Conceptual Frameworks
Motor ___ is articulator specific; motor ___ is muscle specific.
planning; programming
Function of the basal ganglia in motor activity.
Planning and programming of postural and supportive components for motor activity. When damaged, parkinsonism can occur.
The general types of etiologies of dysarthria.
V-vascular, I-infectious/inflammatory, T-traumatic/toxic, A- autoimmune, M-metabolic, I-idiopathic/iatrogenic, N-neoplastic, D-degenerative
A definition for the dysarthrias.
A collective name for a group of neurologic speech disorders resulting from abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for the control of respiratory, phonatory, resonatory, articulatory, and prosodic aspects of speech production.
+ reduced loudness
+ reduced stress
+ monopitch, monoloudness
+ repeated phonemes
+ palilalia
+ short rushes of speech and increased overall speech rate
Hypokinetic Dysarthria
Feedback-based error correction and monitoring is a concept that belongs to what conceptual framework?
DIVA -- Directions Into Velocities of Articulators
Function of the cerebellum in motor activity.
Integrating and coordinating execution of smooth, directed movements.
What is Huntington's Disease? What's affected neurologically and how is speech affected?
It's an inherited autosomal dominant degenerative CNS disorder that typically begins by the 4th to 5th decades of life. Death is expected within 10-20 years post-onset. Neurons in the caudate nucleus and putamen are lost, as well as those across the cortex. Decreased GABA (an inhibitor) and unbalanced dopamine activity in the striatum causes chorea. Hyperkinetic speech characteristics can be prevalent, and may be the first sign of the disease. Note that presentation may appear similar to spasmodic dysphonia.
Auditory-perceptual methods.
+ slow rate
+ equal excess stress
+ imprecise consonants
+ distorted vowels
+ hypernasality
+ strain-strangled voice
Spastic Dysarthria
Key neural areas for motor execution (there are 6!).
Motor cortex, cerebellum, brainstem, thalamus, lower motor neuron, basal ganglia.
The basic components of the lower motor neuron system.
What is Parkinson's Disease? What happens in PD neurologically? How is motor speech affected?
It's a slowly progressing neurodegenerative disease affecting 2-3% of the population over 65, usually beginning mid to later life. Life expectancy post-dx is 15 years. Nerve cell loss in the substantia nigra and decreased dopamine (excitatory?) in the striatum contribute to many clinical signs of PD, for which dopaminergic drugs can provide some relief. Hypokinetic speech characteristics can develop.
What are the speech subsystems?
respiration, phonation, articulation, resonance, and prosody
•Hyper-nasality
•Nasal emission
•Continuous breathiness
•Audible inspiration (stridor)
•Short phrases
Flaccid dysarthria
The four major functional divisions of the motor system & the fifth higher division.
What are the 1) final common pathway, 2) direct activation pathway, 3) indirect activation pathway, 4) control circuits, and 5) planning and programming level in the motor system? (see pp. 29-30)
The basic components of the upper motor neuron system.
Corticobulbar and corticospinal tracts. (Please keep in mind that there are components of the indirect activation pathway in the upper motor neuron system as well: corticorubral tracts, pyramidal system, etc)
What is multiple sclerosis? What causes it neurologically? What dysarthria is associated with it?
MS is a demyelinating disease that most often affects the cerebellum and its afferent and efferent pathways. Spastic dysarthria may be seen, although 80% of people with MS may have ataxia. Watch out for paroxysmal ataxic dysarthria (PAD), aka episodic ataxia, because its presence can be suggestive of MS or another demyelinating disease.
rate, short phrases, increased rate in segments, increased rate overall, reduced stress, variable rate, prolonged intervals, inappropriate silences, short rushes of speech, excess and equal stress, syllable segmentation
+ slow rate
+ forced inspiration/expiration
+ strained/harsh voice
+ voice stoppages
+ irregular artic distortions
+ inappropriate silences and prolonged phonemes
Hyperkinetic Dysarthria
Left posterior inferior frontal gyrus, pre-motor cortex, putamen of BG & cerebellum, frontal-limbic system. Programs specify muscle tone, movement direction, force, range, rate, and mechanical stiffness of joints. Ataxic and hyperkinetic dysarthria are most commonly affected.
Is Bell's Palsy a UMN or LMN syndrome? Why? What cranial nerve is affected?
LMN syndrome that affects CN VII (facial nerve). Ipsilateral upper and lower facial muscles are paralyzed. It's LMN because for cranial nerves, cell bodies of upper motor neurons are in the head and neck area of the motor cortex. Axons descend, decussating just before synapsing with cell bodies of lower motor neurons which make up the motor nucleus of that cranial nerve.
What is myasthenia gravis? What causes it neurologically? What dysarthria is associated with it?
A neurological disease affecting only the neuromuscular junction. It most commonly affects women in their 30's, and men in their 60 to 70's. There is an autoimmune response against acetylcholine (ACh) receptors in the post-synaptic membrane at the motor endplate. This affects muscle contraction and rest may be needed to replenish strength and supply of ACh. Watch for ptosis, facial weakness, flaccid dysarthria, triple furrowed tongue atrophy (if present), and dysphagia. A speech stress test can be very useful with the use of Tensilon to see if speech will improve. There is also a rare type of MG in which there's inadequate release of ACh (Lambert-Eaton MG).
Articulatory characteristics that can be considered during perceptual analysis. There are 8 possibilities.
imprecise consonants, prolonged phonemes, repeated phonemes, irregular articulatory breakdowns, weak pressure consonants, distorted vowels, distorted articulatory groping, and increased errors with increased rate
+ moderately severe
+ imprecise consonants
+ imprecise, slow AMRs and slow rate
+ irregular articulatory breakdowns
UUMN Dysarthria