Motor Speech Disorder (Overview) PDF

Motor Speech Disorder (Overview) By Wong Yee Yan (Yanis) 1  Speech vs Language Feldman, H. M. (2019). How Young Children Learn Language and Speech. Pediatrics In Review, 40(8), 398–411. 2 https://doi.org/10.1542/pir.2017-0325 ...

Motor Speech Disorder (Overview) By Wong Yee Yan (Yanis) 1  Speech vs Language Feldman, H. M. (2019). How Young Children Learn Language and Speech. Pediatrics In Review, 40(8), 398–411. 2 https://doi.org/10.1542/pir.2017-0325  3 https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/ Dysarthria ⚪ Hallmark characteristics Problems in motor execution due to damage to ⚪ Motor neurons ⚪ Areas of the brain that control movement ⚪ Associated characteristics Other motor problems (e.g., limbs) Language problems Cognitive problems 4  a ⚪ Causes > - Movement de Cerebral Palsy (CP) -- child ⚪ Traumatic brain injury (TBI) – child & adult ⚪ Tumors – child & adult ⚪ Stroke ⚪ Parkinson Disease (PD) ⚪ Amyotrophic Lateral Sclerosis (ALS) ⚪ Multiple Sclerosis (MS) ⚪ Many others 5 Speech Subsystems Any area of speech production can be affected Respiration (breathing) Phonation (laryngeal system) Resonance (movement of velum) Articulation (movement of tongue/lips) Prosody Depends on location of damage 6  Prosody Affect Speech movement in terms of Resonance - Speed Articulation - Strength - Range phonation - Timing - Accuracy Respiration Green, J. R., Yunusova, Y., Kuruvilla, M. S., Wang, J., Pattee, G. L., Synhorst, L., Zinman, L., & Berry, J. D. (2013). Bulbar and speech motor assessment in ALS: Challenges and future directions. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 14(7–8), 494–500. https://doi.org/10.3109/21678421.2013.817585 7 Location of damage Upper Motor vs Lower Motor Neuron 8  Characterization: Types of Dysarthria Flaccid Dysarthria Location of damage Lower motor neurons Muscle - Muscle atrophy (wasting) - Weak - Reduced muscle reflexes Speech Characteristics - Respiration - Slow speech rate - Phonation - Breathy - Resonance - Hypernasality - Articulation - Imprecise articulation https://www.youtube.com/watch?v=jPFepAOQg0M 9  Characterization: Types of Dysarthria Spastic Dysarthria Location of damage Upper motor neurons Muscle - Spasms (muscle keeps contracting rather than relaxing) - Muscles are tight - Exaggerated reflexes Speech Characteristics - Respiration - Slow speech rate - Phonation - Harsh voice quality - Articulation - Imprecise articulation https://www.youtube.com/watch?v=xB9NgPZSQFA 10 https://www.youtube.com/watch?v=PZix1F6Gygk  Characterization: Types of Dysarthria Ataxic Dysarthria Location of damage Cerebellum Muscle - Incoordination - Inaccurate and dysrhythmic movements - Minimal weakness & normal reflexes Speech Characteristics - Respiration - Slow speech rate - Prosody - Monotonous, Disruption in stress patterns https://www.youtube.com/watch?v=7BnGxeMAM_s 11  Characterization: Types of Dysarthria Hypokinetic Dysarthria (Parkinson’s Disease) Location of damage basal ganglia Muscle - Muscles are rigid - Resting tremor - Difficulty starting and stopping movement Speech Characteristics - Respiration - Slow or fast speech rate - Phonation - Reduced loudness - Prosody - Monoloudness, monopitch https://www.youtube.com/watch?v=w-HfkQK4dnY 12  Characterization: Types of Dysarthria Location of damage A Hyperkinetic Dysarthria (Huntington’s Chorea) basal ganglia Muscle - Involuntary movements Speech Characteristics - Phonation - Breathy or strained/strangle – may alternate - Articulation - Imprecise articulation - Prosody - Hesitations in unusual places; Short phrases and long unnatural pauses https://www.youtube.com/watch?v=KleHA0fv0Eg (4:00) 13 Characterization: Types of Dysarthria Mixed Dysarthria Location of damage multiple parts of motor system Muscle - Combined elements of all Speech Characteristics the other dysarthrias - Respiration depending on the systems - Phonation involved - Resonance - Articulation - Prosody 14 Assessment ⚪ Oral-Motor exam Examine how the muscles move to assess which areas are damaged and in what way ⚪ Speech sample Spontaneous speech Individual speech sounds (e.g., picture naming) Perceptual method Instrumental method 15 Recommendation ⚪ Treatment What to focus on will depend on the specific characteristics identified Many of these diseases are PROGRESSIVE ⚪ Client is expected to get worse ⚪ Greater focus on compensation fawarded to someone in loss , recognition ofinpuy suffering , 16  Re-organization ⚪ Drugs and/or surgery may be used for some disorders ⚪ Speech therapy: May focus on individual sounds (as with speech sound disorders) Usually focus is more on general aspects of articulation ⚪ Speed or slow rate ⚪ Increase loudness ⚪ Exaggerate articulator movements ⚪ May need to consider alternative means of communication 17  Apraxia of Speech ⚪ an impaired ability to program motor commands that are necessary for speech production ⚪ difficulty putting phonemes together in the correct order to form words ⚪ Increasing difficulty with increasing length of words ⚪ Inconsistent speech error ⚪ groping for the right sound or word ⚪ Incorrectly use prosody https://www.youtube.com/watch?v=SfPBdzBKl8w&t=3s 18 19