Motor Speech Disorders

- speech disorders resulting from neuro impairments affecting:

     -motor planning

     -programming

     -neuro muscular control

     -execution of speech

Apraxia of Speech

-neuro speech disorder reflecing an impaired capacity to plan or program sensory motor commands neccessary for directing movements that result in  phonetically and prosodically normal speech.

Dysarthria

-A collective name for a group of neuro speech disorders resulting from abnormalities in strenght, speed, range, steadiness, tone, accuracy of movemnts req for the control of:

-respiration

-resonance

-articulation

-phonation

-prosody

-posture (patty added)

Basal Ganglia

Function:

-major motor relay station

-controls cognition

-movement coordination

-voluntary movement

-regulate muscle tone

-control postural adjustment during skilled movement

-adjust movement to environ. changes

-add Dr. M notes

*problems in basal ganglia -->dysarthria, word finding

Corpus Callosum

-connects the right and left hemispheres of the brain

     -integrates motor, sensory and cognitive activity

-Dr M notes

Motor Strip

-controls all movement including those necessary for speech

-the number of motor neurons assigned to striated muscle depends on degree of fine motor control, not size!

Confirmatory Signs

-tremor

-aclonus (sudden jerking of muscles)

-hemi balismus (violent thrashing)

-tic

-dysknesia (abnormal motor movement)

-athetosis (slow writhing)

-dystonia (disordered muscle tone)

-gait and station

-muscle weakness

-reflexes

Duffy's OME-What to Test

1. Face at rest

2. jaw at rest

3. face during sustained postures

4. jaw during sustained posture

5. face during movement

6. jaw during movement

7. tongue at rest

8. tongue during sustained postures

9. tongue during movement

10. velopharynx at rest

11. velopharynx during movement with mirror under nares

12. larynx

13. respiration

14. reflexes (gag and jaw jerk)

Face during sustained postures

-smile wide

-purse lips

-puff cheeks--push againtst

-hold mouth open

-look for:

symmetry

range of motion

strength and tone

quick or slow?

Jaw during sustained postures

-open your mouth--keep open while I try to close it

-clench jaw--keep close while I try to open it

Look for:

can move side to side

range of opening

resistence to strength in both open and close

Face during movement

-smile widely then pucker lips--do quickly

-lift eyebrows-inability inplies damage to cranal nerve 7 (facial)

look for:

symmetry

expressions

Jaw during movement

open and close quickly a few times

look for:

symmentry of open/close

range of motion during speech

alternating motor rate regularity

Tongue at Rest

-let tongue relax onto floor of mouth

full or half?

symmetry?

unilateral groove?

tremors?

wet/dry?

slow or fast movements?

Tongue during sustained postures

-stick out tongue and hold it

-keep out while i push

-push tongue against your cheek

deviation to one side?

resistence to pushing?

Tongue during movement

-move tongue from side to side as fast as possible

speed

accuracy

regularity

range of motion

Velopharyx at Rest

-open mouth wide

look at palate and palatal arches

does it hang low? Does it rest on tongue?

Velopharyx during movement

-put mirror under the nares

-say ahhhh as long as possible

presence/absence of palatal movemnent

nasal airflow on vowels and s and p?

Larynx

-cough

-grunt

-take deep breath and let out slowly

how sharp is the cough/grunt?

deep or shallow breath?

Respiration

-observe quiet breathing and some non speech activities

sharpness of breath?

respiration after exertion?

normal posture?

irreg breathing?

hiccoughs?

Reflexes

-relax, close eyes and let lips part

gag reflex--symmetrical?

jaw jerk-expect jerk during closing

sucking reflex

snout relfex

palmoental reflex

Sequential Motor Rates

pa pa pa etc

rate of movements?

how steady?

regular patterns?

Alternate Motor Rates

pa ta ka

rate?

reg patterns?

steadiness?

Mutism

-absence of speech due to LMN damage

-brainstem strokes, MS, ALS (degenerative diseases!)

*output is limited to only a few syllables or voicings

Locked in Syndrome

-speechlessness and total immobility of limbs--limited to vertical eye movement

-cognition is intact

-brainstem strokes, lesions or tumors

-results in death

Cerebeullum Mutism

-mutism occuring 6-9 yrs of age following surgery to posterior fossa for tumor removal

Onset

-acute: within minutes

-subacute: within a few days

-chronic: occured within months

Evolution

-transient: symptoms resolve after onset (TIA)

-improving: reduced over time but not resolved

-progressive: symptoms continue and new symptoms appear

-exacerbating with remissions: symptoms resolve but reoccure with more symptoms

-stationary or chronic: unchanged for a period of time

Flaccid Dysarthria

-LMN involvent/lesion

-symptoms:

breathiness-respiratory weakness

hypernasality

impercise consonent production

mono pitch/mono loudness

nasal emission

stridor

Palilalia

-compulsive repetition of utterances

-often associated with parkinsons, alzheimers and tourrettes.

Neurogenic Dysfluencies

-dysfluencies due to brain damage (stroke)

-can happen anywhere in speech, not just initial word or sound

-really annoys the person

-imitation and spontaneous speech is the same

Echolalia

-unsolicited repetition of other utterances

Upper Motor Neuron System

-the priniciple pathway that mediates voluntary movement

-comprised of multiple tracts

1. cortex to spinal cord

2. cortex to brainstem and cranial nerve nuclei

-fiber of UMN originate in the motor cortex and descend through the interal capsule (thalsmus) and terminate in the spinal cord

*only cortico-spinal tracts or cortico-bulbar tracts

Lower Motor Neuron System

(Final Common Pathway)

all other components of the motor syst must act thru the LMN---last link in the chain

-originates in brainstem and directly controls skeletal muscles