Case Study
A 68-year-old man presents with slurred speech that has worsened over the past year. During the speech-language evaluation, his conversational speech is noted for irregular articulatory breakdowns, excess and equal stress, prolonged phonemes, and inappropriate silences. His prosody is noticeably disrupted, and his rate fluctuates inconsistently. Oral mechanism exam reveals no signs of weakness or fasciculations.
Ataxic Dysarthria
Which type of feedback is associated with greater long-term generalization in motor learning
Delayed, reduced-frequency feedback
In a patient with both AOS and severe nonfluent aphasia, what should treatment focus on?
Language comprehension and formulation
For a patient with spastic dysarthria, what breath support approach should be used with caution or avoided
EMST
Give me an example of a medical intervention for a motor speech disorder?
Botox for spasticity, Levodopa for Parkinsons
A patient with damage to the hypoglossal nerve (CN XII) presents with significant tongue weakness, reduced range of motion, and imprecise articulation. The patient has difficulty with lingual sounds, especially alveolar and velar consonants. Oral mechanism exam reveals fasciculations and atrophy of the tongue on the affected side. Vocal quality and resonance are normal. You diagnose them with:
Flaccid Dysarthria
What is a common intervention for flaccid dysarthria?
Effortful breath support exercises (e.g., blowing, sustained phonation)
Pushing/pulling techniques to increase respiratory drive and increase vocal fold adduction
Head or postural adjustments
Palatal lift prosthesis (for velopharyngeal insufficiency)
Overarticulation drills for imprecise consonants
Compensatory speaking strategies: reducing speech rate, increasing pauses
What is a pro and a con of teaching Pt to reduce their rate?
Pro: increase articulation and intelligibility
Con: may decrease naturalness of speech
What is the primary goal of dysarthria management?
Maximizing speech intelligibility, efficiency, and naturalness
What is a major difference in treatment of AOS and dysarthria?
Dysarthria treatment focuses on restoring or compensating for impaired neuromuscular execution (e.g., improving breath support, resonance, articulation through strengthening or compensation).
Apraxia of Speech (AOS) treatment focuses on retraining the planning and sequencing of motor movementsfor speech (e.g., Sound Production Treatment, articulatory cueing, and repetition of specific speech targets).
An 80-year-old woman with a diagnosis of ALS presents with slow speech rate, imprecise articulation, hypernasality, strained-strangled vocal quality, monopitch, and short phrases. Neurologic findings reveal bilateral facial weakness and reduced range of motion in the tongue and soft palate. There is no evidence of language impairment or apraxia.
Spastic Dysarthria
What is a common intervention for spastic dysarthria?
Relaxation and Voice Techniques
Easy onset phonation
Yawn-sigh technique
Breathy voice onset to reduce strain
Laryngeal massage or circumlaryngeal techniques
Overarticulation strategies (exaggerated precision)
Pacing boards or metronomes for slow, controlled speech
Intonation drills to improve monotone/monoloudness
Focus on breath group training (speaking in shorter, well-supported phrases)
A patient with moderate apraxia of speech is learning to self-correct and monitor speech errors using structured repetition and minimal contrast pairs.
SPT (Sound Production Treatment)
A patient with spastic dysarthria has a strained voice and slow, effortful speech.What would be an appropriate intervention?
relaxation techniques, breathy/easy onset, yawn sign
Tell me a compensatory strategy to support clear articulation.
Over-articulation (exaggerated speech movements)
Slowing rate of speech
Using pausing or pacing strategies
Increasing loudness (when appropriate)
Emphasizing key words
Reducing sentence complexity or using shorter phrases
An 80-year-old female was admitted to the hospital after the sudden onset of mild slurred speech. Her medical history includes a 15-year history of hypertension and a previous transient ischemic attack. Neuroimaging revealed a small infarct in the left internal capsule. On speech-language evaluation, she demonstrated mild right lower facial weakness and reduced range of motion of the right side of her tongue. Speech was characterized by imprecise articulation and a mildly slowed rate. Vocal quality was mildly hoarse, but resonance and prosody were within normal limits. There was no evidence of aphasia or apraxia.
UUMN Dysarthria
Tell me something important to consider when treating AOS?
Careful stimulus selection (high frequency words, meaningful words, automatic reactive speech, oral nasal distinctions/ manner distinctions/ voicing distinctions)
Orderly task progression
Intensive drill
Motor learning principles
What is the rational behind Melodic Intonation Therapy?
It leverages preserved right-hemisphere melody processing
What is the primary goal of using a pushing or pulling task in voice therapy for dysarthria?
To increase vocal fold adduction for stronger phonation
Identify one shared principle for treating AOS and Dysarthria
Both dysarthria and apraxia of speech benefit from motor learning principles, including intensive, repetitive, and task-specific practice to improve speech production.
A 63-year-old woman presents with involuntary movements that interfere with her speech. She has a known diagnosis of Huntington’s disease, confirmed genetically five years ago. Her husband reports that her speech has become unpredictable—sometimes clear, but often interrupted by sudden voice stoppages, loud bursts of speech, and variable pitch. During your evaluation, her speech is noted for irregular breakdowns, inappropriate silences, excess loudness variation, and a strained-harsh vocal quality. You observe visible choreic movements of her face and limbs during conversation. Oral mechanism exam reveals normal strength and range of motion, but there is reduced coordination due to involuntary movement.
Hyperkinetic
Explain to me the rationale behind SpeakOut! program
SPEAK OUT! emphasizes intentional, effortful speaking (saying words with intent) to override the reduced automatic motor output.
SPEAK OUT! is based on principles of motor learning and neuroplasticity, which suggest that intensive, repetitive, and purposeful practice can strengthen and retrain motor pathways.
Similar to LSVT LOUD, SPEAK OUT! promotes speaking with intention and loudness, but it is generally less physically taxing, making it a good alternative for some patients.
What are some things you can do with someone with SEVERE AOS and aphasia with limited verbal output?
Script training
Automatic Speech tasks
Carrier phrases
Gestures
AAC - (simple)
What distinguishes communication-oriented management from speaker-oriented treatment in dysarthria?
It involves environmental and listener strategies to enhance message transmission
Explain why speech-based tasks are generally favored over nonspeech oral motor tasks in AOS treatment, according to motor learning principles.
Speech-based tasks are favored in AOS treatment because, according to motor learning principles, learning is most effective when practice is task-specific. Speech involves highly complex, coordinated movements that are distinct from nonspeech tasks like blowing or tongue wagging. Therefore, practicing actual speech movements (e.g., syllables, words, phrases) leads to better generalization and improvement in real-world communication. Nonspeech tasks do not transfer effectively to speech performance.