Flaccid Dysarthria:

Locus

Lower Motor Neuron

- cell body, axons, neuromuscular junction, muscle disease

- cranial or spinal nerves

- always between nerve and muscle

Flaccid Dysarthria:

Primary Unique Deficit

Weakness

Reduced Muscle Tone

Flaccid Dysarthria:

Symptom Clusters:

Phonatory Incompetence

audible inspiration

breathiness

short phrases

Flaccid Dysarthria:

Symptom Clusters:

Resonatory Incompetence

hypernasality

imprecise consonants

nasal emissions

short phrases

Flaccid Dysarthria:

Symptom Clusters:

Phonatory-Prosodic Insufficiency

harshness

monopitch

monoloudness

Flaccid Dysarthria:

Most Distinguishing Speech Characteristics

hypernasality

breathiness

nasal emissions

audible inspiration

short phrases

Flaccid Dysarthria:

Confirmatory Signs

Jaw: hangs open (bilateral lesion) or deviates to one side when opened (unilateral weakness)

Face: fasciculations (chin, perioral); asymmetry (unilateral), droop, drool, reduced ability to hold breath; synkenisis (abnormal contraction of muscle in they eye/face)

Tongue: deviates to one side (unilateral); reduced ROM (bilateral); fasciculations/atrophy, reduced strength

Palate: asymmetry (unilateral), reduced gag reflex

Larynx: weak cough and glottal coup

-progressive weakness with use, reduced reflexes, atropy, weakness, fasciculations

Flaccid Dysarthria:

Possible Affected Nerves

Trigeminal (5): jaw, chewing

Facial (7): facial musculature

Glossopharyngeal (9): gag reflex, swallowing disorders

Vagus (10): larynx, palate, pharynx

Accessory (11): cranial: typically in combo with 10; spinal: shoulders, neck, head droop

Hypoglossal (12): tongue musculature, chewing, swallowing

Flaccid Dysarthria:

Etiologies

any etiology that can damage the lower motor neuron

surgical trauma most comon (31%)

degenerative and muscle disease (21%)

Spastic Dysarthria:

Locus

Upper Motor Neuron (bilateral)

damage to both Direct Activation System (weakness) and Indirect Activation System (spasticity)

Spastic Dysarthria:

Primary Unique Deficit

Spastic Dysarthria:

Symptom Clusters

Prosodic Excess

Articulatory-Resonatory Incompetence

Phonatory Stenosis

Prosodic Insufficiency

Spastic Dysarthria:

Symptom Clusters:

Prosodic Excess

excess and equal stress

slow rate

Spastic Dysarthria:

Symptom Clusters:

Articulatory Resonatory Incompetence

imprecise consonants

distorted vowels

hypernasality

Spastic Dysarthria:

Symptom Clusters:

Prosodic Insufficiency

monopitch

monoloudness

reduced stress

short phrases

reduced vocal variability and ROM

Spastic Dysarthria:

Symptom Clusters:

Phonatory Stenosis

low pitch

harshness (!!!)

strained-strangled voice

pitch breaks

short phrases

slow rate

Spastic Dysathria:

Most Distinguishing Speech Characteristics

strained-strangled voice

harshness

slow speech rate

slow, regular AMRs

hypernasality

reduced variability of pitch and loudness

Spastic Dysarthria:

Etiologies

Most common: vascular (non-hemorrhagic) and degenerative

Also:  TBI, ALS, Progressive Supranuclear Palsy

Spastic Dysarthria:

Patient Complaints

speech is slow, effortful

fatigue

hypernasality

difficulty swallowing, drooling

pseudobulbar effect

Spastic Dysarthria:

Confirmatory Signs

paralysis of other body parts

hyperactive reflexes

pathological reflexes (suck, snout, palomomental, jaw jerk)

Babinski's Sign

drooling

pseduobulbar effect

Ataxic Dysarthria:

Locus

Cerebellum/cerebellar control circuit

typically bilateral or vermis

Ataxic Dysarthria:

Primary Unique Deficit

Ataxic Dysarthria:

Symptom Clusters

Articulatory Inaccuracy

Prosodic Excess

Phonatory-prosodic Insufficiency 

(primarily a disorder of articulation and prosody)

Ataxic Dysarthria:

Symptom Clusters:

Articulatory Inaccuracy

imprecise consonants

irregular breakdowns

vowel distortions

Ataxic Dysarthria:

Symptom Clusters:

Prosodic Excess

excess and equal stress

prolonged phonemes

prolonged intervals

slow rate

Ataxic Dysarthria:

Symptom Clusters:

Phonatory-prosodic Insufficiency

harshness

monopitch

monoloudness

variable, sudden loudness

Ataxic Dysarthria:

Patient Complaints

slurred speech

"drunken" quality of speech

unable to coordinate speech with breathing

"stumble" over words

Ataxic Dysarthria:

Most Distinguishing Speech Characteristics

irregular and transient articulatory breakdowns

irregular AMRs

vowel distortions

excess and equal stress

excess loudness variations

dysprosody

Ataxic Dysarthria:

Confirmatory Signs

difficult walking and standing

wide-based gait

titubation

nystagmus

ocular dysmetria

hypotonia

dysmetria

dysdiadokinesis

dysseynergia

jerkiness of movement

intention or terminat tremor

slow voluntary movements

Ataxic Dysarthria:

Etiologies

degenerative diseases (hereditary, friedreich's, multiple sclerosis, olivopontocerebellar atrophy)

vascular disorders

neoplastic disorders

trauma

toxic metabolic disorders

Hypokinetic Dysarthria:

Locus

Extrapyramidal System

Basal Ganglia Control Circuit

Hypokinetic Dysarthria:

Primary Unique Deficit

rigidity

reduced ROM

Hypokinetic Dysarthria:

Symptom Clusters

Hypokinetic Dysarthria:

Symptom Clusters:

Prosodic Insuffiency

monopitch

monoloudness

reduced stress

short phrases

variable rate

short rushes of speech

imprecise consonants 

Hypokinetic Dysarthria:

Most distinguishing speech characteristics

reflect the effects of rigidity, reduced range of motion, reduced force, slow individual but sometimes rapid repetitive, motion

-fast rate (only dysarthria with this)

-reduced stress

-monopitch and monoloudness

-inappropriate silences

-breathiness (only flaccid has worse breathiness)

Hypokinetic Dysarthria:

Etiologies

degenerative disease (most common)

vascular (nonhemorrhagic)

Hypokinetic Dysarthria:

Patient Complaints

quiet, weak voice

not audible in noise

rate too fast

lack emotional tone

difficult to get started

fatigue

Hypokinetic Dysarthria:

Confirmatory Signs

resting tremor

rigidity

bradykinesia

akinesia

postural abnormalities

masked facial expression

reduced chest and abdominal movements during breathing

infrequent swallow and drooling

tremor of jaw/lips

abnormal AMRs

lack of animation

flat, unemotional affect

Unilateral Upper Motor Neuron Disease:

Locus

Unilateral Upper Motor Neuron Disease:

Primary Unique Deficit

weakness

spasticity (?)

incoordination (?)

Unilateral Upper Motor Neuron Disease:

Clinical Signs

reflect unilateral weakness and incoordination of tongue and lower face movements during speech (KEY)

unilateral central facial weakness

unilateral lingual weakness

hemiparesis/plegia

Unilateral Upper Motor Neuron Disease:

Site of Lesion

internal capsule

corona radiata

frontal lobe

Unilateral Upper Motor Neuron Disease:

Etiologies

any process that can damage the UMNs unilateral

Stroke is most common (overwhelmingly)

turmors

surgical trauma

lacunar strokes

Apraxia:

Motor Speech Programmer

the motor programming component of motor speech control

has primary role in establishing the motor program for acheiving the cognitive and linguistic goals of spoken messages

organizes the motor commands that result in the production of temporally sequenced sounds, syllables, words and phrases at a particular rate and pattern of stress and rhythm 

Apraxia:

Site of Lesion

Apraxia:

Confirmatory, Nonspeech Signs

varying degress of right side weakness

Babinski's and hyperactive gag reflex

limb apraxia

nonverbal, oral apraxia

Apraxia:

Etiologies

anything that damages dominant hemisphere structures involved in motor speech planning/programming

-Stroke is the most common cause

-degenerative diseases include: MS, corticobasal degeneration, primary progressive aphasia, Cruetzfeldt-Jakob disease

Apraxia:

Patient Complaints

-speech won't come out right

mispronounce words

surprised at errors

more errors on harder or multisyllabic words

frequently attempt to correct

Apraxia:

Affected Speech Productions

speech sequential motion rates

imitation of multisyllabic words

imitation of sentences

"automatic" speech (counting, singing, etc) may be preserved

Apraxia

Articulatory Characteristics 

substitutions, distortions, omissions, additions, repetitions

affricates, fricatives, consonant clusters most frequent errors

vowel error/distortions

more errors for infrequent sounds and nonsense syllables

errors increase with length

inconsistent errors **

speakers aware of errors

Apraxia:

Prosody, Rate, Fluency Features

typically slow rate

prolonged consonants and vowels

silent pauses preceeding speech initiation

dysprosody

equalized stress

difficulty varying propositional stress

restricted or altered pitch

false articulatory starts and restarts

effortful grouping

sound and syllable repetition

imitation particularly difficult **

Apraxia:

Salient Features

trial and error groping

dysprosody without normal stress and rhythm

difficulty initiating speech

articulatory inconsistency