motor speech disorders: praxis review
TRANSCRIPT
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Motor Speech Disorders: Praxis Review
NBASLHJune 11, 2021
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TRAVIS T. THREATS, PH.D.,F-ASHA, F- NAP
Professor and Chair, Department of Communication Sciences and Disorders
Interim Chair, Department of Occupational Sciences and Occupational Therapy
Saint Louis UniversitySt. Louis, Missouri
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TOPICS COVERED
• Definitions of Motor Speech Disorders
• Neurology brief review
• Etiologies
• Types of Motor Speech Disorders
• Using the International Classification of Functioning, Disability, and Health as a framework for understanding Motor Speech Disorders
• Assessment principles
• Intervention principles
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WHAT ARE MOTOR SPEECH DISORDERS?
• An acquired speech disorder caused by a known neurological impairment
• May or may not also have an accompanying cognitive or language disorder, but by itself does not affect comprehension, cognition, or language skills
• Wide range of impairments depending upon where the damage is
• Can involve:• Planning/Programming
• Execution
• Control
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BRIEF NEUROLOGY REVIEW
• Necessary because need to know what is damaged and what is not, with some treatments indicated for some types and the same contraindicated for other types
• Regions/structures of brain which underpin speech production-• Motor cortex – Where signal begins, where motor fibers for voluntary movement emerge
• Broca’s area – Responsible for motor programming of speech
• Basal ganglion- Important for muscle tone, starting, controlling and stopping movement
• Cerebellum – Coordination of voluntary muscle movements
• Upper motor neurons - Nerves that leave the motor cortex
• Lower motor neurons (cranial nerves for speech)- Nerves that synapse with upper motor neurons to go to muscles need for speech
• Motor end plates-Where synapses with actual muscles, to cause contraction
• Muscles-The actual work of moving articulators
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ETIOLOGIES
• Strokes
• Head trauma
• Side effects of medications
• Progressive neurological diseases like ALS or Parkinson’s Disease
• Neuromuscular disorders such as cerebral palsy
• Brain tumors
• Dementia
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APRAXIA OF SPEECH
• Disorder characterized by difficulty sequencing and voluntarily controlling muscle movements, often includes prosody difficulties as a result.
• It is a programming disorder
• Muscles are NOT weak or paralyzed and may be able to use them normally for facial expressions and eating
• Due to damage to Broca’s area
• Characterized by effortful speech, slowed, distorted, false starts, and inconsistent errors, with the longest utterances causes the most difficulty due to their programming demands.
• Usually aware of errors
• Often accompanies Broca’s aphasia but can exist on its own
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DYSARTHRIA TYPES AND THEIR AREAS OF DAMAGE
• Ataxic- Cerebellum
• Flaccid – Lower motor neurons
• Hyperkinetic – Basal ganglia
• Hypokinetic – Basal ganglia
• Spastic – Upper motor neuron
• Mixed – damage to more than one of above systems
• Unilateral upper motor neuron – Unilateral upper motor neuron damage
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DYSARTHRIA – SYSTEMS THAT CAN BE AFFECTED
• Respiration
• Phonation
• Articulation
• Prosody
• Resonance
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DYSARTHRIA SYMPTOMATOLOGY
• Ataxic- Incoordination of speech, imprecise speech, distortion of vowels, uneven prosody and rate- like intoxicated
• Flaccid – Weakness and hypotonia, slurred indistinct and slowed, reduced movements, breathy, possible hypernasality, and poor respiration
• Hyperkinetic – Abnormal, extraneous movements, with distorted and slowed speech, prolongations, excess or reduced stress, monopitch and monoloudness. Examples- Tourette’s syndrome, tardive dyskinesia
• Hypokinetic – Reduced range of movement, rigidity, reduced stress, very monotone, short rushes of speech, long pauses of speech. Example- Parkinson’s disease
• Spastic (bilateral) – Weakness and spasticity, involves effortful slow speech to overcome excessive muscle tone, hyper adduction of vocal folds, strained voice quality, reduced stress in prosody
• Mixed – Any combination of above. Many etiologies hit more than one substrate of speech
• Unilateral upper motor neuron – Weakness and spasticity, can be combination of breathiness and harsh voice, hypernasality, reduced rate of speech
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DEVELOPMENTAL APRAXIA OF SPEECH OR CHILDHOOD APRAXIA OF SPEECH
• Debated
• May be covered under childhood speech sound disorders lecture, as it is congenital not acquired like the classic definition of Motor Speech Disorders
• Difficulties with sensorimotor problems with controlling and sequencing movements for speech
• Do not have motor weakness
• Often accompanying history of feeding problems and phonological awareness difficulties
• There is often not any physical evidence of neurological damage, maybe just cannot detect it
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UNDERSTANDING MOTOR SPEECH DISORDERS VIA THE LENS OF THE ICF
• The medical model is what has been presented so far – Diagnosis, Label, Symptoms
• Treatment follows whatever the diagnosis is, thus would say “Intervention strategies for Flaccid Dysarthria” - note not the person being treated but the disorder.
• Published by the World Health Organization (WHO) is 2001, it is the framework for the fields of speech-language pathology, occupational therapy, physical therapy, recreational therapy, rehabilitation nursing, and physical medicine and rehabilitation
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Body function&structure
(Impairment)
Activities(Limitation)
Participation(Restriction)
Environmental Factors
Personal Factors
Health Condition (disorder/disease)
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Body Structure and Function
Impaired skeletal development, poor respiratory support, articulation impairment
Activity/Participation
Decreased ability to have conversations , difficulty with socializing at school/work,
gaining employment, voting
Health Condition
Spastic cerebral palsy
Environmental factorsBarriers – Others acceptance/comfort with interacting with people using augmentative/alternative communication, insurance payment for devicesFacilitators – Appropriate training, attitudes, resources, family dynamics
Personal factorsVigilance, other health factors, Personality
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ASSESSMENT IN MOTOR SPEECH DISORDERS
• Structure
• Function
• Activity/Participation
• Environmental Factors
• Personal Factors
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INTERVENTION FOR MOTOR SPEECH DISORDERS
• Structure
• Function
• Activity/Participation
• Environmental Factors
• Personal Factors
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