motor exam 1

What are Motor Speech Disorders (MSDs)?

Neurologic speech disorders caused by impairments in the planning, programming, control, or execution of speech movements.

Two primary types of MSDs

Dysarthria and Apraxia of Speech (AOS)

Dysarthria

Disorder of speech movement execution affecting strength, speed, range, accuracy, steadiness, or tone.

Apraxia of Speech (AOS)

Motor planning/programming disorder without primary weakness.

8 dysarthria types

Flaccid; Spastic; Ataxic; Hypokinetic; Hyperkinetic; Mixed; Unilateral Upper Motor Neuron (UUMN); Undetermined

CNS

Brain and spinal cord

PNS

Cranial nerves and spinal nerves

CN V

Trigeminal - jaw movement/articulation

CN VII

Facial - lip movement/facial expression

CN IX

Glossopharyngeal - pharynx/resonance

CN X

Vagus - larynx, velum, pharynx; phonation/resonance

CN XI

Accessory - head and shoulder

CN XII

Hypoglossal - tongue movement/articulation

Final Common Pathway (FCP)

LMN system; cranial & spinal nerves; damage → Flaccid dysarthria

Direct Activation Pathway

UMN/Pyramidal; corticobulbar & corticospinal; skilled voluntary movement

Unilateral UMN damage

Contralateral weakness; UUMN dysarthria

Bilateral UMN damage

Spasticity; Spastic dysarthria

Indirect Activation Pathway

Extrapyramidal; posture, tone, automatic movement

Basal Ganglia damage

Hypokinetic or Hyperkinetic dysarthria

Cerebellar damage

Ataxic dysarthria

Gold standard appraisal

Perceptual analysis

Other appraisal methods

Instrumentation (acoustic/physiologic)

Six salient features

Strength; Speed; Range of Motion; Accuracy; Steadiness; Tone

Oral motor exam looks for

Symmetry, weakness, ROM, speed, accuracy, tone, tremor, fasciculations, atrophy

Tongue deviation

CN XII lesion

Facial droop

CN VII lesion

Fasciculations indicate

Lower motor neuron lesion

Spasticity indicates

Upper motor neuron lesion

AMRs

/pa/, /ta/, /ka/; assess speed & regularity

SMRs

/pataka/; sensitive to AOS; assesses sequencing

Conversation task

Assesses articulation, prosody, naturalness

Vowel prolongation

Assesses respiration/phonation, pitch, loudness, stability, voice quality

Picture description

Volitional speech

Oral reading

Connected speech with reduced volitional demand

Intelligibility

Degree a listener understands the speaker

Standardized intelligibility tests

AIDS and SIT

Confirmatory signs

Pseudobulbar affect, fasciculations, atrophy, neurologic signs

Diagnosis should include

Diagnosis, severity, speech characteristics, confirmatory signs, significance, prognosis/treatment

Damage → Flaccid

Final Common Pathway (LMN)

Damage → Spastic

Bilateral UMN

Damage → Hypokinetic

Basal ganglia (hypokinesia)

Damage → Hyperkinetic

Basal ganglia (hyperkinesia)

Damage → Ataxic

Cerebellum