neurogenic speech disturbances

Question 1

mutism etiologies

Answer 1

• Severe dysarthria
• Laryngectomy
• Apraxia of speech
• Aphasia
• Disorders of arousal or consciousness
• Postictal

Question 2

anarthria

Answer 2

• Speechlessness resulting from severe loss of neuromuscular control over speech
  (AoS or dysarthria in its most severe form)
• Language and cognitive abilities may be intact
• May be end stage of dysarthria for degenerative diseases:
  Amyotrophic lateral sclerosis (ALS), Multiple system atrophy (MSA), Progressive supranuclear palsy syndrome (PSPS), Corticobasal syndrome (CBS)
• Spastic and hypokinetic dysarthria types most likely to lead to anarthria

Question 3

locked-in syndrome

Answer 3

• Mutism
• Quadriplegia
• Preserved consciousness and vertical eye movements or blinking
• Severe spastic or mixed spastic-flaccid type dysarthria
• Usually severe dysphagia

Question 4

AOS with mutism

Answer 4

• Only lasts a few days if stroke is etiology
• Usually have concomitant non-verbal oral apraxia

Question 5

aphasia with mutism

Answer 5

• May be present initially
• Usually transforms into transcortical motor aphasia
• Prosody may be flat

Question 6

Disorders of arousal, responsiveness, and diffuse cortical functions

Answer 6

• coma
• vegetative state
• minimally conscious state
• akinetic mutism

Question 7

coma

Answer 7

• Unarousable unresponsiveness and absence of sleep/wake cycles on EEG
• Typically caused by diffuse bilateral cerebral hemisphere damage, brainstem injury, or both

Question 8

vegetative state

Answer 8

• Wakeful unawareness often associated with severe bilateral cerebral hemisphere involvement without brainstem involvement

Question 9

minimally conscious state

Answer 9

Have a degree of awareness and responsiveness; may not be entirely mute

Question 10

akinetic mutism

Answer 10

• Reduced motivation (abulia) to speak, difficulty initiating and sustaining the cognitive and motor effort required for speech
• Massive bifrontal lobe damage

Question 11

Etiology-specific neurogenic mutism

Answer 11

• Speech arrest: Following seizure (ictal, post-ictal state)
• Drug-induced mutism
• Mutism after corpus callosotomy

Question 12

Rancho Los Amigos levels of cognitive functioning

Answer 12

I. No Response: Total Assistance
II. Generalized Response: Total Assistance
III. Generalized Response: Total Assistance
IV. Confused/Agitated: Maximal Assistance
V. Confused, Inappropriate Non-Agitated: Maximal Assistance
VI. Confused, Appropriate: Moderate Assistance
VII. Automatic, Appropriate: Minimal Assistance for Daily Living Skills
VIII. Purposeful, Appropriate: Stand-By Assistance
IX: Purposeful, Appropriate: Stand-By Assistance on Request
X. Purposeful, Appropriate: Modified Independent

Question 13

acquired neurogenic stuttering

Answer 13

dysfluent speech acquired as a direct result of neurologic disease

Question 14

acquired neurogenic stuttering - etiologies

Answer 14

• Stroke and closed head injury most common
• Parkinson’s disease, PSPS, MS, dementia, corticobasal syndrome, multiple system atrophy, seizure disorders, dialysis dementia, brain tumor, anoxia, bilateral thalamotomy, thalamic or globus pallidus deep brain stimulation, drug toxicity or abuse

Question 15

acquired neurogenic stuttering - characterisitcs

Answer 15

• sound/syllable repetitions, prolongations, and blocking/hesitation
• May not be restricted to initial syllables
• Can occur within content and function words
• Awareness of dysfluencies but without significant anxiety or secondary struggle behavior
• May not demonstrate an adaptation effect or improvement with choral reading or singing

Question 16

acquired neurogenic stuttering- possible associated deficits

Answer 16

• Aphasia
• Apraxia of speech
• Dysarthrias (hypokinetic more than other types)

Question 17

palilalia

Answer 17

compulsive repetition of words and phrases

Question 18

palilalia - etiologies

Answer 18

• Parkinson’s disease/parkinsonism, Alzheimer’s disease and other dementias, progressive supranuclear palsy syndrome, closed head injury, stroke, tumor, multiple sclerosis, Tourette’s syndrome, post thalamotomy
• bilateral basal ganglia pathology

Question 19

palilalia- characteristics

Answer 19

• Repetitions of words or phrases
• Increased rate and decreased loudness with successive repetitions (not invariable)
• Most prominent during spontaneous and elicited speech; tends to be reduced during reading, repetition, and automatic speech tasks
• Most common toward end of utterances but can occur anywhere
  adaptation effect uncommon
• Awareness of deficit possible but no anxiety or secondary struggle
• Reiterations can be inhibited temporarily, with effort

Question 20

echolalia - types

Answer 20

• Mitigated
• Ambient
• Effortful
• Silent, simultaneous

Question 21

echolalia

Answer 21

unsolicited repetition of another’s utterances

Question 22

echolalia-etiologies

Answer 22

Stroke, Alzheimer’s disease, Pick’s disease and other dementias, PSPS, corticobasal syndrome, carbon monoxide poisoning, Tourette’s syndrome, status epilepticus, schizophrenia, mental retardation, ASD, post emergence from coma

Question 23

echolalia- characteristics

Answer 23

• Unsolicited repetition of others’ utterances
• Compulsive, parrot-like quality
• Repetition may be complete or partial, sometimes with spontaneous correction of syntax

Question 24

echolalia- associated deficits

Answer 24

• aphasia
• diffuse cognitive deficits

Question 25

attenuation of speech- etiologies

Answer 25

common: closed head injuries (CHI)

Question 26

attenuation of speech- characteristics

Answer 26

reduced speed of verbal responding , reduced linguistic and cognitive complexity of content, reduced vocal loudness and incomplete phonation, and flattened prosody

Question 27

attenuation of speech- associated deficits

Answer 27

- cognitive and affective impairments - Dysphonia/aphonia associated with postintubation, psychogenic

Question 28

disinhibited vocalizations- characteristics

Answer 28

e.g. verbal or vocal tics, repetitive grunting, groaning, humming, or lip smacking

Question 29

disinhibited vocalizations - associated deficits

Answer 29

Diffuse cognitive impairment

Question 30

disinhibited vocalizations- etiologies

Answer 30

Alzheimer’s disease, Tourette’s syndrome

Question 31

FAS

Answer 31

- Neurologic speech disorder in which articulatory and prosodic characteristics are perceived as a foreign accent (A.K.A. pseudoforeign accent) - Unreliability among listeners regarding the specific accent perceived

Question 32

FAS- devient speech characteristics

Answer 32

- Vowel changes-diphthongization; distortions and prolongations, omissions of unstressed vowels, epenthesis - Consonant changes-alterations in voicing, place, and manner features, leading to perception of substitutions - Prosodic changes-alterations in stress, rhythm, and intonation

Question 33

FAS- etiologies

Answer 33

Stroke, CHI, MS, brain tumor, dementia, and primary progressive aphasia

Question 34

FAS- associated deficits

Answer 34

- aphasia - AOS - nonverbal oral apraxia

Question 35

aprosodia

Answer 35

- Disturbances in the prosodic components of speech that are tied to the expression of attitudes, emotion, and emphasis - Require an ability to manipulate speech planning, programming and, monitoring for pragmatic/social purposes

Question 36

aprosodia- patient complaints

Answer 36

- Voice does not convey felt emotions - Altered pitch, either lower or higher - Reduced pitch range - Reduced loudness

Question 37

aprosodia- perceptual characteristics

Answer 37

- Flattened, robot like spontaneous prosody - Reduced pitch and loudness variation - Reduced or abnormal intonational range - Reduced affect, expression, and emotion; indifferent - Tendency to equalize stress - Poor expression of irony and sarcasm - Poor projection of voice - Lack of emphasis - Abnormal quality to emotional crying and laughter

Question 38

aprosodia- accompanying deficits

Answer 38

- Paucity of spontaneous emotional and propositional gestures - Left-sided neglect - Visuoperceptual disturbances cognitive-communicative deficits - Left central facial weakness - Dysarthria (unilateral UMN) - Left hemiparesis

Question 39

aprosodia - etiologies

Answer 39

stroke most common but can include any process that damages right or nondominant hemisphere