SP-MSC 335 [MIDTERM].pdf

SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 restoration, you want them to return to INTERVENTIONS FOR MOTOR SPEECH CONDITIONS...

SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 restoration, you want them to return to INTERVENTIONS FOR MOTOR SPEECH CONDITIONS their pre-onset condition (100% capacity in terms of speech and TREATMENT CONSIDERATIONS communication) yan yung goal ng Interventions for Motor Speech Conditions restoration that’s why it may not be a TREATMENT CONSIDERATIONS (Duffy, 2013) realistic goal for many patients, Speech vs Communication especially with those who have Communication is the exchange of ideas neurological issues, there will be between speaker and listener (interactive residual impairments (may natitirang portion). impairment). The goal of restoration is 100% capacity in terms of Speech is the ability to physically produce communication and speech. individual sounds and sound patterns related to a specific language. It is the act of speaking Most speech, language, and or the action of producing or articulating communication disorders are not speech. Speech is the use of the vocals and curable or treatable. articulatory structures to produce sound. ○ Compensation promotes the use of residual function; modifications in rate Language is a symbolic, rule-governed and prosody, prosthetic devices, voice system to convey a message composed of amplification, AAC spoken or written words or gestures. Eto yung natitirang functioning after Goal of intervention is to “maximize the the impairments. effectiveness, efficiency, and naturalness of communication.” Example: A patient who has a severe ○ Restoration condition and the patient can’t speak ○ Compensation but can understand and can write ○ Adjustment what he wants to say. What we want is effective communication. Speech is just one modality by which we It’s more of maximizing the communicate, there are other ways of functioning and skills of the patient for communication (e.g., written, reading, communication. The majority of our listening, speaking, gestures, AAC, and patients will rely on compensation. nonverbal means like “makuha ka sa tingin”). ○ Adjustment includes temporary or Communication is the ultimate goal of permanent changes that aim to management reduce the need for lost function; The patient needs to be able to communicate restricting verbal interactions, effectively regardless of the modality. Our changes in lifestyle, reorganization of default is speech, but if the patient really can’t home and work environments use speech, our role is to teach the patient to Restoration and compensation communicate in other ways. focuses more on the individual ○ Restoration aims to reduce whereas the adjustment focuses more impairment and restore lost function; on the environment–what you can not a realistic goal for many patients, modify in the environment that can especially those with moderate to make the communication of the severe conditions patient more effective. There is an underlying assumption that you can restore the performance For example, if a patient, before the of the patient 100% after the condition works in a vocally impairment. For example, a stroke demanding setting and interacts with patient who can’t speak properly—for people, but after he had the condition, 1 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 he was placed in a different office that ICF (WHO, 2001) doesn’t need much interaction with Don’t just focus solely on the condition or people. This is a form of adjustment, it impairment of your patient, always look at the focuses more on the environment and bigger picture—the limitations, restrictions, external factors. environmental and personal factors that will affect your treatment. In restoration, you want to reduce Comorbidities impairment and restore loss function Most often than not, speech is the least whereas compensation you want to prioritized area because there are other areas promote the current functioning of the like swallowing that needs to be addressed patient. first. But this is a case-to-case basis, it’s also When we adjust the patient’s environment, important to look at the patient’s how do we know the extent of our comorbidities. involvement? Do we also educate other Motivation and Needs people involved with the patient? Are they motivated to go to therapy or are - This is a case-to-case basis, it they okay with their current form of depends on the patient, and it communication? depends on the environment of the Environment patient. Usually, we relay our Work setting, environment at home, is the adjustments to the patient, then we patient receiving enough support emotionally, ask if it’s feasible or kaya ba siya. financially, etc. - Our role is to provide Health Care Support recommendations, which can be indicated in the report. - Usually, it’s not our role anymore to educate or counsel the people in the work, we just focus on the patient. Prognosis Prognosis is the expected course of the disease, in relation to different factors where treatment or intervention is involved. What is the difference between the prognosis of a patient who had a stroke vs. a patient who has Parkinson’s disease? - They have different prognosis. You also have to consider the etiology of the condition. - Example for Parkinson’s disease, it is a neurodegenerative condition so you’ll expect a gradual degeneration of skills as time goes on, so what’s your plan for that? → Client Perspective - For stroke on the other hand, we What the patient thinks and what their family expect their improvement is fast for thinks. What are their priorities and the first two months, we call that a motivations and needs? This also includes the spontaneous recovery, and then after environment of the Px, the support the Px 6 months - 1 year, ‘pag chronic na receives, etc. condition nagplateu na skill. 2 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 → Clinical Expertise Medialization thyroplasty for vocal Clinical reasoning. How do you analyze fold paralysis cases, how do you evaluate and provide intervention? II. BEHAVIORAL INTERVENTION A. Prostheses and Assistive Devices → Evidence Prostheses Internal - the evidence you get through ○ May help improve resonance assessments for individuals with External - journals, published and unpublished velopharyngeal incompetence articles that are reliable, books It works for CLAP patients and it also works for patients with INTERVENTION APPROACHES neurological conditions. Pag Interventions for Motor Speech Conditions incompetent, physiologic yung I. MEDICAL INTERVENTIONS problem this usually results We aren’t the ones who give and evaluate or from neurologic impairment. recommend this. This is done usually by ○ Can either be temporary or physicians. long-term ○ Palatal lift prosthesis A. Pharmacologic Management Assistive Devices Medications for degenerative ○ May facilitate speech diseases such as dopaminergic production and functional drugs for Parkinson’s disease and communication maintenance medicines for ○ Voice amplifiers and speech neurologic conditions valves (for tracheostomized Kasama na din dito yung individuals) prophylactic or preventive medicines. ○ Alternative/Augmentative Like many old people who have Communication (AAC) System hypertension or diabetes, they have Especially for patients with maintenance medicines. limited to no verbal output BoTox Injections for Spasmodic Dysphonia B. Behavioral Intervention Medications that may affect speech 1. Speech-Oriented Approaches production ○ Primarily targets speech In an in-patient setting, most of them intelligibility, while efficiency of are taking medicines. Usually, the communication is only medications’ side effect is lethargic, secondary so you also have to consider that. ○ Works by improving physiologic As well as medicines that may cause support to reduce impairment slurred speech, you have to take that and maximizing use of residual into account so you may ask or skills to compensate request the physician or nurse for Your goal is more restoration. the patient to take the medicine after You want to reduce impairment therapy or you can change the and maximize use of residual schedule of the patient. skills. It’s more of restoration and a little of compensation. B. Surgical Management Surgical operations for tumors, You want their speech to return aneurysms, and occluded arteries to normal as close as possible. Your priority here is speech. 3 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 2. Communication-Oriented Be mindful of the Approaches non-verbal cues of the ○ Focuses on facilitating patient communication, whether or not ○ Stimuli to be presented speech improves Age-appropriate materials ○ Environmental modifications (e.g., toys for pediatric and AAC patients, newspaper for Focuses more on the geriatric patients) adjustment and ○ Context and setting of compensation. You're activities focusing on communication ○ Individual vs Group regardless if the speech is Therapy improving or not. You can only do so much in one-on-one sessions. For C. CONSIDERATIONS IN BEHAVIORAL group therapy, you can INTERVENTION target social Medical Diagnosis, Severity communication skills, and Rating, and Speech generalization skills of the Characteristics patient (e.g., the patient It’s more of the impairment of can only speak well when condition and health condition speaking with you, but itself. when with other people it’s Onset of Therapy: Acute vs the opposite). Chronic Example: Stroke patients will SPEECH-ORIENTED APPROACHES have better improvement if Interventions for Motor Speech Conditions treated early. So meaning during the acute phases of the condition DYSARTHRIA Speech-Oriented Approaches within two months, the patient started to have therapy already, ➔ Interventions for each subprocess of speech the higher the recovery rate. production Same with the pediatric ◆ Respiration population. ◆ Phonation ◆ Resonance In general, it would really be ◆ Articulation better to start therapy as early as ◆ Fluency (rate and rhythm) possible. ➔ Approaches and techniques may be applied Establishment of Baseline to regardless of the type of dysarthria, but the measure changes in clinical pathophysiology should be considered outcomes Yung approaches for treatment will thus focus Internal Evidence. So this is the on the subprocess that is affected by the pre-intervention baseline. Then condition. If there is a problem with the you will compare the performance respiration and phonation of the patient, then of the px baseline and post you can start with that. intervention to determine if the treatment was effective or not. The treatment can be applied to the different Organization of sessions types of dysarthria but then again you have to ○ Frequency, duration, consider the pathophysiology. setting, rest periods and fatigue 4 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 I. RESPIRATION —head, neck, shoulders, and trunk, so Facilitation of optimal breathing pattern that the posture will be nice when and breath groups speaking. Of course, in terms of the When we talk about breath groups, this pattern, we also want to facilitate the use is the number of words that a person can of the diaphragm (diaphragmatic produce in one breath. breathing). Instrumental biofeedback The optimal breathing pattern for We can use instrumental biofeedback to neurotypical individuals will stand around help the patient visualize better the 5-7 words per breath. respiratory exercises. Expiratory Muscle Strength Training For patients who had neurologic This is an example of a non-speech task. conditions usually binababa natin breath ○ Uses a handheld pressure threshold group nila. The patients have the device tendency to still have the same breath ○ Regimen: 4 weeks, 15-20 min/day, 5 group but their breath support isn’t okay days/week anymore so what happens is their speech ○ Has evidence on improving rate goes fast, and their voice weakens so respiratory strength and swallowing their speech intelligibility is poor because function that’s their usual way of speaking (nakasanayan na nila), they got used to it already, so our role is to identify what their optimal breath group is for the patient. Exercises should be done in the context of speech tasks (specificity and salience) Focusing more on speech tasks means if we want the patient to improve his/her II. PHONATION respiration it has to be in the context of Physiologic Voice Therapy speech. The patient has to take deep Symptomatic Voice Therapy breaths and also needs to control when Direct voice therapy strategies he/she is expiring air. Client education, vocal hygiene, and Nonspeech respiratory exercises may be counseling (indirect strategies) done when the patient is unable to Indirect strategies such as client generate sufficient subglottal pressure to education, etc., initiate phonation Use of assistive devices Example: Expiratory Muscle Strength ○ Voice Amplifiers Training wherein a patient blows through ○ Speech Valves a tube or device. Breathing exercises in the spirometer. III. RESONANCE Use of optimal breath group Targeted together with articulation ○ Number of words that can be Modification of speaking pattern – rate produced comfortably in one breath reduction and over articulation ○ Teach patients to keep utterances Resonance can be targeted with within their optimal breath group articulation. ○ May gradually increase the length of Example: modification of speaking pattern utterances as respiration improves by rate reduction and over articulation Postural Adjustments may further improve resonance We need to make the patient monitor their Biofeedback posture. It should be aligned in one plane A nasometer–can be used during therapy. 5 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 Nonspeech velopharyngeal movement Integral Stimulation tasks that control and modify the breath Phonetic Placement steam (e.g., blowing, whistling) Phonetic Derivation May improve control and modify the Overarticulation breath stream, but be careful when using Contrast Therapy (Minimal and Maximal non-speech exercises, as much as Contrast) possible we want to maximize the Intelligibility Drills specificity of neuroplasticity meaning you’re using the muscles for their V. FLUENCY (Rate and Rhythm) intended use. Delayed Auditory Feedback You will hear earphones wherein you can It is not our goal for the patient to whistle hear yourself. So when you speak, you but we want them to be able to speak, so can hear your voice in delay. The delay as much as possible, you’d want to use can be adjusted. What happens is it speech exercises. enhances the biofeedback because it’s delayed and naririnig mo. It is sometimes But if there is really velopharyngeal used for people who have a fast speech incompetence, kahit anong exercises na rate. gawin niyo, meron pa rin yun Pacing – Metronome and Pacing Board incompetence. You can’t treat it ng basta There is a regular beat to essentially build basta. That’s why you can use a palatal the rhythm of speech. This facilitates the lift prosthesis. rhythm. You can reduce the beat or ticking Use of palatal lift prosthesis of the metronome or make it fast. So example, everytime the patient hears the IV. ARTICULATION ticking, he/she will say a word. Strength Training ○ Limited evidence for non-speech Pacing board - you can ask the patient to oro-motor tasks (i.e., active range of point to each space. motion exercises Example: Very common for SLPs to Example: one space per syllable use lingual exercises. Like, open mouth and bring out your tongue and A-ko ay i-sang gu-ro. pakitulak itong tongue depressor. But, sir Kerwyn says that there is limited evidence and in terms of neuroplasticity we have the concept of specificity and salience. We need to use muscles or structures for the intended purpose which is speech. Pausing So as much as possible, you’d want Many of them forget to pause kaya to use or facilitate speech kinakapos ng hininga. You have to teach exercises—yung magsasalita sila or them the appropriate timing of pausing. at least magphophonate sila. Kelan ka ba magpapause and kelan ka Stretching / Passive Range of Motion hihinga. Exercises Tapping ○ Has evidence of reducing spasticity Similar to a pacing board but they can tap and stretch reflex in the limbs (arms an object (table, arm) to increase or and legs) reduce the speech rate of the patient. ○ Limited evidence of speech muscles 6 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 APRAXIA OF SPEECH the same except for one aspect like Speech-Oriented Approaches the /p/ and /b/) I. ARTICULATORY KINEMATIC Targets of treatment are APPROACHES sounds/phonemes, but the stimuli can A. Integral Stimulation (Rosenbek et al., be words, phrases, or sentences 1973) The Eight-Step Continuum for II. SENSORY CUEING STRATEGIES Treating AOS (Rosenbek et al., 1973) Auditory, Visual, Tactile, and Kinesthetic Emphasizes task continuum, Cues (meaning there is progression of Phonetic Contrasts tasks; from easy to difficult) intensive ○ Similar to minimal contrast pairs used and extensive drill, and meaningful in Sound Production Treatment communication ○ Uses word pairs with minimal or “Watch, listen, and say it with me” maximal changes in placement, So that it’s easy to remember, integral manner, or voicing stimulation involves watching, listening, and saying it with me. III. RATE AND RHYTHM APPROACHES Targets prosody, stress, and rhythm which First few steps of integral stimulation can facilitate articulation will involve watching and listening to Pag apraxia of speech, usually their the clinician and then the succeeding rate and rhythm are usually impaired. steps will include saying the word with ○ Pacing the patient ○ Contrast Stress Drills Initial maximal provision of stimulus Means you’re stressing a specific prompts, and then gradual fading word or syllable in a word. In terms of cueing, there’s initial Example: ceremony vs. ceREmoNY maximal provision of cues or prompts You can also do that in words. You meaning you are helping the patient can highlight specific words in a and then gradually fade these cues. sentence by stressing them out. You Each step may use a syllable, word, can ask the patient to imitate. phrase, or sentence ○ Melodic Intonation Therapy (MIT) Depending on the targeted level of This was initially developed for speech production patients with aphasia specifically Broca’s aphasia but later on you will B. Sound Production Treatment see an overlapping mechanism in This is a more modern approach that was terms of physiology between Broca’s also derived from integral stimulation. So aphasia and Apraxia of speech. More it uses some aspects of integral or less the structures affected are the stimulation but at the same time, it uses a same, the difference is the function. bit of contrast therapy (minimal contrast) Uses minimal contrasts Pag Broca’s aphasia ang affected is Provides a context for practicing and linguistic planning. While Apraxia of refining speech motor plans that are speech the affected are motor needed to distinguish minimally planning and motor programming. different sounds So patients with apraxia of speech, IV. KEYWORD TECHNIQUES AND SCRIPT they have difficulties with cognate TRAINING yung phoneme (they are essentially Keyword Techniques ○ Uses words that the patient can produce correctly and automatically. 7 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 These words will be repeated to So again for patients with apraxia of establish voluntary motor control. speech, they can easily do automatic ○ The initial sound of these words can speech tasks kesa sa volitional. So you’d be used to produce new utterances. want the residual functioning of the patient ○ “Fine” → “Five, Fire, Fight” (similar to to facilitate more volitional phrases. phonetic derivation) Use of Carrier Phrases The patient can already say or use “I want…” the word “fine” then if you want to “Can you please give me” expound the repertoire of the patient’s “Can you please pass…” speech, you can use fine as a key So it's like script, but it’s essentially carrier word to facilitate the production of phrase wherein the patient’s produce it five, fire, fight. and the patient will add the words in relation to what he needs in the end. But of course you want to use Pairing a highly-used symbolic gesture functional words, mamaya hindi with its associated sound or word naman pala ginagamit yung words na Like “hi” or “goodbye” or “okay” or “yes” or yung ng patient. “no” Script Training When you practice with the patient to ○ Practicing highly relevant produce speech, you can pair it with phrases/sentences in specific gestures so that it’s easier for them to contexts plan and retrieve the word that they need. Example: if the patient greets his Alternative/Augmentative Communication colleagues at work, “good morning” or After exhausting all your efforts for “good afternoon” baka you can teach speech-oriented approaches you can try that or practice that specific script for AAC. the patient. “Good morning, then say the name of the person.” COMMUNICATION-ORIENTED APPROACHES ○ Topics are selected by the individual Interventions for Motor Speech Conditions In the end, the patient can only tell Again, what we discussed earlier is restoration and a what is highly relevant for them. So bit of compensation. Communication-oriented when we create the script or the list of approaches on the other hand, more of adjustment ito scripts that will be practiced by the and a bit of compensation as well. patient you have to plan it together with the family and the patient. COMMUNICATION -ORIENTED APPROACHES Used when speech intelligibility and efficiency V. ADDITIONAL APPROACHES are reduced or not functional, and when Automatic Speech Tasks speaker-oriented approaches are not effective Example, the patient can say the days of As SLPs, we usually start with the week automatically. So if you ask the speaker-oriented approaches but there is patient to recite it, he can do it but if you already a move, especially since clinicians are ask him what day it is today, he can no more aware of AAC, when it’s really not longer answer. realistic for the clinician to have a goal to restore the speech of the patient You can maximize the automatic speech of the patient. So for example if it’s By all means, you can proceed with the Wednesday today, you ask him to stop on communication-oriented approaches already. Wednesday and then ask the patient If you think speak-oriented approaches won’t again what day it is today. More of work, you can skip it and proceed to the maximizing the residual skills. communication-oriented approaches already. 8 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 These strategies are independent of the type tapos nagkita kayo ulit. Ano sasabihin of motor speech condition and focuses on mo at ano tatanong mo? Paano mo siya facilitating communication kakamustahin? ○ Speaker Strategies ➔ Modifying sentence content, structure, ○ Listener Strategies and length ○ Interaction Strategies So if the patient has difficulty with long As we have defined communication, it’s an utterances, you can start with short exchange of ideas or ideas, thoughts between utterances. If patient has difficulty with a speaker and a listener or a sender or a formulating complete sentences, you can receiver. start with phrases, instead of saying “gusto ko ng tubig.” he can say, “drink A. SPEAKER STRATEGIES water” For speaker strategies, you want to teach the patient and the family these things: It is not our goal for the patient to ➔ Preparing listeners with alerting signals formulate complete sentences, or for the Example: Patient will already speak, you patient to say the speech properly but can teach the patient to face the listener rather for the patient to communicate his and look at them in their eyes. That can wants and needs. be an alerting signal for the listener that ➔ Using gestures and other modalities he/she has to listen. (e.g., AAC) O kapag kailangan mo ng magsalita, ➔ Monitoring listener comprehension humarap ka doon sa kausap mo at You can teach the patient kung paano tignan mo siya sa mata. niya ba maintindihan yung sinabi mo ➔ Conveying how communication should You can teach the patient, “Naitindihan take place mo ba? Gets mo ba? May tanong ka This is very relevant for AAC users. ba?” Example, they can show their iPad or whatever AAC system and then B. LISTENER STRATEGIES communicate to the listener that this is You can teach this to the patient and family. their communication device and that is So if it's the patient’s turn to listen, we must how they communicate. teach them the following: ➔ Maintaining eye contact If the patient can’t speak, he has to write. ➔ Listening attentively and actively working “You can talk to me as usual but I will at comprehension respond by writing.” Papabasa niya sa Take note, they have neurologic kausap niya. impairment sila, there’s a chance that their comprehension is affected and So more of telling your listeners how other cognitive skills, so we have to communication takes place. teach them how to listen attentively and ➔ Setting the context and identifying the actively topic ➔ Modifying physical environment You can also teach the patient how they Kung nasa labas yung patient at can set the context and identify the topic nahirapan siyang intindihan kung ano that they want to talk about. So of yung sasabihin ng kausap niya. Baka course, this is context-specific, you can pwede niyang sabihin, “can we move to try doing role-playing. a quieter place?” Or they can request the speaker to move closer to them for them Example: to hear the person better SLP: What will you do if you met an old ➔ Maximizing hearing and visual acuity friend, matagal na kayo hindi nagkita, 9 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 Kung kailangan magsuot ng hearing So we have to the px and their family in a aids, pasuot natin yun. Kung kailangan situation (simulate a situation like nila magsuot ng reading glass or any role-playing) device or apparatus that will maximize their hearing and vision, we must remind them that that is important for them to ACQUIRED MOTOR SPEECH CONDITIONS communicate effectively. Define and differentiate the following: Conceptualization C. INTERACTION STRATEGIES ○ Prelingusitic thoughts ➔ Scheduling important interactions Linguistic Planning Kailangan na talaga yung patient and ○ Formulation of the verbal message family. Kailangan silang maturuan kung ○ Turning the concepts into words paano pa ma-maximize yung ○ Content, form, use of a word communication interaction. You can Conceptualization from desire, you’ll also schedule important interactions. retrieve the related concepts (linguistic planning) which will then be translated into So every morning when the patient words or verbal message wakes up, the caregiver asks, “may Motor planning gusto ka ba?”, “ano gusto mo kainin ○ Translation of phonologic mamaya?” representation. Phonological representation is transformed into a So you will schedule the caregiver to ask motor plan. the patient regarding their needs first ○ Example: /pa/ → the sound /pa/ is thing in the morning. This is important so produced by the lips (placement, that we can establish meaningful manner, voicing) communication between the patient and Motor programming family. ○ Once you have that motor plan you ➔ Selecting a conducive speaking and will specify the details on how to listening environment actually produce the speech sound Kunware maingay sa labas or nasa loob through the construction of the ng labas ng kwarto, baka pwede isara muscle (tone, range, rate) muna yung pinto. Motor control ○ Pathway starting with direct activation Sabihin natin, “pag nakikipag usap po to downwards (descending pathway tayo kay patient, as much as possible from the cortex to pababa) dapat tahimik para marinig niya tayo ng ○ Indirect and Direct activation, Control maayos at para marinig din natin sila.” Circuits ➔ Identifying breakdowns and establishing ○ While the signals descends there is methods for feedback fine tuning and improves coordination Paano magcocommunicate si patient and inhibits the muscles that should kapag hindi niya masabi or not move and excites the muscles macommunicate ng maayos yung gusto that should move niya or mali pagkainitindi ng listener. Dito Motor execution na papasok yung repairing breakdown. ○ Final common pathway ➔ Reparing breakdowns → Actual movement Teach both parties (patient and family, listener and speaker, sender and receiver) when to identify kung meron may communication breakdown and what they do when it happens. 10 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 MOTOR SPEECH CONDITIONS (Duffy, 2013) FLACCID Neurological speech disorders affecting any Dysarthria level/s of speech motor system including LESION LOCUS planning, programming, control, or execution Lesion locus means saan part ng speech motor May affect any of the sub-processes of system nagkakaproblem speech production: speech motor Lesions lie within the cell bodies, axons, or planning/programming, respiration, phonation, neuromuscular junctions of lower motor resonance, articulation, and prosody neurons (LMNs; final common pathway) Types Cranial Nerves. If there are problems ○ Dysarthria specifically to cranial nerves or their “A collective name for a group of connections to the muscles (final common speech disorders resulting from pathway) this leads to flaccid dysarthria disturbances in muscular control over May affect only a single muscle group or a the speech mechanism due to speech sub-system, but may also affect damage of the central or peripheral multiple subsystems nervous system. …paralysis, If the recurrent laryngeal nerve is cut during weakness, or incoordination of the surgical operation there will be paralysis which speech musculature” leads to breathiness of voice. Considering that Pag dysarthria ang problem aspect, you can consider having vocal fold nasa motor control and paralysis due to iatrogenic etiology where the motor execution neuron is severed during operation. ○ Apraxia of speech “impaired capacity to plan or If the recurrent is only affected, the only program the sensorimotor problems will be in the larynx. commands necessary for directing movements that result in phonetically PATHOPHYSIOLOGY and prosodically normal speech.” Muscle weakness and reduced muscle tone Problem for apraxia of that affect speed, range, and accuracy of speech is motor planning speech movements and motor programming Clinical characteristics: weakness, hypotonia, hyporeflexia, atrophy, fasciculations, and If there is a problem with conceptualization and progressive weakness with use linguistic planning the possible disorders would be hypotonia – low tone of muscles, hyporeflexia aphasia or cognitive communication disorder – reduced reflexes DYSARTHRIA ETIOLOGIES Acquired Motor Speech Conditions Myasthenia Gravis (MG) TYPES OF DYSARTHRIA ○ Autoimmune disease affecting 1. Flaccid neuromuscular junctions of muscles 2. Unilateral UMN (reduced acetylcholine) 3. Spastic If nagkaproblem sa neuromuscular 4. Hyperkinetic junction sa Final Common Pathway 5. Hypokinetic yun. So if there’s a problem there, it 6. Ataxic may lead to flaccid dysarthria. A combination of two or more types is called mixed dysarthria Acetylcholine (neurotransmitter) is needed to trigger the contraction of the muscles. Since this neurotransmitter triggers the flow of 11 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 ions in the muscles which leads to ○ Adductor paralysis may lead to contraction. severe breathiness and short breath ○ Rapid weakening of voluntary groups muscles with use and consequent The vocal folds are not improvement with rest approximating. It’s just opened. Progressive use, the performance ○ Abductor paralysis may compromise gets worse but if the patient gets rest breath support and cause stridor the performance is better. Nakaclose yung vocal folds or partly abducted. This may compromise So the performance degenerates breath support because there is because the transfer of increased blockage during inspiration neurotransmitters over time is and expiration. This also leads to inefficient. various adventitious sounds meaning ○ Clinical signs: ptosis (drooping maingay pag humihinga such as eyelids), facial weakness, flaccid stridor or wheezing. dysarthria, and dysphagia ○ Bilateral lesions of SLN (superior Usually for Flaccid Dysarthria, the laryngeal nerve) which innervates the main characteristic is HYPO cricothyroid muscle may restrict (reduced tone, strength, and reflexes) control of vocal pitch ○ Lesions on the pharyngeal branch CHARACTERISTICS may cause hypernasality and nasal Trigeminal Nerve (CN V) air emissions ○ If both sides are affected, it may lead The vagus nerve forms a plexus to bilateral weakness may together with Cranial Nerve IX and XII significantly reduce jaw movement and that plexus also innervates the which affects articulatory contacts of velum so it can affect the resonance tongue, lips, and teeth → imprecision of the patient. ○ Imprecise articulation Respiration If one side is only affected, the jaw ○ Reduced vital capacity can still move unlike if it's bilateral ○ Abnormal respiratory patterns (both sides are affected), there is ○ Reduced breath groups reduced movement of the jaw already. Phonation Facial Nerve (CN VII) ○ Vocal fold paralysis and incomplete ○ Imprecise articulation of sounds glottal closure requiring facial movements such as Pag recurrent laryngeal nerve or bilabial and labiodental sounds superior laryngeal nerve lesion, you Hypoglossal Nerve (CN XII) can expect vocal fold paralysis or ○ Weakness, atrophy, and incomplete glottal closure fasciculations of tongue ○ Atypical acoustic values and ○ Results to distortion of all phonemes increased perturbation requiring lingual movement Jitter, shimmer, noise to harmonics Vagus Nerve (CN X) ratio. If these are high, it means ‘di rin ○ Unilateral lesions of the RLN may maganda yung quality ng voice. cause vocal fold paralysis resulting to ○ Increased airflow rate hoarseness and breathiness Resonance ○ Bilateral lesions of RLN may cause ○ Reduced palatal movement the vocal folds to maintain either an ○ Increased nasal air emission and abductor or adductor position resonance (hypernasality) If the nerve that innervates the velum is affected you can expect reduced palatal 12 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 movement and increased nasal air emission Common sites of lesions: internal capsule and and increased resonance leading to basal ganglia hypernasality. Because the basal ganglia is near the internal Articulation capsule, the basal ganglia is also affected. But ○ Imprecise articulation (distortion) take note that there is another type of ○ Slow but regular alternating motion dysarthria for the affected basal ganglia, but rates because of its positioning or if there is ○ Reduced speech rate bleeding in the basal ganglia or hemorrhage, ○ Reduced speech intelligibility that also affects the internal capsule and The alternating motion rate, for flaccid dysarthria there corona radiata. is reduced speed but it has regular rhythm. Rhythm or regularity of sound is governed by control circuits. So PATHOPHYSIOLOGY pag irregular yung rhythm or tempo that suggests a Unilateral, contralateral weakness lesion in the control circuits. Problems with one side. If there is lesion in the left side of the brain, either in the cortex or If it’s slow but in a regular AMR, it still doesn’t mean capsule, dahil they cross to the other side, it that the person has flaccid dysarthria. leads to contralateral weakness. So if there is lesion at the left side of the brain you can Flaccid Dysarthria - YouTube expect lesions on the right side of the body. - This video shows a woman with flaccid Clinical signs: hemiparesis, hemiplegia, hyper dysarthria performing AMRs. She has Bilateral or hyporeflexia, unilateral facial weakness, Cranial Nerve XII damage causing poor and unilateral lingual weakness tongue strength/ROM. The patient also Hemiparesis - one sided weakness displays Cranial Nerve X damage with Hemiplegia - severe form of hemiparesis, this reduced palatal movement causing is paralysis (limited movement) hypernasality. Hyperreflexia is usually indicative of an upper - In this video, the patient has a tracheostomy motor neuron disorder tube inserted. So you expect the patient to produce speech through a speech valve. Hyporeflexia naman kasi pwedeng dahil - Observations in the patient’s speech: affected na yung pathway pababa, there is performance degrades toward the end; reduced innervation of muscle difficulty with lingual sounds (/ta/) and velar sounds (/ka/), this is because the patient has When you ask the patient to protrude tongue, damage in the Cranial Nerve XII the tongue usually deviates towards the (Hypoglossal) stronger side. So kapag may weakness, if there is weakness in the right side, so once it UNILATERAL UPPER MOTOR NEURON contracts, the tongue will deviate towards the DYSARTHRIA (UUMN) left side kasi wala ng magbabalance out sa Dysarthria weak side (right side) LESION LOCUS Unilateral lesions in the cortical areas for You will expect the tongue deviating towards speech production, the pyramidal tract, and the stronger side during protrusion. upper motor neurons (direct activation system) ETIOLOGIES Results from the upper motor neuron system, Stroke (both ischemic and hemorrhagic) pathways starting from the cortex down to the Traumatic brain injury brainstem, where it synapses to the cranial Usually happens on one side nerve nuclei. Kasama sa UMN yung cortex, Brain tumors corticobulbar tract, internal capsule, corona This usually grow on one side radiata 13 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 CHARACTERISTICS (but may also have irregular Physical signs AMR if respiration and ○ Unilateral lower facial weakness prosody is affected) Drooping of one side of the face Hindi naman control circuits ○ Unilateral lingual weakness yung affected so you can Tongue deviates towards the stronger expect a more or less regular sides rhythm or AMR but since Symptoms there is weakness, there is ○ Slurring speech slow, regular, and imprecise ○ Drooping of lower face AMR. ○ Drooling On the weak side Minor stroke captured on video: Watch as it hap… ○ Dysphagia (relatively mild) - While driving home from work, Stacey Yepes, Kaya mild kasi sa isang side lang 49, could sense she was beginning to have a siya, may kabila pa na stroke. To ensure others could see what was magcocompensate happening to her, she pulled over, took out Respiration her smartphone and began recording. ○ Reduced vital capacity ○ Reduced breath groups Phonation ○ Decreased vocal loudness and changes in vocal quality ○ Unilateral VF paralysis Kapag stroke ang cause, stroke can also lead to paralysis. Kapag stroke, sa central nervous system yung problem, you will consider that upper motor neuron site of dysarthria, but if problem mismo is cranial nerve like vagus nerve or RLN, you will consider - Slurred speech it as flaccid dysarthria. You always - Left side of the face is drooping look at the etiology. - Problems with respiration (hinihingal) - Lesion is at the right side of the brain because If there is a problem in the upper there is a left side weakness motor neuron, UUMN yung dysarthria. If the problem is the lower motor The most common effect of stroke in terms of different neuron that is flaccid dysarthria. types of motor speech conditions is unilateral upper ○ Increased perturbation motor neuron dysarthria. Resonance ○ Hypernasality and nasal air emissions Usually in ischemic stroke, there are blockages in the (infrequent) artery, it rarely happens that at the same time that the Articulation arteries are blocked because they have different ○ Imprecise articulation and reduced pathways, usually it happens on the one side. Most speech intelligibility common cause of UUMN is because of stroke. ○ Reduced speech rate Reduced strength, For Sir Kerwyn this is the most common type of endurance, and speech of lip dysarthria during his practice. and tongue Slow, regular, and imprecise AMR–alternating motion rate 14 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 SPASTIC DYSARTHRIA ETIOLOGIES Dysarthria Stroke (bilateral lesion) PATHOPHYSIOLOGY Although this is a very rare occurrence Bilateral UMN lesions usually results to because usually, even in hemorrhagic stroke, spasticity – muscle weakness, reduced range it’s unilateral. of motion, and slow rate of movement But in some instances, where both sides of Pag bilateral UMN lesions it is spastic the brain have blockage and affected speech, dysarthria but if its one side, it is UUMN. it may be considered a form of spastic Spasticity → matigas yung muscles (stiff), ‘di dysarthria. masyado makagalaw. Encephalitis and Meningitis Encephalitis – inflammation in the brain Remember, it doesn’t mean if the muscles are Meningitis – inflammation in the meninges spastic, they are strong or there is increased (three layers of membranes that protect the strength as well. It actually leads to another brain and spinal cord) form of weakness because hindi masyado makagalaw yung muscle. Usually, if the infection is systemic (meaning Clinical signs: positive Babinski sign, the whole body system is involved). For hypertonicity and hyperreflexia, clonus example, the brain, if there is inflammation of (repetitive reflex contraction when a muscle is the brain it doesn’t happen to one side only, kept under tension appearing as a rhythmic usually the whole brain will have inflammation. tremor) If this happens, this will lead to spastic Positive Babinski sign is an indication of dysarthria. Upper Motor Neuron Disorder. Traumatic Brain Injury for example, lesions that can happen from a In contrast with flaccid dysarthria, if the LMNs car accident are affected it’s HYPO (hypotonic and Degenerative Diseases hyporeflexia). But if the UMNs are affected it ○ Amyotrophic Lateral Sclerosis (ALS) becomes HYPER (hypertonic and ○ Progressive Pseudobulbar Palsy - hyperreflexia) UMN damage manifesting as dysarthria and dysphagia POSITIVE BABINSKI SIGN ○ Multiple Sclerosis - affects Myelin Babinski reflex and negative Hoffman's sign in p… Sheath of CNS - Positive Babinski Sign and other types of Myelin Sheath insulates the axon to abnormal reflexes are indicative of UMN lesion facilitate better saltaztory conduction (HYPER). of the action potentials. So ‘pag nauubos yung Myelin Sheath, bumabagal yung pag-propagate ng action potential across the axon which may lead to problems with speech production (e.g., dysarthria). - This is the Positive Babinski Sign. The big toe CHARACTERISTICS rises while the other toes bumababa. Physical signs - As SLPs we don’t do this, neurologists are the ○ Pathologic reflexes (e.g. jaw jerk, ones doing this. positive Babinski) - You can think of this as another confirmatory sign ○ Drooling and dysphagia for bilateral lesions or for spastic dysarthria. ○ Spasticity of oral-peripheral structures - The normal response for this test is that all toes Symptoms bababa. 15 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 ○ Increased effort and fatigue when HYPERKINETIC DYSARTHRIA speaking Dysarthria ○ Poor control of emotional expression LESION LOCUS This is because everything is Associated with disease of the basal ganglia contracted, so expressing facial control circuit resulting to movement disorders expression is difficult Characterized by excessive involuntary Respiration movements ○ Difficulty of breathing Remember! HYPER means sobra sobra, over, Spasticity along the larynx may occur excessive, or masyadong marami. And during breathing as well. Remember, KINETIC means movement. our muscles are connected. So when there’s spasticity in the neck, it’s It’s usually involuntary, so a person with this possible the laryngeal muscles are type of dysarthria cannot control the affected as well. movement because he/she cannot inhibit the ○ Reduced breath groups movements due to the control circuit being Phonation affected. ○ Strained-strangled vocal quality (harsh) PATHOPHYSIOLOGY Increased spasticity in the laryngeal Presence of involuntary movements interrupt, muscles is possible too. distort, or slow intended speech movements ○ Monopitch and monoloudness The involuntary movements hinder speech ○ Pitch breaks movements. Resonance Categorized into subtypes based on ○ Hypernasality movement disorders Articulation ○ Imprecise consonants and distorted ETIOLOGIES vowels Movement disorders – tremors, chorea, ○ Reduced speech intelligibility and dystonia, myoclonus speech rate Neurologists are the one who manages and ○ Prosodic problems (excessive, specializes in these types of movement reduced, or equal stress) disorders because if a person has a Nahihirapan silang icontrol yung movement disorder it doesn’t affect speech prosody. It’s either excessive, only, it affects the whole body. masyadong naka-stress lahat ng Huntington’s disease (chorea) words; or reduced, walang stress; or Stroke of the basal ganglia equal stress, pare-parehas lang yung stress yung each syllable ng word. HYPERKINETIC DYSARTHRIA OF TREMOR Usually results from essential tremors Spastic dysarthria When we say tremors, these are the rhythmic - The patient's speech is: Unintelligible, vibrations of the muscle. Depending on the strangled voice, slow speech rate, laborious type of tremor, this can happen at rest, during (hard) speech, 2-4 words in one breath movement, or when positioned against gravity. What neuromotor control is affected in UUMN and Essential Tremors – Idiopathic movement Spastic Dysarthria? disorders (idiopathic means it happens without - Direct Activation. Anywhere along the cortex apparent cause) until where the synapse of cranial nerve nuclei Tremors intensify when muscles are being in the brain cell. used, as opposed to resting tremor More of essential or action tremors happen 16 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 Larynx is most commonly affected resulting to https://youtu.be/FAR_TjmZ5YM voice tremors during vowel prolongation - Considering that the person in the video has We call this vocal flutter (nanginginig yung Huntington’s Disease, she exhibited chorea or boses). Para siyang boses ng singers ‘pag choreic movements. kumakanta, nagvvibrate (vibrato). - Movements such as: raising of shoulder, sudden These are uncontrolled vocal flutters, ‘di niya and subtle movements on the face, lips, and jaw ma-inhibit yung shaking or vibration of his/her while speaking, sudden eyes blinking, and flaring voice. of the nose Tremors may also be seen in the tongue, lips, - The choreic movements affected her speech: jaw, or palate unintelligible, slurred, towards the end of her This may hinder speech intelligibility. sentences breathiness of voice was observed this may be because nauubusan na siya ng breath HYPERKINETIC DYSARTHRIA OF CHOREA support. Chorea – quick, unpredictable, and jerky movements HYPOKINETIC DYSARTHRIA As opposed to tremors (usually these are Dysarthria small repetitive movements), sa chorea LESION LOCUS medyo large yung movements. Associated with disease of the basal ganglia Subtle exaggerations of facial expressions control circuit, usually bilateral, resulting to Bigla biglang nag-grimace, tumataas yung reduced dopamine levels kilay. Any sudden, quick, and unpredictable Hypokinetic – less or reduced movements movements can be considered as chorea. Frequently manifested in Parkinson’s disease Quick involuntary adductor and abductor movements of vocal folds leading to voice PATHOPHYSIOLOGY arrests with intermittent strained quality Rigidity, reduced force and range of motion, So chorea can also affect the larynx. slow (sometimes fast) repetitive movements Imprecise articulation with quick movements Clinical signs such as lip compression, facial retraction, You will expect these signs for a patient with darting of tongue, and head jerking Parkinson’s Disease as well as Hypokinetic Again, due to the problem with the control Dysarthria. circuits and indirect activation (extrapyramidal ○ Resting tremors tracts) ○ Rigidity Irregular Alternating Motion Rates (AMR) and ○ Bradykinesia (slow movements) unsteady vowel prolongation ○ Postural abnormalities In terms of the rhythm of the speech ○ Gait and balance problems production, it’s inconsistent or irregular. Gait means walking LARYNGEAL DYSTONIA / SPASMODIC Sir Kerwyn had a patient before who DYSPHONIA was having difficulty walking. The Adductor Spasmodic Dysphonia – doctors thought it was a knee intermittent strained-harsh vocal quality problem. So the patient underwent Abductor Spasmodic Dysphonia – knee replacement surgery. And even intermittent breathy or aphonic segments of after that surgery, the patient still speech experiences difficulty walking. Turns Imprecise articulation, monopitch, out the patient has Parkinson’s monoloudness, inappropriate silences, slow Disease and the disease causes gait rate and balance problems in the patient. 17 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 ETIOLOGIES As SLPs are we the one to diagnose what type of Stroke – bilateral basal ganglia damage Dysarthria the patient exhibited? Or is it under the role Again, it’s very unlikely if the stroke has of a Neurologist? bilateral lesion in the same location - SLPs are the ones to diagnose what type of Parkinson’s Disease Dysarthria the patient has. - The neurologist’s role is to diagnose what type CHARACTERISTICS of primary neurological disease or problem the Physical Signs patient has (e.g., stroke). ○ Masked facial expressions - We have medical diagnosis and speech and ○ Resting tremors of jaw, lips, and language diagnosis. Medical diagnosis will tongue come from medical doctors, while speech and ○ Reduced range of motion language diagnosis will come from SLPs. Symptoms - Dysarthria, Apraxia of Speech (AOS), Voice ○ Soft voice Disorders, Language Disorders, and ○ Mumbling, stuttering, and difficulty Dysphagia, all are speech and language initiating speech diagnoses. Thus, these conditions are Some patients with Parkinson’s diagnosed by SLPs. Disease may exhibit stuttering-like - In contrast, medical conditions such as stroke, symptoms. TBI, ASD, Parkinson’s Disease, Alzheimer’s Neurogenic stuttering or stuttering Disease, Huntington’s Disease, and all types resulting from neurogenic conditions of disease are diagnosed by medical doctors. such as Parkinson’s Disease is called Palilalia. ATAXIC DYSARTHRIA ○ Stiff lips Dysarthria Respiration LESION LOCUS ○ Reduced vital capacity Damage to the cerebellar control circuit ○ Reduced breath groups ○ Cerebellar Stroke Sharing the same signs and E.g., Blockage of arteries at the symptoms with other types of cerebellum dysarthria ○ Posterior Traumatic Brain Injury Phonation E.g., you were hit by a baseball bat at ○ Hypophonia (reduced vocal the back or your head hoarseness) ○ Cerebellar Tumor ○ Breathy vocal quality Remember, the cerebellum is located at the ○ Monopitch and monoloudness posterior part of the skull ○ Low pitch Articulation Ataxia’s main problem is COORDINATION. This can ○ Imprecise consonants happen in the limbs as well (e.g, incoordination while ○ Palilalia (neurogenic stuttering) walking, dancing, reaching, and grabbing something). ○ Short rushes of speech When ataxia happens during speech production, it’s ○ Variable speech rate called Ataxic Dysarthria. ○ Rapid and irregular AMR Since control circuits are affected PATHOPHYSIOLOGY ○ Reduced stress and inappropriate Inaccuracy in force, range, timing, and silences direction of movements Clinical signs: nystagmus (shaking of the eye), LSVT LOUD Speech Therapy for Parkinson dis… titubation (rhythmic tremor of head), hypotonia - The patient exhibited: Hoarseness, Monoloudness, Stuttering, “cannot be heard” 18 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 Ataxic movements are halting, imprecise, Phonation jerky, poorly coordinated, and lacking in speed ○ Monopitch and monoloudness and fluidity ○ Vocal tremors Movements are not well-coordinated Articulation ○ Irregular articulatory breakdowns ETIOLOGIES ○ Excessive variation in loudness – Degenerative diseases affecting the explosive speech cerebellum ○ Excessive and equal stress on each Stroke, traumatic brain injury, encephalitis, syllable – scanning speech severe hypothyroidism This also indicates that the patient Friedreich’s Ataxia has a problem with coordinating the ○ Autosomal recessive genetic disorder loudness levels and stress in each causing progressive neurological syllable of a word. damage ○ Reduced speech rate; slow and ○ Affects the spinal cord, peripheral irregular AMR nerves, and cerebellum All types of dysarthria that affect the Since the cerebellum is affected, it control circuits have an irregular may also lead to ataxia. rhythm of the AMR. CHARACTERISTICS MIXED DYSARTHRIA Physical signs Dysarthria ○ Irregular jaw, face, and tongue AMR Combination of two or more types of Control circuits are affected so AMR dysarthria becomes irregular Neurological diseases may affect more than ○ Nystagmus one component of the motor system ○ Imprecise and uncoordinated limb Amyotrophic Lateral Sclerosis (ALS) – movements considered as mixed flaccid-spastic dysarthria Symptoms because it affects both UMNs and LMNs ○ Poor control of breathing during bilaterally speech ALS is a neurodegenerative condition that ○ “Drunken” speech quality affects both the UMN (spastic) and LMN Respiration (flaccid) bilaterally. So its characteristics are ○ Reduced vital capacity similar to both flaccid and spastic dysarthria. ○ Incoordination of respiration and Speech characteristics form a combination of phonation (onset of voice production) the different types of dysarthria For these patients, mahirap i-coordinate kung kelan magpproduce APRAXIA OF SPEECH ng voice during the stream of air Acquired Motor Speech Conditions when we exhale. LESION LOCUS Associated with dominant hemisphere (usually We sometimes need to teach them left) lesions how to coordinate the onset of voice Typically involves the Broca’s area and the production and during respiration. supplementary motor areas Frequently associated with aphasia, since it For example, when we instruct them affects the left hemisphere to say “aaaa” they would expire air May also co-occur with other communication first and then produce the “aaaa” a bit disorders later like this “*expire air*... aaaaa”. May also occur in isolation ○ Irregular respiratory patterns and movements 19 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 PATHOPHYSIOLOGY Usually patients with AOS will have good A disorder in planning or programming of monitoring of their speech. Remember, AOS temporal and spatial components of in isolation affects only these areas: motor movements among the muscles that generate planning and motor programming. the sequence of speech sounds necessary for intelligible speech In other words, conceptual programming and Motor planning and motor programming is linguistic planning is functional. They know affected in AOS what to say, but there is a difference when Motor speech programmer located in the left they want to express themselves verbally. hemisphere activates preprogrammed Thus, explaining why they have repetitive movements sequences and the muscles for attempts or self-correction speech according to appropriate timing, order, and duration. e.g., when you ask for the name, [the px name This all happens before producing action is Anna] she’ll say, “amo.. Ani… hindi– hindi.. potentials or contraction of muscles. It is still in Anna”) There’s a realization with the px. But conceptualization, specifically motor planning when you ask them, “can you write down your and motor programming name?” they should be at ease doing this. Short utterance length and may tend to use ETIOLOGIES gestures and other modalities to communicate Stroke - most common cause To compensate for the difficulty with motor Degenerative diseases - Primary Progressive planning and motor programming, they will AOS (PPAOS), Corticobasal Degeneration observe short utterance length among these (CBD), Progressive Supranuclear Palsy apraxic patients. They may also use gestures (PSP), and Amyotrophic Lateral Sclerosis and other modalities to communicate. (ALS) Visible and audible trial-and-error groping for Creutzfeldt-Jakob Disease (CJD) - rapidly correct articulatory postures progressive, infectious prion disease Groping for example is when you ask for her associated with aphasia and AOS name which is Anna, she’ll respond “Aaaa… Ahh-”. She’s trying to look for the correct Remember, we also have the developmental type of articulatory posture during speech production AOS, which is called Childhood Apraxia of Speech Slow speech rate, accompanied by (CAS). prolongation of consonants and vowels Disturbed prosody – equalizing stress across CHARACTERISTICS syllables and words, with restricted alteration Tone, strength, symmetry, and reflexes of oral of pitch, loudness, and duration mechanism muscles may appear to be This is also seen in patients with ataxia, those functioning typically who have problems in coordination. They Assuming that the case is isolated AOS, there share a similar characteristic with AOS with are no other communication disorders like equalizing stress. This can be also observed Dysarthria, you will expect that the tone, in other types of dysarthria strength, and symmetry is typical. Main Linguistic factors may affect speech accuracy problem is motor planning – word familiarity, length, and complexity Imprecise or distorted articulation, perceived Accuracy is for example, if the patient is as substitutions, omissions, or additions of already very familiar with the word, he/she can speech sounds say it more smoothly than words that he/she If only the motor planning is affected, and the isn’t familiar with. Other linguistic factors such respiration, phonation, and resonance is not a as length of the utterance as well as perceived as difficulty it is more prominent in complexity may also make the speech more articulation difficult for patients with apraxia Repetitive attempts at self-correction 20 SP-MSC 335: Motor Speech Conditions BSSLP Batch 2024 More complex sounds and sound sequences ○ Transposition errors have the tendency to have more errors Interchanging sounds Sequential motor rates (pa-ta-ka) are poorly ○ Linguistically complex utterances are sequenced more difficult The sequential motor/motion rates can be Broca’s aphasia will show problems with different every time because they have conceptualization and linguistic planning, difficulty in sequencing sound whereas isolated AOS does not Automatic speech such as counting and Take note, in terms of the levels of neuromotor singing may be easier, as opposed to control: Broca’s aphasia will show problems volitional speech with conceptualization and linguistic planning Counting and singing is more automatic than whereas isolated AOS does not, meaning you asking them “what is your name?”, “how old will not expect language concerns/issues with are you?”, “what did you do last night?”. and AOS only difficulty in language output so on. Be careful when diagnosing apraxia of speech. You have to RULE OUT th