1
Q
flaccid dysarthria
A
impairments of lmns in cranial or spinal nerves (pns damage)
2
Q
flaccid dysarthria causes
A
caused by any disorder that disrupts flow of neural impulses along lmns travel to reach muscles
3
Q
location of damage flaccid
A
final common pathway
4
Q
final common pathway
A
last and only road nueral impulses from umns travel to reach muscles
5
Q
flaccid injuries
A
brainstem stroke, growing tumor, viral or bacterial infections, physical trauma, surgical accidents, mysathenia gravis, guillain-barre syndrome, polio, muscular dystrophy, progressive bulbar palsy
6
Q
speech charateristics flaccid
A
- May NOT demonstrate deficits in all areas; severity level will vary
- Hallmarks: slow-labored articulation, marked degrees of hypernasal resonance, hoarse-breathy phonation
7
Q
resonance characteristcs flaccid
A
- Hypernasality most common
- Nasal emission
- Weak pressure consonants
- Shortened phrases
8
Q
articulation characteristics flaccid
A
imprecise consonant production
9
Q
phonation characteristics flaccid
A
Phonatory incompetence (incomplete adduction of VFs during phonation) giving hoarse-breathy voice
10
Q
respiration characteristics flaccid
A
- May not be affected
- If it is, you would see reduced loudness and speaking on residual air
11
Q
prosody characteristics flaccid
A
- Monopitch, monoloudness
- Not unique to flaccid so not a diagnostic marker
12
Q
evaluation tasks
A
- Look for clusters of symptoms when trying to diagnose
- Conversational speech and reading: Can evoke errors of resonance, arctic, respiration, and prosody
- AMR: /puh puh puh/ /tuh tuh tuh/ /kuh kuh kuh/. Will highlight a slowed rate of phoneme production
- Prolonged vowel: Will elicit breathy voice quality heard in phonatory incompetence
- Speech stress test: Necessary IF myasthenia gravis is suspected
13
Q
treatment flaccid
A
- Treatments are according to which cranial nerve
- Needs and abilities vary greatly
14
Q
resonance treatment flaccid
A
Velar strength-training procedure; modification of speech; reduce rate
15
Q
phonation treatment flaccid
A
Pushing and pulling procedures, hard glottal attack
16
Q
prosody treatment flaccid
A
Pitch range exercises, intonation profiles, contrastive stress drills
17
Q
respiratory treatment flaccid
A
Correct posture, prosthetics, speaking immediately on exhalation
18
Q
spastic dysarthria
A
bilateral damage to umn tracts
19
Q
pyramidal system spastic
A
damage = weak/slow skilled movements
20
Q
extrapyramidal system spastic
A
damage = weakness, increased muscle tone (spasticity), and abnormal reflexes
21
Q
injuries spastic dysarthria
A
- stroke - most common; only occurs in LH and RH as a combo OR single in brainstem
- degenerative diseases: ALS, multiple sclerosis
- TBI
-infection
-tumors
22
Q
speech characteristics spastic
A
-imprecise consonants, monopitch, monoloudness, reduced stress, harsh vocal quality
- Errors result bc of spasticity, slowness, weakness in vocal-tract muscles
23
Q
articulation characteristics spastic
A
Imprecise consonant productions, vowel distortions
24
Q
phonation characteristics spastic
A
Harsh vocal quality, Strained-strangled, Low pitch
25
resonance characteristics spastic
hypernasality
26
prosody characteristics spastic
Monopitch, monoloudness, short phrases, short rate of speech
27
evaluation tasks spastic
- Conversational speech and reading
- AMR (ppp, ttt, kkk)
- Vowel prolongations
28
treatment spastic
- Phonation deficits: work on relaxation, easy onset of phonation, yawn-sigh, tongue and lip stretching
- Articulation deficits: intelligibility drills, phonemic placement, minimal contrast drills
- Prosody deficits: pitch range exercises, contrastive stress drills, chunking utterances
- Resonance deficits: pharyngeal flap, palatal lift
29
special spastic
- Pseudobulbar affect- uncontrollable crying or laughing
- Drooling and swallowing issues
- Pseudobulbar palsy- weakness and slowness in same muscle
30
uumn dysarthria
- caused by damage to upper motor neurons one side of the brain that supply cranial and spinal nerves involved in speech production
- usually less severe than with bilateral damage
31
location of damage uumn
- Lower face and tongue
- Any condition that damages upper motor neurons on one side of brain after damage to either left or right hemisphere
32
injuries uumn
- Most frequent cause is stroke; specifically stokes involving frontal lobe
- Tumors and TBI can be a cause, but they are uncommon
33
speech characteristics uumn
- Weakness in lower face, lips, and tongue on opposite side of lesion
- Mild or moderate speech production errors - often short term with recovery after days or weeks
34
articulation uumn
-primary deficit
- Imprecise consonant production, articulatory breakdowns, slow and irregular AMRs
35
phonation uumn
Mild to harsh vocal quality
36
resonance uumn
Hypernasality
37
prosody and respiration uumn
Rarely impaired
38
evaluation tasks uumn
- Medical records
- Conversational speech or reading paragraph
- AMR tasks
- Prolonged vowel
39
treatment uumn
- Coexciting deficits are usually treated
- Artic may be so minor that SLP may decide not to treat
- Intelligibility drills, phonetic placement, exaggerating consonants, minimal contrast drills
40
ataxic dysarthria
due to damage to cerebellum or its neural pathways
41
location of damage ataxic
cerebellum, inferior peduncles, middle peduncle, superior pedunle, cerebellar control circuits
42
cerebellum ataxic
coordinate timing and force of muscular contractions; attached to brainstem; communicates with rest of CNS through 3 bundles of neural tracts called cerebellar peduncles
43
inferior peduncles ataxic
receives sensory info
44
middle peduncle ataxic
smooths and refines the planned movement
45
superior peduncle ataxic
Sends out the motor impulses
46
cerebellar control circuits ataxic
neurons that course through 3 cerebellar pathways
47
injuries ataxic
- Stroke
- Toxic conditions
- Metabolic conditions
- Traumatic head injury
- Tumors
48
speech characteristics ataxic
- Movements appear poorly coordinated, problems controlling timing/force for speech, slurred, monotonous arctic, primarily disorder of artic and prosody
- Scanning speech - slow, deliberate production of syllables with each syllable in a word receiving equal stress
49
articulation ataxic
- Imprecise consonant production
- Distorted vowels
- Irregular articulatory breakdowns
- Decomposition of movement: manifestations of cerebellar dysfunction, where instead of smooth coordinated movements, they are distinct and jerky
50
prosody ataxic
- Equal and excess stress
- Prolonged phonemes and prolonged intervals between phonemes
- Monopitch and monoloudness
51
phonation ataxic
- Harsh vocal quality
- Voice tremor
52
resonance ataxic
- Hyponasality
53
respiration ataxic
- Uncoordinated movements in respiratory muscles, contributing to speech deficits
- Paradoxical movements: movements that occur when muscles work against each other rather than in coordination
54
evaluation tasks ataxic
- Speech alternate motor tasks: slower than normal, difficulty maintaining steady rhythm with repetition
- Reading, conversational speech, and repeating sentences containing numerous multisyllabic words
55
respiration treatment ataxic
- Do not need to address strengthening
- Concentrate on controlling airflow more accurately during speech, as uncoordinated movements of respiratory muscles cause speech on residual air, affecting prosody and phonation
- Slow and controlled exhalation
- Speak immediately on exhalation
- Stop phonation early
- Optimal breath group - teaching how many syllables or words can be said clearly on one full inhalation
56
prosody treatment ataxic
- Slow rate
- Incorporating more typical stress and intonation into utterances
- Rate control: Reciting syllables to a metronome, Finger or hand tapping, Cued reading material
- Stress and intonation: Contrastive stress drills, Pitch range exercises, Intonation profiles, Chunking utterances into syntactic units
57
articulation treatment ataxic
- Intelligibility drills
- Phonetic placement
- Exaggerating consonants
- Minimal contrast drills
58
hypokinetic
any process that damages basal ganglia (extrapyramidal system)
59
main cause of hypokinetic
- Parkinsonism - collective term for different disorders sharing many similar symptoms
- Causes:
Idiopathic parkinson’s disease
Neuroleptic-induced parkinsonism
Postencephaltic parkinsonism
Traumatic head injury
Toxic metal poisoning
Stroke
60
symptoms hypokinetic
- Resting tremor
- Bradykinesia: slow, reduced range of movement
- Rigidity
- Spasticity
- Akinesia: delay in initiation of movements
- Postural reflexes
61
location of damage hypokinetic
dysfunction in basal ganglia; depends on balanced interaction of dopamine and acetylcholine
62
speech characteristics hypokinetic
harsh vocal quality, reduced stress, monoloudness, imprecise consonants; significant indvidual differences
63
prosody hypokinetic
monopitch, reduced stress, and monoloudness most common
64
articulation hypokinetic
imprecise consonants, repeated phonemes, palilalia
65
phonation hypokinetic
harsh/breathy quality, aphonia, low pitch
66
respiration hypokinetic
sometimes noted
67
evaluation tasks hypokinetic
-conversational speech and reading: evoke errors of prosody
-AMRs: highlight artic errors
-vowel prolongations: assess vocal quality
68
pharamcologic treatment hypokinetic
-L-dopa
-replacing dopamine in striatum
-correct neurotransmitter imbalance by decreasing acetylcholine activity in striatum
69
surgical treatments hypokinetic
-ablative surgery
-deep brain stimulation
-stem cell implantation
70
articulation treatment hypo
- Most common deficit: imprecise consonants due to reduced range of motion in arctic
- Compounded by increased ate
- Rate reduction, stretching, traditional artic tasks
71
phonation treatment hypo
- Adduct VFs only partially or have harsh or breathy voice quality
- Pushing and pulling procedure, hard glottal attack, LSVT
72
respiration treatment hypo
- Speaking immediately on exhalation
- Stop phonation early
- Optimal breath group
73
prosody treatment hypo
- Intonation profiles
- Contrastive stress drills
- Chunking utterances into syntactic units
- All used to Slow rate
74
hyperkientic dysarthria
caused by damage to the basal ganglia
75
causes of hyperkinetic dysarthria
- Myoclonus - involuntary and brief contractions of part, whole, or group of muscles in same area
- Tics
- Essential tremor - benign hyperkinetic movement disorder that causes tremulous movements in affected body parts
- Dystonia
- Degenerative diseases
- Traumatic head injury
- Stroke
- Infections
76
evaluation tasks hyper
-Vowel prolongation
- AMRs
- Conversational speech and reading
- Careful observation of associated involuntary movements
77
treatment hyper
-Pharamacologic - drugs that suppress involuntary movements that cause speech deficits
- Botox
- Deep brain stimulation
78
treatment for huntingtons disease
- Early stages - maintain normal prosody and optimal rate
- Middle stages - rate of speech, rhythmic breathing and relaxation, speaking on exhalation
- Progressive dementia - work closely with caregivers
79
treatment for tic disorders
Behavioral treatments:
- Habit reversal training
- Relaxation therapy may be helpful when combined with other treatment procedures
- Exposure response prevention
- Comprehensive behavioral intervention for tics
80
dystonia (part of hyper)
- Causes involuntary, prolonged muscle contractions
81
dystonia artic hyper
imprecise consonants, distorted vowels, irregular articulatory breakdowns, prolonged phonemes
82
prosody dystonia
monopitch, monoloudness, inappropriate silences, shortened phrases
83
phonation dystonia
harsh vocal quality, strained-strangled quality, excess loudness variation
84
respiration and resonance dystonia
less impacted
85
treatment dystonia
- Sensory tricks - idiosyncratic strategies that can suppress involuntary movement for a time
- Bite blocks - to stabilize jaw during speech
- Easy onset of phonation
86
chorea (part of hyper)
- Sydenham’s chorea - rare disorder affecting children after rheumatic fever
- Huntington’s disease - progressive inherited disorder
- Tardive dyskinesia - caused by taking certain antipsychotics
- Stroke - rare to cause chorea
87
speech characteristics chorea
Prolonged intervals between syllables and words, inappropriate silences, prolonged phonemes, intermittent breathy voice quality
88
mixed dysarthria
- when neurologic damage extends into two or more parts of motor system; any combo of pure dysarthrias
- Prominence of each pure dysarthria within mixed dysarthria within mixed dysarthria varies significantly among individuals
89
injuries mixed dysarthria
- Single or multiple strokes
- Brain tumors
- Traumatic head injuries
- Degenerative diseases
- Infectious diseases
- Multiple sclerosis
- multisystems atrophy
- amyotrophic lateral sclerosis
- wilson's disease
-friedreich's ataxia
90
multiple sclerosis
- Progressive demyelinating disease
- Can occur in brainstem, cerebellum, cerebral hemispheres, and spinal cord
- Can cause any pure or any combo of mixed dysarthria
- Ataxic-spastic most common
91
multisystems atrophy
- Collective term for group of degenerative disorders, many including parkinsonian symptoms:
- Shy-drager syndrome
- Progressive supranuclear palsy
- Olivopontocerebellar atrophy
92
amyotrophic lateral sclerosis
- Progressive degeneration of any four areas of motor neurons
- Often progresses from affecting two motor neuron groups to all four
- Mixed dysarthria predominates throughout much of this disorder
93
wilson's disease
- Very rare hereditary disease preventing normal metabolism of dietary copper
- Penicillamine successful in treating most patients
- Dysarthria of earliest signs
- ataxic-spastic -hypokinetic present in many
94
friedreich's ataxia
- Rare, inherited, progressive disorder
- Causes neuron degeneration in cerebellum, brainstem, and spinal cord
- Untreatable, fatal
- Ataxic-spastic most prevalent
95
treatment mixed
- General rule: first treat component most severely affecting speech production
- When all are equally affected: respiration, resonation, phonation, articulation, prosody (RRPAP)
- AAC for ALS
96
apraxia of speech
disorder of motor timing and sequencing
97
ideational apraxia
uncommon; disturbance in conception of object or gesture
98
ideomotor apraxia
disturbance in performance of movements needed to use object, make gesture, sequence movements
99
location of damage apraxia
Motor speech programmer - neural network in the brain that sequences motor movements needed to produce speech.
- first analyzes linguistic, motor, sensory, and emotional info
- Near perisylvian area of left hemisphere
100
injuries apraxia
- Stroke
- Degenerative disease
- Trauma
- tumor
101
speech characteristics apraxia
- Primarily disorder of articulation and prosody
- Slow, labored, halting speech
- Instances of groping
102
articulation apraxia
most common errors
103
prosody apraxia
frequently abnormal
104
respiration apraxia
may have difficulty taking deep breath on command
105
resonance and phonation apraxia
seldom issues
106
assessment strategies apraxia
- SMRs - sensitive assessment
- Conversational speech and reading aloud - determine effects of prosody
- Repeating words of increasing length
- Reading or repeatin low-frequency, multisyllabic words in isolation or sentences
107
categories to determine correct diagnosis apraxia
- Primary clinical characteristics
- Non Discriminative clinical characteristics
- Behaviors usually found in disorders other than apraxia
- Behaviors that rule out presence of apraxia
108
treatment apraxia
Goal: help patient relearn motor sequences to produce phonemes accurately
109
sequencing treatment apraxia
- Repetitive and intensive drill
- Patients learn to self-monitor
- Concentrate on functional words
110
articulatory kinematic treatments apraxia
Concentrate on improving timing and placement of articulatory movements through modeling, positioning of articulators, and repetition
111
rate and rhythm procedues apraxia
Assume apraxia primarily result of timing errors
112
AAC apraxia
Recommended with limited verbal communication
113
interystemic facilitation and reorganization treatment apraxia
Patient’s communicative strengths used to assist verbal speech
114
parkinsonism
known cause
115
parkson;s disease
unknown etiology
116
important to know parkinsonism
- Basal ganglia damage
- Festinating speech: same as gait just speech related
- Festinating gait: walking starts slow → fast, quick, short
117
features of CAS
- inconsistent errors
- inappropriate prosody
-groping
-vowel errors
118
treatments CAS
-prompt
-rest
-dttc
-NDP3
-cycles
119
prompt
-tactile-kinetshetic-propriocetive based tx
-emphasizes normalization of speech movement patterns in an age-appropriate, functional lexicon of words
120
ReST
-high intensity practice of randomly presented pseudowords with varying phonetic structure and lexical stress
121
dttc
-cueing hierarchy
-never in isolation, start with the easiest and work it up
122
NDP3
-bottom-up approach builds from single sounds to syllables and syllable sequencing
123
1. primary clinical characteristics
-prosody
-slow speech rate
-slow speech rate w/pauses
-distorted phonemes with substitutions
-consonants and vowels are distorted
-inconsistent articulation errors
124
2. nondiscriminitive clinical characteristics
-self-corrects and shows signs of awareness
-difficulty initiating speech
-speech errors increase as word length increases
-artic groping
125
3. behaviors usually found in disorders other than AOS
-demonstrates difference between expressive and receptive speech and language skills
-has transposition errors
-anticipatory articulation errors
-presence of limb or oral apraxia
126
4. Behaviors that rule out presence of AOS
-fast speech rate
-normal speech rate
-normal prosody
motor speech
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