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Dr. Scherz Lecture
NDT SLP Lecture
Question | Answer |
---|---|
What type of speech is associated with motor speech disorders? | Slow, Labored, & Distorted |
What causes dysarthria? | Muscle weakness |
What is speech apraxia? | Know what they want to say but can't get motor command to tongue, lips, & jaw Not a weakness issue, can't get signal from brain to muscles of articulation |
What is aphasia? | Left hemisphere language impairment Difficulty choosing words, may not remember words, difficulty understanding |
What is associated with a right hemisphere disorder? | Cognitive impairment Difficulty acknowledging problem Left-side neglect |
Anatomy of a Stroke | Primarily a vascular event Can be either hemorrhagic or ischemic Depending on site of lesion, effect on speech, language & cognition differs |
What are 2 types of ischemic stroke? | Embolism- starts somewhere & travels (Everywhere) Thrombus- starts somewhere & stays there (There) |
What is often called the "speech artery"? | Left Middle Cerebral A. Blood flow disruptions to areas supplied by this artery can impact language comprehension & expression |
Broca's Area | Responsible for speech production |
What happens when Broca's is damaged? | Slow, labored, effortful speech Inability to use syntactic info to determine meaning of complex sentences Inability to interpret meaningful gestures |
Damage to Wernicke's area leads to what? | Impaired language comprehension Speech has a natural-sounding rhythm, but contains mostly jargon or ambiguous word choices |
What is the arcuate fasciculus & what happens if it's damaged? | Association fibers that connect Wernicke's area with the region near Broca's area Damage- inability to repeat words/phrases heard |
What happens when we hear a word & are asked to repeat it? | Auditory Input to Wernicke's Language Decoding Arcuate Fasciculus Motor Planning- Broca's Articulation- Motor Cortex |
What is dysarthria? | Group of speech disorders resulting from weakness or paralysis of musculature Motor speech disorder |
Speech susbystems that may be impaired with dysarthria | Respiration- lack of air Phonation- vocal folds don't move together Resonance- echoing of air flow in an enclosed space Prosody- pitch variation/animation/rhythm/melody; monotonous voice Articulation- tongue/lips ok; stroke- sluggish, slurred, distort |
Motor Speech Disorders | Flaccid Dysarthria (LMN) Spastic Dysarthria (UMN) Ataxic Dysarthria (Cerebellum) Hypokinetic Dysarthria (BG) Hyperkinetic Dysarthria (BG) Mixed |
Speech Apraxia- a motor speech disorder | Difficulty w/ motor programming for voluntary speech Longer/more complex words- more difficult Error patterns- inconsistent Prosody- difficult Groping for right sound/word No apparent mm wkness/impairment Example: guy saying tornado... |
Aphasia- an acquired language disorder; what 4 areas does it affect? | Speaking Listening Reading Writing |
What are the most frequently assessed behaviors in a person with aphasia? | Conversational speech sampla Auditory comprehension Repetition Naming Writing/Reading Automatic speech/singing Non-verbal communication (gestures, etc.) |
WHO Model for Treatment | Body fxns vs. Impairments Body Structures Activities vs. activity limitation Participation vs. handicap |
What is the ultimate goal when treating aphasia? | "Functional" communication |
Treatment for Aphasia | Partner training/education Supported Communication: multi-modality communication, one-on-one interaction, social opportunities |
Right Hemi Stroke- what is more of a problem than aphasia? | Cognitive-Communication Deficits |
Major issues affecting communication in a person with a right hemi stroke? | Left-side neglect Impulsivity/emotional lability Anosognosia Attn Deficits Inference Failure |
When to refer to an SLP | Trouble understanding pt >70% of time Pt has difficulty following basic instructions Pt doesn't seem to make sense when talkng Pt gets frustrated when trying to communicate |
What is dysphagia? | Difficulty with feeding & swallowing as a consequence of a variety of medical problems in 1+ body systems Impairment in any 1 or combo of swallow phases Condition from interruption in maintenance of nutrition, hydration, eating pleasure |
Who presents with dysphagia? | Young & old individuals with 1+ of: CVA Neuromm Disease Progressive Neuro Disease Head/Neck Cancer Degenerative Arthritis Infections Structural Abnormalities |
What to look & listen for, & measure in pts with aphasia? | Medial/swallowing hx Cognition, memory, linguistic abilities Fatigue, alertness, behavior Posture & hand to mouth mvmt Oropharyngeal structure/fxn- resting & in motion |
Oral Phase of Swallowing | Voluntary Preparation/containment Lingual transport Mid-palatal mvmt |
Pharyngeal Phase of Swallowing | Reflexive Preparation/compression Preparation/engulfing Pharyngeal xfer |
Esophageal Phase of Swallowing | Reflexive Esophageal transport |
Which CN have afferent control during swallowing? | Trigeminal Facial Glossopharyngeal Vagus- pharyngeal branch |
Which CN have efferent control during swallowing? | Trigeminal Facial Hypoglossal Glossopharyngeal Vagus |
Importance of Oral-Motor Exam | Neuro eval- CN (ssy & motor) Structures (presence/absence) Mm & Fxn- strength, ROM, latency, necessary pressure to speak/swallow/breathe Motor speech & voice issues- dysarthria (UMN vs. LMN) |
Critical Relationship of Breathing/Swallowing | Have to stop breathing to swallow, otherwise food/drink can travel down pharynx instead of esophagus & cause aspiration Babies don't stop breathing to swallow for some time after birth, which is normal |
What is dysphonia? | Disorder of the voice |
Where is voice produced? | Larynx, which contains vocal folds, which can move loser together to produce voice or further apart to inspire air |
What causes dysphonia? | Inflamed larynx Nodules Hypothyroidism Trauma Vocal fold paralysis Edema Psychological |
Treatment of Dysphonia | Conservative "vocal hygiene": Drink clear fluid, Rest x2-3 days, reduce stress, smoking alcohol (dry vocal cords) Speech therapy- coordinating phonation & respiration Medical/pharmacological Surgery |