motor speech disorders final

laryngoscopy

shows...

-timing/cessation of glottal closure

-position of the vocal folds

aeordynamic measures

measures...

-resistance of vocal folds to subglottal air pressure

-duration difference between sustained vowel vs. voiceless fricativea

hypoadduction impairment

-reduced loudness, breathy voice, hoarse voice quality

-LMN damage, progressive supranuclear palsy, TBI

-flaccid dysarthria

hyperadduction impairment

-pressed, harsh, strain-strangled, variant loudness

-pseudobulbar palsy, spastic cerebral palsy, Huntington's, adductor laryngeal dystonia

phonatory instability impairment

tremorous voice, rough, hoarse, voice quality, pitch breaks, glottal fry, arrhythmic

- short or long term

short term phonatory instability

jitter, shimmer, cycle-to-cycle basis

- detected acoustically

long term phonatory instability

-slow fluctuations (<2/sec)

-flutter (7-10/sec)

- tremor (3-10/sec)

-detected perceptually

phonatory coordination impairments

loss of voicing distinctions of phonemes or aspiration-nonaspiration distinctions

LSVT

PD (hypokinetic dysarthria)

1) 4 times/week for 1 month

2) energetic, high effort to increase loudness

3) exclusive effort on respiratory-phonatory effort

4) increase sensory awareness of loudness/effort (vowel to conversation)

prosthetics most beneficial to...

those with adequate articulation who haven't responded to behavior intervention

artificial larynx most beneficial to...

aphonic, severely breathy, lack respiratory support

surgery for hypoadduction

-deep brain stimulation (PD)

-pallidotomy, thalatomy (PD)

-laryngeal framework surgery (abductor spasmodic dysphonia, VF paralysis)

treatment of hyperadduction

-reduce vocal effort

-rotate head backward

-increase f0

-initiate utterance with higher lung volume

-antispasticity medications

-botox

-RLN resection

treatment phonatory instability

-improve respiratory laryngeal timing

-improve articulatory distinctions

hypernasality most frequently seen in...

flaccid, spastic, or hyperkinetic dysarthrias

where is nasal emission most commonly observed?

pressure consonants, voiceless fricatives

where is hypernasality most commonly seen?

vowels

levator veli palatini

X, XI

raises soft palate

tensor veli palatini

V

stretches soft palate

palatoglossus

X, XI

raises back of tongue

palatopharyngeus

X, XI

shuts off nasopharynx

uvulae

X, XI

shortens and raises uvula

phonatory aerodynamic system

voice function analyzer

- measure nasal airflow and oral air pressure

- produce oral consonants

- patient needs to be able to close mouth

interventions for mild VPD

behavioral: some degree of VP closure

interventions for severe VPD

prosthetic: palatal lift or nasal obturator when patient can't achieve VP closure by modifying speech patterns

-used with behavior treatment

-consider course of illness

see-scape

increases intraoral pressure

behavioral approaches for VPD

-see-scape

-reducing speech rate

-reducing loudness

-CPAP

CPAP

positive air pressure delivered to nasal cavity

-patient works against this resistance to strengthen muscles

wpm paragraph reading

160-170

wpm sentence reading

190

wpm conversational speech

150-250

pauses can take up to ___ of paragraph and ___ of conversational speech

30%, 50%

articulatory movement rate

4.5-5.9 sylabes/second

hypokinetic dysarthria may sound ______ than typical

faster

articulatory undershoot

imprecise articulation that reduces distinctive features

best computer software for sentence reading

speech intelligibility test (SIT)

best computer software for paragraph reading

acoustic analysis software

consequences of technique selections

balance between intelligibility and naturalness

rigid rate control techniques

"one word at a time" strategies

-severe impairments

-least natural speech

-external support

rigid rate techniques

1) alphabet board

2) finger tapping

3) pacing board

rate control techniques that preserve prosody

1) rhythmic cueing

2) "backdoor" approaches

components of restoration-normalizing function approach

medical management, biofeedback training, strengthening exercises

components of compensation approach

prosthetic, behavioral

antispasticity meds are used for ______ dysarthria

spastic

botox is used for _______ dysarthria

hyperkinetic

what is biofeedback typically used to manage?

reduce abnormally high muscle tone (spastic dysarthria)

-may also be used to work on increasing muscle tone in patients with flaccid dysarthria

sEMG

electrodes placed on lips, jaw, forehead and alert signals patient when muscle has too much tone

assessment of communicative function

can the client successfully signal emotion, emphatic stress, syntactic junctures

- reading sentences with different emotions

intervention for impairment

reducing the neuromotor problem with strengthening or decreasing tone

intervention for activity limitation

developing compensatory mechanisms

intervention for participation restriction

provide opportunities for communication and eliminate barriers to performance of communicative roles

intervention for environmental factors

reducing environmental, physical, social, and attitudinal barriers to participation

communication effectiveness scale

patient ranks the difficulty of communicative tasks

CP defined by

-movement and posture disturbance

-non-progressive

-occurs in the developing fetal/infant brain

-co-occurring issues

spasticity

most common (80%)

-incrased muscle tone, hyperreflexia, retaining primitive reflexes, abnormal posture/movement, resistance to externally imposed movement, distal portions of limbs more involved

-dependent on alertness and stress

-start with flaccid/hyporeflexia then becomes spastic

dystonia/choreoathetosis

-15%

-diagnosed after 6 months

-involuntary, uncontrolled/recurring movements (twisting), whole body involvement, changing tone

-dependent on alertness/stress

-significant oromotor problems

ataxia

-5%

-diagnosed after 6 months

-loss of coordination, wide stance, unsteady gait, difficulty with hand/arm control, increased/decreased muscle tone, whole body involvement

GMFC 1

walks without restrictions; limitations with more advanced gross-motor skills

GMFC 2

walks without assistive devices; limitation in walking outdoors

GMFC 3

walks with assistive devices; limitation in walking outdoors

GMFC 4

self-mobility with limitations; power mobility outdoors

GMFC 5

self mobility severely limited even with use of assistive technology

fine motor function 1

handles objects easily

fine motor function 2

handles most objects but with somewhat reduced quality/speed

fine motor function 3

handles objects with difficulty; prepare/modify objects

fine motor function 4

handles limited selection of objects easily in adapted situations

fine motor function 5

severely limited ability with simple actions

CFCS 1

effective communication

CFCS 2

effective communication with familiar partners

CFCS 3

effective communication with familiar partners only

CFCS 4

inconsistent with familiar partners

CFCS 5

seldom effective with familiar partners

NSMI

no speech/motor involvement

SMI-LCT

speech motor involvement and age appropriate language/cognitive skills

SMI-LCI

speech motor involvement and impaired language/cognitive skills

ANAR

unable to produce speech

hemiplegia

involvement of one side

diplegia

lower limbs more impacted than upper

triplegia

involvement of 3 limbs

quadriplegia

equal involvement of 4 limbs

bulbar involvement

speech motor systems involved (not including respiratory)

integral stimulation

moderate-severe AOS

-auditory, visual, and tactile stimuli to facilitate imitation

-eight-step continuum

tactile cues

clinician uses tactile cues to show the client how movements should be made and provides tactile stimulation for location

simultaneous production

clinician says target utterance while the client watches and listens; clinician and client say the utterance together, simultaneously, while the client continues to watch the clinician

mimed production

clinician says the utterance while the client watches and listens

-the client then imitates the utterance immediately after the clinician

-auditory cue is faded, but the clinician continues to mime the movement while the client produces it

immediate repetition

client imitates the clinician's utterance without auditory and visual cues during the client's production

successive approximation

client imitates the clinician's utterance with several successive productions made by the client

delayed repetition

client imitates the clinician's production but must wait 1-5 seconds between hearing the utterance and producing it

reading

the clinician presents written stimuli, followed by the client's oral reading with no auditory/visual cues from the clinician

reading with delay

the clinician presents written stimuli, followed by delayed spoken production by the client

answering questions

the clinician elicits the target utterance by asking a question

role playing

the clinician elicits the target utterance by engaging in role playing

multiple input phoneme therapy (MIT)

shape a variety of utterances from the stereotypies that may eventually be used volitionally

-severe AOS, repetitive verbal stereotypies

sound production treatment

improving spatial targeting and timing of articulation at the segmental and syllable level

-minimal contrasts

-stimuli determined by patient's unique error patterns

-targets are treatment sounds, stimuli are words, phrases, or sentences

-minimal assistance in the first steps

melodic intonation therapy

-developed for patients with broca's aphasia

-melodic pattern of a phrase is emphasized

-clinician models while tapping the rhythm

contrastive stress

using prosodic cues and stress patterns to facilitate speech production and prosody

-mild-moderate AOS

-targets speech naturalness

(video of old man w/ glasses and black/blue shirt)

what was the phonatory impairment profile

a. Hypoadduction

b. Hyperadduction

c. Incoordination

d. Mixed

a

Which of the following is an intervention designed to improve prosody in ataxic dysarthria

a. Finger tapping for every syllable spoken

b. Reducing the loudness

c. Limiting variation in syllable durations

d. Prolongation of stressed syllables and use of pauses

d

integral stimulation steps

-simultaneous production

-mimed production

-immediate reproduction

-successive reproduction

-delayed reproduction

What is the F0 contour within a breath unit in a interrogative sentence

a. Reset-high-low

b. Low-high-reset

c. High-low-reset

d. high-reset-low

b.