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Motor Test 2

Motor speech Disorders CH 3-5, 13

What subsystems are deficits found for Dysarthria? All subsystems
What subsystems are deficits found for aphasia? None, subsystem functioning is normal
Aphasia results from Tumors, trauma, CVA
Site of lesion for Dysarthria PNS, CNS, or both
Site of lesion for Aphasia cortical r cerebral hemisphere language areas
speech and language features of dysarthria slow, strained and labored speech, and distortions
speech and language features of aphasia slow strained and labored speech and exhibits substitutions, omissions, additions
Does dysarthria have word finding difficulties no word finding difficulties
Does aphasia have word finding deficits exhibits word finding deficits
what modalities are impaired by aphasia Listening, speaking, reading and writing
what modalities are impaired by dysarthria speaking
what areas do speakers with dysarthria NOT have difficulties with understanding verbal and written language
Dysarthria results from tumors, trauma, CVA, ALS, MS etc
What features OF DYSARTHRIA differentiate it from aphasia? no difficulties understanding verbal and written language, no word retrieval difficulties, exhibit distortions, site of lesion in the PNS CNS or both, can result from ALS, MS etc, deficits in all subsystems
What features of APHASIA differentiate it from dysarthria? deficits can occur in all 4 modalities, word retrieval difficulties, substitutions/omissions/additions, lesion in the cortical or cerebral hemisphere language areas (typically Left), subsystem functioning is typically normal
what features are the SAME between AOS and aphasia? unilateral lesion to L hem, respiration, phonation, and resonance are normal, free of neuromuscular impairment (paresis, spasticity, involuntary movement)
what features of AOS differentiate it from aphasia? all 4 modalities are intact, etiology is predominately stroke, prosody NOT normal, right hemiparesis more common, speech sound distortions are more common, groping is present, artic hesitancy, errors approximate target, errors increase with complexity
what features of APHASIA differentiate it from apraxia of speech? difficulties in all modalities, normal prosody, stroke is main cause, effortless articulation, unaware of errors, errors farther from target, increasing complexity has little effect on errors
Language of confusion results from... TBI and right hemisphere lesions
Especially with TBI, language of confusion can co-occur with... Dysarthria
If a speaker with a TBI exhibits Dysarthria, it typically resolves after 1 year
differentiation between dysarthria and language of confusion should focus on nature of the lesion (traumatic), location of the lesion, and uniqueness of the deficits (cognitive)
TBI occurs as a result of... sudden onset that can be focal or diffuse
focal lesions are less complex and fewer in number
highest frequency of TBI occurs in males 15-24 years old
majorities of TBIs and Right hemisphere lesions are from falls or MVA
damage from TBI occurs at site of impact, area opposite of the impact as a result of countercoup action, near bony prominences inside the skull that shear and lacerate the brain
damage from TBI result in problems with speech (dysarthria &/or AOS), language, swallowing, cognition, behavior, personality, motor control, vision and hearing
communication deficits from TBI include similar language problems as in aphasia (anomia, comprehension problems), deficits in pragmatics, difficulties with discourse including lack of cohesion in conversation resulting in rambling pattern of speech
Right hemisphere lesions are more closely aligned with TBI than aphasia
5 major deficits of right hemisphere lesion left neglect, denial of illness or motor difficulties, impaired judgement and self-monitoring, reduced motivation, visual perceptual deficits (visual tracking during reading)
what is the same about AOS and Dysarthria? neurologic speech disorder
AOS is a MSD resulting from a deficit in the motor programming domain of expressive communication
Dysarthria is a MSD resulting from a deficit in the execution domain of expressive communication
In AOS, programming deficits do not exist for... automatic or involuntary tasks so certain speech/non speech tasks will not be impaired
For dysarthria, during the physical exam abnormalities in...will be noted movement, rate, precision, coordination, and strength in both speech and non speech tasks
Site of lesion for AOS left cerebral hemisphere- parietal, frontal, and related subcortical circuits
site of lesion for Dysarthria can vary depending on the type
which MSD has more consistent errors dysarthria
which MSD will increase errors with increasing length and linguistic complexity AOS
Prosody and articulation only are impaired for what MSD AOS
Variable phonemic errors are found in AOS
prosody, articulation, respiration, phonation, and nasal resonance are impaired for dysarthria
Developmental dysarthria has a presence of... where phonological disorders do not neurological diagnosis and site of lesion
what systems are impaired with developmental dysarthria? respiratory, phonatory, or resonance systems
what systems are impaired in phonological disorders no systems are directly impaired
what errors are present with developmental dysarthria? distortions
what errors are present with phonological disorders? substitutions or omissions
inconsistent errors on consonants and vowels in repeated productions of syllables/words for children is consistent with what DX CAS
consistent errors, even when the same word is repeated in isolation and when errors phoneme is produced in connected speech in children is consistent with what DX phonological disorders
lengthened and disrupted coarticulatory transitions between sounds and syllables is a feature of what developmental disorder CAS
inappropriate prosody (lexical or phrasal stress) is a feature of what developmental disorder CAS
a greater number of omissions (phoneme and diphthongs) are observed with what childhood disorder CAS
Children with ____ have no difficulty transitioning between sounds phonological disorders
it is not wise to make a CAS diagnosis for children under the age of--- 3
Main focus on therapy if phonological processes or speech apraxic behaviors are not present language simulation
what DX's- may have difficulty understanding written and verbal language aphasia, dementia, and language of confusion
what DX may have slow strained and labored speech aphasia and dysarthria
what dx may have presence of circumlocutions when speaking dementia
what dx is associated with use of non-intended words that can be or may not be semantically related aphasia
what dx has a site of lesion that can occur within the PNS dysarthria
what disorders commonly occurs with non verbal or oral apraxia AOS and aphasia
diffuse or focal lesions may be present with language of confusion (TBI or R Hem Stroke)
cognitive deficits (episodic mem, attention, orientation, problem solving, visiospatial skills) are consistent with what disorders dementia and language of confusion, (possibly aphasia)
presence of a neuromuscular condition such as rigidity, spasticity or paresis dysarthria
presence of anomias are associated with what disorders aphasia and dementia, posible TBI depending on lesion site
impaired judgement and self monitoring is associated with what disorders R Hem Stroke, TBI (possible), and dementia
for children with a limited verbal expression, what would need to be identified to confirm a DX od developmental dysarthria? a neurological condition
what DX in children may lead to limited verbalization of speech delayed language, CAS, and developmental dysarthria
static or isometric exercise muscle length and joint position do not change, leads to greater strength than dynamic or isotonic exercise
isotonic exercise muscle tension remains the same while muscle length changes
dynamic exercise leads to increase speed of contraction, greater maximum velocity of shortening muscle fibers, beneficial for speech because they mimic the muscle contraction needed for speech production
task specific exercise to improve speech production, use speech production task exercises (continuous positive airway pressure)
overload involves muscle being stimulated beyond a given level to achieve hypertrophy of muscles and recruitment of more motor units, leads to increase in strength, endurance, and power in muscle functioning, (NOT FOR SPEECH)
How much strength does one need for speech production? about 15% of total force
Principles of Neuroplasticity body activity competes for representation in brain, alteration in brain representation MAY be limited to the specific function being trained, brain reorganization will only occur with extensive prolonged practice,
explain the principle of neuroplasticity: body part activity competes for representation in the brain use it or lose it/ use it and improve it
explain the principle of neuroplasticity: alteration in brain representation MAY be limited to the specific function being trained non speech exercise may not help speech to improve
explain the principle of neuroplasticity: influence of training on neural reorganization may be linked to time reorganization may occur more earlier in the disease process
explain the principle of neuroplasticity: relevant speech tasks may include plasticity to a greater extent than non relevant activity practice slowing speaking rate to improve intelligibility compared to working on producing repetitive productions of non sense syllables
what factors influence acquisition and retention of a motor skill? 1. randomized practice 2. feedback on every trial for improved acquisition and summary for retention 3. generalization (retention) of learning improves with variable practice, acquisition is greater with non variable practice
to make informed choices regarding treatment options, what factors should a therapist consider? 1. empirical evidence from published research 2. experimental evidence from personal clinical experience 3. physiological rationale based on understanding of normal process of the body 4. values of the client 5. system features (economic, legal, & culture
what is a narrative review? informal reviews- methods used for collecting and interpreting information are frequently not specified- written by one or more researchers
systematic reviews include what 1. study inclusion/exclusion parameters 2. specify databases of search 3. time frame for search of evidence 4. specifics on how studies were evaluated for quality 5. who sponsored the review
what is the importance of having practice guidelines for either assessment or treatment of a disorder? practice guidelines are developed by a panel of experts and sponsored by an org, based on a review of lit. on certain topics and offer explicit descriptions of how pt. should be evaluated and treated to reduce variability of service and improve quality
Phase 1 of outcome research develop hypothesis that will be tested later, establish safety of treatment, small sample sizes
Phase 2 of outcome research carried out if phase 1 is good, refine hypothesis, develop explanations of why the tx should be carried out, determine the ideal situation for this tx
Phase 3 of outcome research treatment described in 1 & 2 is carried out, RCT - Multicenter RCT
Phase 4 of outcome research single subject designs with multiple replications to test the effectiveness of the TX
Phase 5 of outcome research exploration of efficiency cost effectiveness, cost benefits, cost utility, satisfaction measures to understand impact of TX on subjects lives
what are the 3 dimensions for measuring the 'strength' of evidence for a given assessment or tx procedure quality, quantity, consistency of the evidence
Quality- dimension for measuring strength of evidence overall rating of excellence across research studies, typically rated according to the research design features of objectivity, validity, reliability, rigor, open-mindedness, and thoroughness of reporting
Quantity- dimension for measuring strength of evidence includes the number of studies and the size of the sample or effect size
consistency of the evidence- dimension for measuring strength of evidence degree of similarity of findings across studies
what are the two levels of management decisions to consider when treating a client with dysarthria? 1. decision regarding the goals of tx (severity of the function al limitation and the disability experienced) 2. decisions regarding the treatment approach to adopt (heavily dependent upon understanding the pattern of impairment
typical areas of focus for SEVERE dysarthria family education in their role, AAC to maximize S/L development, increase participation of the person in their environment, make tx decisions based on cognitive, linguistic, and motor limitations, the literacy needs of the child
what information from assessment is used for planning treatment nature of the impairment, identifying features that can be modified, identification of existing compensatory strategies, multiple approaches to intervention
as an aerodynamic pressure source, what is the goal of the respiratory system? maintain a relatively stable sub glottal pressure (5-10 cm H20)
severe impairment of respiratory system can adversely influence speech production to the extent that phonation may not be existent
less severe impairment of the respiratory system can influence the functioning go all other subsystems because of the central role respiration plays as the aerodynamic energy source
what are the four areas to be focused on when evaluating the respiratory system? air pressure (vary and control the pressure), lung volume (maintain pressure over time), airflow (control at the larynx), and respiratory shape (movement)
what else should be considered when evaluating the respiratory system the nature of the utterance the person is trying to produce
how to measure air pressure glass/water manometer, phonatory function analyzer, aerophone2, aerowin, phonatory aerodynamic system
how to measure lung volume spirometer like the aerophone2 (normative volume falls between 3.5-5 liters, volume has to be VERY reduced before it has an affect on ability to speak)
how to measure airflow have client phonate a vowel sound, flow volume (total act of air expelled during phonation of a word phrase or sentence), phonatory function analyzer, aerophone 2, aerowin, phonatory aerodynamic system
how to measure respiratory shape pneumograph, inductotrace, magnetometers (research)
how might impairment in respiration influence speech intelligibility loudness (too soft) and breath group lengths
how might impairment in respiration influence speaking rate breath group length affects it
how might impairment in respiration influence naturalness loudness (mono loudness or loudness decay)
what are the four typical respiratory movement impairments in individuals with dysarthria? reduced vital capacity (below 60%), inconsistent lung volume, inappropriate lung volume, excessive lung volume
treatment for respiration focuses on what 3 main areas establishing respiratory support, stabilizing respiratory patterns (eliminate maladaptive behaviors), and increase respiratory flexibility
what is involved in establishing respiratory support helps the pt to generate the sub glottal pressure they need to develop inspiratory and expiratory respiratory drive for speech
what signs indicate a need for stabilizing respiratory patterns may have the clavicular breathing or paradoxical breathing
who might benefit from stabilizing respiratory patterns? initiates speaking at; too high/low lung volume, w/o initial inhalation, initiates breath groups with wrong amt of lung volume, utterances are too loud/soft, speaks into his/her residual volume (loudness decay, bad voice quality)
how would you stabilize respiratory support for a client with near normal inspiratory muscle function and weak expiratory muscles? train them to breath in near 60% of VC prior to initiation of phonation to take advantage of passive respiratory muscle forces
what tools can be used as biofeedback for training targeted lung volumes spirometer and the inductotracecan
when do you use inspiratory checking? when the pt cant maintain the breath for the length of the utterance they are wanting to say
what is inspiratory checking? take in too much air and through passive forces there is too much pressure and need to lower the pressure by slowing the contraction of the lungs by turning on the inspiratory muscles, will slow down the natural compression of letting the system fall
how would you increase respiratory flexibility? heighten awareness of the breathing process, practice reading scripts where correct pause placement is marked, then practice pause use in conversation
when should you work on increasing respiratory flexibility (what pt signs) stereotypic (limited variation) of breath group lengths, never pauses w/o taking a breath, unable to manage a quick inhalation needed to support short breath group utterances
what is Guillain barre syndrome inflammatory disorder of the peripheral nerve charcterized by the rapid onset of weakness and often paralysis of the legs, arms, breathing muscles and face
what is friedreich ataxia? one of a heterogeneous group of degenerative spinocerebellar disorders
what is Huntington's desease hereditary degenerative disorder of the nervous system characterized by chorea, dementia, emotional instability, and a history of familial occurrence
Created by: clp26570



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