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Speech Disorders Final
Terms in this set (88)
Motor/ Efferent nerves
Go from __ to __?
Carry impulses from the CNS to the periphery
Located within the brainstem or spinal cord
Axons that extend from the cell bodies of motor nerves go directly to muscle fibers
Sensory/ Afferent nerves
Go from __ to __?
Carry information from the peripheral sense organ to the CNS
What happens when neurons are excited?
When the neurons are excited, neurotransmitters pass through the synaptic cleft to excite or inhibit the postsynaptic neuron
What happens at the neuromuscular junction?
At the neuromuscular junction, release of the neurotransmitter contracts the muscles
What is included in it?
what is it for?
(Motor Strip, Primary motor cortex, Broadmann's area # 4 & 6)
Site of initiation of voluntary motor movement
(Broadmann's area # 44)
Important for speech motor planning
Organizing and planning complex volitional movements
Motor Strip & Sensory motor area gives rise to the?
corticospinal (cortex to spinal cord) and corticobulbar tracts (cortex to brainstem), which allows for contralateral innervation.
Important areas in the frontal lobe?
Precentral gyrus, broca's area, premotor cortex, motor strip, SMA
Important areas in the parietal lobe?
Postcentral Gyrus/Primary Sensory cortex,
Parietal association cortex
Parietal association cortex
Integrates sensory information (visual, somatosensory, audition) to execute appropriate motor output.
Important areas in the temporal lobe?
Site of auditory reception, Important for auditory and receptive language processing, Heschl's gyrus, wernickes
(Broadmann's area # 41)
All auditory information is projected here
(Broadmann's Area # 22)
Where is it?
What does it do?
Homeostasis, perception, motor control, self-awareness, cognition, emotional experiences, etc
Limbic lobe functions (4)
Receives auditory, somatosensory and visual sensory signals
Relays sensory signals to the Cerebral Cortex
Controls sleep and awake states
Related to control of background movement (postural and supportive aspects), initiation of movement, procedural learning, etc.
Controls balance, posture, & synergy of voluntary movement (mainly proprioception)
Coordinates rapid speech movements
Automatic motor coordinating center
why are spinal nerves important for speech
For speech, these serve the respiratory apparatus - innervate muscles of chest wall
Neurons from the cortex that go directly and synapse with cranial nerves (corticobulbar tract) and spinal nerves (corticospinal tracts)
Send information about voluntary movement
These have multiple synapses between cortex and the cranial/spinal nerves
They might possibly play a role in regulating automatic (subconscious) muscles activities (tone and posture) and movements that accompany voluntary activities.
Final common pathway
Cranial and spinal nerves
Direct activation pathway (pyramidal tract)
Direct connection to final common pathway. Consists of Corticobulbar and Corticospinal tracts.
Motor planning stage
At this stage the phonological units corresponding to the planned utterance are converted into motor plans.
This stage is Articulator specific
Motor programming stage
This stage is muscle specific.
At this stage the spatiotemporal and force parameters (such as muscle tone, velocity, direction, range of movements) and sequence of motor programs for muscles of each articulator are specified.
Motor execution stage
During this stage the hierarchy of motor plans and programs are delivered to the muscles by the lower motor neurons (final common pathway).
The timely movements of the muscles manifests as speech.
what is a motor speech disorder caused by
caused by neurological impairments interfering with motor planning, motor programming and neuromuscular execution related to speech.
what does it cause?
motor execution disorder
Causes weakness, paralysis or incoordination of the muscles
May affect respiration, phonation, resonation, and/or articulation
impaired motor planning
Spastic dysarthria area of damage
Flaccid dysarthria area of damage
Ataxic dysarthria area of damage
Hypokinetic dysarthria area of damage
Hyperkinetic dysarthria area of damage
caused by strokes
bilateral UMN damage
Spastic dysarthria speech char.
Excess and equal stress, slow rate of speech
Strained-strangled-harsh voice quality
Imprecise consonant articulation
Lower vocal pitch
Poor respiratory support
CN VII: Facial nerve
Bilateral facial nerve damage: inhibited jaw movement, paralysis of lip muscles, weak sounds
CN IX: Glossopharyngeal nerve
CN X: Vagus nerve
Hypernasality, nasal emission, vocal fold paralysis (breathiness, monoloudness), dysphagia
CN XI: Spinal Accessory nerve
No direct effects on speech, shoulder/head droop
CN XII: Hypoglossal nerve
Imprecise articulation of sounds that depend on tongue movement
Caused by damage to the cerebellum
Volitional movements are slow and awkward
Ataxic speech char.
"Drunken" quality speech
Impaired force, timing and amplitude of movements
Irregular articulatory breakdown
Alternate between normal and hypernasal speech
Caused by damage in and around the Basal Ganglia
Associated with degenerative disorders - usually Parkinson's Disease
Hypokinetic speech char.
Slow initiation of volitional speech movements (bradykinesia)
Rigidity of speech muscles
Tremor in speech and respiration muscles
Strained and breathy voice quality
Highly variable articulation, periods of suddenly rushed speech, and long periods of silence
Irregular, abrupt and sustained muscle contractions (may be in limbs, face, oral cavity, soft palate, larynx, diaphragm). It can occur in epilepsy.
Rapid, unpatterned, unsustained involuntary movements of the trunk, limb, face, tongue, diaphragm, etc. Common Huntington's Chorea
Continuous, arrhythmic, slow and writhing type of movements that cease during the sleep. Although usually seen in limbs, the muscles of the face, neck and tongue may be affected. A major category of cerebral palsy
Hyperkinetic speech char.
Prolonged intervals between consonants
Excessive variation in loudness
Abnormal silent intervals
Variable stress patterns
Irregular articulatory breakdown
Sudden forced inspiration-expiration
Apraxia of speech
AKA verbal apraxia
A motor speech disorder in which planning of speech movements are impaired
location of apraxia damage
Usually a pathologic condition in the language-dominant hemisphere
Damage usually in the posterior frontal lobe, around Broca's area
AOS speech char.
Highly variable errors (hallmark feature inconsistency in errors)
Groping during speech
Occasional instances of error-free fluent speech
articulatory error patterns for AOS
Substitution errors most common
Clusters are more commonly misarticulated
Affricates and fricatives are commonly misarticulated
Consonant errors more common than vowel errors
Errors increase as word length increases
(e.g., rate, stress) is usually affected due to articulatory errors and groping, and attempts to avoid errors
is affected due to false starts, syllable repetitions, attempts to avoid errors and groping
Influence of task
Automatic speech (counting, days of the week) may be more fluent (and less erroneous) than more thoughtful speech
Errors in both imitative and spontaneous speech responses
Higher error rate for nonsense words than meaningful words
Oral mech. Trigeminal
Observe jaw at rest, biting, lateral movement of the jaw, opening mouth; say /pa/, /ta/, /ka/ repeatedly
Oral mech. Facial
Observe face at rest, smile, raise eyebrows, puff cheeks, closing eyes tightly, frowning
Oral mech. Glossopharyngeal
Swallowing tasks, gag reflex
Oral mech. Vagus
Observe soft palate at rest, say non nasal sounds, grunting, voluntary cough, swallowing (look for laryngeal elevation), prolong /a/, note voice quality
Oral mech. Hypoglossal
Observe tongue at rest, lateral and vertical (up and down) movement of the tongue, move tongue in and out, try to touch the nose with the tongue tip, lick the lip (circular motion)
Oral mech. dysarthria
Look for strength, speed, range, steadiness, tone and accuracy of oral movements.
Oral mech. AOS
Determine if there is co-occurring orofacial apraxia (important observation groping while performing nonspeech related oral movements)
Dysarthria Speech Evaluation
Assess what? (8)
Voice quality, Resonance
Articulation, Overall speech intelligibility
AOS: Speech Evaluation
-Production of speech movements in isolation and sequence
-Production of words with increasing phonologic complexity
-Production of phonologically complex phrases and sentences
Overall speech intelligibility
AAC- very severe pts
Counseling- degenerative diseases
(2) enhances intelligibility
open mouth approach
using mirror to show the range of movements, clinician's verbal feedback
Adequate breath support for speech
inhaling at appropriate linguistic breaks and considering fewer words per breath
Reducing rate of speech
delayed auditory feedback, metronome, pacing board
articulation, sequencing, volatile motor movements, hierarchy
goal is not perfection but successful comm.
Controlling rate and rhythm
metronome, pacing board
Only allow verbal modality
Prompts for Restructuring Oral Muscular Phonetic Targets): Clinician will touch the patient's face to give him/her tactile cues about which oral muscles to move while producing an utterance
an interruption of speech that may be seen as EITHER normal or abnormal.
between 18 months old and 12 years old.
between the ages of 2 and 5 years old.
Lifetime incidence of stuttering
between 1% and 15% of the population
10% of all individuals stutter at some point in their lives
% of children who stutter ___million
ratio of boys to girls
3 to 1
% of adults who stutter
ratio of men to women
2.7 to 1
(a) Disruption in the fluency of verbal expression, which is (b) characterized by involuntary, audible or silent, repetitions or prolongations in the utterance of short speech segments, namely: sounds, syllables, and words of one syllable. These disruptions (c) usually occur frequently or are marked in character and (d) are not readily controllable.
How do we know if someone stutters? (5)
Type of disfluency
Frequency of disfluency
Duration of disfluency
Level of effort, tension, and avoidance
Self-concept as a communicator
Primary symptoms of stuttering
Audible sound prolongations.
Silent prolongations (silent blocks).
How many disfluencies are considered stuttering
Secondary symptoms of stuttering
Gross movements of the body
Finer movements of the body
Breath stream / laryngeal
Limits to Wingate's definition
It doesn't address how stuttering impacts communication (which is the goal of speech production).
It doesn't say much about the person who stutters.
What makes a good clinician
Ability to listen
Ability to adjust to quickly-changing circumstances
Ability to make quick, accurate behavioral observations
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