Dysarthias and Apraxia 10/9/2012
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Is the term for a collection of speech disorders caused by neuromuscular dysfunction characterized by weakness, incoordination, or paralysis in the muscles that control respiration, phonation, resonation, and articulation.
A muscle weakness or a partial paralysis
The inability to move muscles due to a severe weakness.
- -The muscles of the respiratory system are weakened because of the damage to areas of the CNS that control the muscles.
- -Patients have trouble taking an adequate inhale and cotrolling a steady and prolonged exhale.
- -Patients take short, shallow inhalations that don't adequately inflate the lungs that leads to a decreased air supply for speech.
- -The patients speak in short phrases and with inadequate loudness.
- -Breathy due to unilateral or bilateral vocal fold paresis to paralysis
- -Muscles of the larynx are weak due to decreased neural impulses from the brain
- -The vocal fold weaknesses prevents normal valving of the air stream from the lungs.
- -The vocal folds don't close normally leading to mild to severe breathy voice quality which can affect speech intelligibility
- -Voiced sounds are perceived as unvoiced sounds
- -Loudness is decreased
- -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 can't make firm contact with the posterior pharyngeal wall during production of oral speech sounds.
- -Speech sounds hypernasal
- -The individual with dysarthria has decreased breath support, incomplete vocal fold clousure, and velopharyngeal incompetence which means he/she will speak in short pharses, with decreased loudness with a breathy voice that is hypernasal.
- -The mandible, lips, and tongue may have unilateral or bilateral paresis or paralysis
- -Mandible-weakness may lead to slowness of movement that leads to distorted production of consisnants and vowels.
- -Lips-if only one side of the face is affected, the patient may have difficulty reatracting only on the affected side - the healty side will have full range 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 of 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
- -All four systems are involved depending on the location and extent of damage to the CNS, PNS or both.
What is the cause of cerebral palsy?
- -Injury to the nervous system that occurs during the periods of development (prenatal, perinatal, and postnatal) that result in multiple deficits: visual, audiotory, intellectual, motor, speech and language development. The basic problem is motor dysfunction - muscles are weak, paralyzed, uncoordinated.
- -The primary causes of cerebral palsy are anoxia and trauma
- -May also be caused by:
- Maternal disease or metabolic problems; the umbilical cord is wrapped around the neck; premature separation of the placenta; accidents at a very early age.
- -The limbs that are affected are: monoplegia, paraplegia, triplegia and quadripligia.
How severe is cerebral palsy?
Severity ranges from mild to severe and the judgement is based on the degree of independence in communication, ambulation, and self-help.
How is the speech and language development in children with cerebral palsy?
- -All aspects of speech production are affected.
- -Respiration- not enough air power to move vocal folds, soft palate, articulators
- -Phonation- changing tonicity of the vocal folds that intermittent breathiness and a strangled harshness as vocal fold tension decreases and increases. Tension may be so great that no sound is produced.
- -Resonance-gradual premature opening of the velopharynx leading to hypernasality and nasal emission during speech
- -Articulation-mandible may be hyperextended - mouth open - difficulty rounding or protruding lips, abnormal tongue position prevents precise shaping and constriction of the vocal tract for production of vowel and consonants.
- -Prosody-poor respiratory control; disrupted riming of respirtory and laryngeal functioning; poor control of laryngeal tension and intonation (affect meaning); intelligibility may be very limited
Which deficits are interrelated in cerebal palsy?
- -Cognitive, S/L deficits are interrelated in CP.
- -Intelligence and functional motor limitations affect S/L performance.
- -Often see lang. deficits
- -Reduced ability to explore the environment because of motor limitations, MR, hearing loss, perceptual deficits limit the development of vocab, grammar, and conversation.
What causes Dysarthria in adults?
Caused by CVA (cerebrovascular accident), TBI (traumatic brain injury), tumors, neoplasms (new growths) toxins, degenerative diseases such as myasthenia gravis Parkinson's Disease, ALS.
How severe is Dysarthira in adults?
Errors are consistent with the degree of damage and/or site of the damage.
How do we assess Dysarthria?
- Oral peripheral exam:
- -Incluidng reflex and voluntary activities of the structures
- -Add pushing with the tongue against an object such as a tongue depressor, and the ability to push with equal strength into each cheek
- -Respiration-blowing bubble in water-used in many evaluations including voice for evaluation of exhalation
- -Vowel and syllabe prolongations
- -Ax of voice quality
- -Velopharyngeal weakness or paralysis
- -Muscles of articulation-alternating tasks such as pucker/grin repetitions
- Speech:-Syllable repetition with /b, p/ (lips) /d, t/ (tongue) and /k, g/ (velopharyngeal)
- -Speech sample listening for and observing artiulatory precision, speech rate, prosodic pattering, and perceptual features.
- -Reading passage
- -Conversational speech
What are the team members to treat Dysarthria?
Physicians, SLPs, OTs, PTs, audiologists, SpEd teachers, and specialists in Augmentative and Alternative Communication (AAC).
What are the treatments for Dysarthria?
- -Glasses and hearing aids
- -Postural supports, wheelchairs
- -Augmentative and alternative communication systems
- -Speech therapy
Characteristics of Apraxia
- -Articulation errors are not the result of muscle weakness or paralysis.
- -Articulation errors are highly variable.
- -Sound errors are most often substitutions
- -Consonant errors are more common than vowel errors.
- -Errors most often occur at the beginning of words - difficult to initiate speech - pauses, restarts, repetition of sounds
- -The longer the word the greater chance of error
- -The patient gropes - trial and error - trying to find the correct placement of the articulators to produce the sounds. It looks the person is struggling to talk.
- -There are islands of fluent, error free, clear words, phrases, and sentences. At these times, the patient automatically and effortlessly says the word/phrase/sentence - but can't do it volitinally.
- -many can sing just fine - but not say the words
- -Patients can use profanity - even if they never swore because this is automatic.
What causes Apraxia?
- -Caused by damage in the region of the posterior inferior left frontal lobe - in or around Broca's area.
- -A stroke is the most common cause of apraxia for adults
- -The motor functions of Broca's area are planning and programming for voluntary movements of the articulators.
- -Speech apraxia is the result of an impaired ability to plan, sequence, coordinate, and initiate motor movements of the articulators.
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