Motor Speech Disorders Samantha - PowerPoint Presentation

Slide1

Motor Speech Disorders

Samantha

Shune,

PhD,

CCC-SLP

sshune@uoregon.eduSlide2

Preview

Brief introduction to motor speech disorders

Brief neuroanatomy primer

Video samplesSlide3

IntroductionSlide4

Neurogenic Communication Disorders

Neurogenic communication disorders can be defined as impairments in speaking, listening, reading, and writing skills that result from damage in different parts of the nervous system.

These impairments include:

Aphasia

Cognitive-Communication Disorders

Motor Speech Disorders

Dysarthria

Apraxia of SpeechSlide5

Cognitive-Communication Disorder

Aphasia

Apraxia

of Speech

DysarthriaSlide6

Motor Speech Disorders

Motor speech disorders can be defined as disorders of speech resulting from neurologic impairments affecting the:

Motor planning,

Motor programming, or

Neuromuscular execution of speech

Dysarthria and apraxia of speechSlide7

Motor speech disorders are a significant proportion of acquired communication disordersSlide8

Etiologies of Motor Speech Disorders

VITAMIN D (

Dworkin

, 1991)

V vascular accidents

I infectious processes

T traumatic insults

A allergic or anoxic

M metabolic disorders

I idiopathicN neoplasmsD degenerative demyelinating

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Major types of MSDs

Type

Localization

Neuromotor

basis

Flaccid

Dysarthria

Lower

motor neuron

Weakness

Spastic Dysarthria

Bilateral upper motor neuronSpasticity

Ataxic DysarthriaCerebellumIncoordination

Hypokinetic

Dysarthria

Basal ganglia control

circuit

Rigidity/reduced range of movement

Hyperkinetic

Dysarthria

Basal ganglia control circuit

Involuntary movements

Unilateral Upper Motor Neurons (UUMN) Dysarthria

Unilateral

upper motor neurons

Weakness,

incoordination

, or spasticity

Mixed

More than one

More than one

Apraxia

of Speech

Left

(dominant) hemisphere

Motor planningSlide10

Distribution of

MSDs

Type

Percentage

Flaccid

Dysarthria

8%

Spastic

Dysarthria

7%

Ataxic Dysarthria

9%Hypokinetic Dysarthria

9%Hyperkinetic Dysarthria19%Unilateral Upper Motor Neurons

Dysarthria

8%

Mixed

28%

Apraxia

of Speech

7%

Dysarthria

, type undetermined

4%

From Duffy, 2012Slide11

Methods for Studying & Categorizing

MSDs

Perceptual

Eyes, ears, and hands

Examples

Prolonged /a/

Diodokinetic

task /

pataka

/ Read grandfather passageOral motor examinationSlide12

Methods for Studying & Categorizing

MSDs

Instrumental

Acoustic methods

Same data as perceptual = speech signal

Provides quantification, description, and confirmation of human (clinical) perceptionSlide13

Methods for Studying & Categorizing

MSDs

Instrumental

Physiologic methods

Study of movements of speech structures, air flow and air pressure, muscle contraction, nervous system, CNS and PNS activities in relationship to biomechanical activity and and CNS activity during speech planning and execution.

Ex.

Electromyography and aerodynamic measuresSlide14

Methods for Studying & Categorizing

MSDs

Instrumental

Visual imaging methods

Allows visualization of upper

aerodigestive

tract during speech

Ex.

Videofluoroscopy

NasoendoscopyVideostroboscopySlide15

(Re)visiting neuroanatomySlide16

Speech Motor System

The final common pathway

Lower motor neurons

Cranial and spinal nerves

The direct activation pathway

Upper motor neurons (pyramidal system)

Corticobulbar and corticospinal tracts

The indirect activation pathway

Upper motor neurons (extrapyramidal system)

The control circuitsBasal ganglia and cerebellarSlide17

Final Common Pathway

Lower motor neuron system

Brainstem and spinal cord

 muscles

Includes: cranial nerves supplying muscles for phonation, resonance, articulation, and prosody; spinal nerves for respiration and prosody

CN V (trigeminal), VII (facial), IX (glossopharyngeal), X (

vagus

), XI (accessory), XII (hypoglossal)Slide18

Damage to lower motor neuron system

Weakness

Paralysis

Diminished reflexes

Decreased muscle tone

Atrophy

Fasciculations

Flaccid dysarthriaSlide19

Direct Activation Pathway

Upper motor neurons with direct, fast connection and influence on lower motor neurons

Includes: corticobulbar tract (cortex to brainstem/cranial nerves); corticospinal tract (cortex to spine/spinal nerves)Slide20

Damage to direct activation pathway

Loss or reduction of skilled movement

Unilateral upper motor neuron lesion = contralateral weakness

Particularly of tongue, lower face

Bilateral upper motor neuron lesion = bilateral weakness and alterations in muscle tone (spasticity)

Normal reflexes

UUMN, spastic dysarthriaSlide21

Indirect Activation Pathway

Upper motor neurons with indirect influence on lower motor neurons

Effects of damage:

Increased muscle tone (spasticity)

Hyperreflexia

UUMN, spastic dysarthriaSlide22

Control Circuits

Basal ganglia and cerebellum

Coordinate, integrate, control movement

activites

Effects of damage

Cerebellar control

Ataxia, incoordination

Intention tremor

Dysdiodokinesia

Ataxic dysarthriaBasal ganglia control

Hypokinesia (too little movement)Hyperkinesia (too much movement)Hypokinetic, hyperkinetic dysarthriaSlide23

What does this damage look like in speech?

Flaccid (‘weakness’)

Articulation: imprecise consonant production

Phonation: breathy/hoarse voice quality,

diplophonia

, short phrases, weak cough or glottal coup, vocal

flutter, audible inhalations (stridor)

Prosody:

monopitch

, monoloudnessResonance: hypernasality, nasal emissions, weak pressure consonantsRespiration: reduced loudness, short phrases, strained vocal qualitySlide24

Spastic (‘spasticity’)

Articulation: imprecise consonant

production, labored and slow production

Phonation:

harsh and/or strained-strangled vocal quality, low pitch, short phrases, pitch breaks

Prosody:

monopitch

,

monoloudness

, slow rateResonance: hypernasalityRespiration: [shallow, slow inhalation]Slide25

Ataxic (‘incoordination’)

Articulation: imprecise consonant

production, distorted vowels (slurred), irregular breakdowns

Phonation:

harsh vocal quality, voice tremor

Prosody:

equal and excess stress, prolonged phonemes and intervals between phonemes,

monopitch

,

monoloudness, slow rateResonance: [intermittent hyponasality]

Respiration: exaggerated and/or paradoximal mvmtSlide26

Hypokinetic (‘diminished movement’)

Articulation: imprecise

consonants, repeated phonemes,

palilalia

Phonation:

harsh or breathy voice, low pitch

Prosody:

monopitch

,

monoloudness (low), reduced stress, inappropriate pauses, short rushes of speechResonance: [mild hypernasality]

Respiration: faster breathing rates, incoordination of muscles, shallow breath support, poor control of exhalation for speechSlide27

Hyperkinetic (‘extraneous movement’)

Articulation: imprecise

consonants, distorted vowels, prolonged phonemes

Phonation:

harsh, strain-strangled, or breathy voice, excess loudness variation, voice stoppage

Prosody:

prolonged intervals between syllables/ words, variable rate of speech,

monopitch

, inappropriate silences,

monoloudnessResonance: hypernasality and hyponasality

Respiration: unexpected inhalations and exhalationsSlide28

Motor System Actions

Motor Planning

Motor Programming

Motor Execution

Higher level

Goal-oriented

What

to do

Plans are inflexible

Sets the plan for place & manner of articulation

Premotor cortex

Insular cortex

Lower level

Procedure-oriented

How

to do it

Modifiable via sensory feedback

Detailed program of motor acts across 5 speech systems

Basal ganglia

Cerebellum

Lowest level

Muscle oriented

Do

it

Modifiable via sensory feedback

Executes muscle movements

Upper motor neurons

Lower motor neurons

Apraxia of Speech

DysarthriasSlide29

Video/Audio samplesSlide30

Questions/comments?