Adv Artic Disorders Test 1

Thoughts are converted to verbal symbols

Selection and sequencing of sensorimotor programs that activate speech muscles

Innervations of the respiratory, phonatory, resonatory & articulatory muscles

Combined processes of speech motor planning, programming, and neuromuscular execution

Changes in speech may announce the presence of...

The effects of neurologic disease on speech are often what 4 things?

What are the 4 reasons to understand neurophysiologic bases of speech disturbances?

There's usually a direct correlation bet/ __________ and the symptoms/speech deficits that go along with it.

Neurologic disorders are common/uncommon?

Few neurologic disorders are _______.

Neurologic disorders are a major cause of _________.

Neurologic speech disorders represent a significant proportion of _________ communication disorders.

Neurologic speech disorders will increase in prevalence because of __________.

Understanding the underlying ___________ can help in planning treatment.

Group of neurologic SPEECH disorders resulting from abnormalities in strength, speed, range, steadiness, tone, or accuracy of movements req. for control of the respiratory, phonatory, resonatory, articulatory, and prosodic aspects of speech production.

The responsible pathophysiologic disturbances of dysarthria are due to _______ or _______ abnormalities.

What are possible symptoms of dyarthria?

What are the characteristics of dysarthria?

Neurologic speech disorder reflecting an impaired capacity to plan or program (SEQUENCE) sensorimotor commands necessary for directing articulatory movements in voluntary speech production that result in phonetically and prosodically normal speech.

What can occur in the absence of physiologic disturbances assoc. w/ dysarthria and in the absence of disturbance in any component of language such as aphasia?

The __________ of apraxia of speech is different than that for most dysarthria types, and its ____________ is different from that for dysarthria and aphasia.

Speech disorders resulting from neurologic impairments affecting the motor planning, programming, neuromuscular control, or execution of speech (including dysarthrias and apraxia).

Acquired neurologic stuttering, Palilalia, Echolalia, some Mutism, Pseudoforeign dialect, and Aprosodia are known as ________________.

Aprosodia is associated with _______ hemisphere dysfunction.

Changes in speech resulting from _______ and _______ deficits sometimes are difficult to distinguish from MSDs bec/ they often co-occur w/ them making dx difficult and are categorized as ______________disturbances.

What are the sensorimotor disturbances implicated in certain MSDs?

What are the NON-neurologic disturbances on speech that are localized outsid of nervous system and are neither neuromotor nor cognitive-linguistic in character?

___________ associated with hormones, neoplasms, or vocal abuse can be the effect of a nonneurologic/nonpsychogenic voice disorder.

What are some examples of abnormal psychologic states that can result in changes in speech?

What are the 3 classifications of Normal Variations in speech production?

Identification of deviant speech indicative of dysarthria often requires an awareness of the ____________ for the patient's age and general physical condition.

Approximately _____% of noncomatose people who have had strokes suffer from some kind of speech or language impairment.

Dysarthria occurs in
____% w/ Lacunar (small) strokes
____% w/ TBI

Dysarthria is present in _____% of people w/ Parkinson's w/ increased prevalence as the disease progresses.

Dysarthria sometimes is a presenting sign for what disease and often emerges during the disease's course?

What method for studying motor speech disorders is primarity based on the "ears" and is considered the gold standard for clinical differential dx, severity, mgmt, & assessment of funtional change?

What are the 3 Instrumental methods for studying motor speech disorders?

What are the 8 components of characterizing motor speech disorders?

CP is an example of a/an ________ MSD 
Parkinson's is an example of a/an __________ MSD.

The following are are categories of what component of characterizing MSDs?
-Congenital
-Chronic/Stationary
-Improving
-Progressive/Degenerative
-Exacerbaing-Remitting

What's the primary goal of neurologic evaluation, one to which differential dx of MSDs can contribute, and can predict certain speech deficits?

What can raise doubts about presumed localization or suggest the presence of additional lesions or even different diseases?

By itself, a MSD usually isn't ________ of a particular neurologic etiology or specific disease.

Because diseases can affect ________________, it's NOT useful to classify MSDs by disease.

When Parkinson's causes dysarthria, its type is always _________.

When Myasthenia Gravis causes dysarthria, its type is always ________.

The underlying pathophysiology (weakness, spasticity) determines the unique _________________ of speech in MSDs.

MSDs can be categorized according to the speech ________ that are affected.

What 5 speech components that may be impaired can contribute to speech dx & often has impact on mgmt decisions?

What component of a speech disorder is ALWAYS relevant to management decisions?

What scheme of Darley, Aronson, & Brown (DAB) forms the framework around which MSDs are discussed?

What are the 8 types of dyarthria?

-Controls voluntary movements
-Thought into movement
-Conscious and unconscious
-If damaged, result is debilitating movement disorder
-Dependent on location/extent of damage

PNS consists of :
____ pairs of cranial nerves
____ pairs of spinal nerves

What's the largest division of the brain?

Nerve cells located in this gyrus immediately in fron of central sulcus play an important role in controlling voluntary movements of the body.

__________ damage can cause significant deficits in the performance of both gross & fine motor actions such as walking, writing, & speech.

What's the most common type of neuron?

What are 2 important neurotransmitters in the motor system?

In the motor system, an imbalance bet/ _______________ may be a cause of spasticity.

Most planning for movement does NOT originate in the primary motor cortex.  The initial planning of a movement is formulated primarily in the ______________.

Area of the cortex that is distributed over 4 areas of the cortex that makes sense of the sensory impulses that have been initally analyzed by the primary cortex.

Where is the neurotransmitter dopamine produced?

What are the 2 reasons dopamine is decreased?

Motor speech disorder caused by damage to the basal ganglia associated with Parkinson's

Motor speech disorder caused by damage to the basal ganglia associated with Huntington's

Fatal, inherited disease that results in progressive loss of neurons in striatum and other areas of the brain.  Symptoms include rapid, involuntary movements of extremities face, & tongue.

Disease with decreased dopamine in striatum.  Symptoms include muscular rigidity, tremor, gait disturbances, & difficulty initiating movement.

Because of its many ______________ with diverse parts of the nervous system, damage to the cerebellum can result in a variety of disorders.

Disturbance in speed, range, and direction of movements.

Muscle groups near the ______ & _______ in particular may be affected by ataxia.  Gait is wide-based, lurching, & stumbling.

Tremor caused my lesions in the cerebellum and is observed only during the performance of voluntary movements & is not present at rest.

Other than drunken gait and intention tremor, what are some other symptoms of cerebellar damage?

What's the MSD usually associated with cerebellar lesions?

Doorway located behind basal ganglia through which subcortical systems of nervous system communicate with cerebral cortex.

Practically every sensory impulse from the body passes through the _______ on its way to the cortex; this sensory info is used to further refine motor impulses from basal ganglia & cerebellum.

Neurons in primary motor cortex have axons among longest that extend from cortex to lower spinal cord.  These axons make up much of the descending motor tract called the _______________.

Primary motor cortex is NOT the designer of ___________ movements.

Principal role of the primary cortex is to take _________ movement patterns that are formulated elsewhere and to transmit them to the ____________ via a tract of motor neurons called the pyramidal system.

The pyramidal system is responsible for carrying impulses that control _____________ movements.

The extrapyramidal system transmits impulses that control the _____________ needed by fine motor movements.

What symptoms result from damage to the pyramidal system?

In the motor speech mechanism, unilateral damage to the pyramidal system results in loss of fine motor movement in the articulators known as...

Damage that affects the __________ tract almost always will affect other neural tracts as well with results that complicate the clinical picture.

Spastic dysarthria is the result of _____________ damage and causing _________.

Flaccid dysarthria is the result of damage to the __________ in cranial nerves that innervate muscles of speech production causing ____________.

Name the 5 purposes of the Motor Speech Examination.

What are the 2 characteristics of EVERY dysarthria that can make it difficult to distinguish among types?

Successful eval of MSDs require clinicians to match what they hear in pt's speech w/ what they know about the functioning of ____________.

What are the 7 questions asked in motor speech eval designed to lead to correct dx?

Dysarthria results from _________ damage to the ________ or _________.

Dysarthria is strictly a SPEECH disorder caused by neuromotor damage; it is NOT...

The sequencing problem in apraxia of speech is NOT the result of ...

Apraxia of speech is nearly always associated with damage to the ______ hemisphere of the brain.
Dysarthria can be caused by damage to ___________.

Respiration provides the ______________ that's needed to set the vocal folds into vibration.

Respiratory muscle innervation damage means less air for speech production which results in...

Production of voiced phonemes through vocal fold vibrations in the larynx.

Normal phonation is dependent on the complete ________ of the folds and enough __________ to set the VFs into vibration.

Neuromotor damage to the nerves that innervate the ____________ muscles can have several effects on speech production

In flaccid dysarthria, the damage causes adduction to be __________ resulting in phonations that have ___________ quality.

In spastic dysarthria, adduction is _________ which causes phonation to have a ____________ quality.

Neuromotor damage to laryngeal muscles reduces the ability to change ______ or _______ during phonation.

Proper placement of oral/nasal tonality into phonemes during speech accomplished by raising/lowering velum.

Shaping of vocal airstream into phonemes.

What articulation errors can be heard after neuromotor damage?

Prosody is the melody of speech and conveys meaning within an utterance through the use of ________ & ________.

Stress is accomplished by changing the _______, _______, & _________ of syllables within words to give them added importance or clarify meaning.

Use of pitch changes and stress to communicate for example whether an utterance is a question, assertion, or exclamation.

If neuromotor damage causes weakness or slowness the resulting speech may have a ______ & ________ quality.

If neuromotor damage casus involuntary movements of vocal muscles, the resulting speech may have ________, __________, & ____________.

What are the 6 "salient features" that are the neuromuscular processes and should be constantly assessed as the MSD eval is administered?

Tasks that move articulators through a single series of rapid back and forth movements, such as repeating "puh, puh, puh" or "tuh, tuh, tuh" as rapidly as possible.  Helpful in differential dysarthria dx.

Tasks that move the articulators repeatedly through a quick sequence of movements, such as repeating "puh, tuh, kuh" on one breath of air.  Helpful in apraxia dx.

___________ speed of movement is a common characteristic of most dysarthrias?

In what dysarthria may there be an increased speed of movement?

What speech component can especially be affected by reduced range of movement in the articulators?

An accurate movement is one in which what features are precisely coordinated?

What tasks are good for assessing the accuracy of movement?

Involuntary contractions that can affect the laryngeal musculature

How is motor steadiness assessed?

Small, constant amt of muscle contraction that's always present even at rest and maintains a muscle in a "ready to move" condition and allows for quick movement when necessary.

Decreased muscle tone is associated with...

Increased muscle tone is associated with...

What cranial nerve is being assessed on tasks that provide motor innervations to the facial muscles.

What cranial nerve is being assessed during the tasks that require jaw movements?

What are some specific tasks to assess cranial nerves for face and jaw?

What cranial nerve is being assessed during tasks for tongue and rest and during movements?

What section of the MSD eval should be done if groping tongue movements are noted?

What are some specific tasks that test the tongue at rest and during movement?

What cranial nerve is being assessed during the section of the evaluation that looks at the structure/function of the velum and pharynx?

What are specific tasks to assess velum and pharynx at rest and during movement?

What are direct ways to observe the actions of the larynx?

What are 3 tasks to indirectly assess laryngeal function?

One should listen crtically to what 3 characteristics of the patient's phonation because each can provide useful dx info?

What are some examples of the quality of phonations?

What are examples of the pitch of phonations?

What are examples of the loudness of phonations?

Hypernasality is most frequently a symptom of which 3 dysarthrias?

What is rarely present in the speech of individuals with dyarthria or apraxia of speech?

What's a specific task testing resonance?

What's another name for Alternate Motion Rate (AMR)?

_______s are very important in motor speech eval bec/people w/ diff types of dysarthria perform differently on this task.

What kind of AMRs do people with flaccid & spastic dysarthria have?

What kind of AMRs do people w/ ataxic & hyperkinetic dysarthria have?

Some w/ ___________ dysarthria have AMRs that are more rapid than normal; said so quickly that articulation of phonemes is blurred.

It's not unusual for people w/ _________ to complete AMR successfully but be unable to even attempt SMR sequence.

Task that screens for myasthenia gravis; count quickly from 1 to 100.  Typical to have rapid deterioration and recovery after rest only to have performance decline again.

Disorder that causes rapid fatigue of muscles during sustained motor activity.

Vegatative movements such as smiling, puckering, tongue protrusion, lip biting, hesitations, groping, & revisions are examples of what type of apraxia?

MSD produced by any process that damages motor unit.  Injury/malformation of cranial/spinal nerves reflecting probs in nuclei, axons, or neruomuscular junctions making up motor units of the final common pathway.

All of __________ dysarthrias share a lesion somewhere between the brainstem/spinal cord and muscles of speech.

What are the 3 primary characteristics of flaccid dysarthrias?

What characteristics often accompany the primary characteristics of flaccid dysarthria?

What are the 9 main headings for diseases/conditions that cause flaccid dysarthria?

-ALS
-Progressive Bulbar Palsy
-Spinal Muscle Atrophies (progressive)
-Kennedy's disease (men only)

-Muscular Dystrophy
-Polymyositis

-Myasthenia Gravis
-Lambert-Eaton Myastenic Syndrome
-Botulism

-Brainstem Stroke
-Wallenberg's Lateral Medullary Syndrome
-Collet-Sicard Syndrome
-Medial Medullary Syndrome

Anatomic Anomalies:  just know that...

-Guillain-Barre Syndrome
-Chronic Demyelinating Polyneuritis

-Polio
-Herpes Zoster
-Sarcoidosis
-AIDS

-Skull Base Tumors
-Radiation Therapy

Surgical trauma to the laryngeal branches of the ________ nerve is a frequent cause of flaccid dysarthria.

What are the clusters of deviant speech dimensions for flaccid dysarthria?

Which dyarthria is produced by bilateral damage to the direct (pyramidal) and indirect (extrapyramidal) activation pathways?

Most salient features of disordered movementin pts w/spastic dysarthria

Spasticity is a hallmark of ___________ disease.

Direct activation pathway (pyramidal tract) is predominantly _________ tending to lead to movement.

In the indirect activation pathway (extrapyramidal tract) many of its activities are _________.

-Fine/skilled movement loss
-Hypotonia
-Weakness
-Babinski sign
-Hyporeflexia (weak/nonexistent)

-Muscle tone increase
-Spasticity
-Clonus (repetitive reflex under tension)
-Stretch reflex hyperactive (too strong/sensitive)
-Gag reflex hyperactive

___________ disorders are more frequently associated with spastic dysarthria than most other types.

Lesions in _____________ are required to produce the bilateral UMN damage usually associated with spastic dysartria.

What 2 vascular disorders are usually associated with hypertension?

Primary Lateral Sclerosis (PLS) is a _________ disease similar to ALS that can cause spastic dysarthria.

Leukoencephalitis is an ___________ disease that affects the white matter of the brain or spinal cord that can lead to spastic dysarthria.

What % of spastic dysarthria cases are caused by degenerative & vascular disease?

_____________ strokes accounted for most of the vascular causes.

What are some patient perceptions & complaints w/spastic dysarthria?

What's a telltale sign of spastic dysarthria that is rare in other dysarthria types?

Dysarthria is common and sometimes severe in ________ dysarthria.

Spastic dysarthria is associated with impaired ___________ rather than weakness of individual muscles.

____________ dysarthria is associated w/ deficits of all the speech valves and for all components of the speech system.

What are the distinguishable features of spastic dysarthria?

What's respiration like in spastic dysarthria?

Ataxic dysarthria affects which 2 speech components most?

Dyarthria associated with damage to the cerebellum

Common sign of cerebellar disease resulting in the over/undershooting of targets.

Tremor occurring during movement or sustained postures and is most obvious as a target is approximated.

-Friedreich's Ataxia (incapacitation/death) 
-Multiple Sclerosis (demylinating)

-Aneurysms
-Arteriovenous malformations
-Cerbellar Hemorrhage
-Strokes

Tumors within/outside cerebellum (16% of metastatic brain tumors)

TBI
Punch Drunk Encephalopathy (Mahammad Ali)

-Chronic Alcoholism
-Lithium/Valium
-Malnutrition/Vitamin Deficiency

-Severe Hypothyroidism
-Hydrocephalus
-Heat Stroke
-Infections (rubella, Creutzfeldt-Jacof, Lyme, CNS tuberculosis)

Degenerative, Demyelinating, & Vascular diseases account for more than ____% of cases of ataxic dysarthria

________ speech AMRs are a distinguishing characteristic of ataxic dysarthria.

Prosodic Excess/Scanning speech using slow word-by-word cadence with equal emphasis on each syllable or word is associated with what dysarthria?

Although uncommon, intermittent hyponasality is more frequently encountered in ________ dysarthria than any other type.

What are distinguishing features of ataxic dysarthria?