Motor Speech Disorders Notes

Mind Over Matter

  • Component #1: Recognizing Differences
    • Open-ended questions:
      • Describe how your speech is different.
      • What bothers you most about your speech?
      • How well do you communicate now compared to before?
    • Self-reported outcome measures:
      • Communication effectiveness survey.
    • Visual Analogue Scale:
      • Example: Pain scale.
      • Establish baseline, PLOF (Prior Level of Function), goal setting.
    • Speech sample:
      • Reading and discourse.
    • Counseling:
      • Subsystems of speech.

Willingness to Change

  • Component #2: Willingness to Change
    • Stage 1: Precontemplation: Lack of awareness or insight.
    • Stage 2: Contemplation: Considering a commitment to begin therapy.
    • Stage 3: Preparation: Committed client but bargaining for a start date.
    • Stage 4: Action: Ready for change and committed to therapy.
    • Stage 5: Maintenance: Home program/community engagement.

Goal Setting

  • Component #3: Goal Setting
    • Find out what is important to your patient and why.
    • Remember, the client is an expert too.
    • Encourage full participation in setting SMART goals.
    • Short or long term goals.
    • Use salient material.
    • Ongoing assessment.

Learning to Self-evaluate and Self-correct

  • Component #5: Learning to Self-evaluate & Self-correct
    • Generalization.
    • Visual analogue scale.
    • Preferred strategy.
    • Fade feedback/cueing.

Acquired Apraxia of Speech

  • Damage occurs near Broca's area.
  • Causes slow, disfluent speech and flat monotonous intonation.

Childhood Apraxia of Speech

  • Specific area of damage not yet established.
  • Delays in speech development, but other motor skills develop normally.
  • Only 1 or 2 children per 1000.
  • Causes have not yet been identified.
  • Severe speech delays.
    • Words dominated by simple syllable shapes and early developing sounds.
    • Vowel errors.
    • Inconsistent speech sound production.
    • Altered intonation and word stress.

Dysarthria

  • Speech disorders due to damage to the central and/or peripheral nervous system pathways.
    • As a group they involve all major subcomponents of speech production.
      • Respiration, phonation, resonance and articulation.

Acquired Apraxia of Speech

  • Disorder in the planning and programming of motor speech movements caused by damage to the left frontal lobe.
  • In most cases occurs alongside Broca's aphasia.
  • Speech sound errors.
  • Prosodic impairment.
  • Slow rate, prolonged consonants and vowels, pauses between words, even stress on syllables.

Cerebral Palsy

  • A syndrome of deficits resulting from injury to the nervous system at or shortly after birth.
  • The child's muscles are weak, paralyzed and/or uncoordinated.
  • Causes dysarthria in children.

What causes CP?

  • Prenatal:
    • Anoxia disease, metabolic problems.
  • Perinatal:
    • Anoxia from umbilical cord problems.
    • Premature separation of the placenta.
    • Brain trauma.
  • Postnatal:
    • Brain trauma.

Orthopedic Classification

  • Monoplegia – one limb.
  • Paraplegia – both legs.
  • Triplegia – three limbs.
  • Quadriplegia - all four legs and arms.

Spastic CP

  • Damage to pyramidal/extrapyramidal tracts.
  • Spasticity
    • Abnormal resistance to muscle lengthening.
  • Muscles resist movement.
  • Hypertonicity
    • Arms bent upward.
    • Legs positioned like scissors.
  • Muscle atrophy.

Athetoid CP

  • Primary damage in basal ganglia.
  • Involuntary writhing and twisting movements.
  • Child appears to be in almost constant motion.

Ataxic CP

  • Caused by damage to the cerebellum.
  • Disturbances in motor coordination.
    • Errors in the speed, direction and accuracy of movement.
  • Difficulty in motor tasks involving a target.
  • Difficulty in motor tasks involving precision and rhythm.

Levels of Severity

  • Mild
    • Good self-help skills, ambulates without appliances, good speech.
  • Moderate
    • Needs help to develop self-help skills, special equipment needed for ambulation, speech impairments.
  • Severe
    • Poor prognosis for developing self-help, ambulation or speech even with assistance.

Speech and Language Development with CP

  • Respiration
    • Reduced vital capacity, inefficient valving at the glottis/velopharynx, and within oral cavity.
    • Cannot generate/maintain subglottal pressure well.
  • Phonation
    • Intermittent breathiness/strangled harshness of voice; compromised by changing tonicity of vocal muscles.
  • Resonance
    • Hypernasality and nasal emission.
    • Premature opening of velopharynx.
  • Articulation
    • Mandible may be hyperextended.
    • Difficulties rounding or protruding mouth.
    • Abnormal tongue position.
    • All prevent precise shaping of vocal tract and lead to articulation problems.
  • Prosody
    • Poor respiratory control -> one or two utterances per breath.
    • Poor laryngeal tension control -> hard to manipulate changes in pitch.

Flaccid Dysarthria

  • Caused by damage to the motor unit.
  • Muscle weakness and atrophy.
  • Rapid fatigue with prolonged use.
  • Hypernasal, nasal emission, breathiness.
  • Better after rest.
  • Increased difficulty over time.

Spastic Dysarthria

  • Bilateral damage to the pyramidal and EP tract.
  • Hypertonicity.
  • Muscles fight against stretching.
  • Articulatory imprecision, slow rate, short phrases, harsh voice quality, reduced loudness, and pitch variation.

Ataxic Dysarthria

  • Damage to the cerebellum.
  • Inaccurate and dysrhythmic movements.
  • Speech is monotonous.
  • Reflexes are normal.
  • Minimal weakness.
  • Speech intelligibility mildly affected.

Hypokinetic Dysarthria

  • Parkinson's disease.
  • Hypertoned and rigid muscles.
  • Resting tremor that disappears with voluntary movement.
  • Accelerated movements and short rushes of speech.
  • Monopitch and loudness.

Hyperkinetic Dysarthria

  • Damage to the basal ganglia of the EP.
  • Involuntary movements that may be fast or slow.
  • Involuntary movements may occur in one limb or whole body.
  • Speech characterized by impaired prosody, articulatory imprecision, and deficits in rate of speech production.

Mixed Dysarthria

  • Diseases that affect more than one part of the motor system at the same time.
    • Multiple sclerosis.
    • Amyotrophic lateral sclerosis (Lou Gehrig's disease).
    • Progressive diseases.

Assessment of Dysarthria

  • Oral-peripheral examination
    • Structures and speech.
  • Frenchay dysarthria assessment
    • Reflexes and voluntary movements of structures during speech and nonspeech tasks.
  • Speech examination
    • Speech intelligibility test.

Intervention for Dysarthria

  • Postural supports.
  • Speech therapy.
    • Reductions in rate.
    • Self-monitoring of intensity.
  • Prosthetic and surgical management
    • Palatal lift or pharyngeal flap for velopharyngeal inadequacy.
    • Vocal fold relocation or injection with Teflon for vocal fold paralysis.
  • Augmentative Communication
    • Systems for speech.
      • Can take various forms.
        • Gestures.
        • Communication boards.
        • Electronic devices.
      • Issues
        • Motor control.
        • Cognitive and intellectual impairment.
        • Is slower than oral speech.