Motor Speech

Question 1

What is the difference between AOS and dysarthria

Answer 1

Dysarthria- motor execution

AOS- motor planning

Question 2

What do the lower motor neurons do?

Answer 2

They are the final common pathway
Carry impulses to muscle fibres
Include cranial nerves for speech
Damage to LMN would result in flaccid weakness

Question 3

What do upper motor neurons do?

Answer 3

Include corticospinal and corticobulbar tracts

Damage results in spasticity

Question 4

What aspects are used to describe dysarthric speech

Answer 4

Physiological- are the muscles moving
Neurological - where is it damaged
Acoustic- what effect does it have on the sound signal?
Perceptual- how does it sound

Question 5

Name the 5 types of dysarthria

Answer 5

Flaccid 
Spastic 
Ataxic 
Hypokinetic 
Hyperkinetic

Question 6

Name some features of flaccid dysarthria

Answer 6

Weakness
Lower motor neurons affected
Phonatory incompetence (breathiness, soft voice)
Resonatory incompetence (hypernasality, imprecise consonants)
Phonatory prosodic insufficiency (harsh voice, monoloudness, monopitch)

Question 7

Features of spastic dysarthria

Answer 7

• prosodic excess (excess stress, slow rate)
• articulatory resonatory incompetence (imprecise consonants, hypernasal)
• phonatory stenosis (strained, harsh, low voice)
• prosodic insufficiency (monopitch, monoloudness)

Question 8

Features of ataxic dysarthria

Answer 8

Articulatory inaccuracy (imprecise articulation, irregular breakdowns)
Prosodic excess (excess stress, slow rate)
Phonatory prosodic insuffiency (monoloudness, monopitch, harsh voice)
Mainly occurs with degenerative diseases

Question 9

Features of hypokinetic dysarthria

Answer 9

Prosodic insufficiency (monoloudness, monopitch, low volume, increased rate)
Often in Parkinson’s disease

Question 10

Features of hyperkinetic

Answer 10

Unpredictable involuntary movements

• respiration- sudden inspiration
• phonation- strained quality
• resonance - hypernasal
• Articulation- imprecise
• prosody- variable rate

Question 11

What is unilateral UMN dysarthria

Answer 11

Occurs in single lesion strokes 
Lower facial and tongue weakness 
Imprecise consonants 
Harsh voice, slow rate
Drooling from affected side

Question 12

Features of AOS

Answer 12

Occurs with dominant hemisphere damage 
Distorted articulation 
Slow effortful speech 
Groping 
Difficulty initiating

Question 13

What features do you look for when completing an observation of a dysarthric client

Answer 13

Speech mechanisms (speed, range of movement, symmetry, tone, precision)
Assess - respiration
-phonation
- articulation
- resonance

Question 14

How do you assess respiration

Answer 14

Posture normal?
Sufficient breath support?
Adequate loudness?
Assess maximum exhalation of /s/
Alternating loudness on /s/

Question 15

How do you assess phonation

Answer 15

Pitch level appropriate?
Voice quality normal?
Maximum phonation on /a/
Alternating pitch on /a/

Question 16

How do you assess resonance

Answer 16

Is nasality normal?
Is there nasal emission?
Observe for symmetrical palatial elevation

Question 17

Assessing articulation

Answer 17

Are consonants and vowels precise
Length of phoneme normal?
Irregular articulatory breakdowns?

Question 18

How do you assess mvmt of oral structures

Answer 18

Frenchay
Observe lips, jaw, face, tongue

Diadochokinetic (DDK) rates

• /p/ /t/ /k/ as fast possible (altering rates of motion)
• /p-t-k/ as fast as possible (sequential rates of motion)

Question 19

Name a scale used to rate severity of speech

Answer 19

Frenchay- 9point scale

Dysarthria profile- 5 point scale

Question 20

Name some assessment tasks for AOS

Answer 20

Spontaneous vs repetition
Automatic vs propositional (automatic better)
AMR vs SMR
(AMR better)
Length complexity

Question 21

What instrument measures muscle contraction.

Answer 21

Electromyography

Question 22

What can be used to visualise oral structures

Answer 22

Ultrasounds/ videofluoroscopys

Question 23

How do you measure respiratory volume

Answer 23

Spirometry

Question 24

What records mvmt of articulators during speech

Answer 24

Electromagnetic articulograph

Question 25

What is the difference between intelligibility and comprehensibility

Answer 25

Intelligibility- understanding acoustic signal | Comprehensibility - the same plus other information (eg gesture) that may contribute to understanding

Question 26

How can you assess and quantify intelligibility

Answer 26

Visual analogue scale % correct item identification by listener ASSIDS ( identify word from set of options) Transcription by listener Frenchay intelligibility section

Question 27

How can you assess a clients functional communication

Answer 27

Interview Dysarthria impact profile Communicative effectiveness survey (4 point scale)

Question 28

What is the purpose of management of motor speech

Answer 28

Maximise- Effectiveness of communication Efficiency of communication Naturalness of communication

Question 29

What are the different approaches to management for motor speech

Answer 29

``` Medical Prosthetic AAC Counselling Behavioural ```

Question 30

What are the two aspects to medical management of motor speech

Answer 30

Pharmacological - (medication eg in Parkinson’s, Botox injections) Surgical -( thyroplasty for VF paralysis, deep brain stimulation but can worsen dysarthria)

Question 31

Name some examples of prosthetic management

Answer 31

Palatal lift prosthesis Voice amplifier Pacing board Delayed auditory feedback

Question 32

What is considered in candidacy for AAC

Answer 32

``` Access (do they also have a physical impairment) Cognitive ability (attention, memory) Motivation Carer support Funding ```

Question 33

What does the speaker oriented approach aim to do

Answer 33

Reduce impairment | Compensate for impairment

Question 34

Management strategies for respiration

Answer 34

Direct- exhalation tasks, vowel prolongation, blowing into bottles Compensation- postural adjustment, abdominal breathing, phrasing

Question 35

Management strategies for phonation

Answer 35

Direct- lee Silverman voice treatment | 16 sessions/ 4 weeks, starting with /a/ working to connected speech, works on perception of loudness

Question 36

Management for resonance

Answer 36

Duffy 2013- non speech tasks eg blowing don’t help | Changing rate, overarticulation may help

Question 37

Management for articulation

Answer 37

``` Integral stimulation (watch and listen imitation) Phonetic placement Contrastive tasks (minimal pairs) Intelligibility drills (help from listener) ``` ``` Over articulation (improve clarity) Reduce rate (Duffy 2013 easiest to achieve) ```

Question 38

Management for prosody

Answer 38

Contrastive stress tasks Phrasing Loudness and pitch control

Question 39

What activities could you do to help AOS

Answer 39

Drill and repetition therapies

Question 40

What evidence is there for LSVT

Answer 40

Yorkston et al (2007) effective to increase intelligibility

Question 41

What evidence is there for Botox injections

Answer 41

Duffy and Yorkston (2003) improvement for spasmodic dysphonia

Question 42

Evidence for AOS therapy

Answer 42

Morgan et al (2018) positive outcome after 1 month with Nuffield and rapid syllable transition treatment

Question 43

Staging of dysarthria

Answer 43

``` 1- no detectable dysarthria 2- dysarthria detectable 3- reduced intelligibility 4- need for speech supplementation 5- no useable speech ```

Question 44

What type of dysarthria is most common in Parkinson’s

Answer 44

Hypokinetic

Question 45

What type of dysarthria is most common in Huntington’s disease

Answer 45

Hyperkinetic (affects basal ganglia)