motor speech

What are the speech errors that are most evident in individuals with chorea

Prolonged intervals between syllables and words -Variable rate of speech -Inappropriate silences -Excessive loudness variations -Prolonged phonemes -Rapid, brief inhalations or exhalations of air.- breathing- you can hear audible sound -Voice stoppages -Intermittent breathy voice quality

The Four main functional divisions of the speech motor system

- FCP= final common pathway (also called Lower Motor Neuron (LMN) system) - Direct activation pathway - Indirect activation pathway - Control circuits

Spatial model of motor speech production deals with/ talks about

-Internal map of the vocal tract in the CNS -Coarticulation =variant -movements of the articulator for a specific phoneme must change depending on starting point

Control Circuits

-contribute to programming movements, -have No direct contact with lower motor neurons, -Serve to coordinate/integrate activities of DAP and IAP

Function of Direct Activating System

-influences consciously controlled, skilled voluntary movement. -movements generated by cognitive activity that works between sensation and movement involving complex planning. Speech definitely mediated by the direct activation pathway. -Contains neurons that regulate LMN and that are controlled by the cortex, cerebellum, or basal ganglia.

Characteristics of Tardive Dyskinesia [associated with Hyperkinetic dysarthria]

-late appearing involuntary movements, -choreic movement of the face, mouth, & neck; lip smacking, tongue protrusions, chewing motions & grimacing, -caused by long term use of antipsychotic drugs -women and elderly are more susceptible

Dysarthria

A collective name for a group of speech disorders secondary to disturbances in muscular control of the speech mechanism due to CNS or PNS damage; It causes problems in oral communication because of paralysis or weakness of the speech musculature.

Hypoglossal Nerve (CN XII)

A lesion here would cause: imprecise articulation. Difficulty with the tip or back of the tongue movement may occur with bilateral lingual weakness. The phonemes most disrupted are "s", "sh", "ch", "r", and "l". Velars (/k/, /g/) can also be difficult to produce. For AMRs /pa/ should be normal, while /ta/ and /ka/ would be imprecise and slow is associated with damage to this cranial nerve

Respiration, phonation and resonance

A lesion to cranial nerve XI would indirectly affect these speech processes

Apraxia of speech

A prosody disorder may occur with this motor speech disorder, as a result of compensatory behaviors i.e. Stopping, restarting, and difficulty initiating phonation and correct articulatory postures.

This model states that variations in articulatory movements are used when: adjacent phonemes vary, speaker rate varies, & stress varies in an utterance.

Acoustic- Auditory Model of motor speech production

Errors of speech are inconsistent and unpredictable. Islands of clear, well-articulated speech exist

Apraxia

Reduced range of movement, tongue strength, speech rate and voice onset time for stops-is reduced

Articulatory characteristics of Spastic Dysarthria

Apraxia of speech

Articulatory errors are primarily substitutions, repetitions, additions, transpositions, prolongations, omissions, and distortions[least common]. Most errors are close approximations of the targeted phoneme. Errors are often perseveratory or anticipatory

Describe the goals for the motor plan in the production of /b/ sound

Bilabial closure [lip closure], vocal fold adduction (closure), & velar elevation[lifting] (to allow for velopharyngeal closure).

Cranial nerve V, Trigeminal Nerve

Bilateral damage to this cranial nerve's motor division can have a devastating impact on articulation

inability to elevate the bilaterally weak jaw, which can reduce precision or make impossible Bilabial, Labiodental, Lingual Dental, lingual-alveolar articulation, as well as lip and tongue adjustments for many vowels, liquids, and glides.

Bilateral lesions to motor branch of the Trigeminal nerve results in

Diseases associated with Spastic Dysarthria

Binswanger's disease Primary Lateral Sclerosis Progressive Pseudobulbar Palsy/Pseudobulbar Palsy Leukoencephalitis

Vagus cranial nerve, X

Both unilateral and bilateral lesions to each of the branches of this cranial nerve would affect prosody by causing short phrases

Acquired Apraxia of speech

Caused by neurological damage to the left frontal cortex surrounding Broca's Area - due to stroke, brain injuries, illness, and infections

Disorder at these levels of the nervous system[ in addition to basal ganglia, lateral cerebellum, fronto-limbic system, and supplementary motor area] would produce dysarthria

Cerebellum, motor cortex, and motor units

Acquired Apraxia of speech and Developmental/Childhood Apraxia of Speech

Characteristics of this disorder: prolonged durations of sounds, reduced prosody, inconsistent errors within an utterance, difficulties initiating speech, groping of articulators

In the spatial target theory of motor speech, speakers anticipate the production of an upcoming sound by adjusting the articulators to accommodate that sound. This is known as __________________

Coarticulation

Weakness seen with Flaccid Dysarthria stems from

Damage to any part of the motor unit: -Cell body, nuclei, Axon or Neuromuscular junction. Can also be due to muscle disease- causing muscle weakness.

In a Comprehensive Motor Speech Evaluation, you assess the motor speech problem at each of these levels of functioning

Disease Activity Participation in life

Acquired Apraxia of speech

Disorder that Is the Inability to transform an intact linguistic representation into coordinated movements of the articulators

Childhood Apraxia of Speech

Disorder that involved a Considerable delay in speech production, limited sound inventory, unintelligibility, and progress slowly in speech therapy

Childhood AOS

Disorder where Causes are not well understood; some research points to hereditary component, not clear there is specific neurological damage In some cases caused by stroke or traumatic brain injury

Spastic Dysarthria

Due to damage to the pyramidal tract

What Damage to the Trigeminal CN V would present as

Effect on speech could be seen in conversation, reading, and Alternating Motion Rates (AMRs)

reading, conversation, and alternate motion rates (AMRs)

Effects of cranial nerve V [trigeminal] lesions on speech are most apparent during

Terms associated with Flaccid Dysarthria

Fasciculations & Fibrillations, Weakness, Atrophy, Hypotonia & reduced Reflexes, Progressive weakness with use [myasthenia gravis]

Decreased muscle tone, hoarse vocal quality, and occasional hypernasality are features of this type of dysarthria

Flaccid Dysarthria

Prosodic excess Articulatory-resonatory Incompetence Prosodic Insufficiency Phonatory Stenosis

Four Clusters of deviant Pattern in Spastic Dysathria

Reduced loudness, pitch and range, Breathiness, Hoarseness, Diplophonia, and Aphonia; possible pitch breaks

Given you have damage to / lesion in vagus cranial nerve [CN X] what are some of the speech characteristics in terms of phonation

Phonatory-Prosodic Insufficiency cluster of speech characteristics associated with FLACCID DYSARTHRIA consists of

Harsh voice, monopitch, & monoloudness; this likely reflects hypotonia & weakness in laryngeal muscles

In preparation for speech these Pre-Motor things have to occur

Have to have idea & want to communicate it verbally; Need to convert abstract idea into meaningfully linguistic units. Syntactic planning Morphologic planning Phonologic planning

What kind of chorea can a stroke cause?

Hemi-chorea Hemiballism

How phonation is affected in Parkinson's / with hypokinetic dysarthria

Hoarseness is common with Parkinson's; low volume/decreased intensity which frequently reduces intelligibility

Terms /characteristics that are associated with the speech of Hypokinetic Dysarthria/ Parkinson's Disease

Hoarseness of voice, festinating speech, low volume/ hypophonation/reducedness loudness/decreased intensity/no power to the voice, stutter, Pallilalia, bradykinesia, slow speaking rate with fast short rushes of speech

Types of hyperkinetic dysarthria include

Hyperkinetic dysarthria of Myoclonus type, hyperkinetic dysarthria of the essential tremor type, hyperkinetic dysarthria of chorea type

Resonatory Incompetence cluster of speech characteristics associated with FLACCID DYSARTHRIA consists of

Hypnasality, imprecise consonants, nasal emission, & short phrases; represents weakness of velopharyngeal valve, leading to excessive nasal resonance and nasal airflow during production of consonants requiring intraoral pressure (nasal emission); short phrases in this case reflect air wastage thru velopharyngeal port during speech

What is the main reason that makes Parkinson's speech (w/ hypokinetic dysarthria) so unintelligible?

Hypophantation / low volume of voice

Apraxia of speech

Impaired ability to plan sensorimotor commands needed for directing movements that result in phonetically and prosodically normal speech. [is the disorder that results from a disruption of the motor planning phase of speech production].

In apraxia

Involuntary motor tasks typically are not affected

Final common Pathway's relationship to speech

It includes Paired cranial nerves that supply muscles for phonation, prosody, articulation, & resonation; It also includes paired spinal nerves involved in respiratory activities and prosody

A disorder at these levels of the brain can lead to certain types of Dysarthria

Lateral Cerebellum Basal Ganglia Supplementary Motor Area Fronto-Limbic System

Facial Nerve (CN VII)

Lesions to this cranial nerve would cause poor biabial closure can occur so that AMRs are mismatched for /pa/, /ta/, and /ka/ with slowness for /pa/. Distortions may occur on bilabials (/p/, /m/, /b/) as well as /w/,/f/, and /v/.

Treatment for Respiration

Maximum Vowel phonation, controlled exhalation tasks;practice exhaling at steady rate for several seconds, posture adjustments (abdominal binders/corsets, supine (laying down may help)); behavior modification- inhale more deeply or use more force when exhale.

How Phonatory-Prosody is affected in Hypokinetic dysarthria

Monopitch and Monoloudness/reduced pitch variability may occur

LMN and the muscle fibers innervated by it are know as the

Motor Unit

Trigeminal Nerve [CN 5]

Motor fibers of this cranial nerve drives jaw movements during speech [because it has maxillary and mandibular nerve branches]

Apraxia of speech

Motor speech disorder where speech intelligibility sometimes INCREASES as speaking rate INCREASES

How Prosody is affected in Hypokinetic dysarthria

Pallilaia (syllable repetitions), festinating speech (fast speech in short rushes), monopitch and monoloudness, inappropriate silences, reduced stress, & reduced rate

Prototypic disease associated with Hypokinetic Dysarthria

Parkinson's disease (most common Etiology/cause of hypokinetc dysarthria)

Hypokinetic dysarthria can result from

Parkinson's disease (most common), Anti-psychotic medications, Frequent blows to the head (trauma)

Methods of Measurement for motor speech disorders

Perceptual Acoustic & Physiologic

Harsh vocal quality, strained-strangled voice quality, low pitch, & frequent pitch breaks[reduced voice onset is also phonatory prob]

Phonatory characteristics of spastic dysarthria

Various Etiologies of Flaccid Dysarthria

Poliomyelitis CVA Congenital conditions Myasthenia gravis Muscular Dystrophy Bulbar palsy Facial palsy Trauma

processes affected most by chorea [which is associated with hyperkinetic dysarthria]

Prosody- prolonged interval between syllables & variable rate of speech; others include monopitch, innapropriate silences & monoloudness [prosody is the one that is affected the most- all of these things impact prosody]

Sudden bursts of loudness are sometimes noted; uncontrollable loudness which interferes with stress pattern [reduced rate of speech affects prosody]

Prosody/Prosodic characteristics with Spastic Dysarthria

Velopharyngeal acoustic physiologic findings with flaccid dysarthria

Reduced or absent palatal movement, reduced or absent pharyngeal wall movement, increased nasal airflow, decreased energy in fundamental frequency, increased formant band, reduced overall intensity, & extra resonances.

Acoustic Physiologic findings of respiratory system with Flaccid Dysarthria

Reduced vital capacity, termination of speech at larger than normal lung volumes. Larger than normal inspiratory & rib cage volumes. Abnormal chest wall movements [over time chest looks abnormally large]. Neck and glossopharyngeal breathing [clavicular breathing].

Hypernasality typically occurs, but is NOT severe enough to cause nasal emission

Resonance in Spastic dysarthria

Dysarthria, which occurs due to disturbances in strength, tone, steadiness, speed, range, and accuracy of movement, affects

Respiration Resonation Phonation Articulation Prosody

These are the Speech Processes

Respiration Resonation Phonation Articulation Prosody

Spastic Paralysis

Results from damage to the direct activation pathway • This type of damage leads to loss or reduction of fine, discrete movement • Weakness more evident in distal than in proximal muscles. • Distal and speech muscles mostly involved in fine motor control

Known etiologies of Chorea include

Rheumatic fever--> Sydenham's chorea, stroke, tardive dyskinesia, Anoxia, Carbon monoxide poisoning

Typically see exaggerated reflexes, which result in increased muscle tone and incoordination with this type of dysarthria

Spastic Dysarthria

Dynamic Systems model states that

Speech as a dynamic pattern of trajectories through articulation -Groups of muscles link up together to perform a particular task

Flaccid Dysarthria

Speech characteristics of the this type of dysarthria includes: -(phonatory) breathiness, short phrases, audible inspiration -(Resonatory) hypernasality (reduced elevation of soft palate; difficult to achieve velopharyngeal closure), imprecise consonants, nasal emission, short phrases - harsh voice, monoloudness, monopitch (difficulty in phonation will interfere/spill into prosody- so affects prosody)

Apraxia of speech

Speech errors result from a disruption of the message from the motor cortex to the oral musculature

Articulation [although Prosody may be abnormal]

Speech process primarily affected in Apraxia

Direct Activation System characterized by

Structures are corticobulbar and corticospinal tracts. Also called pyramidal or direct motor system. Together corticobulbar and corticospinal form part of upper motor neuron systen (UMN)

Indirect Activation Pathway

System that Functions to mediate subconscious, automatic muscle activities: posture, muscle tone, & movement that support & accompany voluntary movement.

CN V Trigeminal CN VII Facial Nerve CN IX Glossopharyngeal CN X Vagus CN XI Spinal Accessory CN XII Hypoglossal

The Six Cranial Nerves Involved in Speech and Swallowing

imprecision and slowness for "puh" may be greater than that for "tuh" or "kuh";

The findings seen during AMRs for lesions to the Trigeminal Cranial nerve (CNV)

Articulation, and Prosody

The speech processes affected with BILATERAL lesions to Cranial Nerve V [trigeminal]

Bilabial, Labiodental, Lingual-dental, and lingual-alveolar sounds, as well as many vowels, glides, and liquids.

The speech sounds/ types of sounds affected with a bilateral lesion to the motor branches of cranial nerve V

Improve impaired subsystem & compensatory strategies

The two Primary strategies / approaches to treatment of motor speech disorders

Cranial Nerve V (CNV)

Trigeminal Nerve

True or False: Some neurodegenerative diseases with unknown pathologies can be associated with flaccid dysarthrias.

True

Acoustic-Auditory Target Model of speech motor production states that

Ultimate goal: Articulatory movements result in understandable acoustic events (speech)

Respiratory difficulties of chorea hyperkinetic dysarthria

Unexpected inhalations & exhalations of air caused by involuntary movements of the chest / diaphragm; this can cause extraneous phonations, halting utterances, & short phrases & excessive loudness variations caused by sudden increases in subglottic air pressure and involuntary exhalations during phonation

a breathy-hoarse vocal quality, decreased loudness, and sometimes diplophonia, and pitch breaks

Unilateral recurrent laryngeal nerve lesions that spare the superior laryngeal nerve and pharyngeal branch cause

Etiologies of Spastic Dysarthria

Vascular disorder- strokes in internal carotid as well as middle and posterior cerebral arteries. a single lesion in the vertebrobasilar arterial distribution can cause bilateral damage. Binswanger's disease Primary Lateral Sclerosis Inflammatory disease: Leukoencephalitis

Are the primary clinical characteristics of flaccid paralysis

Weakness, hypotonia, and diminished reflexes

Are the primary clinical characteristics of flaccid paralysis

Weakness, hypotonia, and diminished reflexes [atrophy and fasciculations commonly accompany them]

Progressive Pseudobulbar Palsy

When dysarthria occurs with dysphagia in PLS, it is referred to as

/s/, /sh/, /ch/, /r/,/ l/; velars /k/, and /g/, along with /t/

a lesion to the Hypoglossal, CN XII would mostly disrupt these phonemes

Spinal Accessory [CN XI]

a lesion to this cranial nerve can indirectly affect respiration, phonation, and resonation

Is important to know regarding brainstem lesions

a single lesion in the vertebrobasilar arterial distribution [in brainstem] can cause bilateral damage, and therefore, result in spasticity

What causes hyperkinetic movement?

a. One theory suggests that there is an imbalance of either dopamine or acetylcholine in the basal ganglia. Any condition that causes too much dopamine to be released into the basal ganglia has an excitatory effect on movement. b. The disruptions of the many interactions of the neurochemicals

Can have an inability to do this if the superior laryngeal branch of the Vagus [CN X] is damaged

alter pitch

Neurosurgical procedures with known risks for cranial nerve damage that can, as a result, cause flaccid dysarthria

anterior cervical spine surgery, carotid endarterectomy, brainstem vascular procedures, even surgeries in base of skull can cause this.

Flaccid Dysarthria

are a perceptually distinct group of motor speech disorders caused by injury or disease of one or more cranial or spinal nerves; they reflect problems in the axons, nuclei, cell body, or neuromuscular junctions that make up the motor units of the final common pathway

Hyperkinetic dysarthrias

are a perceptually distinct group of motor speech disorders that are often associated with disorders of the basal ganglia control circuit; the subtypes designate the specific kind of involuntary movement/movement disorder

Motor goals

are found in the Spatial (place & manner of articulation) and Temporal (timing) specifications of movements for production

-Vocal fold immobility or sluggishness -Incomplete glottal closure/ incomplete VF closure -Increased amplitude of vocal fold mucosal wave -Increased airflow -Increased inspiratory volume -Increased breaths per minute -Reduced range and variability of F0

are the laryngeal / respiratory acoustic & physiologic findings with flaccid dysarthria

The sound production pattern of patients with Parkinson's disease is sometimes described as

articulatory undershoot

How is chorea described

as dancelike- cuz movements appear to be smooth & coordinated, but they are actually unpredictable & purposeless; can be jerky, writhing, complex or fleeting & irregular

measures of nonspeech oral motor skills and should isolate particular motor subsystems to determine impairment

assessment of motor speech disorders should include

Spastic Dysarthria

associated with impaired movement patterns rather than weakness of individual muscles- groups of muscles are affected

Structure that has control circuits important for generating components of motor program for speech

basal ganglia

Motor programming is controlled by these areas in the brain

basal ganglia, lateral cerebellum, supplementary motor area and fronto-limbic system.

What is the neurological basis for Hyperkinetic Dysarthria

basal ganglia: caudate nucleus, putamen and globus pallidus, the interconnections, the basal ganglia control circuit (or sometimes cerebellar control circuit can be involved/affected);

Hemichorea

because the involuntary movements occur only on the contralateral side of the body to the site of lesion (if damage is restricted to only one side of the brain usually affecting the basal ganglia or thalamus) one type of hyperkinetic dysarthria that can occur

this helps to facilitate the diagnosis of hyperkinetic dysarthria

being able to visibly see abnormal orofacial, head, and respiratory movements; their uncontrollable movements can be observed

Inadequate vocal fold adduction that occurs in Flaccid dysarthria causes

breathiness due to inadequate vf closure and short phrases due to air wastage through the glottis

Phonatory Incompetence cluster of speech characteristics associated with FLACCID DYSARTHRIA consists of

breathiness, audible inspiration, & short phrases; this represents incompetence at laryngeal valve, including inadequate vocal fold adduction, and abduction

Given you have damage to the Vagus Nerve (CN X), the Speech characteristics in terms of Phonation would be

breathiness, hoarseness, reduced loudness, diplophonia, reduced pitch or pitch breaks if the lesion is below the pharyngeal branch but including the superior and recurrent laryngeal branches.

Hemiballism

caused by damage to the subthalamic nucleus near the substantia nigra) characterized by wild and violent involuntary movements of the limbs contralateral to the lesion; usually remit spontaneously after a period of days—months; can be treated successfully with medicines. Can go away spontaneously, even without medicine.

Pallilalia

compulsive repetition of syllables (associated w/ Parkinsons/Hypokinetic dysarthria)

flaccid dysarthrias are

considered problems of neuromuscular execution

Execution

contraction of muscle fibers for movement of structures that modulate airstream and acoustic signal

Treatment of developmental apraxia/ childhood apraxia of speech

contrast therapy (minimal pairs), motokinesthetic, phonetic placement, ....

Motor Execution

controlled by areas of the cerebellum, motor cortex, and motor units in the muscles

Trigeminal cranial nerve (CNV- 5)

cranial nerve for Deep pressure and kinesthetic information from teeth, gums, hard palate, and TMJ. Has Motor fibers that innervate muscles of mastication and other extrinsic laryngeal muscles such as mylohyoid, anterior belly of the digastric, tensor tympani, tensor veli palatini

Trigeminal (CNV)

cranial nerve that has sensory fibers important for pain, thermal, tactile sensations from face & forehead, mucous membranes of nose and mouth, teeth & portions of cranial dura mater;

Unilateral lesions on a corticobulbar tract will affect

cranial nerves VII [jaw movement] & XII[tongue movement]

Spastic paralysis results from

damage to direct activation pathway

Dysarthria

defined as Impairment in ability to make the needed changes in ongoing oral-facial movement, which impacts motor speech

Any process that damages these bilaterally can cause spastic dysarthria

direct and indirect activation pathways

During speech motor plan

each different motor goal for each speech sound is identified and arranged to occur concurrently and sequentially

Prosodic excess

excess and equal stress, slow rate [almost robotic sounding] speech characteristic of spastic dysarthria

What leads to motor learning

extensive practice and experience producing speech; speech motor behaviors involve memory!

festinating speech

extremely fast speech together with short rushes of speech (one characteristic of parkinson's speech)

Huntington's Chorea

fatal, progressive disease that is usually genetic & passed from one male to the next; causes hyperkinetic dysarthria; caused by gradual degeneration of neurons in the basal ganglia & cerebral cortex especially in caudate nucleus and putamen in basal ganglia.

type of dysarthria that involves abnormal usage of air

flaccid dysarthria

Choreic movements affect Phonation causing

harsh vocal quality breathiness excess loudness variationd strained strangled vocal quality voice stoppages [may be caused by intermittent, involuntary hyperadduction of the VFs or intermittent VF abductions- paradoxical vf closure]

Phonatory-prosodic characteristics of Flaccid dysarthria

harsh voice, monoloudness, monopitch (difficulty in phonation will interfere/spill into prosody- so affects prosody)

motor plan for /s/ sound

have to move your tongue up to the alveolar ridge. It's a tongue-tip movement where contact is made between one articulator, the front of the tongue, and another articulator, the alveolar ridge

only type of dysarthria where all of the speech processes are affected

hyperkinetic dysarthria

lack of power to voice or reduced loudness can be referred to as

hypophonation

The most apparent speech characteristic with a Hypoglossal (CN XII) nerve lesion

imprecise articulation

Articulatory-resonatory incompetence

imprecise consonants, distorted vowels, resonatory componenet-hypernasality speech characteristic of spastic dysarthria

Articulatory process error examples

imprecise consonants, vowel distortions, prolonged phonemes

location of stroke that will lead to spastic paralysis & spastic dysarthria

in internal carotid as well as middle and posterior cerebral arteries

What causes the resonance difficulties in choreic, hyperkinetic dysarthria?

involuntary movements that alter the timing of velar elevation

Diffuse localization of neurological disorder

involves symmetric portions of both cerebral hemispheres as seen in brain shrinkage (atrophy) in dementia

Motor Planning Disorders i.e. Apraxia

involves the inability to group and sequence the relevant muscle with respect to each other

Multifocal disorder as localization for a neurological disorder

involving more than a single area or more than one group of contiguous structures e.g as in the case of MS may involve both cerebellum and cerebral cortex

Progressive Bulbar Palsy

is a motor neuron disease that primarily affects LMNs supplied by cranial nerves

Use of nonspeech tasks

is a way of developing awareness of articulators / structures- get a sense of where articulators must go etc.

Dysarthria- important to remember regarding these motor speech disorders

is an umbrella term for a group of speech disorders that manifest due to an underlying disease

Dysarthria- defined specifically & in layman terms

is an umbrella term for a group of speech disorders that result from a breakdown in motor programming; they result from disturbances is muscular control

Spastic Dysarthria

is associated with impaired movement patterns rather than weakness of individual muscles; impaired muscle groups

Glossopharyngeal CN IX

is the nerve that is rarely damaged in isolation due to its close proximity with CN X Vagus; the speech deficits seen with damage to this cranial nerve are associated more with CN X

Why is the identification of a dysarthria as hypokinetic important?

it can aid neurologic diagnosis and localization because its presence is strongly associated with basal ganglia pathology (specifically the substantia nigra)

Trigeminal Nerve [CNV]

its branches mediate sensory information including tactile and proprioceptive info about the jaw, face, lip, and tongue movements and their relationship to stationary articulatory structures in mouth [i.e. teeth, alveolus, palate]

Producing speech involves producing both

linguistic units & acoustic events; This requires coordination of muscle groups & programming muscle activities into single motor units to ensure fluent and accurate articulation.

Damage to the direct activation pathway leads to

loss or reduction of fine, discrete movement

Phonatory Stenosis

low pitch, harshness, strained-strangled voice, pitch breaks, short phrases, slow rate- speech characteristics of spastic dysarthria

Bulbar Palsy

medical condition associated with cranial nerve / brainstem injury

Unilateral pharyngeal branch lesion leads to

mild to moderate hypernasality and nasal emission during pressure consonants

Prosodic Insufficiency

monopitch, monoloudness, reduced stress, short phrases, robotic sounding speech/type of speech (those who have this pattern may NOT show/have excess or equal stress which is why there are 4 clusters of deviant patterns) characteristics of spastic dysarthria

Tremor

most common involuntary movement; involves rhythmic (periodic) movements of a body part

Hypokinetic Dysarthria

motor speech disorder that occurs/results from a lesion in the substantia nigra (which is a part of the basal ganglia control circuit); characteristics are most evident in voice, articulation, and prosody.

The combined processes of the speech motor planning, programming and the neuromuscular execution are known as the

motor speech processes

Are specified during motor programming

muscle tone, movement velocity, force and range as well as mechanical stiffness of the joints

Apraxia of speech can occur in the absence of

muscle weakness or language disorders

When disease affects this part of the motor unit, rapid weakening of muscle with use and recovery with rest can occur

neuromuscular junction [disease of neuromuscular junction such as myasthenia gravis]

Essential Tremor

occurs with sustained posture & action & commonly affects the upper limbs, head, or voice.

Cognitive linguistic processes

organizing and changing thoughts/feelings/emotions into verbal symbols according to the rules of the language

Trigeminal Nerve (CnV]

pain sensation from one or more areas of this nerve can be triggered by sensory input from the facial or jaw movements, sometimes leading to restricted lip, face or jaw movements during speech to avoid triggering pain

How might mild choreic movements be expressed

person may appear only restless or jittery. sometimes if infrequent, they may try to hide them by turning them into purposeful movements

target models of motor speech production state

process in which a speaker attempts to attain a sequence of targets corresponding to the speech sounds he is attempting to produce."

motor execution

processes that activate relevant muscles -during and after initiation of movement

motor planning

processes that define and sequence articulatory goals (prior to initiation of movement)

motor planning

processes that define and sequence articulatory goals (prior to initiation of movement); translation between language forms and the movement that occurs to create the sounds understood by the listener.

motor programming

processes that establish and prepare flow of motor info across muscle, as well as timing and force of movement-prior to initiation of movement

Cerebellum helps guide

production of rapid, alternating, repetitive movements - movements present in speaking and smooth movements

Tics

rapid, stereotyped, coordinated, or patterned movements that are under partial voluntary control

Primary Lateral Sclerosis

rare disorder a sub category of motor neuron disease related to ALS-manifested by corticospinal and corticobulbar tract signs alone. No evidence of LMN involvement

hypernasality; meaning the speech process of Resonation is impacted

reduced elevation of soft palate, difficulty achieving velopharyngeal closure would cause

what are the speech deficits in hypokinetic dysarthria mostly associated with?

reduced movement / decreased range of movement

Bradykinesia

reduced speed of muscles (associated w/ hypokinetic dysarthria/parkinsons); this causes difficulty initiating voluntary speech which can manifest as a delay in starting to talk as well as very slow speech

Lingual acoustic physiologic findings with flaccid dysarthria

reduced sustained lingual force- is another reason for slurred speech

Exacerbating

remitting > symptoms develop then resolve or improve (go away) then recur but worse than the initial (MS)

Modifying exhalation by practicing vowel prolongation works on which subsystem

respiration

Bilateral pharyngeal branch lesion can cause

severe hypernasality [if weakness is bilateral]

A Comprehensive Motor Speech Evaluation

should include motor control tasks that involve speech and nonspeech motor activities, assessment of the motor speech problems at each of the levels of functioning - disease, activity, and participation in life, and assessment of each of the subsystems separately - respiration, phonation, resonation, articulation, and prosody

Focal disorder as localization for a neurological disorder

single /specific area or structures/ continuous group of structures e.g. frontal lobe/parietal lobe or left frontal lobe etc.

bilateral UMN damage usually produces

spastic dysarthria

progressive pseudobulbar palsy is associated with this type of dysarthria

spastic dysarthria

hallmark of UMN disease

spasticity

The Motor Plan

specifies the movement goals with respect to the articulators (in speech motor planning)

The Motor Program

specifies which muscles will be used in moving the relevant articulators specified in the motor plan (Speech motor programming)

Binswanger's disease

subcortical arteriosclerotic encephalopathy or vascular dementia often associated with a history of hypertension

Impression that hyperkinetic dysarthria makes

that it interferes with normal speech production, and that if the excessive, involuntary movements could be eliminated, speech production might be normal

jaw will deviate to weak side when opened; will be able to feel the weakness on the one side when the patient bites down

the Non-Speech oral mechanism finding with unilateral mandibular branch lesions [branch of cranial nerve 5, trigeminal nerve]

Feedback model of motor speech production proposed that

the continuous execution of a motor program requires an equally continuous stream of sensory information from muscle and cutaneous senses throughout the respiratory, laryngeal, and orofacial regions.

hypokinetic dysarthria prominently affects aspects of speech motor control such as

the preparation, maintenance, and switching of motor programs

In order to have Motor Control- speed and fluency of speech

the sequences of movements are programmed together as a single movement unit

Cerebellum is

the structure responsible for the execution of smooth, directed movements

Hypokinetic dysarthria

this disorder reflects the effects of rigidity, reduced force and range of movement, and slow individual but sometimes fast repetitive movements on speech

Prosody

treatment of this involves manipulation of these three factors: loudness, pitch, and duration

Flaccid Dysarthria

type of dysarthria Produced by injury to the lower motor neurons (cranial nerves) involved in speech. The effects depend upon which cranial nerves are damaged.

Treatment of Phonatory System

type of treatment that involves Improving voice quality (e.g., postural adjustments, relaxation therapy) & Controlling vocal folds to enhance naturalness of speech

Toxic-Metabolic disease

vitamin deficiency, genetic biochemical disorders, liver and kidney disease, drug toxicity. Development of the disorder can be acute, subacute or chronic.

Surgery in the brainstem or head, neck, or upper chest can temporarily injure or permanently damage speech cranial nerves, and is perhaps the most common cause of

vocal fold paralysis

Key evaluation tasks for hyperkinetic dysarthria

vowel prolongations- tells you about vocal quality; AMR- alternating motion rate- highlights irregular articulatory breakdowns and speech rate variations; Conversational speech

With acute UMN lesions/strokes patient initially shows

weakness/flaccidity which then evolves to increased tone and spasticity

How Severe choreic movements are expressed

will interfere with voluntary movements such as walking, swallowing, & speech

Development of symptoms can be

• Acute - within minutes • Subacute - within days • Chronic -within months

Etiologies of Motor Speech disorder [generally]

• Degenerative • Inflammatory • Toxic-metabolic • Neoplastic • Traumatic • vascular

Final Common Pathway (FCP) or Lower motor neuron system (LMN)

• Made up of cranial & spinal nerves • It is the system/mechanism that mediates all motor activity - last link in the process that connects neural behavior to the action.

Effects of Damage to DAP (Direct Activation Pathway):

• Minor jaw impairment • Tongue weakness on side opposite lesion • Unilateral lesion can produce dysarthria that shows weakness and loss of skilled movement • Bilateral lesions produce spastic dysarthria

Spastic paralysis

• Reflexes diminish at first but later become more pronounced - Positive Babinski sign common in CNS disease in adults. • Following acute lesions patient experiences reduced muscle tone and weakness but then this evolves to increased tone and spasticity

Damage to Indirect Activation Pathway would produce

• Spasticity & hyperflexia • Depending on the particular tracts damaged different effects will result e.g if damage occurs in corticoreticular fibers there will be increased extensor tone • Lesions inferior to medulla produce flaccidity • Dysarthria resulting from IAP lesions - spastic when lesions are bilateral and unilateral UMN dysarthria when lesions are unilateral. This is because the DAP and IAP are usually involved.

The Types of Dysarthria

◦ Flaccid ◦ Spastic ◦ Ataxic ◦ Hypokinetic ◦ Hyperkinetic ◦ Unilateral UMN ◦ Mixed