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Flashcards in Motor Speech Disorders Deck (40)
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1

Motor Speech Overview

Speech is a sensory and motor process
-Requires coordination of respiration, phonation, resonance, and articulation

Damage to the central (CNS) or peripheral (PNS) nervous systems can cause neurospeech disorders
-Apraxia
-Dysarthria

2

Cortex

- contains motor and sensory regions responsible for voluntary movement

3

Broca’s area

- Motor planning area for speech

4

Supplementary motor cortex

- Works with the premotor area to send motor planning info to the primary motor cortex

5

Premotor area

- Assists the motor strip in integrating and refining motor movements

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Primary motor cortex (motor strip)

- Precentral gyrus located in frontal lobe (have this in left and right hemisphere)
-Homunculus

7

Cortical motor regions

involved in planning motor movements

Receive information on the motor ‘plans’ from cortical and subcortical structures

Important cortical motor regions:
-primary moto cortex (motor strip)
-premotor area
-supplementary motor cortex
-broca's area

8

Direct Activation Pathway

Pyramidal tract

Upper motor neuron system-cortex, brainstem, & spinal cord

Divided into two tracts:
-Corticobulbar
-Corticospinal

Origin- cerebral cortex
Destination-cranial or spinal nerve nuclei
Function-voluntary, skilled movements

9

Indirect Activation Pathway

Extrapyramidal tract

Upper motor neuron system

Includes:
-Red nucleus-works with cortex for movement of upper limbs (midbrain)
-Reticular Nuclei-Postural set (pons & medulla)
-Vestibular nuclei-balance (floor of 4th ventricle-pons & medulla)

Origin- Cerebral cortex
Destination-Cranial and spinal nerve nuclei
Function-controls posture, tone, & movements supportive of voluntary movement

10

Control Circuits

Basal Ganglia & Cerebellum

Give their input to cortex
Cortex sends the information down the direct and indirect pathways

They do NOT talk to the lower motor neurons (cranial and spinal nerves)

11

Cerebellum
Functions:

Coordination
Planning
Maintenance of muscle tone

12

Basal Ganglia Functions:

Functions:
Helps cortex select the right motor plan
Inhibits unnecessary movements

13

Lower Motor Neurons

The workers

Origin-brainstem and spinal cord

Destination-Muscle

Functions-
Carry out voluntary movement commands sent from UMNs

14

Cranial nerves

12 pairs; 7 pairs involved in speech production

Provide motor and sensory information to the muscles of respiration, phonation, resonance, and articulation (face and neck)

15

Spinal nerves

31 pairs of spinal nerves

Provide motor and sensory information to the muscles of the body (NOT including face and neck)

16

Apraxia

Error in Motor Planning- Difficulty planning the motor movements for speech

Lesions:
Left frontal lobe
Left parietal lobe
Parts of basal ganglia
Insula

Causes:
CNS degenerative diseases
Trauma
Tumor
Stroke

More likely to co-occur with Broca's Aphasia

Characteristics:
-Inconsistent articulatory errors
-Errors increase as word complexity and length increase
-Groping movements of the articulators
-Difficulty initiating speech
-Inaccurate syllable stress
-Slow rate of speech

Apraxia in adults is an acquired disorder
Childhood apraxia of speech is a developmental problem

17

Dysarthria

– a group of neuromotor speech disorders that result in muscle weakness or loss of muscle control

Site of lesion and respiratory, phonatory, resonance, and articulation characteristics

18

Flaccid Dysarthria

Site of lesion – lower motor neuron (LMN)
Resulting in muscle weakness or paralysis

Deficits may be seen in 1 or more speech subsystems:
-Respiration
-Reduced vital capacity (can’t take deep breath for speech)
-Shallowing breathing
-Phonation
-Breathy voice or aphonia
-Hoarse voice
-Reduced pitch or loudness
-Monotone & monoloudness

Resonance: Hypernasal
Articulation:
-Imprecise consonants – articulation errors

Associated diseases:
-Moebius syndrome – atypical development of brainstem
-Bell’s palsy – Facial nerve (VII) disorder
Guillian-Barre syndrome- viral infection causes muscle paralysis
-Myasthenia gravis – Loss of synapses resulting rapid weakening of muscles
-Muscular dystrophies – muscles affected by various diseases

19

Unilateral Upper Motor Neuron Dysarthria (UUMN)

Site of Lesion – Unilateral UMN damage

Cleft hemisphere damage- can co-occur with apraxia or aphasia
Right hemisphere damage- can co-occur with cognitive deficits or prosody deficits

Speech deficits are usually mild and temporary

Face & tongue weakness is on opposite side of lesion

Phonation:
-Harsh vocal quality
-Articulation
-Imprecise consonants
-Slow rate of speech
-Associated disorders:
-Trauma
-Stroke

20

Spastic Dysarthria

Site of lesion – Bilateral UMN damage

Phonation:
-Monopitch
-Low pitch
-Reduced stress
-Harsh vocal quality’ “strained-strangled”
-Monoloudness
-Articulation
-Imprecise consonants
-Slow rate of speech
-Effortful
-Jerky movements

Resonance:
Hypernasality

Associated diseases/disorders:
-Bilateral damage to UMNs
-Stroke
-Trauma
-Degenerative diseases

21

Ataxic Dysarthria

Site of lesion – Cerebellum

Articulation:
-Irregular articulatory breakdowns
-Phonation
-Inappropriate loudness
-Poor pitch control
-Drunken speech (Duffy, 2005)

Associated Diseases/Disorders:
-Cerebral palsy
-Degenerative diseases
-Friedrich’s ataxia
-Stroke
-Tumor
-Trauma
-Alcohol abuse
-Drug toxicity

22

Hyperkinetic Dysarthria

Site of lesion – basal ganglia

Reduced inhibitory control; results in hyperkinetic (too much) movements

Site of lesion – Cerebellum

Reduced coordination, timing, and rate of movements

Speech characteristics are variable
-Articulation
-Imprecise consonants
-Prolonged speech sounds or long pauses

Phonation:
-Harsh vocal quality
-Excessive loudness
-Monopitch
-Resonance
-Hypernasality
-Associated disorders/diseases:
-Huntington’s disease
-Dystonias

23

Movement disorders associated with hyperkinetic dysarthria

Tremor
-Resting
-Intention

Tics – rapid, repetitive, stereotyped, involuntary movements
-Can be suppressed for short periods of time

Can be movement (e.g., jumping or hitting) or vocal (e.g., screeching or barking)

Chorea – quick, random, involuntary writhing movements
-Can be anywhere on the body
-Interfere with voluntary movements

Dystonia – random involuntary movements
-Interfere with voluntary movements
-Movements are slow, sustained, and writhing

24

Hypokinetic Dysarthria

Site of lesion – basal ganglia

Associated disease:
Parkinson's disease

Phonation:
-Reduced loudness
-Monopitch
-Hoarse voice
-Breathy voice
-Articulation
-Imprecise consonants
-Fast rate of speech- short rushes of speech

25

Hypokinetic Dyarthria Movement Disorders:

Bradykinesia – difficulty and/or slowness in initiating movements (including speech)

Akinesia – reduced movement (e.g., eye blinking, speech, head, and/or swallowing)

Microagraphia – small handwriting

Resting tremor – pill rolling and other parts of body

26

Mixed Dysarthria

Site of lesion – Damage to two or more divisions of the nervous system

-This type of dysarthria is relatively common
-Affects multiple components of the motor system for speech
-Results in a combination of two or more types of dysarthria

Associated Diseases/Disorders:
-Amyotrophic lateral sclerosis (ALS)- affects UMNs and LMNs
Can present with spastic-flaccid dysarthria

-Multiple sclerosis – diffuse demyelization
Can present with spastic, ataxic, or mixed dysarthria

27

Cerebral Palsy

3 major types of CP

Spastic CP – most common motor impairments in CP
-Associated with low birth weight, reduced oxygen and reduced blood flow in premature infants

4 profiles

28

Spastic hemiplegia

arm and leg on one side have weakness

Mild dysarthria


29

Spastic paraplegia

(rare)- weakness of both legs

No dysarthria


30

Spastic diplegia

weakness of all 4 extremities (legs weakest)

Respiratory muscles may be compromised