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Flashcards in Motor Speech Disorders Deck (47):
1

dysarthria

speech disorder caused by neurologic damage

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AOS

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

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CN V function & change in speech

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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CN VII function & change in speech

Facial

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

damage: distortion of bilabial, labiodental sounds, slow rate

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CN X function & change in speech

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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CN XII function & change in speech

hypoglossal

innervation of tongue muscles

damage: mild-sever consonant imprecision vowel distortion

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planning

selecting the sounds you want to say

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programming

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

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Langmore dysarthria eval components

1. motor parameters
2. speech parameters
3. speech motor subsytem

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Langmore's motor parameters (7)

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

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Langmore's speech parameters (4)

1. phonation
2. resonance
3. articulation
4. prosody

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Langmore's speech motor subsystem (4)

1. respiratory
2. laryngeal
3. velopharyngeal
4. orofacial

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what to include in SUMMARY & FORMULATION on comps

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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Severity - Mild (Langmore)

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

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Severity - Mild/Mod (Langmore)

-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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Severity -Moderate (Langmore)

-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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Severity - Mod/Severe (Langmore)

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

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Severity - Severe (Langmore)

-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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Flaccid speech characteristics

-hypernasality
-nasal emission
-short phrases
-breathiness
-inhalatory stridor

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Flaccid motor characteristics

-decreased muscle tone
-decreased/absent reflexes
-weak
-atrophy
-fasiculation

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Flaccid dysarthria neuro damage

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

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Flaccid dysarthria common causes

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

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spastic dysarthria speech characteristics

-harshness
-low pitch
-slow rate
-strained/strangled quality
-pitch breaks
-slow & regular AMRs

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Spastic motor characteristics

- increased muscle tone
-hyperactive reflexes
-slow
-loss of fine motor control & agility/precision

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spastic neuro damage

-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)

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spastic common causes

-degernerative diseases
-stroke (usually multiple strokes or UMN brainstem stroke)

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hypokinetic speech

-monopitch
-monoloud
-variable rate
-rapid "blurred" AMRs
-short rushes of speech
-reduced stress

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hypokinetic motor impairments

-rigidity
-bradykinesia
-akenesia (loss of automaticity)
-festination
-tremor
-excessive tone

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Hypokinetic common causes

-degenerative diseases (PD, PSP)
-vascular strokes

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hypokinetic neurological damage

-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

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ataxic dysarthria speech

**sounds like a drunk person

-irregular articulartory breakdowns
-prosodic excess
-prolongation of phonemes
-irrgular AMRs
-excessive loudness variation

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ataxic motor

-reduced movements
-slow (esp repetitive movements)
-inaccurate/dysmetria
-incoordination/dysdiachochokinesis
-intention tremor

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ataxic neuro

disruption to the cerebellar circuit

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

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ataxic dysarthria causes

-degernerative diseases
-demyelinating diseases (MS)
-TBI
-Vascular
-cerebellar tumors

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hyperkinetic speech

-slow/irregular AMRs
-distored vowels
-prolonged intervals
-voice tremor
-transient breathiness

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hyperkinetic motor

-quick/slow involuntary muscle movements that interfere with voluntary muscle movements
-slow
-reduced force
-irregular rhythm
-dyskinesias

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hyperkinetic neuro

-lack of GABA and excess dopamine with cortico-frontotemporal atrophy

-CNS dysfunction-GG circuits

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hyperkinetic common causes

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

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unilateral upper motor neuron flaccid dysarthria speech

-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

unilateral upper motor neuron flaccid dysarthria damage neuro damage

-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

Vertebobasilar artery stroke

UMN damage --> spastic dysarthria

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

42

ICA stroke (Internal Carotid) -- MCA, ACA

-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

Lacunar Strokes

-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

dysarthria in parkinsons

hypokinetic

*look at hypo kinetic notecard

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dyarthria in PSP

mixed hypo, spastic, and ataxic

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dysarthria in MS

--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)

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dysarthria in ALS

*mixed spastic & flaccid

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