Dysarthia & Apraxia, Quiz 4

• the term for a collection of speech disorders characterized by weakness, incoordination, or paralysis in the muscles that control resp, phon, reson, and artic
• speech disorders caused by neuromuscular dysfunction

a muscle weakness or a partial paralysis

the inability to move muscles due to a severe weakness

variety of areas in the CNS and PNS

• the muscles of the resp system are weakened because of the
•     damage to areas of the CNS that control the muscles
• patients have trouble taking an adequate inhale and
•     controlling a steady and prolonged exhale
• patients take short, shallow inhalations that do not
•     adequately inflate the lungs that leads to a decr air supply
•     for speech
• the patient speak in short phrases and w/ inadequate
•     loudness

• Breathy due to unilateral or bilateral vocal fold paresis to paralysis
•         -paresis: partial 
•         -paralysis: total
• muscles of the larynx are weak due to decr neural impulses from the brain
• the vocal fold weakness prevents normal valving of the air stream from the lungs
• the vocal folds do not close normally leading to mild to severe breathy voice quality which can effect seppch intelligibility
• voiced sounds are perceived as unvoiced sounds
• loundness is decr
• the patient produces fewer syllables on each exhale

• Hypernasality caused by weak movement of the soft palate
•     leading to velopharyngeal incompetence
• neurological damage can cause unilateral or bilateral paresis
•     or paralysis of the soft palate
• the soft palate cannot make firm contact w/ the posterior pharyngeal wall during productionof oral speech sounds
• speech sounds hypernasal
• the indv w/ dysarthria has decr breath support, imcomplete
•     vocal fold closure, and velopharyngeal incompetence
•     which means h/she will speak in short phrases, w/ decr
•     loudness w/ a brathy voice that is hypernasal

• the mandible, lips and tongue may have uni or bilateral paresis or paralysis
• mandible-weakness may lead to slowness of movemnet that
•     leads to distorted production of consonants and vowels
• lips if only one side of the face is affected, the patient may
•     have difficulty retracting only on the effected side-the
•     healthy side will have full rnage of motion. this leads to
•     asymmetry of lip movements (one side moves more than
•     the other) at rest, the weakened side of the lips droops
• tongue-unilateral weakness is seen on protrusion-tip and
•     dorsum deviate (turn toward) the weaker side-the tongue
•     tip is the most crucial part for speech intelligibility
• no error free speech
•     substitution errors are infrequent
•     speech is characterized by phonetic distortions and omissions
•     no difficulty initiating speech
•     consonant clusters are simplified and speech sound additions are rare
•     quality of production and error type(s) is consistent- when asked to repeat an utterance 

• systems 
• dysarthria
• all four systems are involved depending on the location and extent of damage to the CNS, PNS or both

• Cerebral palsy
• Primary causes of cerebral palsy are anoxia and trauma
•     during the following periods of development
•         -prenatal: before birth
•         -perinatal: at the time of birth
•         -postnatal: after birth
• may also be caused by maternal disease, metabolic
•     problems, the umbilical cord is wrapped around the
•     neck, premature separation of the placenta (the fetal life
•     support system), trauma or damage during the birth
•     process, accidents at a very early age
• cerebral palsy is the result of nervous system damage
• often the neuromuscular probs that underlie dysarthria cause
•     probs with swallowing

• diagnosed early on, no muscle tone, not able to lift head
• "Injury to the nervous system that occurs before, at the time of or shortly after birth that result in multiple deficits"
•         -visual
•         -auditory
•         -intellectual
•         -motor-most critical and often the first indicator 
•             infants fail to meet developmental milestones
•             they have impaired neuromuscular functioning and
•                 abnormal reflexes

• from mild to severe
• must consider the degree of independence in three areas:
•     -communication
•     -ambulation
•     -self help skills ADLs

• Motor dysfunction
• Muscles are:
•     -weak
•     -paralyzed
•     -uncoordinated

• monoplegia: one limb
• paraplegia: both legs are involved
• triplegia: three limbs
• quadriplegia: four limbs

• Probs result from weakness and incoordination
• all aspects of speech production are affected
•     -resp: not enough air power to move vocal folds, soft
•         palate, articulators
•     -phon: changing tonicity of ht evocal folds that leads to
•         intermittent breathiness and a stangled harshness as
•         vocal fold tension decrs and incrs. tension may be so
•         great that no sound is produced
•     -reson: gradual premature opening of the velopharynx
•         leading to hpernasality and nasal emission during
•         speech
•     -artic: mandible may be hyperextended leads to mouth
•         open, difficulty rounding or protruding lips, abnormal
•         tongue position prevnets precise shaping and
•         constriction of  the vocal tract for production of vowels
•         and consonants
•     -prosody: 
•         poor resp control
•        disrupted riming of respiratory and laryngeal functioning
•        poor contorl of laryngeal tension and intonation (affect
•        meaning)
•        intelligibility may be very limited

• Cognitive, Speech and Language
• Intelligence and functional motor limitations affect spech and lnaguage performance
• often see language deficits
• reduced ability to explore the environment vecause of motor limitations, MR, hearing loss, perceptual deficits limit development of
•         -vocab
•         -grammar
•         -conversation

CVA (cerebrovascular accident), TBI, tumors, neoplasms (new growths) toxins, degenerative diseases such as myasthenia gravis Parkinson's Disease, ALS

Errors are consistent with the degree of damage and/or site of the damage

• Oral Peripheral Exam
• Speech

• Includes reflux and voluntary activities of the structures
• Add pushing w/the tongue against an object such as a tongue
•     depressor, and the ability to push w/equal strength into
•     each cheek
• Resp-blowing bubbles in water-used in may evaluations
•     including voice for evaluation of exhalation
• Vowel prolongations and syllables
• Assessment of voice quality
• Velopharyngeal weakness or paralysis
• Muscles of artic - alternating tasks such as pucker/grin reps

• Syllable rep w/ /b, p/ /d, t/ and /k. g/
• Speech sample listention for and observing
•     -artic precision
•     -speech rate
•     -prosodic patterning
•     -perceptual features
• Reading passage
• Conversational speech

to max the effectiveness, efficiency, and natrualness of communication

• physicians
• SLPs
• OTs
• PTs
• Audiologists
• SpEd teachers
• specialists in augmentative and alternative communication

• Meds
• Surgery
• Glasses and hearing aids
• Prostheses
• Postural supports, wheelchairs
• Augmentative and Alternative com systems
• Speech Therapy

• caused by damage in the region of the posterior inferior left frontal lobe - in or around Broca's area (expressive speech, left side)
• A stroke is the most common cause
• the motor functions of broca's area are planning and programming for voluntary movements of the artics
• speech apraxia is the result of imparied ability to plan, sequence, coordinate and initiate motor movements of the artics

• Artic errors are not the result of muscle weakness or
•     paralysis
• Artic errors are highly variable (say sounds wrong and
•     distortion is dif every time)
• Sound errors are most often substitutions (rahter than
•     distortions, omissions or additions)
• Consonant errors are more comon than vowel errors
• Errors most often occur at the beginning of words-difficult to
•     initiate speech
•           -pauses, restarts, reps of sounds
• the longer the word, the greater the chance of error
• the patient gropes -trial and error- trying to find the correct
•     placemnet of the artic to produce the sounds.  looks like
•     person is struggling to talk
• there are islands of fluent , error-free , clear words, phrases,
•     and snetences. at these times, the patient automatically
•     and effortlessly says the word/phrase/sentence-but cannot
•     do it volitionally (by own will)
• one of the major characteristics of apraxia is inconsistency,
•     patients can say sequences or automatic speech (count,
•     days of the week, months etc) BUT notnot be bale to say
•     thursday
• many can sing just fine but not say the words
• patients can use profanity even if they never swore, it's
•     automatic

• With dysarthria, the errors are consistent whereas apraxia, the errors vary greatly
• With dysarthria, there is more omissions, distortions or additions, with apraxia, there is mainly substitutions
• There are islands of fluent speech in apraxia, no island in dysarthria