Motor Speech Disorders Exam 1

Central Nervous System (CNS)

consists of the brain and spinal cord

peripheral nervous system (PNS)

consists of cranial and spinal nerves

upper motor neuron (UMN)

the descending tract of an axon that originates in the cerebral cortex and travels in the CNS to synapse with a LMN

lower motor neuron (LMN)

the efferent (carries info from CNS) component of a cranial or spinal nerve that is also known as the final common pathway

direct activation pathway (DAP)

axons that course from the primary motor cortices, premotor cortices, and supplementary motor cortices of the frontal lobes directly down into the brain stem and spinal cord to synapse with lower motor neurons

indirect activation pathway (IAP)

axons that travel a more indirect path between the primary motor cortices and lower motor neurons. Includes many complicated connections with subcortical structures before coursing inferiorly through the CNS to synapse with lower motor neurons

UMN damage

• spasticity (hypertonia & hyperactive stretch reflex)

• resistance to passive movement

• primitive reflexes

LMN damage

• loss of reflexes

• paralysis or paresis

• fasciculations

• muscular atrophy

IAP damage

• muscular rigidity

• tremors

• abnormal or involuntary muscle movements

• disturbance of postural reflexes

motor speech disorder (MSD)

disruption to the effective mnaufacture, refinement, transmission, and execution of motor plans for speech

Apraxia of Speech

an acquired deficit of speech originating from an inability to create and sequence motor plans for speech

dysarthria

group of motor speech disorders resulting from neurological injury to the motor component of the motor-speech subsystems: strength, speed, range, steadiness, and/or accuracy of movements for speech

association fibers

pathways of white matter that connect different structures and areas of the brain within the same hemisphere

commissural fibers

“same” areas between two cerebral hemispheres

projection fibers

white matter tracts that project from the brain to the spinal cord and transmit motor signals from CNS out to the PNS and sensory signals from PNS back to lower CNS to be processed in the brain

flaccid dysarthria

hypotonia and weakness; results from LMN damage

spastic dysarthria

spasticity and weakness; results from bilateral damage to UMN

unilateral upper motor neuron dysarthria (UUMN)

spasticity and weakness; unilateral upper motor damage

ataxic dysarthria

incoordination; results from damage to cerebellum or cerebellar connections within the CNS

hypokinetic dysarthria

reduced movement and reduced range of motion; results from damage to basal ganglia or basal ganglia connections within the CNS

hyperkinetic dysarthria

extra and abnormal movements; results from damage to the basal ganglia or basal ganglia connections within the CNS

mixed dysarthria

characteristics vary depending on whether the upper or lower motor neurons remain most intact. for example, if upper motor neurons are most damaged initially, the voice will sound harsh. if lower motor neurons are most affected, the voice will sound breathy

phonetic cue for a bilabial sound

/p/ → put both lips together and make a “pop” with your lips

phonetic cue for an alveolar sound

/t/ → put your tongue behind your top teeth and move it down and forward

/f/ → /v/

phonetic derivation for using /f/ as a basis for another sound

/g/ → /k/

phonetic derivation using /g/ as a basis for another sound

melodic intonation therapy

a structured speech-language treatment that uses musical elements like melody, rhythm, and left-hand tapping to help people with severe non-fluent aphasia regain spoken communication

phonetic cues

a hint that gives the initial sound, first few sounds, or first syllable of a target word to help someone recall or say it

PROMPT

(prompts for restructuring oral muscular phonetic targets) a hands-on tactile kinesthetic speech therapy approach used by speech-language pathologists to guide a patient’s jaw, lips, tongue, and larynx into correct positions for speech production; includes visual and auditory cues to elicit the correct production of traget phonemes

aphasia

a language disorder caused by damage to the parts of the brain that control speech and language comprehension

buccofacial apraxia

the inability to perform voluntary movements with the face, lips, tongue, or cheeks on command, even though automatic movements work normally

ideomotor apraxia

a neurological disorder where a person cannot perform learned motor tasks when asked, even though they understand the action and can often do it automatically

ideational apraxia

a brain disorder that stops a person from planning and completing multi-step tasks because they lose the mental concept of how tools and everyday objects work together

articulatory-kinematic approach

a primary speech therapy method used to treat motor speech disorders like apraxia of speech by focusing on precise movement and rebuilding motor plans for speech; brain plasticity

motor practice

focuses on drills when treating AOS in order to increase retention

modeling-repetition

type of AOS treatment in which the SLP produces a model with the client observing, then client imitates model

phonetic derivation

AKA shaping; voice, place, manner; deriving one sound to another p → b; helping create a speech sound from a sound the client can already produce

automatic speech (AKA non-volitional speech)

speech that is produced with little to no effort

volitional speech

purposeful, intentional communication that is significantly more impaired than automatic or reactive speech in speech and language disorders like apraxia

intersystemic reorganization

a treatment approach that pairs an impaired system with an intact, different system to help restore or facilitate communication; intervention for acquired apraxia of speech that pairs non-speech activities with speech, with the assumption that initiation of one non-speech action primes and increases the likelihood of initiation of speech

Broca’s area; inferior posterior portion of the left hemisphere

acquired apraxia of speech is believed to the be the result of damage to this area of the brain

maximum performance task

used to test a patient’s maximum limit of ability and to compare the patient’s greatest effort on a speech-like task with a known average performance rate for unimpaired individuals during a motor speech evaluation

characteristics of apraxia

inconsistent and unpredictable articulation errors, groping gestures of the articulators, and error-free automatic utterances are characteristics of this disorder

apraxia of speech

the inability to plan the range, force, and/or timing of the movement of speech musculature during speech is a characteristic of this disorder

primitive reflex

a reflex that is normal in infants, but that is suppressed with age and that can possibly re-emerge with nervous system damage

fasciculation

an irregular, involuntary twitching of a muscle that can be visible just under the skin or mucosa

oral motor evaluation

an assessment done to determine whether muscle strength, tone, and /or range of motion is within normal limits

apraxia of speech

in this motor speech disorder, articulation errors are more frequent on longer/more phonetically complex words

bilateral upper motor neurons

spasticity, resistance to passive movement, and primitive reflex are signs/symptoms of damage to this location(s) within the nervous system

lower motor neuron damage

this type of nervous system damage results in the motor signal not reaching the muscles or the degradation of the signal before reaching the relevant muscles, and may also cause muscular atrophy

indirect activation pathway

muscular rigitidy, tremor, involuntary movement, and/or disturbed postural reflexes are clinical signs of damage to this part of the nervous system

alternating motion rates (AMRs)

a type of maximum performance task commonly used in a motor speech assessment

phonetic derivation

this technique uses the client’s ability to produce one sound with clinician instructions on altering one or more aspects of the sound (like voicing) to aid the client in correctly producing a different sound

hyperkinetic dysarthria

this type of dysarthria is caused by extra and involuntary movements that interfere with speech production

flaccid dysarthria

this type of dysarthria results from the weakness and/or paralysis of the musculature used for speech due to damage to a lower motor neuron

Indirect activation pathway

which location correlates best with the following sign/symptom of neurological damage: tremor?

A. upper motor neuron (UMN)

B. Lower motor neuron (LMN)

C. indirect activation pathway (IAP)

lower motor neuron (LMN)

Which location correlates best with the following sign/symptom of neurological damage: spasticity?

A. upper motor neuron (UMN)
B. lower motor neuron (LMN)
C. Indirect Activiation Pathway (IAP)

indirect activation pathway

Which location correlates best with the following sign / symptom of neurological damage: muscular rigidity?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

indirect activation pathway

Which location correlates best with the following sign / symptom of neurological damage: involuntary muscle movements?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

lower motor neuron

Which location correlates best with the following sign / symptom of neurological damage: muscular atrophy ?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

lower motor neuron

Which location correlates best with the following sign / symptom of neurological damage: loss of reflexes?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

upper motor neuron

Which location correlates best with the following sign / symptom of neurological damage: reemergence of primitive reflexes such as the Moro reflex?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

lower motor neuron

Which location correlates best with the following sign / symptom of neurological damage: fasciculations?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

lower motor neuron

Which location correlates best with the following sign / symptom of neurological damage: paralysis?

A. upper motor neuron

B. lower motor neuron

C. Indirect activation pathway

upper motor neuron

Which location correlates best with the following sign / symptom of neurological damage: resistance to passive movement?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

indirect activation pathway

Which location correlates best with the following sign / symptom of neurological damage: disturbance of postural reflexes?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

lower motor neuron

Which location correlates best with the following sign / symptom of neurological damage: paresis?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

upper motor neuron

Which location correlates best with the following sign / symptom of neurological damage: hypertonia and hyperactive stretch reflex?

A. upper motor neuron

B. lower motor neuron

C. indirect activation pathway

lower motor neuron

Which fits the following definition the best? Descending tract of an axon that either carries information to or from the central nervous system.

A. upper motor neuron

B. lower motor neuron

C. direct activation pathway

D. indirect activation pathway

indirect activation pathway

Which fits the following definition the best? Axons that travel a more indirect path between the primary motor cortices and lower motor neurons. They have many complicated connections with subcortical structures before coursing inferiorly through the CNS to synapse with cranial or spinal nerves.

A. upper motor neuron

B. lower motor neuron

C. direct activation pathway

D. indirect activation pathway

upper motor neuron

Which fits the following definition the best? Descending tract of an axon that originates in the cerebral cortex and travels through the central nervous system to synapse with a cranial or spinal nerve.

A. upper motor neuron

B. lower motor neuron

C. Direct activation pathway

D. indirect activation pathway

direct activation pathway

Which fits the following definition the best? Axons that course from the motor cortices, premotor cortices, and supplementary motor cortices of the frontal lobes directly down into the brain stem and/or spinal cord to synapse with lower motor neurons.

A. upper motor neuron

B. lower motor neuron

C. direct activation pathway

D. indirect activation pathway

projection fibers

These are white matter pathways that project from the brain to the spinal cord and transmit motor (movement) signals from the CNS out to the PNS and also transmit sensory signals from the PNS back up through the lower CNS to be processed in the brain.

A. association fibers

B commissural fibers

C. projection fibers

commissural fibers

These are white matter pathways that connect analogous areas between the two cerebral hemispheres.

A. association fibers

B. commissural fibers

C. projection fibers

association fibers

These are white matter pathways that connect different structures and areas of the brain within a single hemisphere.

A. association fibers

B. commissural fibers

C. projection fibers

flaccid

This type of dysarthria is characterized by hypotonia and weakness due to damage to a lower motor neuron.

A flaccid

B spastic

C unilateral upper motor neuron

D ataxic

E hypokinetic

F hyperkinetic

hyperkinetic

This type of dysarthria is characterized by extra and abnormal movements due to damage to the basal ganglia or basal ganglia connections within the CNS.

A flaccid

B spastic

C unilateral upper motor neuron

D ataxic

E hypokinetic

F hyperkinetic

ataxic

This type of dysarthria is characterized by incoordination and damage to the cerebellum or cerebellar connections within the CNS.

A flaccid

B spastic

C unilateral upper motor neuron

D ataxic

E hypokinetic

F hyperkinetic

spastic

This type of dysarthria is characterized by spasticity and weakness due to damage to bilateral upper motor neurons.

A flaccid

B spastic

C unilateral upper motor neuron

D ataxic

E hypokinetic

F hyperkinetic

hypokinetic

This type of dysarthria is characterized by reduced movement and reduced range of motion due to damage to the basal ganglia or basal ganglia connections within the CNS.

A flaccid

B spastic

C unilateral upper motor neuron

D ataxic

E hypokinetic

F hyperkinetic

unilateral upper motor neuron

This type of dysarthria is characterized by spasticity and weakness due to damage to unilateral upper motor neuron(s).

A flaccid

B spastic

C unilateral upper motor neuron

D ataxic

E hypokinetic

F hyperkinetic

motor speech disorder

This is the disruption of the effective manufacture, refinement, transmission, and execution of motor plans for speech.

A flaccid

B spastic

C unilateral upper motor neuron

D ataxic

E hypokinetic

F hyperkinetic

G motor speech disorder

dysarthria

This is a group of motor speech disorders resulting from neurological injury to the motor component of the motor-speech subsystems which causes abnormalities in the strength, speed, range, steadiness, and/or accuracy of movements required for the respiratory, phonatory, resonatory, and/or articulatory aspects of speech production.

A apraxia of speech

B dysarthria

C aphasia

apraxia of speech

This is an acquired deficit of speech originating from an inability to create and sequence motor plans for speech.

A apraxia of speech

B dysarthria

C aphasia

motor practice

This is the intensive and repetitive productions of movement (i.e., drills).

A motor practice

B modeling-repetition

C articulatory cueing

articulatory cueing

This is the used of cues to articulation and/or deriving placement of the articulators for one sound using another.

A motor practice

B modeling-repetition

C articulatory cueing

modeling-repetition

This is when the clinician produces a target phoneme with the client paying attention to the articulation, then producing the target themselves.

A motor practice

B modeling-repetition

C articulatory cueing

B

Which of the following is an example of a phonetic derivation?

A put your lips together (to elicit a bilabial sound)

B make a /p/ sound, but turn your voice on (to elicit /b/)

A

Which of the following is an example of a phonetic cue?

A put your lips together (to elicit a bilabial sound)

B make a /p/ sound, but turn your voice on (to elicit /b/)

ideational apraxia

This is the inability to conceptualize a task, formulate motor plans required for the task, or hold in memory the idea of the task long enough to accomplish it successfully​.​

A buccofacial apraxia

B ideomotor apraxia

C ideational apraxia

buccofacial apraxia

This is the inability to program and carry out volitional movements of the tongue, cheeks, lips, pharynx, or larynx on command.​

A buccofacial apraxia

B ideomotor apraxia

C ideational apraxia

ideomotor apraxia

This is the lack of ability to program motor movements for pantomiming gestures and for the use of tools despite possessing the knowledge of how the tools are used and their function​.​

A buccofacial apraxia

B ideomotor apraxia

C ideational apraxia

dysarthria

Which motor speech disorder typically has the following characteristic: both volitional and non-volitional speech are equally affected​?

A apraxia of speech

B dysarthria

apraxia of speech

Which motor speech disorder typically has the following characteristic: inconsistent articulation errors (AKA islands of intact articulation)​?

A apraxia of speech

B dysarthria

apraxia of speech

Which motor speech disorder typically has the following characteristic: normal / unimpaired muscle strength, tone, and range of motion?

A apraxia of speech

B dysarthria