CSD 2230 HUMAN COMMUNICATION DISORDERS <ul><li>Topic 7 </li></ul><ul><li>Speech Disorders </li></ul><ul><li>Motor Speech D...
Motor or Neurogenic  Speech Disorders <ul><li>Speech difficulties that are related to problems of movement as a result of ...
Major Types of  Neurogenic Impairment <ul><li>Cerebral Palsy </li></ul><ul><li>Dysarthria of speech </li></ul><ul><li>Apra...
Cerebral Palsy <ul><li>Heterogenous group of neurological disorders that result in difficulty with motor movements </li></...
Dysarthria <ul><li>Group of related speech impairment that result from disturbed muscular control caused by damage to the ...
Apraxia <ul><li>Affects the phonological selection and sequencing of speech sounds and articulation </li></ul><ul><li>Acqu...
What Causes Motor  Speech Disorders? <ul><li>Stroke </li></ul><ul><li>Traumatic brain injury (TBI) </li></ul><ul><li>Anoxi...
Cerebral Palsy <ul><li>A group of nonprogressive neurological difficulties resulting from brain injury very early in life ...
Types of Cerebral Palsy <ul><li>Spastic (hypertonia) </li></ul><ul><ul><li>Characterized by too much muscle tone </li></ul...
Spastic Cerebral Palsy <ul><li>60% of individuals with cerebral palsy </li></ul><ul><li>Motor movements are jerky, labored...
Athetoid Cerebral Palsy <ul><li>30% of individuals with cerebral palsy </li></ul><ul><li>Slow involuntary writhing </li></...
Ataxic Cerebral Palsy <ul><li>10% of individuals with cerebral palsy </li></ul><ul><li>Uncoordinated movements </li></ul><...
Motor and Motor  Speech Characteristics with Cerebral Palsy <ul><li>Speech isn’t always affected and varies somewhat with ...
Motor and Motor  Speech Characteristics with Cerebral Palsy <ul><li>Other issues related to cerebral palsy: </li></ul><ul>...
The Dysarthrias <ul><li>A group of impairments that may affect the speed, range, direction, strength, and timing of motor ...
Types and Associated Etiologies <ul><li>Flaccid dysarthria </li></ul><ul><li>Characterized by hypotonia (weak muscle tone)...
Types and Associated Etiologies <ul><li>Spastic dysarthria </li></ul><ul><li>Characterized by hypertonia (stiff and rigid ...
Types and Associated Etiologies <ul><li>Ataxic dysarthria </li></ul><ul><li>Characterized by a combination of hypotonia (r...
Types and Associated Etiologies <ul><li>Hypokinetic Dysarthria </li></ul><ul><li>Characterized by hypokinesis (decreased m...
Types and Associated Etiologies <ul><li>Hyperkinetic dysarthria </li></ul><ul><li>Characterized by hyperkinesia (increased...
Types and Associated Etiologies <ul><li>Mixed dysarthria </li></ul><ul><li>Caused by diffuse brain damage </li></ul><ul><l...
Apraxia <ul><li>Disorder of motor placement and sequencing that’s unrelated to muscle weakness, slowness, or paralysis </l...
Characteristics of  Apraxia of Speech <ul><li>Groping attempts to find the correct articulatory position </li></ul><ul><li...
 
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Motor Speech Disorders

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  • Motor Speech Disorders Neurogenic or motor speech disorders are speech difficulties that are related to problems of movement as a result of some neurological disorder or injury. They are a heterogeneous group of neurological impairments that affect the planning, coordination, timing and execution of the movement patterns that are used to produce speech. These impairments can affect phonation, resonation and/or articulation. Language disorders can co-occur as well.
  • We will discuss three major types neurogenic speech impairments: Cerebral Palsy, dysarthria, and apraxia of speech. These aren’t concrete categories, but it will give us a framework for discussion.
  • Cerebral palsy is the term applied to a heterogeneous group of neurogenic disorders that result in difficulty with motor movement. It is acquired either shortly before, during, or very shortly after birth. It’s considered a developmental disorder. This is a disorder with a continuum of physical manifestations from being completely ambulatory and mobile to extreme rigidity and immobility. Not all limbs are affected and sometimes speech is affected, sometimes not. IQ can vary tremendously.
  • Dysarthria is a group of related speech impairments that result from disturbed muscular control caused by damage to the mature nervous system. It’s an acquired disorder. Respiration, phonation, resonation, and articulation may be affected. People with dysarthria may have excessively slow or rapid motor function, they may have a decrease in the range or strength of motor skills, they may have poor directionality or motor timing.
  • Apraxia affects the phonological selection and sequencing of speech sounds and articulation. This is an acquired disorder. It affects the ability to organize and plan and execute the movement of speech muscles for the production of speech.
  • What causes motor speech disorders? The leading cause is stroke (CVA). Remember, these can be due to untreated or persistent hypertension, aneurysms, hemorrhages. TBI is another leading cause of motor speech disorders. Brain injury resulting from oxygen deprivation (anoxia). Brain tumors (neoplasms) Infections and toxins (meningitis, mercury, alcohol and drug abuse) Diseases (acquired) like multiple sclerosis, amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), Parkinson’s disease, Huntington’s disease, myasthenia gravis
  • Cerebral Palsy: This really is a group of neurological difficulties resulting from brain injury that occurs in fetal or early infant development. It’s nonprogressive, so it doesn’t get worse as the child ages. Areas affected include motor movement, cummunication, growth and development, locomotion, learning, and sensation. Incidence rate is 1.5-3/1000 births About .5 million people in the US have CP and most are under 21. CP has 3 primary characteristics: 1. it’s a developmental neurogenic disorder that results from abnormal brain functions 2. CP isn’t a disease, in the usual sense because it doesn’t get worse with time 3. the motor patterns are much more predictable that other acquired neurogenic impairments.
  • Types of CP These types vary with the area of the CNS damaged ie motor cortex damage vs damage to the cerebellum Most CP types are classified as either spastic (hypertonia) where there is too much muscle tone, athetoid (dyskinesia) where there is slow involuntary movement of the body, or Ataxic where there is uncoordinated movement. Let’s look at each in turn
  • Spastic CP: categorizes 60% of individuals with CP. They have too much muscle tone. What happens is that opposing muscles become rigid with muscle movement. It makes their motor movements jerky, labored, and slow. They may also exhibit infantile reflex patterns like rooting. In severe forms, walking or standing may be very difficult.
  • Athetoid CP: this accounts for about 30% of individuals with CP and their movements are characterized by slow, involuntary writhing. These people too exhibit infantile reflexes. In severe cases, the person’s back and neck arch a lot. Breathing may be affected.
  • Ataxic CP: accounts for the remaining 10% of CP and is characterized by uncoordinated movement and disturbed balance. They seem clumsy and awkward. Their movements lack direction and strength. It’s especially noticeable in their walk or gait—they may appear drunk Damage is to the cerebellum which is a primary center for balance and coordination.
  • Motor and motor speech characteristics with CP First of all, not everyone w/CP will have motor speech difficulties. For ex, sometimes only the legs are affected. Everything else is spared. This is especially true with the Spastic CP form. Most people with the athetoid form show some motor speech disorders.. Ataxic CP usually involves cognitive impairments as well, so this has implications of its own with speech. All aspects of speech production (respiration, phonation, resonation, articulation and prosody) may be affected. Speech may be slow and labored. In sever cases, it may be unintelligible. CD-ROM Ch.14.02 shows a speaker with spastic CP talking about sports. How much can you understand?
  • Many CPs have breathing problems which affect speech. Their breathing may be shallow, for ex, so they may not have enough breath for a phrase. It may not be sufficient to drive the vocal folds into vibration, so phonation may be affected. They may have a breathy voice. Rigidity may strain the voice, so glottal attacks may be common. They may have resonance problems like hypernasality due to VPI. Articulation may be extremely affected because of the incoordination of the tongue lips, and/or jaw. Speech prosody (pitch, loudness, and duration) may be very monotonous due to lack of control for these subtle speech changes. This might result in speech that’s choppy and full of interruptions. Their speech may be nonrhythmic or nonfluent. Other issues: intellectual, auditory processing, and language impairments. Intervention: In severe cases of CP, sometimes one of the primary activity of the SLP is the assessment and “fitting” of an augmentative and alternative communication system (AAC). These devices can increase conversational participation, speech intelligibility and conversational initiations. CD ROM Ch14.03 shows the same CP speaker conversing with an AAC device.
  • The dysarthrias: This is a group of impairments that may affect the speed, range, direction, strength, and timing of motor movement as the result of paralysis, weakness, or discoordination of the speech muscles. Speech may be slowed or fast or contain involuntary movements. The range of movement may be reduced. Direction may become imprecise. Strenth may decrease and timing my become erratic or monotonous. Dysarthrias represent difficulty in motor speech CONTROL. This is not a language disorder—they maintain good lang structure and vocab. They have good reading compreshension and can maintain conversations. They just lack control of their speech movements.
  • Types and associated etiologies: These muscular disorders represent a variety of neurological diseases Different types of dysarthria are the result of lesions to different parts of the CNS and peripheral nervous system. 1. Flaccid dysarthria—characterized by muscles with a weak, soft, flabby tone (hypotonia). This will result in weakness or paralysis of the affected muscle. These muscles tire easily Speech characteristics include shallow breathing, breathy voice, aphonia (no voice), reduced pitch and loudness, monotone, hypernasility, and imprecise artic. Conditions that cause flaccid dysarthria are Bell’s palsy (facial nerve paralysis), myasthenia gravis, muscular dystrophy. Taped examples of Flaccid Dysarthria—do them all.
  • 1. Spastic Dysarthria—characterized by stiff and rigid muscles (hypertonia). Most common cause is stroke. May be temporary or permanent. Speech movements are difficult and speech is characterized as slow with jerky, imprecise artic and reduction of the rapidly alternating movements of speech. Taped examples of Spastic dysarthria—play the first 3 or 4
  • 1. ataxic dysarthria—characterized by a combination of muscle weakness or reduced tone (hypotonia) and problems with muscle coordination (ataxia). Little or no paralysis exists, and the problem is one involving the accuracy, timing and direction of movement. As a result speech movements are jerky and imprecise. Speech is usually not as impaired as other motor movements and is characterized by excessive and equal stress and imprecise artic especially in repetitive movements. Taped examples of ataxic dysarthria—play the first 3-4
  • 1. Hypokinetic Dysarthria—characterized by a decrease or lack of movement (hypokinesis). Muscles become rigid and stiff, resulting in restricted motor movements. Parkinson’s disease brings about a common form of hypokinetic dysarthria. Parkinson’s disease—in this progressive disorder, the individual’s muscles become rigid, resulting in reduced motor movements. Other characteristics include involuntary shaking or tremors when at rest, slowness of movement, and difficulty initiating voluntary movements. Their speech is characterized by a rapid rate, breathy voice, less speech per breath, difficulty initiating motor movements, and reduced loudness, pitch range and stress. Dysarthria is a symptom of later stages of the disease. Artic suffers during this stage. About .5 million people in the US have Parkinson’s and has received lots of media attention since Michael J. Fox and Janet Reno have made their dx public. Taped examples of Hypokinetic dysarthria from Parkinson’s—play first 3-4
  • 1. hyperkinetic dysarthria—characterized by increased movement (hyperkinesia) in the form of tremors and tics. These types of movements are involuntary. A major characteristic of this motor speech disorder is imprecise artic. Dystonia and chorea are two disorders that illustrate major forms of hyperkinetic dysarthria. Dystonia—this is a condition that can involve the entire motor system or be localize. It’s characterized by a slow increase and decrease of hyperkinesia. Movement is often writhing. Speech characteristics include excessive pitch and loudness variations, irregular artic breakdown and vowel distortions. Play tape example of hyperkinetic dysarthria from dystonia—do some exs Chorea—characterized by rapid or continual hyperkinesia. Movements are characterized as random, irregular, and/or abrupt. May involve the whole body or parts. If speech is affected it’s characterized by inappropriate silences caused by voice stoppage, intermittent breathiness, strained harsh voice and hypernasality, imprecise artic with prolonged pauses and force inspiration and expiration resulting in excessive loudness variations. Play tape examples of hyperkinetic dysarthria from chorea
  • 1. Mixed dysarthria—characteristics of more than one of the above. Due to diffuse brain damage. ALS is a good example of this kind of dysarthria ALS is a rapidly progressive degenerative disease that involves motor neurons and spinal cord. Cognition isn’t affected, but individual gradually looses control of musculature. ALS is characterized by fatigue, muscle atrophy, involuntary contractions and reduced musle tone. Speech characteristics of the later stages include labored, slow rate, short phrasing, long pauses, hypernasality, and severely impaired artic Play tape examples of ALS
  • Apraxia This is a disorder in voluntary motor placement and sequencing that’s unrelated to muscle weakness, slowness, or paralysis. This disorder can affect any muscle group. Apraxia of speech is a problem of speech-sound artic and prosody or rhythm caused by a neurologically based movement disorder. Difficulties are not the result of muscle weakness or slowness (like dysarthria) or of linguistic processing deficits (like aphasia). These people have difficulty executing the movements to position the articulators for correct sound production. This is almost always due to damage to Broca’s area in the brain.
  • Speech characteristics—characterized by groping attempts to find the correct artic position. Frequent artic errors with lots of unrelated substitutions, repetitions and additions. These people hear and recognize their speech errors, so they are continually self-correcting. They can be really variable in their abilities—so at one time they may be able to produce a certain word fluently, but at another time really struggle with the same word. Play tape example of apraxia
  • Motor Speech Disorders

    1. 1. CSD 2230 HUMAN COMMUNICATION DISORDERS <ul><li>Topic 7 </li></ul><ul><li>Speech Disorders </li></ul><ul><li>Motor Speech Disorders </li></ul>
    2. 2. Motor or Neurogenic Speech Disorders <ul><li>Speech difficulties that are related to problems of movement as a result of some neurological disorder or injury </li></ul><ul><li>Heterogeneous </li></ul><ul><li>Affect the planning, coordination, timing, and execution of speech movements </li></ul><ul><li>May affect phonation, resonation, and articulation </li></ul>
    3. 3. Major Types of Neurogenic Impairment <ul><li>Cerebral Palsy </li></ul><ul><li>Dysarthria of speech </li></ul><ul><li>Apraxia of speech </li></ul>
    4. 4. Cerebral Palsy <ul><li>Heterogenous group of neurological disorders that result in difficulty with motor movements </li></ul><ul><li>Acquired shortly before, during, or after birth </li></ul><ul><li>Developmental disorder </li></ul><ul><li>Continuum of physical manifestations </li></ul>
    5. 5. Dysarthria <ul><li>Group of related speech impairment that result from disturbed muscular control caused by damage to the mature nervous system </li></ul><ul><li>Acquired disorder </li></ul><ul><li>May affect respiration, phonation, resonation, and/or articulation </li></ul><ul><li>Speech characteristics include slow or rapid motor function, decrease in the range or strength of motor skills, poor directionality or motor timing </li></ul>
    6. 6. Apraxia <ul><li>Affects the phonological selection and sequencing of speech sounds and articulation </li></ul><ul><li>Acquired disorder </li></ul><ul><li>Affects the ability to organize, plan, and execute the movement of speech muscles </li></ul>
    7. 7. What Causes Motor Speech Disorders? <ul><li>Stroke </li></ul><ul><li>Traumatic brain injury (TBI) </li></ul><ul><li>Anoxia </li></ul><ul><li>Neoplasms </li></ul><ul><li>Infections and toxins </li></ul><ul><li>Acquired diseases </li></ul>
    8. 8. Cerebral Palsy <ul><li>A group of nonprogressive neurological difficulties resulting from brain injury very early in life </li></ul><ul><li>Areas affected include motor movement, communication, growth and development, locomotion, learning, and sensation </li></ul><ul><li>Incidence is 1.5-3/1000 births </li></ul><ul><li>Primary characteristics </li></ul><ul><ul><li>A developmental neurogenic disorder that results from abnormal brain function </li></ul></ul><ul><ul><li>It’s not a disease </li></ul></ul><ul><ul><li>Predictable motor patterns </li></ul></ul>
    9. 9. Types of Cerebral Palsy <ul><li>Spastic (hypertonia) </li></ul><ul><ul><li>Characterized by too much muscle tone </li></ul></ul><ul><li>Athetoid (dyskinesia) </li></ul><ul><ul><li>Characterized by slow involuntary movements </li></ul></ul><ul><li>Ataxic </li></ul><ul><ul><li>Characterized by uncoordinated movements </li></ul></ul>
    10. 10. Spastic Cerebral Palsy <ul><li>60% of individuals with cerebral palsy </li></ul><ul><li>Motor movements are jerky, labored, and slow </li></ul><ul><li>Infantile reflex patterns </li></ul>
    11. 11. Athetoid Cerebral Palsy <ul><li>30% of individuals with cerebral palsy </li></ul><ul><li>Slow involuntary writhing </li></ul><ul><li>Infantile reflex patterns </li></ul>
    12. 12. Ataxic Cerebral Palsy <ul><li>10% of individuals with cerebral palsy </li></ul><ul><li>Uncoordinated movements </li></ul><ul><li>Disturbed balance which is especially noticeable in their gait </li></ul><ul><li>Damage is to the cerebellum </li></ul>
    13. 13. Motor and Motor Speech Characteristics with Cerebral Palsy <ul><li>Speech isn’t always affected and varies somewhat with the type of CP </li></ul><ul><li>When speech is affected, all aspects of speech production may be affected including respiration, phonation, resonation, articulation, and prosody </li></ul><ul><li>CD-ROM Ch.14.02 shows a speaker with spastic CP talking about sports. How much can you understand? </li></ul>
    14. 14. Motor and Motor Speech Characteristics with Cerebral Palsy <ul><li>Other issues related to cerebral palsy: </li></ul><ul><ul><li>Breathing problems </li></ul></ul><ul><ul><li>Rigidity </li></ul></ul><ul><ul><li>Velopharyngeal incompetency </li></ul></ul><ul><ul><li>Uncoordinated articulator movements </li></ul></ul><ul><ul><li>Intellectual processing </li></ul></ul><ul><ul><li>Auditory processing </li></ul></ul><ul><ul><li>Language impairments </li></ul></ul><ul><li>Intervention might include augmentative and alternative communication systems </li></ul><ul><li>CD-ROM Ch14.03 illustrates conversation with such a device </li></ul>
    15. 15. The Dysarthrias <ul><li>A group of impairments that may affect the speed, range, direction, strength, and timing of motor movements </li></ul><ul><li>Results from paralysis, weakness, or discoordination of speech muscles </li></ul><ul><li>Not a language disorder but rather a difficulty in motor speech control </li></ul>
    16. 16. Types and Associated Etiologies <ul><li>Flaccid dysarthria </li></ul><ul><li>Characterized by hypotonia (weak muscle tone) which results in weakness or paralysis of the affected muscle </li></ul><ul><li>Speech characteristics include shallow breathing, breathy voice, aphonia (no voice), reduced pitch and loudness, monotone, hypernasality, and imprecise articulation </li></ul><ul><li>Etiologies include Bell’s Palsy, myasthenia gravis, and muscular dystrophy </li></ul><ul><li>Audio examples of flaccid dysarthria </li></ul>
    17. 17. Types and Associated Etiologies <ul><li>Spastic dysarthria </li></ul><ul><li>Characterized by hypertonia (stiff and rigid muscles) commonly caused by stroke </li></ul><ul><li>Speech movements are difficult and speech is characterized as slow with jerky, imprecise articulation and reduction in the rapidly alternating movements of speech </li></ul><ul><li>Audio examples of spastic dysarthria </li></ul>
    18. 18. Types and Associated Etiologies <ul><li>Ataxic dysarthria </li></ul><ul><li>Characterized by a combination of hypotonia (reduced tone) and ataxia resulting in problems in the accuracy, timing, and direction of movement </li></ul><ul><li>Speech movements are jerky and imprecise </li></ul><ul><li>Audio examples of ataxic dysarthria </li></ul>
    19. 19. Types and Associated Etiologies <ul><li>Hypokinetic Dysarthria </li></ul><ul><li>Characterized by hypokinesis (decreased movement) </li></ul><ul><li>Parkinson’s disease results in a good example of this kind of dysarthria </li></ul><ul><ul><li>Progressive disorder where the muscles become rigid, resulting in reduced motor movements, involuntary shaking or tremors, slowness of movement, and difficulty initiating voluntary movements </li></ul></ul><ul><li>Audio examples of hypokinetic dysarthria from Parkinson’s </li></ul>
    20. 20. Types and Associated Etiologies <ul><li>Hyperkinetic dysarthria </li></ul><ul><li>Characterized by hyperkinesia (increased movements) in the form of involuntary tremors and tics </li></ul><ul><li>Major speech characteristic is imprecise articulation </li></ul><ul><li>Dystonia and chorea provide examples </li></ul><ul><li>Audio examples of hyperkinetic dysarthria from dystonia and chorea </li></ul>
    21. 21. Types and Associated Etiologies <ul><li>Mixed dysarthria </li></ul><ul><li>Caused by diffuse brain damage </li></ul><ul><li>ALS provides a good example of mixed dysarthria </li></ul><ul><li>Audio examples of mixed dysarthria from ALS </li></ul>
    22. 22. Apraxia <ul><li>Disorder of motor placement and sequencing that’s unrelated to muscle weakness, slowness, or paralysis </li></ul><ul><li>When speech muscle groups are affected, it is called apraxia of speech </li></ul><ul><li>Speech difficulties are not the result of muscle weakness or slowness (dysarthria) or of linguistic processing (aphasia) </li></ul><ul><li>Almost always due to damage to Broca’s area in the cortex </li></ul>
    23. 23. Characteristics of Apraxia of Speech <ul><li>Groping attempts to find the correct articulatory position </li></ul><ul><li>Frequent articulation errors </li></ul><ul><li>Self-correcting behaviors </li></ul><ul><li>Variable in their abilities </li></ul><ul><li>Audio example apraxia of speech </li></ul>
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