Final Exam

Question 1

Define the neuromotor basis of hypokinetic dysarthria.

Answer 1

Rigidity/reduced Range Of Motion

Question 2

Describe 1 key function of the basal ganglia

Answer 2

To plan and program postural and supportive components of motor movement

Question 3

Describe 4 major motor symptoms associated with Parkinson’s disease.

Answer 3

1. rest tremor
2. rigidity
3. akinesia
4. loss of postural reflexes

Question 4

Describe 4 other symptoms (including non-motor symptoms) associated with Parkinson’s disease.

Answer 4

1. Gastro-instestinal issues
2. depression
3. sleep disorder
4. sensory abnormalities

Question 5

List a patient’s speech-related complaint that could help differentially diagnose hypokinetic dysarthria from other dysarthria types.

Answer 5

I feel like I am speaking loud enough

Question 6

• List the most distinctive speech features of hypokinetic dysarthria according to Darley, Aronson, and Brown.

Answer 6

Monopitch,
reduced stress,
monoloudness,
inappropriate silences,
short rushes,
rapid rate,
reduced loudness level

Question 7

Define the neuromotor basis of hyperkinetic dysarthria.

Answer 7

Involuntary movements

Question 8

List 3 possible etiology that could lead to hyperkinetic dysarthria

Answer 8

1. Unknown (most common)
2. Toxic/Metabolic
3. Degenerative
4. Trauma
5. Vascular
6. Other

Question 9

• Describe 4 of the major hyperkinetic movement disorders.

Answer 9

1. Tremors
2. Chorea
3. Hemiballismus
4. Dystonia
5. Myoclonus
6. Hemifacial spasms
7. Tics

Question 10

• List the most distinctive speech features of chorea according to Darley, Aronson, and Brown.

Answer 10

• rapid, unpredictable consonant and vowel distortions involving most speech articulators
• Prolonged Intervals
• Variable Rate
• Excess Loudness Variation

Question 11

• List the most distinctive speech features of dystonia according to Darley, Aronson, and Brown.

Answer 11

• slowly varying or prolonged distortions of consonants and vowels.
• these distortions may affect a specific articulator in a fairly regular and predictable manner

Question 12

• List the most distinctive speech features of spasmodic dysphonia according to Darley, Aronson, and Brown.

Answer 12

• Voice Stoppage (voice arrests or vocal spasms)
• Pitch Breaks
• Strained Voice
• Harsh Voice

Question 13

• List the most distinctive speech features of essential tremor according to Darley, Aronson, and Brown.

Answer 13

• Rhythmic Voice Tremor
• Rhythmic Changes in Pitch
• Rhythmic Changes in Intensity

Question 14

Define mixed dysarthria.

Answer 14

Disorders of multiple motor systems
Any combo of 2+ of the single dysarthria types are possible

Question 15

• List 3 etiology that could lead to mixed dysarthria.

Answer 15

Degenerative (ALS), Vascular, Trauma, Demyelinating

Question 16

• Define one difference between bulbar ALS and spinal ALS (related to initial stages)

Answer 16

Spinal- limb symptoms
Bulbar- speech and swallowing symptoms

Question 17

• List the most distinctive speech features of mixed dysarthria (ALS) according to Darley, Aronson, and Brown.

Answer 17

-speech will be involved in most patients
* one study of 100 ALS pts indicated that 75% of patients
could not speak at the time of death
* features of spastic and flaccid dysarthria present to
varying degrees across patients
* features may evolve quite dramatically over time

Question 18

• Define the neuromotor basis of apraxia.

Answer 18

Planning and programming errors

Question 19

Describe Liepmann’s 2 step praxis system.

Answer 19

2-step process that results in the execution of a purposeful movement
Step 1- ideation (IDEA about what needs to be done)
Step 2- Production (execution of task)

Question 20

• List 5 signs/symptoms of apraxia (motor)

Answer 20

1. groping/multiple attempts at a movement
2. spatial errors
3. inaccurate positioning of a body part
4. substitution of one action for another
5. delayed initiation of a movement

Question 21

• Contrast apraxia with dysarthria.

Answer 21

• fairly consistent errors (AOS highly variable errors)
• distortions more than substitutions (AOS frequent substitutions)
• errors often simplifications (AOS errors often complications)
• automatic non-speech oral movements impaired (AOS less impaired)

Question 22

Contrast apraxia with aphasia.

Answer 22

• language comprehension normal in AOS
• word finding normal in AOS
• written language has normal syntax and semantics
• often co-occurs with Broca’s aphasia but AOS can occur in ‘pure’ form (13%
  of pts)

Question 23

• List the specific areas of the brain most commonly associated with apraxia.

Answer 23

Left hemisphere damage, regions of the cortex and subcortex that are involved in the planning of programming of complex volitional movements
Specific areas:
-the lateral premotor cortex
-the insula
-the internal capsule
-the pathways connecting the parietal lobe to the frontal lobe

Question 24

• List the 4 speech features researchers have identified as being the most useful for identifying apraxia of speech.

Answer 24

Inconsistent articulatory errors
o these may be more complex errors rather than simplifications*
* *Effortful groping for correct articulatory postures at times with facial grimacing
o majority of errors are close approximations of target (place errors more frequent than manner and voicing)
Intrusive schwas, syllable segmentation and syllable lengthening (slow
rate and prosodic abnormality)
* *Difficulty initiating utterances

Question 25

* List patient speech-related complaints that could help differentially diagnose apraxia from other motor speech disorders.

Answer 25

“I know the word I want to say but they won’t come out right”

Question 26

* Describe why the Darley, Aronson and Brown classification system (Mayo Clinic) may not be appropriate for childhood motor speech disorders.

Answer 26

Systems are theoretically the same but actual mechanism is different due to development not fully completed, it is unclear whether the mechanisms are the same

Question 27

* Contrast congenital conditions vs. postnatal/acquired conditions vs. degenerative conditions.

Answer 27

Congenital: Initial neurologic damage is static, however the impact continues throughout subsequent motor development. Stabilizes in adulthood. Example: cererbral palsy Postnatal/Acquired: -Sudden onset, Neurologic recovery period, then Stabilization -Despite stabilization…impacts development of later motor skills Example: stroke, TBI, tumor, infection Degenerative: -Period of normal development prior to onset of progressive degeneration of neuromotor pathways -If no medical treatment options available: Treatment planning to meet communication needs while reflecting the expected deterioration of speech skills Example: muscular dystrophy (Duchenne’s), cerebellar degeneration (Freidreich’s ataxia), dystonia, metabolic disease (Wilson’s disease)

Question 28

Describe the primary and secondary characteristics of dysarthria in children and the role of the SLP as it relates to these characteristics.

Answer 28

- Primary: reductions in articulatory accuracy, intelligibility, speaking rate, and overall speech quality - Secondary: results of primary conditions, including difficulties with literacy, language development, and personal-social development skills

Question 29

* Define the primary goal of motor speech disorder management.

Answer 29

-Communication (restore, compensate, adjust) -Maximize efficiency, effectiveness, and naturalness of communication

Question 30

How do Restore, compensate, and adjust help therapy in relation to management of motor speech disorders.

Answer 30

Helps in direction of management

Question 31

Purpose of restore strategies in management?

Answer 31

-reduce impairment, restore original function -consider etiology, type, and severity of the disorder -full or partial recovery expected, restore is the best method (e.g., stroke, traumatic injury)

Question 32

Purpose of compensation strategies in management?

Answer 32

-promoting use of residual function -good when restoration of original function is unlikely or uncertain (even in the short term) -modifying rate, devices to amplify loudness of speech, augmenting speech with use of gestures

Question 33

Purpose of adjust strategies in management?

Answer 33

-either temporary or personal adjustments to the person’s lifestyle -responsibilities in daily life -preparing for loss of speech/function -minimizing adjustment in therapy so that their lifestyle can stay relatively normal

Question 34

Describe 2 conditions in which a patient is not a good candidate for SLP therapy.

Answer 34

-medical prognosis may influence treatment decisions -stamina and alertness may be fluctuating -surgery that is upcoming (such as tumor removal) would not treat until after the surgery

Question 35

* Describe 5 factors related to patient motivation and needs that could influence SLP management decisions.

Answer 35

1. personal goals 2. premorbid personality 3. lifestyle/living environment 4. co-existing motor, sensory, cognitive deficits 5. general health issues 6. health care system

Question 36

Speech Characteristics of Mixed Dysarthria

Answer 36

1. Articulation (98%) - imprecise consonants (95%) - irregular articulatory breakdowns (14%) 2. Abnormal AMRs (91%) - slow (72%) - imprecise (33%) - irregular (33%) 3. Phonation (57%) - harshness (39%) - reduced loudness (9%) - strained (5%) 4. Slow rate (23%) 5. Hypernasal (11%) 6. Weakness - unilateral lower facial weakness (82%) - unilateral lingual weakness (52%)