speech

Ataxic Dysarthria cause

Cerebellar lesions

Ataxic Dysarthria symptoms

Drunk sounding!! inaccurate/irregular movement, impaired prosody

Hypokinetic Dysarthria cause

basal ganglia damage

Hypokinetic Dysarthria symptoms

Too little movement! depletion/insufficiency of dopamine, reduced loudness, short rushes of speech, reduced respiratory movement (e.g. parkinsons)

Hyperkinetic Dysarthria cause

Also basal ganglia damage

Hyperkinetic Dysarthria symptoms

Too much movement!! involuntary movements, voice instability, unpredictable changes in pitch and loudness

Mixed Dysarthria cause

more than one lesion site

Mixed Dysarthria symptoms

multiple symptoms from varying types

Apraxia of Speech (AOS)

Speech disorder resulting from an impairment in sensorimotor programming for volitional speech

Region is the brain most associated with AOS

broca's area

Acquired Apraxia of Speech cause

Brain injury - stroke, degenerative diseases, TBI, anoxia, tumor

Apraxia symptoms - articulation

slow and effortful, initiation difficulty, inconsistent errors, errors increase with complexity

Apraxia symptoms - movement

Groping articulators - a visible or audible trial-and-error struggle where a person tries to move their lips, tongue, jaw, or palate into the correct position to produce a speech sound

Apraxia of Speech - fluency

restarts and repeated attempts at producing a word or sound and syllable repetitions, articulatory groping, initiation of utterances

Apraxia - areas of brain affected

left hemisphere (dominant for language) - frontal lobe, also: parietal lobe, thalamus, basal ganglia, insula

Apraxia non-speech tasks

These remain unaffected!! e.g. smiling, swallowing, etc.

Developmental Apraxia of Speech aka Childhood Apraxia of Speech (CAS)

Present from birth, same errors as acquired AOS, varying severities

Biggest difference between AOS and Dysarthria

Planning problem in the brain v.s. muscle problem in the body

Myasthenia Gravis definition

Happens w/ flaccid dysarthria. Problem at the neuromuscular junction: fluctuating muscle weakness and fatigue

Myasthenia gravis symptoms

slurred speech/imprecise speech, resonance problems, difficulty chewing and swallowing

Parkinson's disease definition

Happens w/ hypokinetic dysarthria. A disorder that is idiopathic, slowly progressive and degenerative.

Parkinson's disease medication

Levadopa (L-DOPA)

Parkinson's disease medication target

Dopamine: acts as its direct biological precursor. Can cross blood-brain barrier whereas DA cannot

Parkinson's disease medication side effects

Akinesia/dyskinesia, rigidity/stiffness, on/off response (phases of immobility and incapacity), extreme emotional state

ALS/ Lou Gerhig's disease

Mixed dysarthria example - flaccid and spastic

Huntington's disease

a hereditary disease marked by degeneration of the brain cells and causing chorea and progressive dementia

Moebius syndrome cause

damage to the VI and VII nerves

Cranial Nerve V

trigeminal (jaw)

Cranial Nerve VII

Facial

Cranial Nerve X

Vagus (larynx, pharynx, velopharynx)

Cranial Nerve XII

hypoglossal (tongue)

Fasciculations

Involuntary contractions or twitchings of muscle fibers

Pathological reflexes

Presence indicates an upper motor neuron lesion such as a stroke, demyelination, etc.

Cerebral Palsy

Muscles are weak, stiff, and/or uncoordinated

CP causes

brain injury in the prenatal, perinatal, or early postnatal periods

CP prenatal causes

Before birth: genetic, agenesis (failure of organ to develop), viruses, anoxia

CP perinatal causes

During birth: anoxia due to cord compression, blockages in airways, aspiration pneumonia, hypoxia due to use of narcotics during birth

CP postnatal causes

birth-8 weeks: brain injury, high fevers, meningitis, encephalitis

Initial signs of CP

maintenance of primitive reflexes, delayed developmental milestones

Associated problems w/ CP

intellectual/cognitive functioning, behavioral problems, depression, ocular abnormalities, deafness/hearing loss, seizures, impaired bowel/bladder control, orthopedic complications, additional dental needs

Dysdiadochokinesis

measure how quickly and accurately a person can produce rapid alternating and sequential articulatory movements

DDKs

AMRs and SMRs

AMR definition

alternating motion rate

AMR example

say "pa-pa-pa-pa..." as fast as you can until I tell you to stop

SMR definition

sequential motion rate

SMR example

say "pa-ta-ka-pa-ta-ka..." as fast as you can until I tell you to stop

Dysdiadochokinesis initiation

Can they begin easily?

Dysdiadochokinesis processed

Even and consistent or disrupted and inconsistent?

Speech intelligibility

Measure in connected speech, not single words most of the time

2 primary approaches to measure intelligibility

word-identification approach and scaled rankings

Word-identification approach

have an unfamiliar listener orthographically transcribe what they think the child said - optimal for tracking progress in therapy

Scaled rankings

making global judgements about a child's intelligibility - good to obtain overall severity/for kids who can't participate in structured tests

Oral Mech

assessment of structure and function

Surgical management

Deep brain stimulation, thyroplasty, pharyngeal flap surgery

Deep brain stimulation

procedure to treat Parkinson's, depression, etc. in which electrodes are surgically implanted in specific areas of the brain and connected to a pulse generator that is placed under the skin and stimulates these brain areas

Pharmacologic management

Medication prescribed that is aimed at relieving symptoms of the larger disease/disorder

Examples of pharmacologic management

L-DOPA, muscle relaxers

Prothetic management

The use of any device, high or low tech, to improve function

Prosthetic management examples

palatal lift prosthesis, amplification system, AAC, pacing board, DAF, biofeedback devices

Behavioral management

used to improve the impaired systems and teach compensatory strategies

Behavioral management tasks

Begin with a feature that can be modified easily, establish an alternative form of communication if needed

Behavioral management therapy types

speaker-oriented (changing the speaker behavior) and communication-oriented (changing the behavior of listeners or the environment)

AAC

Augmentative and Alternative Communication

Unaided AAC

No tech - gestures, manual signs, facial expressions, vocalizations, verbalizations, body language

Aided AAC

low/light tech - pictures, objects, photographs, writing, communication boards/books