Motor Speech Dysarthria Review

- produced by a LMN lesion & causes damage to cranial & spinal nerves

- brainstem stroke

- guillian barre syndrome: demylenization of spinal & cranial nerves

- myasthenia gravis: autoimmune disease that destroys Ach receptors on muscles

- muscular dystrophy: degeneration of m fibers & connective tissue

◦Best distinguishing features for flaccid dys.:◦Hypernasality, nasal emission, continuous breathiness, stridor◦May also hear:◦Hoarseness, harshness, diplophonia, monopitch, monoloudness, short phrases, imprecise articulation◦Everything we hear can be traced to weakness

Oral Motor Exam:

- pathological oral reflexes (suck, snout, jaw jerk reflex)

- drooling

- pseudo bulbar affect

- slow, regular AMRs

Articulation:

- imprecise articulation w/ distorted vowels

Resonance:

- hyper nasality

Prosody:

- short phrases

- monopitch & monoloudness

- excess & equal stress

- slow rate

phonation:

- low pitch

- strained strangled voice

- pitch breaks

- bilateral UMN damage

- ALS:

- TBI

- Multiple sclerosis

cerebellar damage

oral motor exam:

- hypotonia

- slow voluntary movements

- jerkiness of movement

- wide-based gait

- intention tremor

- dysmetric jaw, face & tongue AMRs

articulation:

- irregular, transient articulatory breakdowns

- vowel distortions

prosody:

- excess, equal stress

phonation:

- excess loudness variations

damage to basal ganglia

- anti-psychotic medications

- head trauma

- associated with parkinson's

oral motor exam:

- limited ROM

- resting tremor

- masked facies

articulation:

- Bradykinesia: reduced speed of muscles

- hesitations & false starts

- slow speech

- rigidity

- reduced loudness

- imprecise consonant production

- reduced pitch variability

- festinating speech

prosody:

- Monopitch & monoloudness

- palalia

phonation:

- hoarseness

- low volume

damage to the basal ganglia

- may be unilateral or bilateral damage

articulation/speech:

- irregular consonant & vowel distortions

- slow, irregular AMRs

resonance:

- intermittent hypernasality

prosody:

- inappropriate silences

- excess loudness variations

- excessive/variable stress patterns

phonation:

- voice stoppages

- strained-harsh voice

- audible inspiration

- tremor like voice

Articulation:

- imprecise artic

- slow rate, slow AMRs

Resonance: WNL

Phonation:

- sometimes hoarseness/harshness

- occasional reduced loudness

- spastic-flaccid dysarthria

atrophy & fasciculations

strained strangled voice

slow rate

MSD resulting from disturbed planning or programming of volitional speech actions/patterns in the absence of paralysis, paresis, or incoordination

◦Slow rate of speech◦Articulatory groping◦Errors of phoneme distortion and substitution ◦Syllable segmentation◦Disturbed prosody –misassigned/abnormal stress◦Initiation of speech and artic. transitions are particularly difficult◦Prolonged cons., vowels, and inter sound, syllable, and word durations

AOS◦Errors mostly initial◦Errors more related to phonetic complexity◦Sequencing errors rare◦Additions rare◦Abnormal fluency◦Syllable segmentation

Paraphasia◦Errors can be anywhere◦Errors less related to phonetic complexity◦Sequencing errors common◦Additions common◦Normal fluency◦No syllable segmentation

Speech characteristics depart from less severe form◦Reduced variability of articulatory characteristics:◦Limited speech sound repertoire◦Speech may be limited to a few meaningful or unintelligible utterances◦Imitation of isolated sounds may be in error, and errors may be limited in variety◦Errors may be highly predictable◦Automatic speech may not be better than volitional◦Muteness may be present, but rarely for longer than 1 or 2 weeks if 2°AOS◦Usu. accompanied by severe aphasia and nonverbal oral apraxia

AOS of insidious onset, gradual progression & prolonged course in which AOS is the first, only, or most salient feature & in which criteria are not met for diagnosis of another neurodegenerative disease

• Slow overall speech rate• Lengthened segments between words• Sound distortions• Increased sound distortions or distorted sound substitutions as utterance length or complexity increases• Syllable segmentation within multisyllabic words

• Type 1: predominantly articulatory abnormalities• Distortions & distorted substitutions, repeated sounds, attempted self-correction• More evident when aphasia is present & > AOS• Tends to be association with widespread involvement in premotor, prefrontal, temporal-parietal lobes, caudate, & insula• Type 2: predominantly prosodic abnormalities• Segmentation of words & syllables• More evident in PPAOS without aphasia• Tends to be associated with involvement in premotor cortex & midbrain atrophy• Type 3: no clear difference in prominence of articulatory vs. prosodic abnormalities