Motor Speech Disorders Final

dysarthrias and apraxia!

dysarthria types

flaccid, spastic, hypokinetic, hyperkinetic, ataxic, unilateral upper motor neuron, mixed

flaccid dysarthria cause

injury or disease of one or more cranial or spinal nerves

flaccid dysarthria etiologies

degenerative diseases (ALS), tumors, vascular, muscle disease, surgery, demyelination, infections

flaccid dysarthria features

muscle weakness, hypotonia, diminished or absent reflexes, atrophy, fasciculutations

hypotonia

reduced resistance to passive movement

fasciculations

small, involuntary twitch-like movements

flaccid dysarthria general symptoms

hypernasality, nasal emissions, articulatory impression, reduced phrase length, breathiness, monopitch, monoloudness, reduced prosod

flaccid dysarthria CN V damage - nonspeech findings

jaw deviates to weak side, decreased sensation of face, cheek, tongue, and teeth

flaccid dysarthria CN V damage - speech findings

unilateral lesions minimize affect on speech

bilateral lesion resulting in articulatory errors

greatest impact on chewing

flaccid dysarthria CN VII damage - nonspeech findings

facial droop, food pocketing, cheek biting, fasciculations and atrophy on affected sides, abnormal facial movements

flaccid dysarthria CN VII damage - speech findings

cheeks flutter, poorer “puhs”, distorted labial sounds, bell’s palsy

flaccid dysarthria CN IX damage - nonspeech findings

asymmetry of gag reflux

flaccid dysarthria CN IX damage - speech findings

none

flaccid dysarthria CN X pharyngeal branch damage - nonspeech findings

velum hangs low on affected side, asymmetrical velar elevation during phonation, diminished gag reflex

flaccid dysarthria CN X pharyngeal branch damage - speech findings

hypernasalit

flaccid dysarthria CN X recurrent laryngeal branch damage - nonspeech findings

paralyzed vocal folds

flaccid dysarthria CN X recurrent laryngeal branch - speech findings

breathiness, diplophoni

flaccid dysarthria CN XI damage - nonspeech findings

reduced shoulder elevation, impaired head turning to side opposite of lesion

flaccid dysarthria CN XI damage - speech findings

respiration, phnation, and resonance secondary to postural changes

flaccid dysarthria CN XII damage - nonspeech findings

tongue atrophy on affected side, fasciculations, tongue will deviate to weak side on protrusion

flaccid dysarthria CN XII damage - speech findings

imprecise consonants, hyponasal

phonatory incompetence flaccid dysarthria

breathiness, short phrases, audible inspiration

respiratory incompetence flaccid dysarthria

hypernasality, imprecise consonants, nasal emission, short phrases

phonatory-prosodic insufficiency flaccid dysarthria

harsh voice, monoloudness, monopitch

treatment targets flaccid dysarthria

increase strength, compensate for weakness; aimed at respiratory, phonatory, resonatory, and articulatory components of speech

spastic dysarthria cause

damage to upper motor neuron system resulting in muscle rigidity and spasticity that affects speech production.

spastic dysarthria etiologies

bilateral UMN damage, multiple CVAs, upper brainstem CVA, TBI, disease/infection

spastic dysarthria nonspeech symptoms

fatigue, oral/pharyngeal dysarthria, drooling, pseudobulbar affect

pseudobulbar affect

difficulty controlling expression of emotions (e.g., pathologic laughing and crying)

spastic dysarthria speech symptoms

excess and equal stress, reduced stress, slow rate, imprecise consonants, distorted vowels, hypernasality, monopitch, monoloudness, short phrases, low pitch, harshness, strained/strangled, reduced prosody

unilateral umn dysarthria cause

unilateral damage to pyramidal or extrapyramidal activation pathways

unilateral umn dysarthria etiologies

vascular, tumor, trauma, degenerative disease, multiple possible cause

unilateral umn dysarthria speech symptoms

imprecise consonants, irregular articulatory breakdown, abnormal AMRs, mild to moderate dysphonia

unilateral umn dysarthria patient complaints

slurred speech, drooling, speech poorer under stress/fatigue

unilateral umn dysarthria nonspeech symptoms

differences between emotional and volitional movements, unilateral facial weakness, unilateral tongue weakness

hypokinetic dysarthria cause

basal ganglia control circuit pathology

hypokinetic dysarthria etiologies

degenerative disease (Parkinson’s), vascular, traumas, infections, toxic-metabolic diseases

hypokinetic dysarthria nonspeech symptoms

masked facial expression, excessive drooling, facial tremor, range of motion for single movements greater upon command, reduced ROM, reduced vital capacity, increased respiratory rate, paradoxical rib cage and abdominal movements, vocal fold bowing

hypokinetic dysarthria speech symptoms

hypophonia, reduced loudness, monopitch, monoloudness, reduced prosody, reduced stress, short resuhes of speech, imprecise consonants, short phrases

hypokinetic dysarthria voice quality

harsh, breathy with reduced loudness

hyperkinetic dysarthria cause

basal ganglia control circuit abnormalities

hyperkinetic dysarthria etiologies

degenerative diseases (Huntington’s), tourettes, toxic-metabolic, infections, vascular, traumas, neoplastic, inflammatory

hyperkinetic dysarthria characteristics

effects on muscles/speech, dyskinesia, tics, ballism

dyskinesia

abnormal, involuntary movements regardless of etiology

tics

rapid, sterotyped patterned movements under partial voluntary control

ballism

involves gross, abrupt contractions of axial and proximal muscles of the extremeties that can produce wild flailing movementsresulting in exaggerated motion and erratic behavior.

chorea

involuntary, rapid, nonsterotypic, random, purposeless movements of body structures at rest and during voluntary movement

dystonia

involuntary abnormal postures

myoclonus

involuntary lightning-like jerks o f a body part

spasm

abnormal muscular contractions; repetitive, rapid in onsent, breif in duration

hyperkinetic dysarthria speech symptoms

voice stoppages, transient breathiness, strained/harsh voice quality, excess loudness in variation, intermittent hypernasality, distortions, prolonged intervals and phonemes, variable rate, inapprpriate silenes, excessive-inefficient-variable patterns of stress

hyperkinetic dysarthria patient complaints

effortful speech, involuntary orofacial movements, chewing and swallowing problems

mixed dysarthria

damage to more than one motor control circuit causing more than one type of dysarthria

ALS mixed dysarthria

spastic/flaccid

multiple sclerosis or TBI mixed dysarthria

spastic/ataxic

ataxic dysarthria etiologies

degenerative diseases, vascular, trauma, demyelinating disease, neoplastic/concer-related disease, toxic/metabolic, inflammatory diesase, genetic anomolies

ataxic dysarthria impairments

gait, nystagmus, dysmetria, incoordination, intention tremor

ataxic dysarthria speech symptoms

normal strength, tone, and range; poor movement and breath coordination

ataxic dysarthria speech symptoms

irregular AMRs, impaired coordination of speech movement patterns, imprecise consonants, irregular breakdowns, disordered vowels, excess and equal sress, prolonged phonemes, slow rate, harshness, monopitch and loudness

apraxia of speech

motor programming disorder characterized by impairment in translation of intact phonological plans into accurate movement parameters

apraxia of speech differential diagnosis

segmentation, sound distortions, equal lexical stress

apraxia of speech etiologies

idiopathic (CAS), genetic (CAS), neurological (AOS)

apraxia of speech non differentia symptoms

articulatory groping, increasing errors withincreasing utterance length or complexity, perseverative errors