Dysarthia & Apraxia, Quiz 4

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Dysarthia & Apraxia, Quiz 4
2012-10-07 21:49:11

Jamie Williams
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  1. Dysarthia
    • 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
  2. dysarthria:
    a muscle weakness or a partial paralysis
  3. dysarthria:
    the inability to move muscles due to a severe weakness
  4. What areas may be effected as a result of dysarthria?
    variety of areas in the CNS and PNS
  5. Dysarthria:
    • 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
  6. Dysarthria:
    • 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
  7. Dysarthria:
    • 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
  8. Dysarthria:
    • 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 
  9. The more _______ involved, the greater the _________.
    • systems 
    • dysarthria
    • all four systems are involved depending on the location and extent of damage to the CNS, PNS or both
  10. Dysarthris is most commonly the result of what?
    • 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
  11. Cerebral Palsy
    • 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
  12. Cerebral Palsy:
    Range of severity
    • from mild to severe
    • must consider the degree of independence in three areas:
    •     -communication
    •     -ambulation
    •     -self help skills ADLs
  13. Cerebral Palsy: 
    What is the basic prob?
    • Motor dysfunction
    • Muscles are:
    •     -weak
    •     -paralyzed
    •     -uncoordinated
  14. Orthopedic classificationof the limbs that are affected in cerebral palsy:
    • monoplegia: one limb
    • paraplegia: both legs are involved
    • triplegia: three limbs
    • quadriplegia: four limbs
  15. Speech and Language Development in children with CP
    • 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
  16. What deficits are interrelated in cerebral palsy?
    • 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
  17. What causes dsyathria in adults?
    CVA (cerebrovascular accident), TBI, tumors, neoplasms (new growths) toxins, degenerative diseases such as myasthenia gravis Parkinson's Disease, ALS
  18. Severity of dysarthria in adults?
    Errors are consistent with the degree of damage and/or site of the damage
  19. Assessment of Dysarthria
    • Oral Peripheral Exam
    • Speech
  20. Assessment of Dysarthria:
    Oral Peripheral Exam
    • 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
  21. Assessment of Dysarthria:
    • 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
  22. Treatment of dysarthria:
    what is the goal of therapy?
    to max the effectiveness, efficiency, and natrualness of communication
  23. dysarthria team
    • physicians
    • SLPs
    • OTs
    • PTs
    • Audiologists
    • SpEd teachers
    • specialists in augmentative and alternative communication
  24. Dysarthria:
    • Meds
    • Surgery
    • Glasses and hearing aids
    • Prostheses
    • Postural supports, wheelchairs
    • Augmentative and Alternative com systems
    • Speech Therapy
  25. Apraxia
    • 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
  26. Apraxia Characteristics
    • 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
  27. Differences in Dysarthria and Apraxia
    • 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