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Adult Comps* > Motor Speech Disorders > Flashcards

Motor Speech Disorders Flashcards

1
Q

dysarthria

A

speech disorder caused by neurologic damage

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2
Q

AOS

A

neurologically based motor programming disorder —difficulty producing the correct sounds in correct order

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3
Q

CN V function & change in speech

A

trigeminal

motor: mastication muscles
sensory: face & mucous surfaces of eyes, tongue, & parts of nasoapharyneal space

damage – imprecise consonants, distorted vowels, slow rate

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4
Q

CN VII function & change in speech

A

Facial

motor: facial muscles
sensory: ant 2/3 of tongue

damage: distortion of bilabial, labiodental sounds, slow rate

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5
Q

CN X function & change in speech

A

Vagus

motor & sensory to muscles of the soft palate, pharynx, and larynx

damage: breathiness, decreased loudness, short phrases, hyper nasality, nasal emission, weak plosives (possible hoarseness if unilateral)

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6
Q

CN XII function & change in speech

A

hypoglossal

innervation of tongue muscles

damage: mild-sever consonant imprecision vowel distortion

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7
Q

planning

A

selecting the sounds you want to say

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8
Q

programming

A

how to move from 1 sound to the next, fine movements

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9
Q

Langmore dysarthria eval components

A
  1. motor parameters
  2. speech parameters
  3. speech motor subsytem
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10
Q

Langmore’s motor parameters (7)

A
  1. symmetry
  2. tone
  3. steadiness
  4. strength
  5. range/amp
  6. rate
  7. coordination/accuracy/precision
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11
Q

Langmore’s speech parameters (4)

A
  1. phonation
  2. resonance
  3. articulation
  4. prosody
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12
Q

Langmore’s speech motor subsystem (4)

A
  1. respiratory
  2. laryngeal
  3. velopharyngeal
  4. orofacial
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13
Q

what to include in SUMMARY & FORMULATION on comps

A
  1. diagnosis
  2. severity
  3. describe the speech and motor impairments
  4. relate it to the neurological damage
  5. discuss the major limiting features
  6. prognosis and recommendations
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14
Q

Severity - Mild (Langmore)

A
  • just barely dysarthric
  • completely intelligible
  • artic impaired <10% of words
  • voice &/or resonance may be slightly impaired
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15
Q

Severity - Mild/Mod (Langmore)

A
  • definitely dysarthric
  • intelligible except for occasional words
  • artic impaired 10-30% of words
  • errors involving only a few consonants
  • voice &/or resonance are impaired
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16
Q

Severity -Moderate (Langmore)

A
  • speech sometimes difficult to understand
  • artic impaired 30-50% of words
  • errors involving many consonants & occasional words
  • some combo of resonance, voice, speech, rate & prosody impaired
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17
Q

Severity - Mod/Severe (Langmore)

A
  • speech is often difficult to understand
  • atic impaired 50-70% of words
  • Resonance, voice, speech rate, & prosody all affected
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18
Q

Severity - Severe (Langmore)

A
  • speech is often unintelligible
  • artic impaired 70-90% of words
  • errors involving nearly all consonants and some vowels
  • Resonance voice, speech rate, & prosody are all affected
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19
Q

Flaccid speech characteristics

A
  • hypernasality
  • nasal emission
  • short phrases
  • breathiness
  • inhalatory stridor
20
Q

Flaccid motor characteristics

A
  • decreased muscle tone
  • decreased/absent reflexes
  • weak
  • atrophy
  • fasiculation
21
Q

Flaccid dysarthria neuro damage

A

-damage to any part of 1 or more CNs (nucleus, axon, or jxn) or can result from muscle damage

22
Q

Flaccid dysarthria common causes

A
  1. traumatic – surgical, CHI, neck injury
  2. neuropathies of 1 or more CN
  3. degenerative diseases
  4. CVA – rare
23
Q

spastic dysarthria speech characteristics

A
  • harshness
  • low pitch
  • slow rate
  • strained/strangled quality
  • pitch breaks
  • slow & regular AMRs
24
Q

Spastic motor characteristics

A
  • increased muscle tone
  • hyperactive reflexes
  • slow
  • loss of fine motor control & agility/precision
25
Q

spastic neuro damage

A
  • bilateral UMN damage
  • usually damage to direct and indirect pathways (extrapyramidal & pyramidal pathway)
  • *see pseudobulbar palsy/psuedobulbar affect in pt w/ bilateral UMN damage
    • –displays lack of inhibition of emotional display(d/t extrapyramidal pathway damage)
26
Q

spastic common causes

A
  • degernerative diseases

- stroke (usually multiple strokes or UMN brainstem stroke)

27
Q

hypokinetic speech

A
  • monopitch
  • monoloud
  • variable rate
  • rapid “blurred” AMRs
  • short rushes of speech
  • reduced stress
28
Q

hypokinetic motor impairments

A
  • rigidity
  • bradykinesia
  • akenesia (loss of automaticity)
  • festination
  • tremor
  • excessive tone
29
Q

Hypokinetic common causes

A
  • degenerative diseases (PD, PSP)

- vascular strokes

30
Q

hypokinetic neurological damage

A
  • damage to the striatum in the BG
  • deficiency of dopamine in the substania niagra
  • leads to imbalanced cortical motor output to the LMN that causes the hypokinesia, rigidity, and tremors
31
Q

ataxic dysarthria speech

A

**sounds like a drunk person

  • irregular articulartory breakdowns
  • prosodic excess
  • prolongation of phonemes
  • irrgular AMRs
  • excessive loudness variation
32
Q

ataxic motor

A
  • reduced movements
  • slow (esp repetitive movements)
  • inaccurate/dysmetria
  • incoordination/dysdiachochokinesis
  • intention tremor
33
Q

ataxic neuro

A

disruption to the cerebellar circuit

—-bilateral cerebellar damage is most likely to cause severe ataxic dysarthria

34
Q

ataxic dysarthria causes

A
  • degernerative diseases
  • demyelinating diseases (MS)
  • TBI
  • Vascular
  • cerebellar tumors
35
Q

hyperkinetic speech

A
  • slow/irregular AMRs
  • distored vowels
  • prolonged intervals
  • voice tremor
  • transient breathiness
36
Q

hyperkinetic motor

A
  • quick/slow involuntary muscle movements that interfere with voluntary muscle movements
  • slow
  • reduced force
  • irregular rhythm
  • dyskinesias
37
Q

hyperkinetic neuro

A
  • lack of GABA and excess dopamine with cortico-frontotemporal atrophy
  • CNS dysfunction-GG circuits
38
Q

hyperkinetic common causes

A
  • -diseases of the BG control circuit
  • majority is idiopathic
  • spasmodic dysphonia
  • organic voice tremor
  • degenerative diseases (Huntingtons chorea)
39
Q

unilateral upper motor neuron flaccid dysarthria speech

A
  • similar characteristics of spastic and LMN flaccid but more variability depending on damage
  • facial weakness –> lower 1/2 face and tongue
  • imprecise articulation, slow rate, and reduced loudness
40
Q

unilateral upper motor neuron flaccid dysarthria damage neuro damage

A
  • cerebral hemispheres –> usually internal capsule
  • damage to the direct/indirect pyramidal pathway (corticobulbar tract) which executes precise, skilled, discrete movements

….loss of fine, controlled skilled movements
hypotonia
weakness

41
Q

Vertebobasilar artery stroke

A

UMN damage –> spastic dysarthria

VB arteries are further apart in cortical hemispheres so you need multiple strokes to cause spastic dysarthria

42
Q

ICA stroke (Internal Carotid) – MCA, ACA

A

-may cause unilateral UMN flaccid dysarthria if an MCA stroke

spastic dysarthria if it is bilateral damage

…damage to primary motor cortex/subcortical structures —>may accompany AOS or aphasia if in LH, cognitive deficits likely present if in RH

43
Q

Lacunar Strokes

A
  • small infarcts from occlusions of branches in carotid or VB systems
  • usually subcortical damage –BG, thalamus, internal capsule, direct/indirect pathways

multiple lacunar strokes –> dementia, parkinsonism

….can result in flaccid/spastic/hypokinetic dysarthria

44
Q

dysarthria in parkinsons

A

hypokinetic

*look at hypo kinetic notecard

45
Q

dyarthria in PSP

A

mixed hypo, spastic, and ataxic

46
Q

dysarthria in MS

A

–ataxic & spastic

–due to demylination of the myelin sheath around neuron in the CNS of the white matter

Speech characteristics: irregularities and slowness

  • syllables pronounced slowly and hesitantly
  • harshness
  • defective articulation
  • …in general com pains of fatigue (psychical and cog sense)
47
Q

dysarthria in ALS

A

*mixed spastic & flaccid

speech characteristics:

  • severe harshness and strained-strangled squeezing of low-pitch tones, gurgle
  • disrupted prosody
  • prolonged intervals and phonemes
  • appropriate silences

Adult Comps* (16 decks)

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