Listening Quiz

video 1 = flaccid dysatharia / video 2 = apraxia (inconsistent articulation errors especially w/ longer multisyllabic words, groping for the sound/self-correction) / video 3 = spastic (slow regular rate, strained) / video 4 = ataxic (articulatory under/overshoot, irregular rate of speech) / video 5 = hypokinetic (loudness decay, festination, monoloudess/monopitch, short rushes of speech), video 6 = hyperkinetic (loudness variation, voice stoppages, variable rate, inappropriate silences), video 7 = unilateral upper motor neuron (reduced loudness, mild imprecise articulation, breathy voice, confirmatory sign = unilateral facial droopiness) video 8 = mixed flaccid & spastic (strained, hypernasal)

Differential diagnosis of motor speech disorders in children

1. dysarthria

2. CAS

3. phonological disorder

4. Combination/mixed

dysarthria - children

• impairment at the level of at least one speech system (respiration, phonation, articulation, resonance)

• often associated with a global neurological disorder

• type of dysarthria in children is not very important (can be confusing)

CAS - children

• inconsistency (especially with longer words & DDK)

  • specify what kind (e.g. inconsistency moving from sound to sound OR gesture to gesture)

• speech subsystems are intact (unless mixed with dysarthria/articulation)

main tasks needed to differentiate CAS from other disorders

1. complete oral motor assessment (including DDK)

   • CAS = strenght/ROM intact BUT pa-ta-ka syllables get confused

2. multisyllabic single-word production

   • CAS = notable breakdown

Phonological disorder - children

• relatively consistent phonological pattern; not caused by global neurological disorder

Differential diagnosis of motor speech disorders in adults

• determine dysarthria vs apraxia (sometimes vs aphasia or combo)

• if its dysarthria → determine what type

apraxia in adults

speech characteristics

• inconsistencies

• islands of typical speech

• irregular articulatory breakdowns (self-corrections)

• vowel distortions

• distorted substitutions

• groping

• increased errors with increasing length/complexity

• only articulation and prosody are affected

dysarthria in adults

• consistent and predictable

• no or few islands of typical speech

• mostly distortions

• imprecise production of consonants (final & initial positioned equally impaired)

• smaller vowel space/vowels may sound similar

• all subsystems affected

flaccid dysarthria

• lesion locus = lower motor neurons (cranial & spinal nerves)

• neurological deficit = weakness

• speech characteristics → phonatory

  • breathy

  • diplophonia

  • short phrases

  • reduced maximum vowel duration

  • vocal flutter

• speech characteristics → resonance

  • hypernasality

  • nasal emissions

• speech characteristics → articulation

  • undershooting

• confirmatory signs

  • weak cough

  • weak glottal coup

spastic dysarthria

• lesion locus = bilateral upper motor neurons

• neurological disorder = spasticity

• speech characteristics → phonation

  • strained-strangled voice

  • harsh voice

• speech characteristics → rate/prosody

  • slow

  • regular rate

• speech characteristics → articulation

  • imprecise consonants

ataxic dysarthia

• lesion locus = cerebellum

• neurological deficit = incoordination

• speech characteristics → phonation

  • unsteady/irregular during vowel prolongation

• speech characteristics → rate/prosody

  • irregular

• speech characteristics → articulation

  • overshoot and undershoot

hypokinetic dysarthria

• lesion locus = basal ganglia

• neurological deficit = rigidity

• speech characteristics → phonation

  • loudness decay

  • reduced loudness

  • monopitch

  • monoloudness

• speech characteristics → rate

  • festinating/rapid

  • short rushes of speech

hyperkinetic dysarthria

• lesion locus = basal ganglia

• neurological deficit = involuntary

• speech characteristics → phonation

  • inappropriate silences

  • vocal stoppages

  • voice tremor

  • involuntary noises

  • variable or excess loudness variations

• speech characteristics → rate

  • variable rate

• speech characteristics → articulation

  • prolonged phoneme

unilateral upper motor neuron dysarthria

• lesion locus = unilateral upper motor neuron

• neurological deficit = unspecified/mild

• speech characteristics

  • mild imprecise articulation

  • harsh vocal quality

  • slow rate

• confirmatory characteristics

  • facial droopiness to left or right

  • etc

mixed dysarthria

• characteristics from two or more types