Motor speech exam 1: ALS/Mixed Dysarthria

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janessamarie
ID:
284439
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Motor speech exam 1: ALS/Mixed Dysarthria
Updated:
2014-09-29 22:39:57
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dysarthria ALS
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Description:
ALS and mixed dysarthria
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  1. What is ALS?
    What is affected?
    What is usually the initial symptom?
    Gender? Age? Symptom onset?
    • Rapidly progressing degenerative disease
    • UMN and LMN
    • Weakness
    • Men more than women, 40-70, slow but progressive
  2. How to diagnose ALS?
    Criteria for dx?
    • EMG, clinical history, nerve conduction studies, diff dx
    • El Escorial: Clinically definite (in bulbar region), probable (in 2 regions w/ UMN signs above LMN), or possible (UMN/LMN signs in 1 region)
  3. ALS
    UMN onset
    LMN (spinal) onset
    • speech problems earlier
    • speech fine initially
    • respiratory & swallowing problems
  4. Dysarthria in ALS 
    Bulbar onset worse relative to speech
    Dysarthria type?
    What symptoms are first noted?
    • Mixed flaccid-spastic'
    • Laryngeal (others may show too)
  5. Mixed Spastic-Flaccid Dysarthria
    Characteristics of spastic component?
    Flaccid?
    • Weakness, increased muscle tone, hyperreflexia, extensor plantar reflex, pseudo bulbar palsy (exaggerated emotional response, hyperreflexia)
    • Muscle weakness, atrophy
  6. Mixed Dysarthria
    Respiration? 
    Phonation?
    • Reduced vital capacity and maximum phonation time (bulbar symptoms)
    • Elevated laryngeal resistance d/t spasticity (UMN)
    • strained voice
    • flaccid=weak vocal folds=breathy voice, reduced loudness
  7. Mixed dysarthria
    VP functioning 
    Articulation 
    Swallowing
    • Hypernasality, nasal emission
    • reduced speed, strength, ROM, lingual movements, reduced ability to vary tongue at height
    • May be affected
  8. Overall speech characteristics (dysarthria in ALS)
    slow rate, strained quality, imprecise articulation, hyper nasality, mono pitch, mono loudness, short phrases
  9. Dysarthria in ALS
    Acoustic evidence for: (4)
    Typical changes in functional communication?
    • Lengthened segment durations, lengthened vowels, reduced vowel space, voice onset timing differences
    • reduced speaking rate, reduced length of breath groups
  10. What is intelligibility compared to comprehensibility? 
    Issues to consider relative to comprehensibility?
    • Intelligibility is actual acoustic signal
    • Comprehensibility takes into account context; signal independent information
    • semantic context, gestures, orthographic cues
  11. Considerations with ALS and dysarthria?
    Treatment considerations?
    • Discussion of communication disorder and information to give 
    • stay on top of symptom progression
    • bset strategies for individual based on their needs (access to services, transportation, etc.)
    • Treatment considerations: reduce environment distractions, repeat utterances, reduce length, complexity of utterances, writing key words, alphabet supplementation

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