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What is mixed dysarthria? Mixed dysarthria is a combination of 2 or more pure dysarthria types.
In mixed dysarthria with 2 or more pure types of dysarthria any one of the components may predominate
What determines the characteristics of the pure dysarthrias that appear in a mixed dysarthria? the location and the extent of damage determines the characteristics
One characteristic of a mixed dysarthria as opposed to another the relative predominance of one characteristic over another may change over time.
What is the neurological basis of mixed dysarthria? disease illness or injury that causes diffuse neurological damage
The neurological basis of mixed dysarthria relates to disease illness or injury that causes diffuse neurological damage – to what structures? LMNs UMNs cerebellum basal ganglia control circuit
Many etiologies cross over what? anatomical boundaries – this means that various components of the motor system can be affected simultaneously.
Brainstem Strokes can cause Mixed Dysarthria – why? Brainstem Strokes can affect both upper and lower motor neurons (results in a combination of both Flaccid and Spastic Dysarthria characteristics )
Provide an example of how a Brainstem Stroke could affect an individual as it relates to Flaccid and Spastic Dysarthria: the person may have hypernasality with emission (LMN) strain-strangled voice quality (UMN) and imprecise consonants
TBI can cause a mixed dysarthria TBI can cause a mixed dysarthria if it causes damage to the cerebellum and various cranial nerves
A person with Parkinsonism that incurs a right hemisphere stroke – what outcome? results in hypokinetic UUMN mixed dysarthria
The majority of mixed dysarthria cases have what etiologies? 63% degenerative diseases 12% vascular (single or multiple strokes) 4% Demyelinating MS 5% TBI 4% tumor
A number of degenerative diseases are commonly associated with Mixed Dysarthria… why? Degenerative diseases are commonly associated with Mixed Dysarthria because they tend to affect more than one portion of the motor system.
Degenerative diseases can cause Mixed Dysarthria but may produce different characteristics some primarily affect motor functions others affect sensory autonomic others affect cognitive function as well.
ALS = Amyotrophic Lateral Sclerosis absence of muscle nourishment leading to atrophy/hardening (lateral refers to side/lateral aspect of spinal cord.)
ALS prevalence rare 1.3 per one hundred thousand median age 55 median survival 3 years
ALS involves both of these UMN and LMN – both of these eventually
Bulbar symptoms affect what in ALS? speech and swallowing
Spinal symptoms in ALS affect what? upper and lower extremities
While motor function is profoundly impacted in ALS what remains intact? intellect and sensation
Speech Characteristics with ALS depend on what? Speech Characteristics with ALS depend on what motor neurons are affected (Flaccid initially? Spastic initially? = Eventually flaccid-spastic mixed dysarthria.)
What are the most prominent speech errors with ALS? Imprecise consonants Hypernasality and Harsh Vocal Quality/Strain-Strangled Vocal Quality
With ALS Intelligibility can plumet rapidly even over the course of one year
MS Multiple Sclerosis = the most common of acquired demyelinating CNS diseases
The cause of MS is unknown but a virus may be responsible for triggering the demyelinating process
What purpose does myelin serve? it protects the axon and helps conduction of neural impulses = without myelin neural impulses slow or even stop
In MS the protective myelin in the CNS is destroyed in some areas resulting in the slowing or stopping of the neuron’s ability to conduct neural impulses.
MS can produce a variety of signs and symptoms – why? because with MS lesions are often multiple and disseminated (however damage CAN be focal at times…)
Prevalence of MS 58 per one hundred thousand people but higher in United States and United Kingdom possibly due to colder climate?? Higher incidence in women as compared to men.
Common symptoms of MS visual disturbances chronic tiredness weakness in the limbs (especially the legs) painful spasticity in the extremities dysarthria depression mild dementia in some advanced cases
MS Speech Characteristics most patients with MS do note demonstrate obvious Motor Speech Deficits = more likely a problems with SPEECH ERRORS: loudness control harshness and impaired articulation
Ataxic and Spastic Dysarthria are the two most common dysarthrias so…. Ataxic-Spastic Dysarthria is the most common Mixed Dysarthria
Multisystems Atrophy – collective term for a group of degenerative disorders which MAY include Parkingsonian symptoms.
Multisystems Atrophy Shy-Drager Syndrome Progressive Supranuclear Palsy Olivopontocerebellar Atrophy a group of degenerative disorders that may include Parkinsonian symptoms
PSP Progressive Supranuclear Palsy causes degeneration of neurons in Brainstem Basal Ganglia and Cerebellum loss of voluntary eye movements walkin neck rigidity like Parkinsons spasticity of limbs face neck Dementia Dysphagia HYPOKINETIC SPASTIC OR MIX
SDS Shy-Drager Syndrome degenerative neurological disease unknown etiology affects Brainstem Basal Ganglia Autonomic Nervous System Parkinsonian L-Dopa doesnt help mild spasticity limbs face affects blood pressure bowel bladder ataxia Mix include ataxic.
OPCA Olivopontocerebellar Atrophy rare disease with unknown cause maybe genetic at times? Gradual deterioration of olivary nucleus pons and cerebellum has components of all dysarthria types
Friedreich’s Ataxia can cause ataxic or mixed ataxic spastic Ataxic Spastic is most common mixed dysarthria
Wilson’s Disease rare hereditary disease that prevents normal processing of copper it deposits in eyes kidneys liver and brain especially the BG Symptoms include rigidity bradykinesia tremor limb ataxia dysphagia dementia golden brown ring around the cornea
What is the treatment for Wilson’s Disease? low copper diet and penicillamine hypokinetic dysarthria plus another type or two reduced stress monopitch and monoloud long term dietary changes and medical care can improve speech
AAC with PALS Stage 1: no detectable speech disorder educate regarding disease course obtain info on type of communicator provide basics on AAC
AAC with PALS Stage 2: Obvious speech disorder but still intelligible establish message context maximize partner hearing amplification if rate change begin process of obtaining AAC and start training
AAC with PALS Stage 3: Reduction in speech intelligibility slow rate help improve speech preciseness open mouth overarticulation communication breakdown strategies context specific strategies AAC in place
AAC with PALS Stage 4: Natural speech supplemented with AAC AAC primary method of communication alphabet supplementation alerting system augmented telephone alternative writing assess adequacy for AAC for pt.
AAC for PALS Stage 5: rare to no vocalization AAC only use high tech and supplement with low tech establish reliable yes/no introduce eye pointing technique and use eye blinks for yes and no
Treatment Interventions for PALS: Behavioral Interventions Environmental Interventions Prosthodontic Interventions Supplemented Speech Interventions
Environmental Interventions Optimize hearing of listeners avoid adverse speaking situations reduce background noise amplify speaker
Supplemented Speech Interventions Alphabet Supplementation Topic Supplementation Mixed Topic and Alphabet Supplementation Gestural Supplementation
Intelligibility versus Comprehensibility two different things
Intelligibility the degree to which the acoustic signal is understood by the listener
Comprehensibility the degree to which an utterance produced by a speaker is understood by the listener in natural communication settings
Comprehensibility includes the acoustic signal but also visual information such as lip movement body language facial expression - introduces the topic of the situation the setting etc.
How to improve comprehensibility topics determined by who in 1999? Yorkston Beukelman Strand and Bell
Speaker Strategies for improving comprehensibility provide listener with context don’t shift topics abruptly use turn taking signals get your listeners attention use complete sentences use predictable types of sentences SVO use predictable wording
More Speaker Strategies for improving comprehensibility rephrase your message accompany speech with simple gestures take advantage of situational cues make environment as friendly as possible avoid communication over long distances use alphabet board supplementation
Listener Strategies for Improving Comprehensibility Know the topic of conversation watch for turn taking signals give your undivided attention choose time and place to talk watch the speaker piece together the clues
More Listener Strategies for Improving Comprehensibility Make the environment work for you avoid communicating over long distances make sure your hearing is as good as possible decide on/incorporate ways resolving communication breakdowns establish some rules of the game facilitate communication with others



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