Neurogenic Speech Disorders

Question 1

Neurogenic Speech Disorders

Causes of Neurogenic Speech Disorders

Answer 1

Cerebral Palsy
The Dysarthrias
Apraxia of Speech

Question 2

Related to problems of movement can affect all speech processes

Answer 2

 *Planning
 *Coordination
 *Timing
 *Execution
Heterogeneous group of disorders.

Question 3

Common causes

Answer 3

Common causes  *Stroke
 *TBI
 *Anoxia
 *Brain Tumors  *Infections
 *Toxins
 *Diseases
 Speech may vary widely

Question 4

Cerebral palsy

Answer 4

Nonprogressive neurological difficulty
 Brain injury early in fetal or infant
development
 Affects
 *Movement, communication, development, locomotion, learning and sensation
 Over 500,000 individuals in the U.S. have CP
 30-90% also have dysarthria

Question 5

Hemiplegia

Answer 5

Hemiplegia: one side of the body, the right or left is paralyzed

Question 6

Paraplegia

Answer 6

 Paraplegia: only the legs and lower trunk are paralyzed

Question 7

Monoplegia

Answer 7

Monoplegia: only one limb or a part thereof is paralyzed

Question 8

Diplegia

Answer 8

Diplegia: either the two leg or the two arms are parlayzed

Question 9

Quadriplegia

Answer 9

Quadriplegia (all four limbs are paralzed

Question 10

Types of cerebral palsy

Answer 10

Spastic=-Hypertonia

Athetoid =Dyskinesia

Ataxic = Ataxia

Question 11

Spastic

Answer 11

Spastic
-Hypertonia
-Movement is jerky, labored, slow
-Infantile Reflex patterns
-Motor cortex and/or pyramidal tract

Question 12

Athetoid

Answer 12

Athetoid
-Dyskinesia
-Slow, involuntary writhing -Infantile Reflex patterns -Extrapyramidal tract, basal ganglia

Question 13

Ataxic

Answer 13

Ataxic
-Ataxia
-Uncoordinated and disturbed balance
-Movements lack direction, adequate force and rate, direction control. -Injury to cerebellum

Question 14

Motor Speech Problems with cerebral palsy

Answer 14

Motor Speech Problems
 *All aspects of speech may be affected
 *Swallowing/breathing affected
 *Voice quality reflects hypotonia
 *Resonance is hypernasal
 *Articulation may be extremely difficult, possibly unintelligible
 *Prosody monotonous, choppy, or non-fluent
 *Additional complications
 –Intellectual, auditory, processing, language impairments

Question 15

Lifespan issues with cerebral palsy

Answer 15

 Early Symptoms
 *Irritability, weak crying/sucking, excessive sleeping, little interest in surroundings, persistence of primitive reflexes
 *Motor delays are often the first sign
 *Usually receive early intervention
 -Focus on movement and communication
 *Important to assess cognition
 *May obtain higher education and hold employment
 *May work or learn in special programs

Question 16

Assessment for cerebral palsy

Answer 16

 *TEAM
 *Pediatrician
 *Neurologist
 *PhysicalTherapist
 *Otolaryngologist
 *Speech-Language-Pathologist
 *OccupationalTherapist
 Thoroughly assess oral mechanism and potential for AAC
 Electropalatograph (EPG)

Question 17

Intervention for cerebral palsy

Answer 17

Speech and language training
 Systems approach
 Prosthetic devices/intraoral surgery
 Electopalatograph
 AAC
 Work with Physical Therapist to facilitate movement patterns
 Consult with parents about expectations

Question 18

The dysarthrias

Answer 18

A group of neuromuscular impairments that affect speed, range, direction, strength, and timing of motor speech movements.
*Result of paralysis, weakness, discoordination All speech processes may be affected
Motor movements
*Sloworrapid *Decreasedrangeofstrength *Poordirectionalityorcoordination
Intelligibility most affected by involvement of jaw, tongue, lips and soft palate

Question 19

Types of Dysarthrias and Associated Etiologies

Answer 19

Types of Dysarthrias and Associated Etiologies
 *Different types result from lesion location within the CNS
 Flaccid
 Spastic
 Ataxic
 Hyperkinetic
 Hypokinetic

Question 20

Flaccid Dysarthria

Answer 20

Hypotonia
 Lesions in cranial/spinal nerves,
muscle unit
Reduced vital capacity, shallow breathing, breathy voice, aphonia
 *Bulbar Palsy
 *Myasthenia Gravis
 *Muscular Dystrophy

Question 21

Spastic dysarthria

Answer 21

Results of lesions in lower brain  Bilateral lesions are more severe Speech characteristics
 *Slow and jerky, imprecise articulation, reduced rapid alternating speech
Pseudobulbar palsy

Question 22

Ataxic dysarthria

Answer 22

 Damage to cerebellum
 Result of breakdown in motor organization
and control
 Affects accuracy, timing and direction
 Speech Characteristics
 *Shift in Fo, variability in moving between speech sounds, energy varies across syllables, respiration poorly coordinated, voicing/articulation imprecise

Question 23

Hyperkinetic

Answer 23

Lesions in lower and mid brain Tremors, tics
Inaccurate articulation
 Types
 *Dystonia
 Chorea Huntington Chorea

Question 24

Hypokinetic

Answer 24

Lesions of mid and lower brain Decrease or lack of
appropriate movement Muscles become rigid and stiff  Example:
 Parkinson’sDisease

Question 25

Mixed dysarthria

Answer 25

Symptoms or areas of brain that cross several dysarthrias Diffuse brain damage *Degenerative disorders, toxins, metabolic disorders, stroke, trauma, tumors, infectious disease Example *Amyotrophic Lateral Sclerosis

Question 26

Lifespan issues

Answer 26

Acquired dysarthria mostly occurs in adults  Even slight speech imperfection can cause embarrassment  Reduced social interaction  Progressive disorders  *May be unable to care for themselves  AAC

Question 27

Assessment for dysarthria

Answer 27

 Purpose of Evaluation  *Determine if there is significant long-term  *Describe impairment  *Identify functions not impaired  *Establish goals and baseline for intervention  *Form prognosis  Oral Peripheral Exam and samples of speech in several contexts  Range, speed, and direction of oral movement  Standard Assessment

Question 28

Intervention for dysarthria

Answer 28

Evidenced-based practice does not support non-speech oral motor treatments  Intervention may include  *Drill, progressively complex tasks, feedback  Exercises for respiration and hypernasality  LSVT for Parkinson’s disease  Speech and non-speech movements respond differently to neurosurgical, genetic, pharmacological intervention

Question 29

Apraxia

Answer 29

 Disorder in voluntary motor placement/sequencing, unrelated to weakness, slowness, paralysis  Oral Apraxia  Apraxia of Speech  *Problem of speech-sound articulation and prosody or rhythm  *Groping attempts and great variability  *Repeated attempts to correct errors  *Complex, long words are difficult  *Children can exhibit developmental apraxia of speech

Question 30

Etiology for apraxia

Answer 30

Lesion of the central programming area for speech  Broca’s area  * Details and plans speech motor movements  Most common causes  *Stroke  *Degenerative Disease  *Trauma

Question 31

Assessment apraxia

Answer 31

 Important aspects of assessment  *Imitation of single words of varying length  *Sentence Imitation  *Reading aloud  *Spontaneous speech  Rapid repetition of “puh”, “tuh”, “kuh” and “put-tuh-kuh”  Perform better with auditory-visual stimuli

Question 32

Intervation for apraxia

Answer 32

Attempt to increase muscle tone and strength  Sensory bombardment  Imitation, simultaneous production, spontaneous speech  AAC  Electromagnetic articulography  Decrease speech rate  Frequently used phrases are practiced and incorporated in verbal repertoire