SLP Praxis Exam- Dysarthria

Dysarthria

A group of motor speech disorders characterized by weakness, slowness and/or lack of coordination of the speech musculature as a result of damage to the CNS/PNS, neurological damage resulting in disruption of the speech production processes (articulation, resonance, phonation, respiration, prosody).

Six conditions associated with dysarthria:

1. Cerebral palsy.

2. Stroke (CVA).

3. TBI

4. ALS

5. Parkinson's disease.

6. Multiple sclerosis.

When differentiating a diagnosis among dysarthria, use caution when using the ________-________ approach because listeners may not have the same definition of some of the dimensions and it does not measure severity and distinguish between subtypes.

Auditory-perceptual

The overall goal of treating dysarthria is to improve ________ depending on the type and severity of dysarthria.

Intelligibility

When treating individuals with dysarthria, ________ and ________ overall production is the goal compared to functioning exactly as they were before.

Re-establishing, approximating

Five types of treatment for dysarthria:

1. Behavioral modification.

2. Prosthetic devices.

3. Medical/surgical procedures.

4. AAC

5. Neuromuscular treatment.

Two components to selecting and sequencing treatment objectives for dysarthria:

1. Their relative involvement.

2. Their mutual interdependence.

Seven types of dysarthria:

1. Flaccid dysarthria.

2. Spastic dysarthria.

3. Ataxic dysarthria.

4. Unilateral UMN dysarthria.

5. Hypokinetic dysarthria.

6. Hyperkinetic dysarthria.

7. Mixed dysarthria.

Flaccid dysarthria

Damage to the motor units of the cranial and spinal nerves that supply the speech muscles and in final common pathway (voluntary, involuntary, reflexes affected), lower motor neurons affected and disrupts flow of neural impulses, all speech system may be impacted.

Six clinical characteristics of flaccid dysarthria:

1. Weakness/paralysis.

2. Hypotonia

3. Reduced reflexes.

4. Atrophy

5. Fasciculations/fibrillations.

6. Progressive weakness with use.

Flaccid dysarthria is frequently associated with significant ________.

Dysphagia

The characteristics of flaccid dysarthria are different depending on the combination of ________ ________ involved.

Cranial nerves

The characteristics of flaccid dysarthria varies depending on the ________ of damage (isolated or multiple CN damage).

Location

Two perceptual characteristics of flaccid dysarthria:

1. Nasal emission.

2. Audible inspiration.

Six cranial nerves impact speech production:

1. CN V (trigeminal).

2. CN VII (facial).

3. CN IX (glossopharyngeal).

4. CN X (vagus).

5. CN XI (accessory).

6. CN XII (hypoglossal).

Flaccid dysarthria caused by spinal nerve damage causes reduced ________ as a result of reduced ________ ________ ________.

Loudness, subglottic air pressure

Flaccid dysarthria caused by spinal nerve damage causes shortened ________ ________.

Speech phrasing

Flaccid dysarthria caused by spinal nerve damage causes impaired ________ and ________.

Prosody, breathiness

Flaccid dysarthria caused by spinal nerve damage causes a ________ vocal quality towards the end of an utterance.

Strained

Seven etiologies of flaccid dysarthria:

1. Degenerative disease (ex: myasthenia gravis, ALS, progressive bulbar palsy, etc.).

2. Physical trauma (ex: TBI).

3. Vascular conditions (ex: brainstem CVA).

4. Toxic conditions (ex: botulism).

5. Virus (ex: polio).

6. Tumors

7. Muscular dystrophy.

Four main speech subsystems affected in flaccid dysarthria:

1. Resonance

2. Articulation

3. Phonation

4. Respiration

In flaccid dysarthria, impaired ________ reflects bilateral damage to the pharyngeal branch of the vague nerve because it innervates the velum.

Resonance

Four resonatory characteristics of flaccid dysarthria:

1. Hypernasality

2. Nasal emission.

3. Weak pressure consonants.

4. Shortened phrases.

In flaccid dysarthria, impaired ________ reflects damage to the facial, hypoglossal and trigeminal nerves.

Articulation

In flaccid dysarthria, an articulatory characteristic can include production of ________ ________.

Imprecise consonants

In flaccid dysarthria, impaired ________ reflects damage to the recurrent nerve of the vagus nerve.

Phonation

Phonatory characteristics of flaccid dysarthria include having ________ ________ and an ________ ________.

Phonatory incompetence, inhalatory stridor

Phonatory characteristics of flaccid dysarthria include ________ and reduced ________.

Breathiness, loudness

Phonatory characteristics of flaccid dysarthria include having difficulty with altering ________.

Pitch

In flaccid dysarthria, impaired ________ reflects damage to the cervical and thoracic spinal nerves that innervate the diaphragm.

Respiration

Three respiratory characteristics of flaccid dysarthria:

1. Reduced loudness.

2. Strained vocal quality.

3. Shortened phrase length.

Three types of treatments for flaccid dysarthria:

1. Jaw/lip/velar strengthening.

2. Resonance/surgical treatments

3. Articulation treatment.

Three types of jaw/lip/velar strengthening exercises:

1. Opening/closing jaw.

2. Resistance to movement.

3. Bite block.

Three types of resonatory/surgical treatments for flaccid dysarthria:

1. Pharyngeal flap.

2. Teflon injection.

3. Prosthetic-palatal flap.

Five types of articulatory exercises for flaccid dysarthria:

1. Intelligibility drills.

2. Phonetic placement.

3. Overarticulation

4. Minimal contrast.

5. Postural adjustments.

Spastic dysarthria

Bilateral damage to the pyramidal and extrapyramidal tracts due to upper motor neuron lesion, characterized by imprecise articulation, monotonous pitch/loudness and poor prosody, cerebral cortex to LMN originate from bulbar cranial nerves, perceptually distinguishable from other dysarthrias.

Pyramidal tract

Originates in primary motor cortex, damage results in weakness and slowness of speech muscles.

Extrapyramidal tract

Originates in the cortex and brainstem, functions to maintain posture, regulate reflexes and monitor muscle tone, damage results in weakness, increased muscle tone and abnormal reflexes.

Clinical characteristics of spastic dysarthria include having a reduced ability to facilitate ________/________ movements.

Fine/discrete

Clinical characteristics of spastic dysarthria include increased ________ ________/________.

Muscle tone/spasticity

Clinical characteristics of spastic dysarthria include ________ and ________.

Weakness, hyperreflexia

Clinical characteristics of spastic dysarthria include having a reduced ________/________ of movements and ________.

Range/sloweness, drooling

Clinical characteristics of spastic dysarthria include having a ________ affect.

Pseudobulbar

Pseudobulbar affect

Having unstable emotions.

Clinical characteristics of spastic dysarthria include having a positive ________ ________ and ________ ________.

Babinski reflex, pathological reflexes

Six etiologies of spastic dysarthria:

1. Stoke/CVA (most common cause).

2. Degenerative diseases (ex: primary lateral sclerosis, multiple sclerosis, etc.).

3. Physical trauma (ex: TBI).

4. Brainstem tumor.

5. Cerebral anoxia.

6. Viral/bacterial infection.

Four main speech subsystems affected in spastic dysarthria:

1. Articulation

2. Phonation

3. Resonance

4. Prosody

Four articulatory characteristics of spastic dysarthria:

1. Imprecise consonants.

2. Incomplete articulatory contrasts and clusters.

3. Short voice onset time on voiceless consonants.

4. Vowel distortions.

Three types of articulatory exercises for spastic dysarthria:

1. Tongue stretching.

2. Lip stretching.

3. Traditional articulation treatments (ex: intelligibility drill, phonetic placements, overarticulation, minimal contrast drills).

Three phonatory characteristics of spastic dysarthria:

1. Harshness

2. Low pitch.

3. Strained/strangled vocal quality.

Six phonatory exercises for spastic dysarthria:

1. Head/neck relaxation.

2. Easy onset.

3. Visi-pitch.

4. Yawn/sigh.

5. Laryngeal massage.

6. Reduced length of utterances.

In spastic dysarthria, a resonatory characteristic includes ________.

Hypernasality

Two resonatory treatments for spastic dysarthria:

1. Surgical treatments (ex: pharyngeal flap, palatal lift, Teflon injection, decreasing velar hypertonicity).

2. Behavioral treatments (ex: visual feedback, increasing loudness).

Four prosodic characteristics of spastic dysarthria:

1. Monopitch

2. Monoloudness

3. Short phrases.

4. Slow speech rate.

Four prosodic exercises for spastic dysarthria:

1. Pitch range exercises.

2. Intonation profiles.

3. Contrastive stress drills.

4. Chunking utterances.

Ataxic dysarthria

Damage to the cerebellar systems/cerebellar control circuit pathways resulting in a disorder of sensorimotor control for speech production, characterized by speech errors related to timing/stress, incoordination and reduced muscle tone on speech affecting slowness and inaccuracy in the force, range, timing and direction of speech movements, can aid in the diagnosis of neurological disease and may assist with lesion localization, sounds like "drunken speech", important contributor to the speech deficits of individuals with cerebellar disease, all speech systems may be impacted.

In ataxic dysarthria, ________ is thought to explain the perceptual characteristics but is not proven.

Incoordination

Seven clinical characteristics of ataxic dysarthria

1. Disequilibrium (balance/gait difficulties).

2. Nystagmus

3. Intention tremor.

4. Hypotonia

5. Problems with motor learning.

6. Dysmetria

7. Dysnergia/decomposition of movement.

Ten etiologies of ataxic dysarthria:

1. Autosomal dominant cerebellar ataxia of late onset.

2. Friedichs ataxia.

3. Olivopontocerebellar degeneration.

4. Degenerative diseases (ex: multiple sclerosis).

5. Stroke/CVA.

6. Physical trauma (ex: TBI).

7. Tumors

8. Hypothyroidism

9. Infections

10. Toxic conditions

Five main speech subsystems affected in ataxic dysarthria:

1. Articulation

2. Prosody

3. Phonation

4. Resonance

5. Respiration

Two articulatory characteristics of ataxic dysarthria:

1. Imprecise consonants (slurred, irregular, inconsistent production of consonants).

2. Vowel distortions.

In ataxic dysarthria and unilateral UMN dysarthria, articulatory exercises include ________ articulation exercises (ex: intelligibility drills, phonetic placement, etc).

Traditional

Five prosodic characteristics of ataxic dysarthria:

1. Equal/excess stress.

2. Prolonged phonemes.

3. Slow speech rate.

4. Monopitch

5. Monoloudness

Six prosodic exercises for axatic dysarthria:

1. Metronome

2. Tapping

3. Cued reading materials.

4. Pitch range exercises.

5. Contrastive stress drills.

6. Chunking

Two phonatory characteristics of axatic dysarthria:

1. Harsh vocal quality.

2. Vocal tremor.

Three phonatory exercises for ataxic dysarthria:

1. Voice drills.

2. Postural considerations.

3. Loudness drills.

In ataxic dysarthria, a resonatory characteristic includes intermittent ________.

Hyponasality

Respiratory characteristics of ataxic dysarthria include having ________ movements.

Exaggerated

Respiratory characteristics of ataxic dysarthria include excessive ________ ________.

Loudness variations

Respiratory characteristics of ataxic dysarthria include having a reduced ________ ________.

Vital capacity

Respiratory characteristics of ataxic dysarthria include speaking on ________ ________.

Residual air

Respiratory characteristics of ataxic dysarthria include decreased ________ and ________ vocal quality.

Loudness, harsh

Three respiratory exercises for ataxic dysarthria:

1. Slow/controlled exhalation.

2. Visi-pitch.

3. Speaking immediately on exhalation.

Five components to evaluation for ataxic dysarthria:

1. Oral-motor exam.

2. AMRs

3. Conversational speech/reading.

4. Sentence repetition.

5. Sustained phonation.

Unilateral UMN dysarthria

Damage to the UMN that supply cranial and spinal nerves, unilateral damage that affects muscles of contralateral lower face and tongue, head/neck muscles receive bilateral innervation from the cortex, affects motor neurons in CNS, weakness in extremities on the opposite side, mildness/short duration and frequent co-occurrence with deficits that may mask.

The primary motor sign of unilateral UMN dysarthria is weakness/incoordination of the ________ and ________ ________ contralateral to the site of the lesion.

Tongue, lower face

Complaints from patients with unilateral UMN dysarthria include having ________ ________.

Slurred speech

Complaints from patients with unilateral UMN dysarthria include ________ of lower face.

Drooping

Complaints from patients with unilateral UMN dysarthria include having a heavy ________.

Tongue

Complaints from patients with unilateral UMN dysarthria include ________ and mild ________ problems.

Drooling, swallowing

Three etiologies of unilateral UMN dysarthria:

1. Stoke/CVA (affects internal capsule and nearby areas, frontal lobe/focal lesion).

2. Tumor

3. Physical trauma (ex: TBI).

In unilateral UMN dysarthria, ________ is primarily impacted.

Articulation

Four main speech subsystems affected in unilateral UMN dysarthria:

1. Articulation

2. Prosody

3. Phonation

4. Resonance

Two articulatory characteristics of unilateral UMN dysarthria:

1. Imprecise consonants.

2. Irregular articulation breakdown.

Three prosodic characteristics of unilateral UMN dysarthria:

1. Slow rate of speech.

2. Slow DDK.

3. Imprecise/irregular AMR.

Two phonatory characteristics of unilateral UMN dysarthria:

1. Harshness

2. Decreased loudness.

In unilateral UMN dysarthria, a resonatory characteristic includes infrequent ________.

Hypernasality

Four components for evaluation of unilateral UMN dysarthria:

1. Medical records.

2. Conversational speech/reading.

3. ARM (slowed).

4. Vowel prolongation.

Hypokinetic dysarthria

Damage to the basal ganglia control circuit (extrapyramidal), reduction in dopamine in the striatum, can manifest in all speech processes but mostly voice, articulation and prosody, rigidity, reduced force, range of movement is slow but fast repetitive movements, perceptually the only dysarthria with rapid rate of speech, less movement with more muscle tone.

Five clinical characteristics of hypokinetic dysarthria:

1. Resting tremors.

2. Bradykinesia/hypokinesia.

3. Muscle rigidity.

4. Akinesia

5. Postural reflexes.

Complaints from patients with hypokinetic dysarthria include having a ________/________ voice.

Quiet/weak

Complaints from patients with hypokinetic dysarthria include having a ________ rate of speech.

Rapid

Complaints from patients with hypokinetic dysarthria include lacking an ________ ________.

Emotional tone

Complaints from patients with hypokinetic dysarthria include difficulty ________ speech.

Initiating

Complaints from patients with hypokinetic dysarthria include ________ and ________ problems.

Drooling, swallowing

Hypokinetic dysarthria is mainly associated with ________ ________.

Parkinson's disease

Five etiologies of hypokinetic dysarthria:

1. Degenerative disease (ex: idiopathic Parkinson's disease, ALS, dementia, etc.).

2. Stroke/CVA.

3. Physical trauma (ex: TBI).

4. Toxic conditions (ex: Wilson's disease- lead exposure).

5. Infectious conditions.

Four main speech subsystems affected in hypokinetic dysarthria:

1. Prosody

2. Articulation

3. Respiration

4. Phonation

Five prosodic characteristics in hypokinetic dysarthria:

1. Monopitch

2. Monoloudness

3. Inappropriate stress/pauses.

4. Increased rate of speech.

5. Low pitch

Articulatory characteristics of hypokinetic dysarthria include reduced ________ ________ ________.

Range of motion