Apraxia/Dysarthria Flashcards
(43 cards)
Do patients with AOS typically have coexisting disorders?
Yes - pure apraxia of speech is rare
AOS that is the only, or the dominant, symptom
Primary progressive apraxia of speech
Is apraxia and AOS the same thing?
Not necessarily; Apraxia is a basic disorder of volitional movement; AOS is a special case of apraxia.
Which disorder is caused by injury or damage to motor-speech programming area in the dominant hemisphere? Broca’s area and supplementary motor area are often involved.
Apraxia of speech
When assessing AOS, it’s important to…
- Tape record patient’s speech samples and transcribing responses phonetically
- Evoking repetitive production of a speech sound, syllable or multiple syllables (ex. pataka)
- Evoking the imitative production of progressively longer words
Primary concern with AOS Tx
- Primarily concerned with speech movements rather than non-speech movements
- Practice with a variety of sounds and sound combinations
- Repeated trials on the same target response (drills) is essential for initial learning
Tx targets should include articulatory accuracy, slower rate of speech, systematic practice, gradual increase in the rate, and normal prosody.
How to differentiate apraxia from dysarthria
- Motor plans
- utterances
- Errors
- Bucco-facial apraxia (less or more likely to occur)
- Strength, tone and rom of pharyngeal muscles
- Non-speech motor tasks
———- Motor plans
A: Motor plans affected
D: Motor plans not affected, but neuromuscular weakness
———- Utterances
A: Unpaired/error-free automatic, involuntary utterances
D: Affects both voluntary and involuntary utterances
———- Errors
A: Greater amount of errors for words that are longer and more phonetically complex
D: Errors are consistent regardless of length or complexity of word
———- Bucco-facial apraxia
A: More likely to occur
D: Less likely to occur
———- Strength, tone and rom of pharyngeal muscles
A: Normal
D: Abnormal
———- Non-speech motor tasks
A: Can complete non-speech motor tasks during oral-mech exam without difficulty; breakdown will occur on speech tasks
D: Will have difficulty performing both non-speech and speech motor tasks
Phases of a normal swallow
- Oral prep
- Oral
- Pharyngeal
- Esophageal
Special form of esophageal swallowing disorder due to esophageal motility impairment/failure of the lower esophageal sphincter to relax; consequently, the food is not passed into the stomach but retained in the esophagus
It may be confused with eating disorders commonly reported in young females because of food avoidance, vomiting, and other symptoms associated with EDs
Achalasia
What is the purpose of a flexible endoscopic evaluation of swallowing?
Evaluate laryngeal penetration of food, aspiration, food residue, and completeness of a swallow
Are swallowing maneuvers great Tx ideas?
While they are designed to compensate for specific problems associated with dysphagia, they are supported by weak data.
Indirect Tx of swallowing disorders
Oral-motor control exercises
- Each is designed to reduce a particular problem
- Ex. Increase ROM of tongue movements, increase buccal tension, increase ROM of jaw
Exercises to stimulate the swallow reflex
Name the swallowing maneuver:
Helps close the airway at the level of the vocal folds to prevent aspiration.
Patient is asked to hold the food in the mouth, take a deep breath and hold it soon after initiating a slight exhalation, swallow while holding breath, and cough soon after the swallow
Supraglottic swallow
Name the swallowing maneuver:
Helps close the airway before and during swallow; the procedure also promotes false vocal fold closure.
Patient is asked to inhale and hold the breath tightly by bearing down (action that tilts the arytenoids and helps close the false folds) and swallow while holding breath. Patient coughs soon after the swallow using this technique.
Super-supraglottic swallow
Name the swallowing maneuver:
Helps increase the posterior motion of the tongue and increase pharyngeal pressure. Patient is asked to squeeze as hard as possible while swallowing
May be more effective when combined with infrahyoid motor electrical stimulation
Effortful swallow
Name the swallowing maneuver:
Helps elevate the larynx, and thus, widens the cricopharyngeal opening. The patient is first educated about the laryngeal elevation, then asked to palpate the laryngeal elevation when swallowing saliva, and finally, taught to hold the laryngeal elevation during swallowing saliva, and finally, taught to hold the laryngeal elevation during swallowing for progressively longer durations
Mendelsohn maneuver
3 main procedures of neuromuscular rehabilitation for swallowing disorders
- Neuromuscular electrical stimulation (NMES) to of the neck muscles to improve swallowing
- Transcranial magnetic stimulation
- Transcranial direct current stimulation
Medical Tx of swallowing disorders
- Cricopharyngeal myotomy
- Esophagostomy
- Gastrostomy
- Nasogastric feeding
- Pharyngostomy
- Teflon injection into the vocal folds
————- Cricopharyngeal myotomy ———–
Creates a permanently open sphincter for swallowing.
For patients with parkinson’s disease, ALS, whose main problem is cricopharyngeal dysfunction
————- Esophagostomy ————————
Designed for pts who cannot tolerate oral feeding
Inserting a feeding tube into the esophagus through a hole (stoma)
————– Gastrostomy ————————-
Designed for pts who cannot tolerate oral feeding
Insertion of a feeding tube into the stomach through an opening in the abdomen
————- Nasogastric feeding —————-
Designed for pts who cannot tolerate oral feeding
Tube, inserted through the nose, pharynx and esophagus into the stomach, feeds patient
————- Pharyngostomy ——————-
Non-oral surgical feeding method
Tube is inserted into the esophagus and stomach through hole that has been created through pharynx
————Teflon injection into the vocal folds ———–
Surgical implant method designed to improve airway closure during swallowing
Which dysarthria is the only one that can increase speech?
Hypokinetic
Rapid-fire articulation
Because the ROM of the articulators is reduced, the speech of an individual with hypokinetic dysarthria will often speed up until there is a breakdown.
Describe Hyperkinetic dysarthria.
1. Disease related to it.
2. Speech symptoms
3. Cause
Hyperkinetic - Huntington’s disease
Sudden forced inhalation or exhalation
o Transient breathiness lasting only for a short time
o Transient vocal strain/harshness
o Vocal tremor
o Voice stoppage
o Intermittent hypernasality
o Marked deterioration with increased rate
o Inappropriate vocal voices
o Intermittent breathy or aphonic segments
o Distorted vowels
o Excessive loudness variation
o Irregular/unpredictable DDK
o Facial grimace during speech
o Multiple motor tics à stereotyped repetitive movement
o Myoclonus = sudden and involuntary jerking
o Palate, pharynx, lips, tongue, nostrils or respiratory muscles
o Involuntary head, jaw, face, tongue, velum, laryngeal and respiratory muscles
Cause: Damage to basal ganglia (extra pyramidal system)
o Indirect loop
o NO movement inhibition
o Excessive movement
o Hyperkinesia = extra and involuntary movement
o Variable muscle tone and involuntary movement interfere with speech production
Dysarthria associated with Parkinson’s disease
Hypokinetic
Most common cause of UUMN dysarthria
Stroke - 92%
What is the normal swallowing apnea duration for healthy young people and healthy elderly people?
Young: 1 second
Elderly: 7.8 - 10 seconds
