motor speech diso wk 2

flaccid dysarthria

results from injury/disease affecting one or more LMN

primary features: muscle weakness, reduced muscle tone (hypotonia)

impact speed, range, and accuracy of speech mvmnts

pathophysiology of flaccid dysarthria

hypotonia

diminished reflexes (hyporeflexia)

atrophy

fasciculations and fibrillations

progressive weakness with use

etiology of flaccid dysarthria

vascular disorder (stroke in brainstem), tumor, trauma, viral infection (within LMN system)

Myasthenia Gravis

affects neuromuscular junction

rapid fatigue of muscular contractions over a short period of time, with recovery after rest

caused by antibodies that damage ACh receptors

damage to trigeminal

imprecise artic bilaterally due to reduced jaw strength and stability

slow rate bilaterally (prosody)

damage to facial

mild artic consonant distortions unilaterally (especially labials)

artic consonant distortions, possible vowel imprecision due to reduced lip rounding/spreading, and reduced labial seal/precision

slow rate bilaterally (prosody)

pharyngeal branch (vagus)

responsible for pharyngeal constrictors and palatal elevation/retraction

critical for velopharyngeal closure during speech and swallowing (resonance)

superior laryngeal branch (vagus)

innervates cricothyroid muscle

pitch control

recurrent laryngeal branch (vagus)

innervates all intrinsic laryngeal muscles except cricothyroid

vocal fold mvmnt and voice quality

above pharyngeal branch vagus damage

unilateral breathiness, reduced loudness, reduced pitch, short phrases, hoarseness, diplophonia (respiratory/phonatory)

bilateral breathiness, aphonia, short phrases, inhalatory stridor (respiratory/phonatory)

unilateral mild hypernasality, nasal emission (resonance)

bilateral marked to severe hypernasality, nasal emission (resonance)

weak artic pressure consonants bilaterally

uni- and bi-lateral short phrases (prosody)

below pharyngeal branch vagus damage

unilateral breathiness, reduced loudness, reduce pitch, short phrases, hoarseness, dilophonia (resp/phon)

bilateral breathiness, aphonia, short phrases, inhalatory, stridor (resp/phon)

short phrases uni- and bi-laterally (prosody)

superior branch damage

unilateral breathiness, hoarseness (resp/phon)

bilateral breathiness, hoarseness, reduced loudness/pitch/range (resp/phon)

short phrases uni- and bi-laterally (prosody)

recurrent laryngeal branch damage

unilateral breathiness, hoarseness, reduced loudness, diplophonia (resp/phon)

bilateral breathiness, hoarseness, reduced loudness (resp/phon)

short phrases uni- and bi-laterally (prosody)

hypoglossal damage

resonance altered bilaterally

unilaterally mildly imprecise lingual consonants (artic)

bilaterally mild-severe imprecision, vowel distortions (artic)

bilaterally slow rate (prosody)

evaluation tasks for flaccid dysarthria

conversational speech reading

alternate motion rate task

prolonged vowel

speech stress test

treatment of motor speech disorders

pts learn to listen, evaluate, and self-correct their speech

treatment of flaccid dysarthria

depends on cranial nerve damage

nonspeech oral strengthening exercises

prosthetic devices (palatal lifts, speech bulbs)

techniques for nasal emission

UMN damage

hypertonicity

hyperreflexia

unilateral damage - UUMN dysarthria

bilateral damage - spastic dysarthria

pathophysiology of spastic dysarthria

bilateral damage to UMN

affects direct and indirect activation pathways - weak/slow skilled mvmnts and increased muscle tone/spasticity

spastic dysarthria

strained/strangled voice quality, slow rate, slow and regular AMRs

dysphagia, drooling, weak face/tongue, pathologic reflexes

perceptual characteristics of spastic

monoloudness

monopitch

strained strangled voice

harsh voice (irregular vf vibration)

slow rate

short phrases (due to increased tension)

low pitch

hypernasality (sometimes)

etiology of spastic

vascular disorder (stroke)

degenerative disease (ALS, etc)

trauma

demyelinating disease (MS)

tumor

infection (infectious encaphalopathy)

spastic dysarthria evaluation tasks

conversational speech/reading

alternating motion rate (AMR)

vowel prolongation

trtmnt of phonation deficits

head and neck relaxation, easy onset of phonation, yawn-sigh exercises

prosodic deficits trtmnt (both flaccid and spastic)

lexical stress drills (record vs record)

sentence stress drills

minimal contrast drills