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Dr. Scherz Lecture

NDT SLP Lecture

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
Created by: 1190550002



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