Motor Speech Disorders

Dysarthria

a motor speech disorder that results in abnormal execution

• respiration, phonation, resonance, articulation, prosody affected

• consistent errors

• distortion or simplification of speech

Indirect Motor Pathway

• UMN

• Extrapyramidal System - sensory

• Controls posture, range of motion, speed, muscle tone

• predominantly contralateral

Direct Motor Pathway

• UMN / Pyramidal System - motor

• Controls skilled movement

• Made up of CORTICOBULBAR & CORTICOSPINAL tracts

  • Corticobulbar - predominately bilateral except LOWER FACE which is CONTRALATERAL

  • Corticospinal - bilateral but predominantly contralateral

Final Common Pathway

• LMN

• Function - muscle contraction

• Results in flaccid paralysis & dysarthria

Spastic Dysarthria

• damage to direct/indirect pathways

• bilateral or unilateral

• Unilateral UMN Spastic Dysarthria - lower face weakness, weak & incoordination of articulation

• Bilateral UMN Spastic Dysarthria “Pseudobulbar Palsy”- strained strangled voice and hyper nasality due to excessive muscle tone and emotional lability

Flaccid Dysarthria

• damage to the final common pathway/LMN

• results in weakness, hypotonia, atrophy, breathy voice, reduced loudness

• caused by myasthenia gravis, guillane barre, polio, muscular dystrophy

Ataxic Dysarthria

• damage cerebellar control circuit (coordination & balance disturbed)

• function - ipsilateral body control

• speech characteristics - slow rate, mono pitch, harshness, and irregular articulatory breakdown

Hypokinetic Dysarthria

• damage to basal ganglia

• characterized by excessive muscle tone, reduced strength, reduce ROM

• speech characteristics - reduced volume, hoarse, breathy

Parkinson’s Disease

• damage in substantia nigra / depletion of dopamine

• result in flaccid dysarthria due to disruption of LMN

• tremor, masked facies, micrographia,

Hyperkinetic Dysarthria

• damage to basal ganglia

• characterized by abnormal movements (rapid/slow/rhythmic/irregular)

• huntington’s disease

Myoclonus

• involuntary single brief jerks

• cannot be inhibited

• focal or multifocal

Tremor

• rhythmic movement

Athetosis

• inability to maintain a body part in a single position due to spasticity of muscles

Tics

• rapid, stereotyped, coordinated, movements

Chorea

• rapid, purposeless, unpredictable movements that interrupt course of intended movements

Dyskinesia

• abnormal involuntary movements

Apraxia

• lesion to left hemisphere

• predominately articulation disorder

• island of error free speech

• groping

Dyarthria Tx Objectives

• promote oral motor development

• oralfacial postures

• orofacial reflexes

• muscle tone & strength

• improve range, speech, coordiantion

Apraxia Tx Objectives

• promote voluntary control / sequential movement of articulators

• slow, deliberate speech

• reduce stuggling & groping

A lesion in the vagus nerve can result in

• Flaccid Dysarthria

  • hoarse diplophonic voice

A lesion in the cerebellum can result in

• ataxic dysarthria causing irregular articulatory breakdowns and aprosodia

What is the result of the locus of a lesion being neuromuscular junction?

• weakened muscles

• flaccid dysarthria

• causing fast deterioration in continuous speech

Spastic Dysarthria results in

• strain strangled voice

• speech deficits affecting various speech processes; articulation, phonation, resonance, and speaking rate

A lesion in the hypoglossal nerve results in?

• lingual atrophy (right side if lesion on left side)

• articulatory deficits with lingual sounds

What condition is likely to cause spastic dysarthria?

• multiple lacunar infarcts involving both cerebral hemispheres

What condition is likely to cause flaccid dysarthria?

• myasthenia gravis

What is a probable cause of cerebellar dysarthria?

• muscular dystrophy

• guillain-barre syndrome

• cortical stroke

• friedreich ataxia

• myasthenia gravis

• friedriech ataxia

A patient with muscle atrophy and fasciculations on right side of tongue leads to

• right cranial nerve hypoglossal

• the tongue will be weak moving against insde of cheeks

• PA (AMR) sound is spared

A patient with right facial nerve paralysis, you will expect to see

• weakness and muscle atrophy on the right side

• immobile on right side of face

• cannot smack lips with adequate strength

A patient’s right side tongue appears to be spastic and clumsy after a stroke

• neurological lesion is the left corticalbulbar tract

• right lower face spasticity & clumsy

• spastic dysarthria (unilateral upper motor neuron lesion)

What nerve is responsible for lengthening the vocal folds to raise vocal pitch

• superior laryngeal nerve

When the soft palate is paralyzed on the right side, we expect to observe?

• soft palate and uvula to pull to the left side

When the mandibular (motor) branch of right trigeminal nerve is damaged, we expect to observe?

• jaw deviation to right side

• partly opened jaw can be pushed to the right side easy

• minimal to mild chewing difficulty

• drooling

Hypernasality in spastic dysarthria is a result of

• spasticity of soft palate

• slow and limited palatal movements

Lesion above the split of all branches on the right vagus nerve could result in

• hypernasality

Which statement about the cerebellum is FALSE?

• each cerebellar hemisphere is connect to the cerebral hemisphere on the same side

Speech Deficits in ataxic dysarthria are characterized by

• uncoordinated movements

• predominantly articulatory and prosodic disturbances

• unpredictable, intermittent articulatory breakdowns

Hallmark Speech Characteristics for Right vagus nerve lesion below the pharyngeal nerve but abotve superior and recurrent laryngeal nerve

• inability to raise pitch

• breathy weak voice

• Flaccid Dysarthria

Hallmark characteristics for pseudobulbar palsy

• steady but slow imprecise AMRs affecting all sounds (pa, ta, ka)

• Strained strangled voice

• emotional lability

• markedly slow speaking rate

• hypernasallity

• positive oral reflexes (snout, jaw jer, sucking)

Hallmark Characteristics for Cerebellar degenerative disease

• ataxic dysarthria

• unsteady, irregular speaking rate and articulatory errors in speech AMRs and conversational speech

• drunken speech

• scanning speech prosody

What are the origins of upper motor neurons?

• motor corticies

Where are the endpoints of corticospinal tract?

• anterior horns of spinal cords

Where are the endpopints of corticobulbar tract?

• motor nuclei of cranial nerves in brainstem

Which of the following neural structures in not part of motor cortices?

• supplementary motor area

• medulla oblongata

• primary sensory cortex

• primary motor cortex

• premotor cortex

• medulla oblongata

Basal ganglia and its control of the body movement

• contralateral

Facial nerve and control of face, vagus nerve and control of vocal folds, C3-C5 and control of diaphrgam

• ipsilateral

Corticobular and control of vocal folds and soft palate

• bilateral

Homemade water glas manometer tests what speech process

• respiration

Modified tongue anchor test tests what speech processes?

• resonance

Glottal coup test what speech process?

• phonation

Lip smacking test what speech process

• articualtion

What are the norms for AMRs?

• 5-7 seconds