NDT SLP Lecture
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| What type of speech is associated with motor speech disorders? | Slow, Labored, & Distorted
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| What causes dysarthria? | Muscle weakness
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| 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
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| What is aphasia? | Left hemisphere language impairment
Difficulty choosing words, may not remember words, difficulty understanding
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| What is associated with a right hemisphere disorder? | Cognitive impairment
Difficulty acknowledging problem
Left-side neglect
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| 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
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| What are 2 types of ischemic stroke? | Embolism- starts somewhere & travels (Everywhere)
Thrombus- starts somewhere & stays there (There)
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| 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
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| Broca's Area | Responsible for speech production
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| 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
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| 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
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| 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
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| 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
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| What is dysarthria? | Group of speech disorders resulting from weakness or paralysis of musculature
Motor speech disorder
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| 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
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| Motor Speech Disorders | Flaccid Dysarthria (LMN)
Spastic Dysarthria (UMN)
Ataxic Dysarthria (Cerebellum)
Hypokinetic Dysarthria (BG)
Hyperkinetic Dysarthria (BG)
Mixed
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| 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...
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| Aphasia- an acquired language disorder; what 4 areas does it affect? | Speaking
Listening
Reading
Writing
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| 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.)
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| WHO Model for Treatment | Body fxns vs. Impairments
Body Structures
Activities vs. activity limitation
Participation vs. handicap
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| What is the ultimate goal when treating aphasia? | "Functional" communication
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| Treatment for Aphasia | Partner training/education
Supported Communication: multi-modality communication, one-on-one interaction, social opportunities
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| Right Hemi Stroke- what is more of a problem than aphasia? | Cognitive-Communication Deficits
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| Major issues affecting communication in a person with a right hemi stroke? | Left-side neglect
Impulsivity/emotional lability
Anosognosia
Attn Deficits
Inference Failure
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| 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
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| 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
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| Who presents with dysphagia? | Young & old individuals with 1+ of:
CVA
Neuromm Disease
Progressive Neuro Disease
Head/Neck Cancer
Degenerative Arthritis
Infections
Structural Abnormalities
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| 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
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| Oral Phase of Swallowing | Voluntary
Preparation/containment
Lingual transport
Mid-palatal mvmt
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| Pharyngeal Phase of Swallowing | Reflexive
Preparation/compression
Preparation/engulfing
Pharyngeal xfer
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| Esophageal Phase of Swallowing | Reflexive
Esophageal transport
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| Which CN have afferent control during swallowing? | Trigeminal
Facial
Glossopharyngeal
Vagus- pharyngeal branch
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| Which CN have efferent control during swallowing? | Trigeminal
Facial
Hypoglossal
Glossopharyngeal
Vagus
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| 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)
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| 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
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| What is dysphonia? | Disorder of the voice
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| Where is voice produced? | Larynx, which contains vocal folds, which can move loser together to produce voice or further apart to inspire air
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| What causes dysphonia? | Inflamed larynx
Nodules
Hypothyroidism
Trauma
Vocal fold paralysis
Edema
Psychological
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| 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
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