Chapter 9 Notes
Chapter 9 Notes 1230.0
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This 7 page Class Notes was uploaded by Emily Clark on Sunday November 1, 2015. The Class Notes belongs to 1230.0 at Bowling Green State University taught by Lynne Hewitt in Fall 2015. Since its upload, it has received 34 views. For similar materials see INTRODUCTION TO COMMUNICATION DISORDERS in Language at Bowling Green State University.
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Date Created: 11/01/15
Chapter 9: Motor Speech Disorders - Motor Speech Disorders • Some speech disorders are the result of damage to parts of the nervous system responsible for the planning and programming movements for speech, - Or they are the result from the impairment of the ability of muscles to produce speech because they are weak, paralyzed, or uncoordinated. • Childhood Apraxia of Speech - Childhood apraxia of speech (CAS) is a controversial disorder. - Experts do not agree on its characteristics or cause. - CAS has been given several labels, including developmental apraxia and developmental dyspraxia of speech. • CAS does not occur often. - Typically these children demonstrate a severe speech disorder with the words dominated by • simple syllable shapes • vowel errors • sounds that develop early - Children with apraxia may use gestures because of difficulty with communicating words. - Most children with the disorder will eventually develop intelligible speech • But there may continue to be minor differences and intonation and stress. - Children with CAS do not demonstrate significant sensory loss, structural abnormalities, or emotional disorders • So neurological and genetic factors have been proposed as the cause of the disorder. - Reliable identification of children with CAS is difficult because clinicians do not agree on what characteristics set the disorder apart from other childhood disorders. - Children with a CAS are in treatment for an extended period of time, frequently several years due to the severity of the disorder and lack of proven treatment techniques. - Treatment includes drill based work on speech movement, phonological process remediation approaches, and tactile/gestural approaches. • Acquired Apraxia of Speech - Acquired apraxia of speech AOS is a disorder in the planning and programming of speech movement due to left frontal lobe brain damage. 1 - AOS has a controversial history because researchers could not agree on whether the disorder could occur independently of Broca's aphasia, a language disorder. • In most cases AOS does not occur independently from Broca's aphasia. - AOS is characterized by slow rate, prolonged consonants and vowels, pauses between words, and even stress on syllables. - Speakers with AOS tend to substitute less complex consonants for more complex consonants. - Treatment for a proxy of speech focuses on improving the ability to program movements of increasingly more demanding syllables, words, and phrases. • Other approaches focus on rate, intonation, and rhythm to facilitate production of sequences of syllables. • Dysarthria in children - It is most commonly associated with cerebral palsy. • In adults it results from cerebrovascular or progressive neurological disease. - Frequently, the neuromuscular problems that underlie dysarthria cause difficulties in swallowing as well as speech. • Cerebral palsy - Injury to the nervous system that occurs before, at the time of, or shortly after birth can cause cerebral palsy. • This syndrome causes deficits in visual, auditory, intellectual, and motor functions in the critical early development for speech and language. - The primary causes of cerebral palsy are anoxia, in which the brain has a restricted oxygen supply. • The causes are divided into three groups prenatal, perinatal, and postnatal. - Classification of Cerebral Palsy • There are several ways of classifying cerebral palsy - By the limbs affected - By neuromuscular characteristics - By the severity of the disorder Orthopedic Classification • - Based on the limbs affected • 1 limb= monoplegia • 3 limbs= triplegia • 2 limbs= paraplegia • 4 limbs= quadriplegia 2 • Neuromuscular Characteristics - Damage to the pyramidal tract and the extrapyramidal system leads to Spastic Cerebral Palsy This type includes arms that are bent upward and legs that are positioned like a scissors. • - Damage to the basal ganglia and associated components of the extrapyramidal tract leads to Athetoid Cerebral Palsy. • Which is characterized by a writhing and twisting motion. - Damage to the cerebellum results in Ataxic Cerebral Palsy. • Characterized by errors in speed, direction, and accuracy. - There are two other types of cerebral palsy: Rigid and Tremor. These types have a low frequency of occurrence and rarely occur alone. • • Severity - Ranges from mild to severe and is usually determined by an overall judgement of the level of impairment. • Based on the degree of independence in communication, ambulation and self-help skills. - Typical diagnostic descriptions include: • Severe athetoid quadriplegia Mild spastic paraplegia • • Moderate ataxic quadriplegia - Motor Development in Children with Cerebral Palsy • Motor deficits are the focal point of a diagnosis of cerebral palsy. - Delayed motor development is most frequently observed in children with that disorder. - Children have developmental delays in sitting, standing, walking, and speech development related to the motor impairment. • Children with cerebral palsy often fail to develop reflexes related to walking. - Speech and Language Development in Children with Cerebral Palsy • Speech disorders in cerebral palsy result from weakness and incoordination • ALL aspects of speech are effected. • Respiration - Is characterized by reduced vital capacity and impaired ability to generate and maintain pressure below the vocal folds. • Phonation - Intermittent breathiness and strangled harshness in voice quality as vocal fold tension increases and decreases. Resonance • 3 - Hypernasality and nasal emission during speech production is caused by a gradual premature opening of the soft palate during the productions of syllables. • Articulation - Because of hyperextension of the articulators, individuals with cerebral palsy frequently have significant articulation problems. • Speech Development - The highest frequency of errors are on fricatives and glides requiring tongue movement. - The latest developing sounds in normal children are the most delayed in children with cerebral palsy. - The melody of speech (prosody) is also affected and causes a reduction in speech intelligibility. - Recommended treatment includes behavioral adjustments that are compensatory, such as reducing speech rate and augmentative communication systems. • Acquired Dysarthria - This disorder differs from cerebral palsy in several respects. • In this disorder the adult developed speech and language is already acquired. - Primitive reflexes do not contribute significantly to the speech deficits that are observed. - Adult patients usually present sensory problems related to the aging process. - Classification of Acquired Dysarthria • Historically, acquired dysarthias were categorized by the causative disease process or the part of the body affected. • Flaccid Dysarthria - Interruption of normal input to the muscles from the peripheral nervous system causes muscle weakness and atrophy (wasting). - The problem in flaccid dysarthria may be impulses from the central nervous system are interrupted as they course down to the muscle fibers. - Motoneurons can be injured by trauma, or they can deteriorate from degenerative disease. - Depending on what parts of the motor unit are affected, individuals with flaccid dysarthria demonstrate reduced muscle tone, with atrophy and weakness and reduced muscle reflexes. - Speech rate is slow with breathy phonation, hypernasality, weak production of stops and fricatives, articulatory imprecision and reduced phrase length. 4 • Spastic Dysarthria - When the pyramidal and extrapyramidal tracts are damaged on both side of the brain surface, impaired innervation to the muscles causes them to be weak causing hypertoncity and hyperreflexia. • This leads to the types of muscle spasms that are characteristic of spastic dysarthria. - All four limbs as well as the trunk, head and neck are affected. - Speech is characterized by articulatory imprecision, slow rate, short phrases, and a harsh voice quality. - A variety of conditions can lead to spastic dysarthria. • Ataxic Dysarthria - The primary characteristics of ataxic dysarthria relate to coordination. - Movements are inaccurate and dysrhythmic. • However, reflexes are normal and there is only minimal weakness. - Ataxic dysarthria results from damage to the cerebellum, which functions to coordinate the direction, extent, and timing of movements. - Prosody tends to be monotonous and there are disruptions in stress patterns. - The good news is that speech intelligibility frequently is only mildly affected. • Hypokinetic Dysarthria - The individual’s muscles are hypertoned and rigid, resulting in reduced movement. - Many people experience a resting tremor that disappears with voluntary movement. - People with this type of dysarthria have difficulty starting and stopping movements. - Parkinson’s disease is a primary example of a disorder that results in this type of dysarthria. - The speech movements are small but the rate is often fast. • Hyperkinetic Dysarthria - When the basal ganglia of the extrapyramidal system are damaged, involuntary movements are a telltale sign. - These movements can be slow or fast, rhythmic or dysrhythmic, involve the whole body or just isolated parts. - People often have breakdowns in the flow of speech, which sounds like hesitations in unusual places. - The voice quality of these individuals may be breathy or strangled depending on the state of fluctuating tonicity of the laryngeal musculature and degree of breath support. • Mixed Dysarthrias - Several disease processes affect more than one part of the motor system at the same time. Two such diseases are multiple sclerosis and amyotrophic lateral sclerosis (Lou Gehrig’s • disease). 5 - The Oral-Peripheral Examination • This is how an SLP determines the anatomic and functional integrity of speech production structures. - It entails a careful examination of structures such as the tongue, jaw and lips at rest and during nonspeech and speech activities. • The Frenchay Dysarthria assessment assesses reflex and voluntary activities of speech structures during speech and nonspeech activities. • The SLP should also assess respiration during non-speech related and speech related tasks. The SLP should assess articulatory structures of the upper airway, including muscles of the • tongue, jaw and lips to determine whether they are weak, atrophic or uncoordinated. Based on these systematic observations, the clinician obtains an estimate of the functional • integrity of each subcomponent of the speech production system. - The Speech Examination • Provides important information about the type and extent of dysarthria. • These samples serve as assessment vehicles to estimate articulatory precision, speech rate, prosodic patterning, and other perceptual features. • The severity of impairment to any major component of the system may have major effects on speech intelligibility. • Treatment of individuals with Dysarthria - A team of individuals including physicians, SLPs, occupational therapists, audiologists, special educators, and physical therapists works to help children with dysarthria develop independence. • Drugs are prescribed to reduce spasticity and involuntary movement • Braces and special seating equipment help facilitate sitting and walking. Prescriptive glasses and hearing aids may improve sensory functioning. • • Specialized teaching is employed to deal with deficits in attention, memory, and learning. • Counseling can help to reduce emotional liability. - Surgery and drugs are beneficial for some disorders in which dysarthria is a symptom. • Sometimes the two treatments can be beneficial in motor performance. - Surgical and prosthetic management may be used to improve speech performance directly. - Postural supports are necessary to place the individuals into the best position for speaking. • Slings to hold up the arms and wheelchairs to maintain an upright position help support posture. - Speech therapy often is geared toward improving speech intelligibility. • Treatment focuses on the development of coordinated volitional control of the speech production system. - For individuals with good intelligibility, the focus of treatment may change to improving the naturalness of speech. 6 - The focus could also be on comprehensibility, the adjustments the speaker and communication partner make, and the environmental alterations undertaken for successful conversation. • Augmentative Communication - All humans augment their communication with facial expressions and gestures. - Augmentative refers to supplementing speech using various techniques and aids. - Individuals with dysarthria use these types of systems all the time. - These types of systems take many forms. • Some systems don’t use any type of device like nodding yes or no. • Two systems that use devices are aided and unaided. - There can also be nonelectronic(gestures) or electronic(scanning systems) - Augmentative communication differs in several important respects from oral speech. • If a person uses a communication board then the two communicators cannot sit face to face. • If the individuals use gestures than the partner must interpret what the gestures mean. - For individuals with dysarthria augmentative communication may be the primary means of conveying message. - To help an individual decide which system to use, SLPs need to assess intellectual, sensory, motor, and academic skills. - How and what meaning is conveyed by the augmentative communication user depends on the person’s age and situation. - The overriding goal is to develop an augmentation system within the capabilities of the user that meets communication needs with maximum efficiency. - A period of training with the system is essential. - The initial focus of rehabilitation should be to maximize oral speech function and to augment or to substitute an alternative communication system only if necessary. 7