Fripty Study Bundle SLP Set 15 - Student Developed - Fripty Approved

What is apraxia of speech?

neurogenic speech sound disorder due to sensorimotor problems in positioning and sequentially moving muscles for the volitional production or speech.

theres a slower rate of speech, distorted speech sound subs, syllable segmentation, articulatory groping, false starts, prosodic impairments, increased errors with longer utterances

unimpaired reflex and automatic acts. no muscle weakness.

different from nonverbal oral apraxia, which is a disorder of nonverbal movement involving oral muscles.

What are some causes of apraxia of speech?

lesions to brocas area, primary motor areas, or supplementary motor area. primary progressive apraxia of speech (caused by degenerative disease, like alzheimers, MS), left hemisphere trauma, surgical trauma, tumors and seizures

What are communication deficits seen in patients with AOS?

Initiation may be slowed or delayed

May use compensatory strategy of reduced rate

Problems in volitional sequencing of movements required for speech

Variability of speech errors

Substitutions more commonly seen than distortions and omissions

Anticipatory substitutions

Post positioning errors (dred for dress)

Metathetic errors (tefalone)

Increased frequency of errors on longer words

Groping and struggling

Attempts at self correction (unsuccessful)

Slower rate of speech

Silent pauses between words

Impaired intonation

Are pts who have AOS aware of their deficits?

Yes

What's the difference between apraxia of speech and primary progressive apraxia of speech?

PPAOS is considered "pure" AOS, where it's the only symptom and the onset is insidious.

How do you assess AOS?

Detailed case history

-Careful examination of medical records

-Interview client/family

-Detailed observation of speech production

Tape record patients speech samples and transcribe responses taking note of groping, self correction, etc

Getting them to repeat speech sounds and patakas

Getting them to repeat progressively longer words

Getting them to repeat words and phrases and sentences

Getting them to count

Picture descriptions

Oral reading

Oral test

Assess limb apraxia

Standardized test such as the APRAXIA BATTERY FOR ADULTS

What do you target in AOS treatment?

Behavioral treatment is most effective

-Initially target easily produced words

-Focus on speech movements

-Drill a variety of sounds and sound targets

-Include articulation, slow rate, prosody

-Emphasize total communication (verbal expressions, gestures, writing, AAC)

-Self-monitoring skills

-Techniques used for aritic and phono

What should treatment procedures include in AOS?

Instruction

Demonstration

Modeling

Shaping

Phonetic placement

Frequent cueing

Use of rhythm

Immediate feedback

What cueing techniques should be used for AOS?

Tactile

Simultaneous production by the clinician and client

Clinician modeling followed immediately by client imitation

Delayed imitation

Carrier phrases

Singing

Phonetic contrasts

What is Sound Production Treatment?

A therapy approach for AOS. Emphasizes teaching articulation of words with minimal contrast.

What is dysarthria?

Neurological based speech disorder characterized by abnormal strength, speed, range, steadiness, tone and accuracy. Affects all aspects of speech production, including respiration, phonation, articulation, prosody and resonance.

What causes dysarthria?

non progressive conditions (stroke, infections, TBI, etc), degenerative neurological conditions (parkinsons, ALS, MS), trauma, infections (AIDS), toxic-metabolic (drugs, encephalopathy, etc)

Where is the lesion for ataxic dysarthria?

Damage to the cerebellar system. So, coordination of muscle movements is difficult.

What speech deficits do you see in ataxic dysarthria?

Respiration

-exaggerated and paradoxical movement during speech

Phonation

-monopitch, mono loudness, harshness

Resonance

-hyponasality (only in some)

Articulation

-imprecise production. irregular breakdowns. distortion.

Prosody

-excessive and even stress. prolonged phonemes and intervals between words/syllables. slow rate of speech

Other

-gait disturbances: instability of trunk and head, tremors and rocking, rotated head posture, hypotonia

-movement: over and undershooting. uncoordinated, slow, imprecise movements

Where is the lesion for flaccid dysarthria?

Damage to lower motor neurons. These are the connections that go from spinal and cranial nerves to muscles. It may only affect one muscle or a group of muscles.

What neurological conditions may cause flaccid dysarthria?

ALS, MSA, myasthenia gravis, demyelinating diseases, trauma, infections, strokes, etc.

What speech deficits do you seen in flaccid dysarthria?

Respiration

-reduced subglottic air pressure, weak inhalation

Phonation

-breathy voice, audible inspiration, short phrases

Resonance

-hypernasality, nasal emissions

Articulation

-imprecise consonants

Prosody

Other

-weakness, hyptonia, atrophy, diminished reflexes, fasciculations (which are isolated twitches of resting muscles), rapid weakness of muscle

Where is the lesion for hyperkinetic dysarthria?

Damage to the basal ganglia. It may affect muscle tone and involuntary movements. Mainly prosody.

What speech deficits do you see in hyperkinetic dysarthria?

Respiration

-Audible inspiration or forced and sudden inspiration/expiration.

Phonation

-Voice tremor, intermittently strained, vocal noise, harsh, loudness variations

Resonance

-Sometimes hyper nasality, but mild

Articulation

-Imprecise consonant productions, distorted vowels, slower

Prosody

-Prolonged inter-word intervals, silent periods, phoneme prolongations, excess and equal stress, mono pitch, monoludness, reduced stress, short phrases

What is/are ______________

-orofacial dyskinesia

-myoclonus

-tics

-chorea

-athetosis

-dystonia

-tremor

All associated with hyperkinetic dysarthria

-orofacial dyskinesia: abnormal, involuntary movements of the orofacial muscles

-myoclonus: involuntary, rapid jerks of body parts. like hiccups

-tics: commonly of face and shoulders. typically patterned, rapid and stereotyped.

-chorea: purposeless, random involuntary movements of body parts

-athetosis: slow, writhing, purposeless movements.

-dystonia: contractions of muscles that cause abnormal posture.

What is spasmodic torticollis? blepharospasm?

spasms of the neck muscles

forceful and involuntary closure of eyes

Where is the lesion for hypokinetic dysarthria?

basal ganglia. most common cause is Parkinson's.

What speech deficits do you see in hypokinetic dysarthria?

Respiration

-Reduced vital capacity, irregular breathing

Phonation

-Monopitch, low pitch, monoloudness, harsh, breathy

Resonance

-Hypernasality in some

Articulation

-imprecise or distorted consonants

Prosody

-reduced stress silent intervals, short rushes of speech, variable and increased rate in segments, short phrases

Other

-Tremors, but diminished when moving voluntarily

-Mask-like-face

-Micrographic writing

-Walking disorders (slow initiation, rapid, shuffling steps)

-Postural disturbances characterized by difficult changing positions

-Decreased swallowing and accumulation of saliva in mouth

Where is the lesion for spastic dysarthria?

BILATERAL damage to UMN.

What speech deficits do you see in spastic dysarthria?

Respiration

Phonation

-Hyperadduction of VF

-Breathy

-Harsh

-Pitch breaks

-Strained/ strangled

Resonance

-Hypernasality

Articulation

-Imprecise production

Prosody

-Excess and equal stress, mono, reduced stress

Other

-Spasticity and weakness of face

-Reduced range

-Increased muscle tone

What type of dysarthria is commonly associated with ALS?

Mixed flaccid-spastic

What type of dysarthria is commonly associated with MS?

ataxic-spastic

Where is the lesion in unilateral upper motor neuron dysarthria?

Upper motor neurons that supply cranial or spinal nerves.

What are speech deficits associated with UUMN dysarthria?

Respiration

Phonation

-harsh voice, reduced loudness, strained harshness, wet hoarseness, breathiness

Resonance

-hypernasality

Articulation

Prosody

-slow rate, excess and equal stress, mono pitch, mono loudness

Other

-unliateral lower face weakness, tongue weakness, palatal weakness

-hemiplegia

How do you asses dysarthria?

Complete case history

-Examine medical records

-Interview patient/family

-Record a conversation and reading sample

-Imitation tasks

-Sustained vowel

-Diadochokinetic rates

-Assess speech production mechanisms, respiratory problems, phonatory problems, articulation, prosody, resonance, speech intelligibly, muscle strength, range, accuracy, tone and steadiness

-Use standardized measure like Frenchay Dysarthria Assessment

How do you assess the speech production mechanism during a dysarthria assessment?

Observe facial symmetry, tone, tension, droopiness, expression, etc

Observe facial structures as the patient puffs cheeks, retracts and rounds lips, bites lower lip, etc

Note jaw movements and deviations

Observe VP mechanism

Assess nasal airflow by holding a mirror at the nares as the patient prolongs the vowel /i/

Assess laryngeal function by asking the patient to cough

How do you assess respiration during a dysarthria assessment?

Observe patients posture and breathing habits during rest and speech

How do you assess phonation during a dysarthria assessment?

ah prolongation task

take note of pitch, breaks, diplophonia, loudness

take note of voice tremors

take note of quality

How do you modify respiration when treating dysarthria?

Teach consistent production of subglottic air pressure

Teach maximum vowel prolongation

Teach controlled exhalation

Teach silent to push, pull during speech tasks

Modify posture

How do you modify phonation when treating dysarthria?

Using biofeedback

Portable amplification

Artificial larynx

How do you modify resonance when treating dysarthria?

Mirror

Open mouth wider

Nose clip

How do you modify articulation when treating dysarthria?

Bite block for jaw control

phonetic placement

instruction -> demonstration -> modeling -> shaping -> immediate feedback

compensatory skills

How do you modify speech rate when treating dysarthria?

delayed auditory feedback

pacing board

metronome

hand tapping

How do you modify pitch when treating dysarthria?

Visi-Pitch