Oral motor Exam 3

_______ is the absence of speech, not necessarily sensorimotor, that has many possible etiologies.

neurogenic mutism

List the etiologies of neurogenic mutism.

severe dysarthria, laryngectomy, apraxia of speech, aphasia, disorders of arousal or consciousness, or postictal (after seizure)

____ is speechlessness resulting from severe loss of neuromuscular control over speech. It will present when AoS or dysarthria is in its most severe form.

Anarthria

Anarthria may be the end stage of dysarthria for _____.

degenerative disease

What are the three types of dysarthria that will most likely lead to anarthria?

spastic, hypokinetic, and mixed

_____ will present with mutism, severe dysphagia, preserved consciousness, vertical eye movements or blinking, and quadriplegia. What type of dysarthria will these individuals present with?

locked-in syndrome; severe spastic or mixed spastic-flaccid

Apraxia of speech with mutism only lasts ______ if stroke is the etiology, but will usually have concomitant non-verbal oral apraxia.

a few days

Aphasia with mutism may be _____, but usually transforms into ______. Prosody will be ____ for these individuals.

present initially; transcortical motor aphasia; flat

_____ presents as unarousable unresponsiveness and absence of sleep/wake cycles on EEG. It is typically caused by diffuse bilateral cerebral hemisphere damage, brainstem, injury, or both. These individuals have no _____, only reflexes.

Coma; purposeful movements

_____ presents as wakeful unawareness often associated with severe bilateral cerebral hemisphere involvement without brainstem involvement. ____ are preserved.

vegetative state; sleep/wake cycles

__ have a degree of awareness and responsiveness and may not be entirely mute. They may be able to ____, smile, cry, or reach for things.

minimally conscious state; visual tract

_____ individuals have reduced motivation (_____) to speak, difficulty initiating and sustaining the cognitive and motor effort required for speech, and it is caused by massive bifrontal lobe damage.

Akinetic mutism; abulia

The three types of etiology-specific neurologic mutism are _____ (following seizure), ____ (organ transplant, cancer treatment), and ______ (not very common).

speech arrest; drug-induced mutism; mutism after corpus callosotomy

Neurogenic mutism may be from severe dysarthria (______) and commonly results from ______ or ____ neurologic damage.

anarthria; bilateral or diffuse

_____ is dysfluent speech acquired as a direct result of neurologic disease.

Acquired neurogenic stuttering

List the etiologies of acquired neurogenic stuttering.

stroke and closed head injury (most common); Parkinson's disease; progressive supranuclear palsy syndrome (PSPS); MS; dementia; corticobasal syndrome; multiple system atrophy; seizure disorders; dialysis dementia; brain tumor; anoxia; bilateral thalamotomy; thalamic or globus pallidus deep brain stimulation; drug toxicity or abuse

The characteristics of acquired neurogenic stuttering include: _____ repetitions, prolongations, and blocking/hesitation, may not be _______, can occur with ___ and ___ words, ____ of dysfluencies but _____________, and they may not demonstrate _________ with choral reading or singing.

sound/syllable repetitions, prolongations, and blocking/hesitation; may not be restricted to initial syllables; can occur within content and function words; awareness of dysfluencies but without significant anxiety or secondary struggle behavior; may not demonstrate an adaptation effect or improvement with choral reading or singing

Possible associated deficits with acquired neurogenic stuttering include _____, ______, and _____.

aphasia, apraxia of speech, dysarthrias (hypokinetic more than other types)

_____ are compulsive repetition of words and phrases.

palilalia

List the etiologies of palilalia.

Parkinson's disease/parkinsonism, Alzheimer's disease and other dementias, progressive supranuclear palsy syndrome, closed head injury, stroke, tumor, multiple sclerosis, Tourette's syndrome, post thalamotomy, bilateral basal ganglia pathology

The characteristics of palilalia include: ______ of words and phrases, ____ rate and ____ loudness with successive repetitions, most prominent during ____ and ____ speech (tends to be reduced during reading, repetition, and automatic speech tasks), most common toward ______, awareness of deficit is possible but no ______, ____ can be inhibited temporarily with effort.

repetitions of words and phrases; increased rate and decreased loudness with successive repetitions; most prominent during spontaneous and elicited speech; tends to be reduced during reading, repetition, and automatic speech tasks; most common toward end of utterances but can occur anywhere; awareness of deficit is possible but no anxiety or secondary struggle; reiterations can be inhibited temporarily, with effort

True or false: Adaptation effect in people with palilalia is common.

False; it is uncommon

____ is unsolicited repetition of another's utterances.

echolalia

The characteristics of echolalia include: ____ of others' utterances, _____/____ quality, repetition may be ____ or ____, sometimes with spontaneous correction of syntax.

unsolicited repetition of others' utterances; compulsive, parrot-like quality; repetition may be complete or partial, sometimes with spontaneous correction of syntax

What are the types of echolalia? (4)

mitigated (only some words, helping comprehension); ambient (portions of speech from other conversation); effortful (self generated response, repeat phrases before other person gets response out); silent, simultaneous (quietly echoes)

List the etiologies of echolalia.

Stroke, Alzheimer's disease, Pick's disease and other dementias, PSPS, corticobasal syndrome, carbon monoxide poisoning, Tourette's syndrome, status epilepticus, schizophrenia, mental retardation, ASD, post emergence from coma

True or false: echolalia can co-occur with aphasia and diffuse cognitive deficits.

true

______ presents with reduced speed of verbal responding, reduced linguistic and cognitive complexity of content, reduced vocal loudness and incomplete phonation, and flattened prosody. Associated deficits include ______ impairments and ______ associated with postintubation, psychogenic. This is caused by closed head injury.

attenuation of speech; cognitive/affective; dysphonia/aphonia

____ are involuntary productions (verbal or vocal tics, repetitive grunting, groaning, humming, or lip smacking), associated with diffuse cognitive impairment. The etiologies include ____ and ____.

disinhibited vocalizations; Alzheimer's disease and Tourette's syndrome

____ is a neurologic speech disorder in which articulatory and prosodic characteristics are perceived as a foreign accent (_______). There is _____ among listeners regarding the specific ____ perceived.

foreign accent syndrome; pseudoforeign accent; unreliability; accent

The deviant speech characteristics of foreign accent syndrome include: _______( diphthongization, distortions and prolongations, ____ of unstressed vowels, _____), _____ (alterations in voicing, place, and manner features, leading to perception of ______), and ______ (alterations in stress, rhythm, and intonation).

vowel changes (diphthongization, distortions and prolongations, omissions of unstressed vowels, epenthesis)

consonant changes (alterations in voicing, place, and manner features, leading to perception of substitutions)

prosodic changes (alterations in stress, rhythm, and intonation)

List the etiologies and associated deficits of foreign accent syndrome.

Stroke, CHI, MS, brain tumor, dementia, and primary progressive aphasia

_____ are disturbances in the prosodic components of speech that are tied to the expression of attitudes, emotion, and emphasis. It required an ability to manipulate speech planning, programming, and monitoring for pragmatic/social purposes.

aprosodia

Patient complaints of aprosodia include: voice does not _______, altered ____(either higher or lower), reduced ____ and ____.

convey felt emotions; pitch; pitch range; loudness

The perceptual characteristics of aprosodia include: _____, ____ like spontaneous prosody, reduced ___ and ____ variation, reduced or abnormal _____, reduced ___, ____, and ___, tendency to equalize ____, poor expression of ___ and ____, poor projection of ____, lack of emphasis, and abnormal quality to emotional crying and laughter.

flattened, robot like spontaneous prosody; reduced pitch and loudness variation; reduced or abnormal intonational range; reduced affect, expression, emotion (indifferent); tendency to equalize stress; poor expression of irony and sarcasm; poor projection of voice; lack of emphasis; abnormal quality to emotional crying and laughter

List the accompanying deficits of aprosodia.

paucity of spontaneous emotional and propositional gestures; left-sided neglect; visuoperceptual disturbances; cognitive-communication deficits; left central facial weakness; dysarthria (UUMN); left hemiparesis

True or false: stroke is the most common etiology of aprosodia and can include any process that damage right or nondominant hemisphere.

True

____% of all patients with acquired communication disorders present with functional speech disorders. Associated conditions include ____ and ____.

4.9%; conversion disorder, somatization disorder

List the types of functional speech disorders/how they present.

Stuttering-like dysfluencies; prosodic abnormalities; articulation abnormalities; voice; language/cognitive abnormalities; breathing abnormalities

Individuals with functional speech disorders, stuttering-like dysfluencies can includes excessive ______ (long stretches of fluent with brief severe stuttering or vice verse), excessive _____ (stuttering on every other sound or syllable), speech ______, and absence of ____, ____, and ____.

variability; consistency; speech struggle behavior; absence of aphasia, AoS, and dysarthria

_____ involves physical symptoms that suggest a medical or neurologic cause but for which there is no demonstrable organic cause. There is ___ or _____ of volitional muscle control or sensation that is not consciously motivated.

Conversion disorder; loss or alteration

Patient characteristics of conversion disorder include: may occur in _____ when in a stressful situation, _______ frequently present, may have history of _____, ____, or _____. It will effect more ___ than ____.

healthy individuals when in a stressful situation; psychological disorder are frequently present; may have history of drug/alcohol, sexual abuse or poor relationships; affect more women than men

__ is a chronic illness characterized by recurrent, multiple physical complaints and a belief that one is ill. It usually develops ______ and may be accompanied by _____, ____, and _____. There is a lack of acute conflict, stress, or anxiety.

somatization disorder; before age 25; interpersonal problems, impulsivity, and antisocial personality traits

List the questions to ask yourself when diagnosing a functional speech disorder.

Can the speech disorder be classified neurologically?

Are oral mech exam findings consistent with the speech disorder and patterns of abnormality found n neurologic disease?

Is the speech deficit consistent? suggestible? susceptible to distractibility?

Does speech fatigue in a lawful manner?

____ can be congenital or acquired. There are different types depending on etiology.

childhood dysarthria

True or false: cerebral palsy type will always correspond with the dysarthria type.

false

What are the 3 types of cerebral palsy? ____ is the most common, may affect different body parts, muscles affected by ____, and may retain primitive reflexes. ____ is the next most common, affects the entire body, present with dystonia (uncontrollable muscle contractions) and choreoathetosis (involuntary twitching or writhing). ____ is the least common, affects the entire body, and hypo- or hypertonia, movement overshoot.

spastic; spasticity; dyskinetic; ataxic

What are the 2 types of functional motor classification systems for CP? ____ describes functional gross motor skills and is used for ages 6-12 years. ____ describes fine motor skills and is used for ages 4-18 years.

Gross motor function classification system (GMFCS); Manual Ability classification system

Impairments that may accompany cerebral palsy include: _____, _____, _____, _____, _____, and ______.

musculo-skeletal problems, seizure disorders, sensory impairments, intellectual disability, saliva management, feeding disorders

Speech characteristics in spastic cerebral palsy include ____, ____/____, and ____.

breathy, monopitch/monoloudness, hypernasality

Speech characteristics in dyskinetic cerebral palsy include ____, ___, and ____.

slow rate, inappropriate voice stoppages, dysrhythmia, reduced stress

Speech characteristics in ataxic cerebral palsy include ___ and ___.

dysrhythmia, irregular articulatory breakdowns

True or false: language and/or cognitive deficits may be present with all CP types.

true

List some other etiologies of childhood dysarthria (not including CP).

degenerative disease; infectious disease; fragile X; TBI; stroke; types of dysarthria (depending on site of lesions)

True or false: Cerebral palsy is the most common cause of childhood apraxia of speech.

false; childhood dysarthria

_____ is a disorder of motor programming/planning and is difficult to diagnose before the age of 3. It accounts for ___% of all childhood speech sound disorders.

childhood apraxia of speech; 5%

True or false: there is no gold standard of speech characteristics of childhood apraxia of speech.

true

True or false: non-verbal oral apraxia is always present in CAS

false; may or may not be present

True or false: CAS is relatively common and overdiagnosed.

false; relatively uncommon and overdiagnosed

True or false: CAS is higher in males than females (2-3:1)

true

What are the red flags for CAS?

little to no babbling; very reduced number of sounds; lack of differentiating vowels

Why can diagnosis of CAS before age 3 be difficult?

presence of developmental disabilities or co-morbid conditions; no single list of diagnostic features; some primary characteristics of CAS are characteristic of emerging speech in typically developing children; lack of sufficient speech sample size; inability versus unwillingness; changes in speech occurring during the first 3 years may alter the diagnosis

___ feature list for CAS includes inconsistent errors on consonants and vowels in repeated productions of syllables or words, lengthened and disrupted coarticulatory transitions between sounds and syllables, and inappropriate prosody, especially in the realization of lexical or phrasal stress.

ASHA consensus-based feature list

______ checklist includes difficulty achieving initial articulatory configurations and transitions into vowels, syllable segregation, lexical stress errors or equal stress, vowel or consonant distortions including distorted substitutions, groping (nonspeech), intrusive schwa, voicing errors, slow rate, slow DDK rate, and increased difficulty with longer or more phonetically complex words.

Strand's 10-point checklist

CAS assessment should include _____, _____, ______ (% consonants correct, syllable segregation, and lexical stress problems), and _____. Be sure to assess ____ and/or ______, sequences of ____, articulation of ____ and ___, spontaneous speech, and prosody.

hearing screening, language screening/assessment, multisyllabic words picture naming test (% consonants correct, syllable segregation, and lexical stress problems) and oral motor exam including diadochokinesis; praxis, orofacial movements, orofacial movements, syllables and phonemes

List some examples of CAS assessment protocols.

Diagnostic Evaluation of Articulation and Phonology (DEAP); Verbal motor production assessment for children; dynamic evaluation of motor speech skill; the orofacial praxis test; kaufman speech praxis test for children; madison speech assessment protocol

____ is a cultural consideration of CAS and may have an increased impact on intelligibility and error frequency.

tonal languages

List the cultural considerations of CAS assessment and diagnosis.

errors may be manifested differently in each language; may rely on earlier mastered sounds across all languages spoken; may appear to favor or use one language over another (but difference may be due to the relative ease of the phonemic inventory and word structure in that language rather than an indication of language choice or dominance)

True or false: Response to treatment will not help differentially diagnose CAS.

false; may help differentially diagnose CAS

Managing motor speech disorders may involve improving ____, ______, ____, ____, and ____.

speech intelligibility; comprehensibility; efficiency; naturalness; AAC

True or false: Onset of management of MSDs doesn't matter.

False; management should start early

True or false: Baseline data and organization of sessions are important.

true; baseline data is important for establishing goals and measuring change

The goals of MSD management are to be as ____, ____, and ____ as possible. You can achieve this by _____, ____, or _____. ____ a disorder might not be realistic if there is an entire loss of function. _____ promotes use of residual function. _____ a disorder reorganizes the environment or responsibilities (these adjustments might be temporary or permanent).

effective, efficient, and natural as possible; restoring, compensating, or adjusting; Restoring; compensation; adjusting

List the factors that influence decision making for management of MSDs.

medical prognosis; impairment, limitation, and restrictions; environment and communication partners; motivation and needs; associated problems; and healthcare system

True or false: Treatment duration and intensity is determined by: course of the disease, severity of deficits, specific goals of management, prognosis, motivation, communication needs, resources, and healthcare coverage.

true

What are the broad approaches to management of MSDs?

Medical (pharmacological-meds, botox; surgical); Prosthetic (assistive devices); Behavioral: speech oriented- increasing physiologic support or making mx use of residual abilities or communication oriented- environmental manipulations, educating frequent communication partners

True or false: AAC includes gestures, symbols, and aids.

true

Principles of motor learning are ____ number of trails, ____ practice, ____ practice, ____ practice, and ____ practice.

large number of trials; distributed practice; variable practice; random practice; complex practice

When referring to neuroplasticity, ____ areas must assume function. Changes supporting recovery are similar to those ______ in typical brains.

undamaged; underlying learning

True or false: Neuroplasticity role of some changes remains controversial.

true

Compensatory behaviors that induce brain changes may be ______ and _____ or may be ______.

adaptive and improve function; maladaptive (development of seizures)

List the principles of exercise-dependent neuroplasticity.

use it or lose it, use it and improve it, specificity, repetition matters, intensity matters, time matters, salience matters, age matters, transference, interference

What are the 5 considerations you should consider when organizing treatment sessions?

frequency, task ordering, error rates, fatigue, individual vs group therapy

True or false: All people with a MSD are a candidate for therapy.

false; not all people with a MSD are a candidate for therapy

True or false: Not all approaches are appropriate for all dysarthria types and some may be contraindicated.

true

True or false: Speaker-oriented and communication-oriented approaches are not appropriate and are not necessary for many individuals with dysarthria.

false; both speaker-oriented and communication-oriented approaches are appropriate and necessary for many individuals with dysarthria

True or false: If an individual has adequate loudness and appropriate breathing for speech, you should continue to focus on respiration.

false; don't focus on respiration

Referring to speaker-oriented treatment for dysarthria, how can you increase respiratory support?

required 5cm water pressure for 5 sec, controlled exhalation, pushing/pulling/bearing down, inspiratory and expiratory muscle strength training (allow for larger/faster inspirations, specifically for individuals with hypokinetic dysarthria)

List the types of prosthetics used for respiration speaker-oriented treatment for dysarthria.

abdominal trussing for posture and support: binding/corset, supervised and limited, individuals with spinal cord injury or paralysis of abdominal muscles

abdominal force for increased expiratory strength (lean or push on something)

Respiration speaker-oriented behavior treatment for dysarthria includes: ____ before speech, ____ per expiration (establish optimal breath group and advance as tolerated), and _______ + _______.

deep breath before speech, limit breaths per expiration, speech breathing treatment + Lee Silverman Voice Therapy (LSVT)

Speaker-oriented surgical phonation treatment for dysarthria includes _________ (medialization type I thyroplasty, arytenoid adduction surgery, or surgical anastomosis) and _______ (recurrent laryngeal nerve resection, botox injection, laryngeal adductor denervation-reinnervation, lateralization type II thyroplasty).

vocal fold paralysis or bowing; adductor spasmodic dysphonia

List the prosthetics for phonation speaker-oriented treatment for dysarthria.

SpeechVive for increasing loudness in individuals with Parkinson's disease, ambulatory voice monitoring and feedback devices; portable voice amplifier

Phonation speaker-oriented behavior treatment for dysarthria includes _____ techniques, ______ at the beginning of exhalation, ____ head, _____ manipulation, and ______.

effort closure techniques; initiate phonation at the beginning of exhalation; turning head; lateral digital manipulation; LSVT

True or false: Phonation speaker-oriented behavioral treatment for dysarthria is not effective for strained vocal quality.

true

True or false: Resonance speaker-oriented medical/surgical treatment has limited data.

true

_____ is a type of resonance speaker-oriented medical/surgical treatment for dysarthria that gets injected into pharyngeal walls that have a gap in pharyngeal wall and soft palate.

injection pharyngoplasty

List the resonance speaker-oriented prosthetic treatment types.

palatal lift prothesis, nasal obturator or one-way nasal speaking valve (occludes any airflow coming out)

Resonance speaker-oriented behavioral treatment for dysarthria includes modifying _____, _____ (CPAP), _____, and ______ movement (usually not effective).

the pattern of speaking, resistance training, feedback, and nonspeech velopharyngeal movement

True or false: Neural anastomosis, which is an articulation speaker-oriented medical/surgical treatment for dysarthria, is not effective for speech and is for cosmetics/functionality.

true

True or false: A botox injection can reduce tremor or dystonia for individuals with dysarthria, specifically focusing on articulation.

true