Chapter 10 - 131 Motor Speech Disorders PDF

CH. 10 MOTOR SPEECH DISORDERS Course 131 Dr. Latifa Albusairi  MOTOR SPEECH DISORDERS A heterogeneous group of neurological impairments that effect motor planning, programming, coordination, timing, and execution of movement patterns used for speech production in bot...

CH. 10 MOTOR SPEECH DISORDERS Course 131 Dr. Latifa Albusairi  MOTOR SPEECH DISORDERS A heterogeneous group of neurological impairments that effect motor planning, programming, coordination, timing, and execution of movement patterns used for speech production in both children and adults. Caused by 1. Neurological disorder 2. Brain Injury MOTOR SPEECH CONTROL  UPPER MOTOR NEURON SYSTEM Made up of 1. Pyramidal Tract (direct activation pathway) - responsible for rapid, discrete, volitional movement of the limbs and of the articulators for speech production. - directly connects the cortex to the neurons that directly control the activation of muscles for the initiation of movement. 2. Extrapyramidal tract (indirect activation pathway) - important for regulating reflexes and maintaining posture and muscle tone, thus providing the necessary framework to facilitate movement carried out by the direct activation system. Together, the direct and indirect activation pathways form the upper motor neuron system.  B ASAL GANGLIA A set of subcortical nuclei in the cerebrum involved in the integration and selection of voluntary behavior Forms part of the brain’s extrapyramidal system Main function: To modulate the activity of the primary motor cortex and indirectly influence movement  CRANIAL NERVES Central nervous system ( CNS ) is made up of the brain and spinal cord. Peripheral nervous system ( PNS ) is made up of 12 pairs of cranial nerves. By transmitting messages to muscles and receiving sensory information, the PNS helps CNS communicate with the body.  CRANIAL NERVES CONTINUED Motor speech is all about planning: Controling how to get speech sounds out of the brain and to the speech organs This control happens through the cranial nerves Motor speech is also related to respiration, phonation, resonation, & articulation Any delay in the brainstem can affect how quickly you breath, how your vocal folds open and close, how the velum is lifted upwards… This all relates back to the cranial nerves and how they transmit information to the speech organs MOTOR SPEECH DISORDERS  DYSARTHRIA VS. APRAXIA OF SPEECH Two primary areas of motor speech disorder 1. Dysarthria 2. Apraxia of speech In these two conditions the connection between the brain and speech mechanism is damaged or interrupted. This results in a disturbance in motor planning, programming, neuromuscular control, and/or execution of speech.  DYSARTHRIA A group of speech disorders caused by disturbances in central & peripheral nervous system that controls the muscles of speech production Resulting in slurred/slow speech making the person difficult to understand There are many types of dysarthria and symptoms depend on where the lesion are located in the nervous system  FLACCID DYSARTHRIA Weak muscles, reduced in tone, low reflexes, atrophy (progressive degeneration or shrinking of muscles) Speech characteristic Breathiness Monopitch Hypernasal Short phrases Poor articulation https://youtu.be/jPFepAOQg0M  SPASTIC DYSARTHRIA Spastic (abnormaly tight) muscles, increased muscle tone (strength to move jaw & tongue to speak) Speech Characteristics Slow rate Strained/strangled voice Hypernasal Imprecise articulation Stressed https://m.youtube.com/watch?time_continue=85&v=PZix1F6Gygk&feature=emb_logo  ATAXIC DYSARTHRIA Incoordination, reduced muscle tone, poor accuracy and timing of movements Speech characteristics Irregular breakdowns in articulation Imprecise consonants Vowel distortions Prosodic abnormalities (rate of speaking, phrasing, pausing, rhythm, stress & vocal quality) https://vimeo.com/432168926  HYPOKINETIC DYSARTHRIA Reduced movement, muscle rigidity and stiffness , difficulties starting and stopping movements Speech characteristics Accelerated speech rate Imprecise articulation due to reduced range of motion articulators Breathy/harsh/hoarse voice quality Reduced loudness Disfluencies https://m.youtube.com/watch?v=DUQGc4uRdHo  HYPERKINETIC DYSARTHRIA Involuntary movements Speech Characteristics Irregular breakdowns in articulation Prosodic abnormalities Variable speech rate https://youtu.be/3TWl6NEDSkk  MIXED DYSARTHRIA Combination of two or more dysarthrias Speech Characteristics Imprecise articulation Slow rate Harsh voice Monopitch, monoloudness Hypernasality Stressed https://youtu.be/0qiqrQepMeQ  APRAXIA OF SPEECH A distinct neurological speech disorder that impairs the ability to plan or program the sensory and motor commands needed for speech production. ( it is a motor speech disorder that results in the inability to control the muscles used to form words) Speech Characteristics Disordered articulation of vowels & consonants Slowed rate Prosodic disturbances (pausing, lengthening of speech segments) ETIOLOGY OF MOTOR SPEECH DISORDERS  MOTOR SPEECH DISORDERS CAN BE Acquired congenital occurring after occurring at or the neuromotor before birth. system is fully mature. 20  Acquired dysarthria may be due to Stroke Traumatic Brain Injury Progressive degenerative diseases (Parkinson’s, Multiple sclerosis) Congenital dysarthria may be due to Cerebral palsy Maternal wellbeing during pregnancy Structural problems at birth ASSESSING MOTOR SPEECH DISORDERS  TYPICAL COMPONENTS OF DYSARTHRIA ASSESSMENT Case history: medical and family history, associated deficits, medications etc. Non-speech examination: cranial nerve exam, oral-motor exam, sustained vowel prolongation, facial & neck muscle tone observations Speech production: vocal quality, loudness & pitch quality, repetition of simple & complex words and sentences Prosody: variation in pitch, loudness Other components to assess may include: Language assessment Cognitive-communication assessment Swallowing assessment TREATING MOTOR SPEECH DISORDERS  TARGETING SPEECH-PRODUCTION SUBSYSTEMS Areas to focus on during treatment Respiration Phonation Articulation Resonance Prosody