Motor Speech Disorders

Question 1

MSD

Answer 1

breakdown in control over muscular speech movements as a consequence of CNS or PNS damage

Question 2

Two classes of MSD

Answer 2

Dysarthria, Apraxia of Speech

Question 3

Dysarthria

Answer 3

any disorder where respiration, phonation, articulation, resonation, or prosody is affected.

Question 4

Defective voice and articulation from abnormal muscular control while…

Answer 4

speaker’s language and knowledge of how to produce sounds are normal.

Question 5

Apraxia aka

Answer 5

cortical dysarthria and phonetic disintegration

Question 6

apraxia may occur…

Answer 6

alone or as part of Broca’s or motor aphasia

Question 7

Muscle strength in apraxia

Answer 7

intact, but loss of knowledge of correct placement of articulators for production of phonemes

Question 8

Apraxia, instead of distortions, one hears…

Answer 8

substitutions, additions, omissions, reversals of sounds

Question 9

T/F in Apraxia, trial and error movements can be present

Answer 9

TRUE

Question 10

FD-Flaccid dysphonia

Answer 10

secondary to unilateral VF paralysis owing to lesion to RLN unilaterally

Question 11

FD-Flaccid dysarthria

Answer 11

caused by flaccid paralysis of phonatory, resonatory, articulatory musculature owing to multiple CN lesions bilaterally

Question 12

FD-Spastic dysarthria

Answer 12

resulting from spasticity of the peripheral speech musculature because of bilateral UMN lesions

Question 13

FD-Ataxic dysarthria

Answer 13

muscular incoordination from a lesion in the cerebellum

Question 14

FD-Hypokinetic dysarthria

Answer 14

in Parkinsons from rigidity of peripheral speech musculature caused by lesion in the basal ganglia.

Question 15

HD-Hyperkinetic dysarthria-chorea

Answer 15

quick, spontaneous, uncontrolled movements from lesion in basal ganglia

Question 16

HD-Hyperkinetic dysarthria-distonia

Answer 16

slow, continuous, uncontrolled movements from a lesion in the basal ganglia

Question 17

HD-Hyperkinetic dyarthria-organic voice tremor

Answer 17

spontaneous rhythmic movement of laryngeal musculature from lesion of undetermined origin

Question 18

HD-Hyperkinetic dyarthria-Paloatopharyngolaryngeal Myoclonus

Answer 18

spontaneous clonic muscular movementof larynx, pharynx, soft palate from lesion in brainstem.

Question 19

HD-Hyperkinetic dyarthria-Gilles de la Tourette’s Syndrome

Answer 19

uncontrolled barking and coperlalia from lesion of undetermined origin

Question 20

MD-Mixed dysarthria-amyotrophic lateral sclerosis (ALS)

Answer 20

spastic and flaccid simultaneous, caused by degenerative lesions of UMN and LMN systems

Question 21

MD-Mixed dysarthria-Multiple Sclerosis (MS)

Answer 21

ataxic and spastic simultaneous, demylenization of UMN and cerebellar motor neurons

Question 22

MD-Mixed dysarthria-Wilson’s Disease

Answer 22

ataxic, spastic, hypokinetic dysarthria occur due to excess copper deposits in neurons of cerebellum, pyramidal system, and basal ganglia

Question 23

MD-Apraxia of Speech

Answer 23

inability to produce or sequence sounds in absence of significant paralysis

Question 24

3 quick diagnostic activities

Answer 24

1. contextual speech sample from reading standard paragraph
2. prolongation of vowel
3. repetition of “puh” “tuh” “kuh”

Question 25

Diadokinetic rates

Answer 25

Repetition of puhduhkuh as fast and evenly as possible. Evaluates rate, regularity, and duration of alternate movements of the articulators.

Question 26

Prolongation of vowel

Answer 26

Evaluate quality, loudness, duration, steadiness of phonatory control

Question 27

Speech sample from paragraph

Answer 27

evaluate integration of respiratory, phonatory, resonatory, articulatory, prosodic elements of contextual speech.

Question 28

QUICK Ataxic Dysarthria

Answer 28

Results from damage to the cerebellar system. It is characterized predominantly by articulation and prosody problems.

Question 29

QUICK Flaccid Dysarthria

Answer 29

Results from damage to the motor units of cranial or spinal nerves that supply speech muscles. Depending on the nerves involved, it may be characterized by respiratory, phonatory, articulatory, prosodic or resonance disorders.

Question 30

QUICK Hyperkinetic Dysarthria

Answer 30

Develops due to damage to basal ganglia circuitry | Causes extraneous, involuntary movement of speech musculature. Prosodic disturbances are dominant.

Question 31

QUICK Hypokinetic Dysarthria

Answer 31

damage to the basal ganglia; often seen in parkinson's disease; hypertoned and rigid muscles; resting tremor that disappears with voluntary movement; accelerated movements and short rushes of speech; monopitch and loudness

Question 32

QUICK Spastic Dysarthria

Answer 32

Results from bilateral damage to the upper motor neurons (UMN). Increased muscle tone with spasticity in various muscles of the vocal tract resulting in weakness, reduced range of motion, decreased fine motor control. Laryngeal muscles and velum are most affected

Question 33

QUICK Mixed Dysarthrias

Answer 33

A combination of two or more pure dysarthrias. The most common are flaccid-spastic dysarthria and ataxic-spastic dysarthria.

Question 34

QUICK Unilateral Upper Motor Neuron Dysarthria

Answer 34

Dysarthria due to damage to the pathway that supply cranial or spinal nerves involved in speech production. Characterized by poor control of facial muscles and articulation difficulty.

Question 35

How do you evaluate respiration?

Answer 35

Listen to volume of speech, ask pt to count from 1-20 on one breath, ask pt to produce /a/ from soft to loud, listen to conv. If you hear -- it may mean... Reduced overall loudness, monoloudness, short phrases -- Weakness of muscles Reduced overall loudness, monoloudness, impaired loudness control -- Abnormal tone Sudden forced inspiration or expiration, speaking on low air -- In-coordination of respiratory muscles

Question 36

How do you evaluate phonation?

Answer 36

Listen to spontaneous cough to judge strength of closure, Ask pt to produce /a/ and hold it and listen for tremor, Ask pt to grunt (produce glottal stop), Ask pt to sing a few notes up and down to determine control of laryngeal movement, Listen to reading or conversation. If you hear -- it may mean... Breathiness, hoarseness, monopitch, decreased loudness, short phrases, audible inspiration -- Weakness in laryngeal muscles Breathiness, hoarseness, monotone, decreased loudness, low pitch -- Reduced tone Strained, strangled dysphonia, harshness, low/high pitch, monoloudness, pitch breaks -- Increased tone Inappropriate pitch changes, inconsistent hoarseness,voicing errors, tremors, excessive loudness variations, audible inspiration -- Incoordination of laryngeal muscles.

Question 37

How do you evaluate resonance?

Answer 37

Ask pt to say /i/ and occlude nose and release (if no problem with resonance, there will be no change is quality. If pt is hypernasal, there will be a change in quality; Repeat nasal vs non-nasal sentence (Please pat the pretty puppy. My mom made many more.) Place mirror under nose if nasal emission is suspected, Observe movement of soft palate. If you hear -- it may mean... Hypernasality and/or nasal emission -- Weakness of velopharyngeal muscles. Hypernasality -- Increased tone.

Question 38

How do you evaluate articulation?

Answer 38

Assess oral motor movements unrelated to speech, diadochokinesis (alternate/sequential), word/phrase repetition, word/sentence/passage reading, conversation. If you hear -- it may mean... Certain sounds consistently misarticulated -- Indicates dysarthria vs. apraxia Slow alternative motion rates (AMR) and sequential motion rates (SMR) -- many types of dysarthria AMRs and SMRs irregular in rhythm -- Hypokinetic and some types of Hyperkinetic dysarthria.

Question 39

What is prosody?

Answer 39

Results from the appropriate use of the respiratory, phonatory and articulatory sub-systems. Prosody is stress, intonation, rate and rhythm.

Question 40

How do you evaluate prosody?

Answer 40

Stress: Get perception of syllable emphasis (word/sentence level), contrastive stress drills, signaled by pitch, loudness and duration Intonation: Get perception of changes in fundamental frequency during speech, repetition of 8 basic word -level patterns, Declarative/interrogative sentence repetition, ask pt to repeat a sentence with different meanings, Rate and Rhythm: Rate is artic time and pause time. Rhythm is a durational relationship between artic time and pause time. Listen to conversational speech. Tips to calculate normal rate: 130-220 words per minute 3-5 syllables per second 12-20 syllables per breath

Question 41

Etiology and types of dysarthria

Answer 41

Tumors rarely cause hyperkinetic dysarthria. Toxic and metabolic disturbances rarely cause flaccid and unilateral upper motor neuron dysarthria. Infectious and inflammatory conditions do not often cause dysarthria of any type. Demyelinating diseases may cause any type of dysarthria, but rarely hypokinetic. Anatomic malformations are usually associated with flaccid dysarthria. Neuromuscular junction disorders, muscle disease, and neuropathy cause flaccid dysarthria. Hypernasal - Nasal emission usually doesn't occur with spastic dysarthria. Hyponasal - Dysarthria does not cause hyponasality.

Question 42

Differential Diagnosis: Dysarthria Types

Answer 42

Spastic: Strained, strangled phonation with hypernasality, imprecise consonants and impaired stress. Flaccid: Typically breathy, hypernasal, and imprecise consonants, but depends on site of lesion. Hypokinetic: Increased rate with imprecise consonants and decreased loudness. Hyperkinetic: Typically strained phonation with hypernasality, imprecise consonants, and variable rate (but depends on etiology). Unilateral Upper Motor Neuron: Harsh phonation, imprecise consonants with irregular articulatory breakdowns Ataxic: Excessive loudness variations, irregular articulatory breakdowns, impaired prosody

Question 43

cognitive-linguistic processes

Answer 43

thoughts, feelings, emotions are converted into verbal symbols through language. Where the desire to move may originate

Question 44

motor speech planning and programming

Answer 44

neuromuscular organization of verbal messages which activate speech muscles at appropriate times.