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