Speech Disorders Unit 3

0.0(0)
studied byStudied by 0 people
learnLearn
examPractice Test
spaced repetitionSpaced Repetition
heart puzzleMatch
flashcardsFlashcards
Card Sorting

1/78

encourage image

There's no tags or description

Looks like no tags are added yet.

Study Analytics
Name
Mastery
Learn
Test
Matching
Spaced

No study sessions yet.

79 Terms

1
New cards

Motor Speech Disorder Definition

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

2
New cards

Motor Speech Disorders Types/Impairments

Includes dysarthria and apraxia of speech

Other oral movements may be impaired, including chewing and smiling

May co-occur with language impairments

3
New cards

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

Dysarthria Definition

4
New cards

Speech disorder which results from an impairment in (sensori)motor programming for volitional speech

  • No problems with the muscles themselves, just the programming

Apraxia Definition

5
New cards

Motor Speech Disorders Causes

Acquired: stroke, TBI, degenerative diseases

Developmental: cerebral palsy, developmental disabilities

6
New cards

Upper and Lower Motor Neurons

Upper: motor areas of cerebral cortex & some subcortical structures

  • Initiate voluntary movement

Lower: connect brain & spinal cord to muscle fibers

  • “Final common pathway”: nerve impulses = contraction of muscle fibers

7
New cards

Types of Dysarthria

Flaccid

Spastic

Ataxic

Hypokinetic

Hyperkinetic

Mixed (1/3 of patients)

8
New cards

Lesion Site: Lower Motor Neuron

Primary Defect: Weakness

Flaccid Dysarthria

9
New cards

Lesion Site: Upper Motor Neuron

Primary Defect: Spasticity

Spastic Dysarthria

10
New cards

Lesion Site: Cerebellum

Primary Defect: Incoordination

Ataxic Dysarthria

11
New cards

Lesion Site: Basal Ganglia Circuit

Primary Defect: Rigidity, Reduced ROM

Hypokinetic Dysarthria

12
New cards

Lesion Site: Basal Ganglia Circuit

Primary Defect: Involuntary Movement

Hyperkinetic Dysarthria

13
New cards

Lesion Site: More than one of above

Primary Defect: Multiple

Mixed Dysarthria

14
New cards

Flaccid Dysarthria Causes

Uni/bilateral LMN stroke (brainstem stroke)

Myasthenia gravis

Muscular dystrophy

15
New cards

Flaccid Dysarthria Signs

Muscle weakness

Reduction of muscle reflexes

Loss of muscle tone

Atrophy of muscles

Fasciculations

16
New cards

Damage to nerves VI and VII

Clear speech with very little facial movement

Moebius Syndrome

17
New cards

Problem at neuromuscular junction: fluctuating muscle weakness and fatigue

ACh is attacked by antibodies so muscle can’t contract

Speech Sample: Slurred/imprecise speech, resonance problems, difficultly chewing & swallowing

Myasthenia Gravis

18
New cards

Muscular Dystrophy

Genetic

Degenerative & progressive

Diffuse, chronic effects

  • Main symptom is muscle weakness

Over 30 types but 9 major forms

  • Duchenne

  • Becker

  • Myotonic

19
New cards

Spastic Dysarthria Signs

Spastic paralysis (stiff, contracted muscles)

Hyperactive and pathological muscle reflexes

Strained/harsh voice, slow & labored speech

20
New cards

Ataxic Dysarthria Causes

Cerebellar lesions

Coordinates and sequences speech movements

Integrates sensory feedback into revised production

21
New cards

Ataxic Dysarthria Signs

Inaccurate/irregular movements

Impaired prosody

Can sound “drunk”

22
New cards

Hypokinetic Dysarthria Cause

Basal ganglia damage

  • Reduces movement or leads to failure to inhibit involuntary movement

Depletion/insufficiency of dopamine = reduced movement

Prototypical example: Parkinson’s disease

23
New cards

Hypokinetic Dysarthria Signs

Most evident in voice, articulation, and prosody

Reduced loudness

Short rushes of speech

Reduced respiratory movement

24
New cards

Medical Management

Levadopa (L-DOPA): precursor to dopamine, can cross blood-brain barrier whereas DA cannot

Given with another drug to prevent the peripheral synthesis of dopamine from L-DOPA

25
New cards

Side Effects of L-DOPA

Akinesia/dyskinesia

Rigidity/stiffness

“On-Off Response”: Phases of immobility and incapacity associated with depression alternating with jubilant “thaws”

Extreme emotional state (anxiety, hypersexuality), confusion, hallucinations

26
New cards

Hyperkinetic Dysarthria

Basal Ganglia Damage

Huntington’s Disease

Types of Involuntary Movements

  • Tardive Dyskinesia

27
New cards

Tardive Dyskinesia

Repetitive, involuntary, jerky, purposeless movements

Often a side effect of medication

28
New cards

Mixed Dysarthria

Amyotrophic Lateral Sclerosis (ALS): mixed flaccid/spastic

Cerebral Palsy: several types

29
New cards

CP Overview

Non-progressive (symptoms may change with age)

Muscles are weak, stiff, and/or uncoordinated

Most common childhood movement disability in US

1/3 of people DO NOT have cognitive impairment

30
New cards

Initial Signs of CP

Maintenance of primitive reflexes

  • Asymmetric tonic neck reflex

  • Positive supporting reaction: leg muscles contract in a straight standing position when balls of feet make contact with solid surface

  • Moro reflex: reaction to loss of support/feel of falling

  • Sucking, rooting, and biting reflexes

Delayed developmental milestones

31
New cards

Classifications of CP

Spastic

Dyskinetic (athetoid)

Ataxtic (dystonic)

Mixed

Mild Case

32
New cards

Acquired Apraxia of Speech

Result of brain injury

Impaired motor planning/programming

Difficulties only with voluntary movement for speech. Non-speech tasks remain unaffected

Prosody and articulation are disrupted

33
New cards

Articulation in Apraxia Patients

Slow/effortful

Initiation difficulty

Inconsistent errors (close to target)

Errors increase with complexity

34
New cards

Movement in Apraxia Patients

Groping Articulators

Silent Posturing

35
New cards

Prosody in Apraxia Patients

Due to compensation

Impaired stress, slow/effortful rate, prolonged phonemes, odd pauses

36
New cards

Apraxia of Speech: Fluency

Restarts and repeated attempts at producing a word or sound, and syllable repetitions

Articulatory groping, sometimes with facial grimacing

Initiation of utterances especially problematic

Not the same as stuttering!

37
New cards

Concomitant Apraxia

Oral apraxia

Limb apraxia

38
New cards

Oral Apaxia

Problems with voluntary oral nonspeech movements

e.g., blowing a kiss, smiling, etc.

Movements are okay when they are reflexive

39
New cards

Limb Apraxia

Problems with voluntary arm movements

40
New cards

Evaluation Components

History

Oral Motor Examination

Perceptual Assessment

Intelligibility Assessment

Acoustic & Physiological Measures

41
New cards

Dysdiadochokinesis

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

AMR: alternating motion rate

  • Say “pa-pa-pa-pa…” as fast as you can

SMR: sequential motion rate

  • Say “pa-ta-ka-pa-ta-ka…” as fast as you can

42
New cards

Speech Intelligibility Measure

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

Two primary approaches to measuring intelligibility

  • Word-identification approaches

  • Scaled ratings

43
New cards

Differential Dx: Dysarthria, Spastic

Strained-strangled phonation, hypernasality, imprecise consonants, impaired stress

44
New cards

Differential Dx: Dysarthria

Flaccid

Breathy, imprecise consonants, hypernasal

45
New cards

Differential Dx: Dysarthria

Hypokinetic

Decreased loudness, poor vocal quality, imprecise consonants

46
New cards

Differential Dx: Dysarthria

Hyperkinetic

Involuntary movements, variable rate, strained phonation, hypernasality, imprecise consonants

47
New cards

Differential Dx: Dysarthria

Ataxia

Irregular articulatory breakdowns, impaired prosody

48
New cards

Differential Dx: Apraxia of Speech

Phonetic Complexity

Test along a hierarchy of phonetic complexity

  • rain → train → strain

  • come → compute → computer → computation → computational

49
New cards

Differential Dx: Apraxia of Speech

Cueing for Response

Test along a hierarchy of cues (no feedback → visual → tactile)

Test along a hierarchy of timing between cue and response (simultaneous → immediate → with delay)

50
New cards

Differential Dx: Apraxia of Speech

Length of utterance

Test along a hierarchy of lengths

  • I → I eat → I eat lunch and so on

51
New cards

Differential Dx: Apraxia of Speech

Linguistic complexity

Test along a hierarchy of linguistic load

  • Repetition → Conversation → Picture Description → Narrative

52
New cards

Management Approaches for Dysarthria

  1. Medical Management

    1. Surgical management

    2. Pharmacologic management

    3. Prosthetic management

  2. Behavioral Management (speech therapy)

53
New cards

Surgical Management

Deep Brain Stimulation

Thyroplasty

Pharyngeal Flap Surgery

54
New cards

Pharmacologic Management

Usually directed at relieving symptoms of the larger disease/disorder

Improvement in general function may not be accompanied by commensurate change in speech function

Know the drug the client is taking and for what

Begin other therapy when the effects are stable

55
New cards

Prosthetic Management

Includes the use of any device to improve function

  • Palatal lift prosthesis, amplification system, AAC, pacing board, DAF, biofeedback devices

  • ACC can be used to replace or supplement existing speech

  • Consider surgery, prosthetics before behavioral therapy if possible

56
New cards

Behavioral Management

  1. Improve impaired system(s)

  2. Teach compensatory strategies

Therapy can be: speaker-oriented or communication-oriented

Establish alternative form of communication if needed in early stages

Begin with a feature which can be modified readily and with minimal instruction

57
New cards

Speaker-Oriented Therapy

Focus on changing the speaker behavior (improve function or compensations)

58
New cards

Communication-Oriented Therapy

Focus on changing the behavior of listeners or the environment

59
New cards

Progressive neurodegenerative disorder that affects nerve cells in the brain and spinal cord, leading to loss of muscle control

Muscle weakness, twitching, cramping, difficulty speaking, swallowing, and breathing, paralysis and significant respiratory issues

ALS/Lou Gehrig’s Disease

60
New cards

Neurodegenerative disorder caused by the loss of dopamine-producing neurons in the substantia nigra

Resting tremors, muscle rigidify and stiffness, bradykinesia, postural instability, cognitive decline in later stages

Parkinson’s Disease

61
New cards

Genetic disorder leading to the progressive breakdown of neurons, especially in the basal ganglia

Involuntary jerking, or writhing movements (chorea), cognitive decline, psychiatric symptoms, loss of motor control

Huntington’s Disease

62
New cards

Deep Brain Stimulation

Surgically implanting electrodes into specific brain regions to deliver controlled electrical impulses to help regulate abnormal neural activity

63
New cards

Dysarthria or Apraxia of Speech

  • Motor speech execution disorder

Dysarthria

64
New cards

Dysarthria or Apraxia of Speech

  • Motor speech programming disorder

AOS

65
New cards

Dysarthria or Apraxia of Speech

  • Muscles have reduced range, strength

Dysarthria

66
New cards

Dysarthria or Apraxia of Speech

  • Consistent errors

Dysarthria

67
New cards

Dysarthria or Apraxia of Speech

  • No island of clear speech

Dysarthria

68
New cards

Dysarthria or Apraxia of Speech

  • Consonants imprecise

Dysarthria

69
New cards

Dysarthria or Apraxia of Speech

  • No weakness or paralysis

AOS

70
New cards

Dysarthria or Apraxia of Speech

  • Inconsistent errors

AOS

71
New cards

Dysarthria or Apraxia of Speech

  • Island of clear speech

AOS

72
New cards

Dysarthria or Apraxia of Speech

  • Errors increase with complexity

AOS

73
New cards

Trigeminal Nerve (V)

Jaw Movements

74
New cards

Facial Nerve (VII)

Facial and lip movement

75
New cards

Vagus Nerve (X)

Larynx, pharynx, velopharynx

Controls phonation, resonance, and swallowing

76
New cards

Hypoglossal Nerve (XII)

Tongue movement

77
New cards

Prenatal Causes of CP

Genetics, agenesis, viruses, anoxia

78
New cards

Perinatal Causes of CP

Anoxia due to cord compression, blockage of the airways, aspiration pneumonia, hypoxia due to use of narcotics during birth

79
New cards

Postnatal Causes of CP

Brain injury, high fevers, meningitis encephalitis