Neuromotor Disorders

Question 1

Dysarthria

Answer 1

(muscle); any where in motor system

A group of speech disorders resulting from disturbances in muscular control

Damage to the CNS or PNS causes some degree of weakness, slowness, incoordination, or altered muscle tone characterizes the speech mechanism.

Problems:

1. Tone (low or high tone – not contracting enough or contracting too much)
2. Strength (hypercontration is not an indication of strength)
3. ROM (range of motion – tongue movement)
4. Coordination

Question 2

Flaccid Dysarthria

Answer 2

• always due to damage of the LMN; brain stem lesions are most common
• speech observed depends on the speech processes that are involved
• Two significant symptoms:
o 1. Weakness
o 2. Hypotonia

Question 3

Dysarthria – Weakness

Answer 3

• Stems from damage to the motor unit
• When damaged, motor unit becomes inactivated with a lost or diminished ability to contract
• When there is complete inactivation to a muscle, there is paralysis; when there is reduced inactivation to the muscle, there is paresis
• Difference between high, normal, and low tone

Assessment: vowel prolongation, diadochokinetic rate, connected speech sample

Question 4

Speech and Vocal Chara. due to a Lesion

Answer 4

1. Hypernasality
2. Imprecise consonants
3. Breathiness
4. Monopitch
5. Nasal emission
6. Audible inspiration
7. Harsh voice quality
8. Short phrases
9. Monoloudness

Question 5

Spastic Dysarthria

Answer 5

• Caused by bilateral damage to the upper motor neurons
• The muscles described as “spastic” have increases muscle tone, but are not stronger because of it; muscles are stiff and move sluggishly through a limited range
• Speech is labored

Question 6

Spastic: Most salient charact.

Answer 6

• Strained-strangled, harsh voice w/monopitch and monoloudness
• Hypernasality (related to vowels) w/ nasal emission (related to consonants)
• Slow, labored, imprecise articulation
• Short phrasing (voice qualities and respiration)

Question 7

Ataxic dysarthria

Answer 7

• Caused by damage to the cerebellum or its pathways
• Damage results in “dragging and blurred” quality of speech that sounds something like drunken speech

Question 8

Ataxic: Most salient charact.

Answer 8

• Imprecise articulation (consonants and vowels) with irregular breakdowns
• Intonation and stress misplaced with prolonged sounds and intervals
• Harsh vocal quality (not common in all patients)

Question 9

Hypokinetic Dysarthria (too little movement)

Answer 9

• Caused by damage to the basal ganglia or their connections in the CNS (eg., Substania nigra where dopamine is produced). It typically carries the diagnosis of Parkinson’s Disease but may have other etiologic factors such as TBI. Stroke, toxic metal poisoning, etc.
• Too much dopamine can have adverse affects
• Characteristics may be found in any of the processes; respiration, resonatory, phonatory, articulatory, or prosody
• Characteristics are most evident in phonatory, articulatory, and prosodic processes
• Only dysarthria where increased rate of speech is a symptom (walking after a stroke – slow down to be safe, even though it’s the normal rate; weaker muscles in speech, so normal rate is still too fast)

Question 10

• Hypokinetic: Most salient characteristics

Answer 10

• Imprecise artic w. rushes of speech and palilalia (jumbled speech sounds because how fast they are talking) at times
• Inappropriate silences (akinesia? – ask them to do something and they don’t do it or do so slowly)
• Breathy and possibly harsh vocal quality (low and soft)
• Monoloudness and monopitch
• Masked facies (have difficulty expressing feeling in their faces – like flat affect)

Question 11

Typical charact. Of Parkinson’s Disease

Answer 11

1. Tremors

• resting – tremor you see at rest (can see it in the lingual muscle or in the face)
• action – see them when they start to move
• 2. Bradykinesia
     * Slow and reduced ROM
     * tiny shuffling; arms don’t swing
• 3. Muscle rigidity
     * there is constant resistance to extending a joint; relatively equal in all muscle groups
• 4. Akinesia
     * delay initiating movements
     * problem with postural reflexes

Question 12

Hyperkinetic dysarthria (too much movement)

Answer 12

Multiplicity of causes that all relate to problems with the basal ganglia

• Multiple movement doesn’t seem to have any meaning
• Chorea (random involuntary movements that appear smooth, coordinated, and dancelike)

Question 13

Hyperkinetic dysarthria: Most Salient Charact

Answer 13

• Variations of the speech rate and loudness
• imprecise articulation (consonants and vowels)
• long silence (internals) between syllables and words and prolonged phonemes

Question 14

Unilateral UMN Dysarthria

Answer 14

• This is not part of the initial classification system espoused by Mayo Clinic
• Bilateral damage to the brain often causes significant speech symptoms
• Unilateral damage usually produces only mild to moderate speech impairment (tongue deviates to one side)
• The most apparent symptoms are those of the lower face and tongue
• With milder cases, recovery may be over a short period of time and may be relatively complete
• May co-occur with aphasia, apraxia, and other disorders (makes it difficult to distinguish between the others

Question 15

Unilateral UMN Dysarthria: Most salient charact.

Answer 15

• Imprecise artic w. slowed diadoch. Rates
• Mild to moderate harsh vocal quality (only in some patients)
• Temporary and mild symptoms typical

Question 16

Mixed Dsyarthria

Answer 16

• Occurs when two or more of the parts of the motor system are impaired, and at least two types of dysarthrias are demonstrated
• Realistically, neurological damage often affects various areas; for example, a single brain stem stroke can affect

Question 17

Etiologies of Mixed Dysarthria

Answer 17

• Multiple Sclerosis (MS)
• Amyotrophic Lateral Sclerosis (ALS)

Question 18

Multiple Sclerosis (MS)

Answer 18

• A progressive disease where the myelin degenerates
• It is quite common, occurring in approx. 100/100,00 people
• More often occurs in women (1.7:1) and in their 30s
• With MS, you can have focal lesions or those that affect many areas – determines the speech charact. Observed
• Research demonstrates that about 85% fo the MS pop has adequate speech or mild deficits

Question 19

Amyotrophic Lateral Sclerosis (ALS)

Answer 19

• Etiology is unknown; occurs in about 1.5/100,000 of pop.; more common in males
• Progression can be quick and is deadly, occurring in a few months or sometimes years after diagnosis
• Most all motor movements are affected toward the end of life
• Cognitive impairment is not a symptom
• Tend to die because of something like pneumonia

Question 20

Speech Chara. of Amyotrophic Lateral Sclerosis (ALS)

Answer 20

• Impaired loudness control
• Harsh voice quality
• Imprecise articulation
• Impaired emphasis (scanning speech)
• Decreased vital capacity
• Hypernasality
• Inappropriate pitch level
• Breathiness
• Increased breathing rate
• Sudden articulatory breakdowns

Question 21

Apraxia

Answer 21

(motor programming – frontal lobe)

• impairment of the brain that specifically relates to motor programming (Brodmann’s area 44), Broca’s area
• Damage to UMN: Spastic
• Damage to LMN: Flaccid
• Can also have mixed
• speech muscles have bilateral innervation (get chips from more than one factor) – required to have bilateral damage for severe impairment
• unilateral damage do not (chips come from one factory)
• comes from the Greek word praxis, which means “performance of action” literally means “without action” but realistically should be called dyspraxia (disordered action)

Question 22

Limb Apraxia (pointing, writing)

Answer 22

• Difficulty in performing actions using his limbs (arms, legs, hands, feet); Examples would be:
  
  • 1. Inability to demonstrate how to make an “okay” sign
  • 2. Inability to demonstrate how to brush your teeth
• More severely impaired patient will have difficulty actually performing these actions

Question 23

Dressing apraxia

Answer 23

• Difficulty in performing action that are specifically related to dressing Ex:
  
  • 1. Putting on a shirt
  • 2. Buttoning a shirt
  • 3. Getting the right clothes on in the correct sequence

Question 24

Constructional Apraxia

Answer 24

Difficulty in performing actions that relate to visual-spatial activities ex:

• 1. Drawing pictures
• 2. Constructing things made of various piece (eg., house out of Lincoln logs)

Question 25

Nonverbal Oral Apraxia

Answer 25

* Relates to oral postures that could be in conjunction with verbal gestures but are not Ex: * 1. Sticking out your tongue * 2. Pretending you are blowing out a candle * 3. Shape your mouth as if you’re saying “ooh” * 4. Puffing out your cheeks * Can co-occur with aphasia, AOS, or even dysarthria; however, these four can be entirely independent; it often co-occurs with AOS * It doesn't usually affect spontaneous

Question 26

Apraxia of Speech

Answer 26

* Deficit in the ability to sequence the motor commands needed to correctly position the articulators during the voluntary production of phonemes * The more automatic the speech output, the more likely that it will be less impaired (counting, days of the week) * It is common for AOS and NOA to co-occur

Question 27

Chara. Of AOS

Answer 27

1. Errors can be inconsistent and can vary with repeated attempts 2. Articulatory groping; trial and error 3. Near mutism may be common in severe cases (but usually doesn’t last long) 4. Voluntary speech is more problematic than automatic speech 5. Artic errors are more common on multisyllabic words than single syllable words 6. Frequently "appearing” phonemes are less likely to be in error than infrequent usage phonemes 7. Constant clusters are more likely to be in error than single consonants more often than vowels 8. Initial position consonants are more likely to be impaired than middle or final consonants 9. Points of articulatory

Question 28

Phonatory Apraxia

Answer 28

* Difficulty phonating on command * Tends to only be seen in fairly severe patients; tends to resolve fairly nicely

Question 29

Childhood AOS

Answer 29

* Previously called “dev. Apraxia” (reimbursement issues – less likely to cover “developmental”) * Etiology typically unknown but is some type of neurological dysfunction * No single feature that is adequate for a diagnosis

Question 30

Childhood AOS: Most salient features (ASHA)

Answer 30

* Inconsistent errors on consonants and vowels in repeated productions of syllables or words * Lengthened and disrupted co-articulatory transitions between sounds and syllables (it’s difficult to move the sound beyond isolation) * Inappropriate prosody