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MOTOR SPEECH DISORDERS
This document provides definitions and descriptions of motor speech disorders. It begins by defining motor speech disorders as resulting from neurological impairment that affects the retrieval, activation, or execution of speech movements. The two main types are described as dysarthria and apraxia. Dysarthria is defined as a group of speech disorders caused by disturbances in muscle control for speech. Various types of dysarthria are outlined based on the site of lesion and perceptual characteristics. Apraxia is defined as a disorder of the planning and programming of speech movements. Causes and characteristics of apraxia are also described.
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MOTOR SPEECH DISORDERS
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- 3. Definition : • Disordersof speech results from neurological impairment. (or) • A collection of communication disorders involving: 1) the retrieval and activation of motor plans for speech (apraxia) 2) the execution of movements for speech production (dysarthria) (speech = movement)
- 4. Types of motorspeech disorders: • The two main types of motor speech disorders are Dysarthria and Apraxia.
- 5. Dysarthria Definition: A group ofspeech disorders resulting from disturbances in muscular control-weakness, slowness, or incoordination- of the speech mechanism due to damage to the central or peripheral nervous system or both.
- 6. Dysarthria site oflesion: •Upper motor Neuron (UMN) -Cerebellum, basal ganglia, substantia nigra, and pseudobulbar palsy) •Lower motor neuron (LMN) -cranial nerves V, VII, IX, X, XI, XII - all involved with movements of speech
- 7. Dysarthria etiology •Degenerative (ALS) •Inflammatory(Meningitis, encephalitis) •Toxic/Metabolic (kidney liver disease, vitamin deficiency) •Neoplastic (tumor) •Traumatic (closed head injury) •Vascular disease (CVA)
- 8. TYPES OF DYSARTHRIA •Ataxic • Spastic • Flaccid • Hyperkinetic • Hypokinetic • Unilateral UMN • Mixed
- 9. Darley, Aronson, &Brown (1975, 1969) have developed a perceptual classification system of dysarthrias : • Pitch • Loudness • Voice quality • Respiration • Prosody • Articulation
- 10. Types of Dysarthria,Their Associated Lesion Loci, and the Neuromuscular Deficits Dysarthria type Lesion locus Distinctive neurologic deficit Flaccid Lower motor neurons (cranial and spinal nerves) Weakness Spastic Upper motor neurons (bilateral) Spasticity Ataxic Cerebellum (cerebellar control circuit) Incoordination Hypokinetic Basal ganglia control circuit Rigidity, reduced range of movement Hyperkinetic Basal ganglia control circuit Involuntary movements Unilateral upper motor neuron Upper motor neuron (unilateral) Weakness, (?) incoordination, (?) spasticity Mixed Two or more of the above Two or more of the above
- 11. Flaccid Dysarthria • Siteof Lesion - Peripheral nervous system or lower motor neuron system. • Neuromuscular Symptoms – Weakness – Lack of normal muscle tone • Perceptual Characteristics – Hypernasality – Imprecise consonant productions – Breathiness of voice – Nasal emission
- 12. Spastic Dysarthria • Siteof lesion - Pyramidal and extrapyramidal systems • Neuromuscular Symptoms – Muscular weakness – Greater than normal muscular tone • Perceptual Characteristics – Imprecise consonants – Harsh voice quality – Hypernasality – Strained-strangled voice quality
- 13. Ataxic Dysarthria • Siteof lesion - Cerebellum • Neuromuscular Symptoms – Inaccuracy of movement and Slowness of movement. • Perceptual Characteristics – Imprecise consonants – Irregular articulatory breakdowns – Prolonged phonemes – Prolonged intervals – Slow rate
- 14. Hypokinetic Dysarthria • Siteof Lesion - Subcortical Structures involving Basal Ganglia • Neuromuscular Symptoms – Slow movements – Movements limited in extent (limited range of movement) • Perceptual Characteristics – Articulatory mechanism - Impaired because of reduced range of motion involving the lips, tongue, and jaw. Disturbance may range from mildly imprecise to total unintelligibility.
- 15. Hyperkinetic Dysarthrias • Siteof Lesion - Subcortical Structures involving Basal Ganglia • Neuromuscular Symptoms – Quick, unsustained, involuntary movements • Perceptual Characteristics associated with Gilles de la Tourette's syndrome – Emission of grunts as a result spontaneous contractions of the respiratory and phonatory muscles – Barking noises – Echolalia – Coprolalia: obscene language without provocation or reason.
- 16. Mixed Dysarthrias • AmyotrophicLateral Sclerosis – Site of Lesion - Progressive degeneration of the upper & lower neuron system. Most cases appears without a known cause – Neuromuscular Symptom • Impairs the function (weakness and paralysis) of all the muscles used in speech production – Perceptual Characteristics • Slow rate • Shortness of phrase • Imprecision of consonants • Hypernasality • Harshness
- 17. Apraxia of Speech •“Disorders of the execution of learned movement which cannot be accounted for either by weakness, in coordination, or sensory loss, or by incomprehension or inattention to command”. • Although it can affect any component of speech production, it is primarily a disturbance of articulation and prosody.
- 18. Apraxia: Also knownas... • Apraxia • Dyspraxia • Verbal Apraxia of Speech (VAS) • Childhood Apraxia of Speech(CAS) • Developmental Apraxia.
- 19. Causes : • GeneticDisorder • Stroke • TBI • Unknown
- 20. • Localization - Apraxiaresults from a unilateral, left hemisphere lesion involving the third frontal convolution, Broca's area. There is a possibility of apraxia following more posterior, probably parietal lesions.
- 21. Early Possible Indicators •Decreased babbling/cooing in infancy • Late acquisition of first words • Avoidance of first words (grunts/points) • One syllable words favored beyond age 2 Limited consonant/vowel repertoire noted (compared to developmental expectations) • Open mouth posturing prominent.
- 22. Speech Characteristics • ArticulationProcess – Common characteristic is the patient's groping to find the correct articulatory postures and sequences. – Facial grimaces, moments of silence, and phonated movements of articulators are common occurrences. – Consonant phonemes are involved more often than vowel phonemes – Articulation errors are inconsistent and highly variable, not referable to specific muscle dysfunction – Articulatory errors are primarily substitutions, additions, repetitions, and prolongations-essentially complications of the act of articulation. • Prosody Process – Durational relationships of vowels and consonants are distorted – Rate of production is slow – Alterations of the intonation
- 23. Apraxia 23 1.Koskia, L.,M. Iacobonia, and J.C. Mazziottaa, Deconstructing apraxia: understanding disorders of intentional movement after stroke. Current Opinion in Neurology, 2002. 15: p. 71- 77. Controversial: Ideational may be a severe form of ideomotor apraxia
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- 26. Apraxia 26 Motor Engram Paralyzed hand Therefore No engramhere Ipsilateral side must need the left-side engram
- 27. Apraxia 27 Motor engram damaged Paralyzed hand Ideational ApraxiaIdeomotorApraxia No imitation Motor engram okay Diffuse damage Can imitate Confused motor sequences
- 28. Apraxia 28 Ideomotor Apraxia (Unilateralideomotor apraxia) Inaccurate pantomime of skilled movements on both sides of body in response to verbal demand: Incorrect but recognizable movement Partial movement = abridgement of target move Distorted movement Use of body part as object Incorrect orientation of arm, hand, or fingers for movement Substitution of verbal response Inaccurate imitation of pantomimed skilled movements on both sides Evidenced by types of errors above Inaccurate performance of skilled movements using objects Movement not appropriate for object Partial movement (abridgement) Incorrect orientation of arms, hands, limbs Incorrect orientation of object in space Use of body part as object Ideational Apraxia Inaccurate sequencing of individual steps within a goal- directed sequence Confusion of sequential order of steps Omission of one or more steps Substitution of incorrect actions for one or more of the actions in a series Inability to use a tool to act on another object Relatively preserved performance of individuals actions within the series on verbal command Relatively preserved imitation of individual actions within the series Lesions: Primarily parietal, with possible extension to frontal. Also, supplemental motor cortex of frontal, possible to corpus callosum, insular cortex and adjacent white matter, basal ganglia (caudate nucleus & lenticular nuclei) Lesions: Frontal lobe, extension to parietal & temporal Lateral surface of temporal lobe Parietal lobe
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- 30. Apraxia 30 Heilman, M.Kenneth, John Coyle, Edward Gonyea & Norman Geshwind. (1973). Apraxia and agraphia in a left hander. Brain, 96, 21-28. • “. . .Account for the presence of agraphia in the hand opposite a hemisphere which still serves speech, following a lesion in the hemisphere ipsilateral to that hand.” • Apraxia & agraphia on the right • Case 1: Callosal lesion = right sided agraphia and apraxia • Left hander with Right Dominance for both handedness and speech. • Left hand writing requires no callosal activity SPEECH Skilled Engrams Motor Control Motor Control
- 31. Apraxia 31 Heilman, M.Kenneth, John Coyle, Edward Gonyea & Norman Geshwind. (1973). Apraxia and agraphia in a left hander. Brain, 96, 21-28. • They discuss the Poeck & Kerschensteiner (1971) case • Patient is Right Dominant for both speech and motor skills but writes with the right hand. • So left hemisphere controls right hand via the corpus callosum • Callosal lesion = • apraxic & agraphic with right hand • Left paresis? Damage to callosum at site? • Why not second lesion on left parietal? No other Gerstmann symptoms SPEECH Skilled Engrams Motor Control Motor Control Paresis