Most affected are voice, articulation & prosody

• Rapid and blurred speech

• Prosodic Insufficiency: flat attenuated speech

• Inappropriate silences

• Harshness/breathiness

• Reduced loudness

• Palilalia: repetitions of words and phrases at increased rate and decreased loudness

 Primary is rigidity resulting in reduced force and decreased range of movement

• Resting/static tremor

• Bradykinesia: delays or false starts at the beginning of the movement and slowness of overall movement

• Masked facial expressions

• Festination: slow, rapid shuffling steps

• Stooped posture

• Primary is hyperkinesia/dyskinesia- abnormal involuntary movements

• Excessive muscle tone

• unpredictable breakdowns of articulation

• Abnormalities in rate and prosody

• Sudden and forced respiration

• Hypernasality

• Harshness

• Excess loudness variations

• Phonatory stenosis

• Prosodic excess

• Prosodic insufficiency

• Imprecise consonants

• Hypernasality

• Harshness

• Slow rate

• Monopitch

• Short Phrases

• Distorted Vowels

• Excess and equal stress

• Strain-strangled voice

• Spastic and flaccid clusters

• Can’t control loudness

• Harshness

• Articulatory Imprecision and breakdowns

• Hypernasality

• Breathiness

Nonverbal and limb apraxia have difficulty performing purposeful movements

• Most affected are articulation & prosody

• Slower and more variable

• Prosody, rate and fluency affected

• Articulation breakdowns with substitutions and omissions

• Inconsistent errors

• Parkinson’s Disease/Parkinsonism

• Pick’s Disease

• Toxic-Metabolic Conditions

• Vascular conditions

• Trauma (TBI)

• Infections COnditions: Viral Encephalitis, AIDS

• Degenerative Diseases

• Huntington’s Disease

• Primary generalized dystonia

• Toxic-Metabolic Conditions

• Tardive dyskinesia

• Antiparkinsonian drugs

• Infectious processes: Sydenham’s chorea

• Vascular Disorders (not common)

• Neoplasm

• Motor Neuron Disease

• MND

• Spinal muscular atrophies

• Progressive Bulbar Palsy

• Primary lateral sclerosis

• Degenerative Disease

• ALS

• MS

• Fredreich’s Ataxia

• Progressive supranuclear palsy

• Toxic-Metabolic Conditions (e.g. Wilson’s Disease)

• Vascular Disorders (e.g. multiple strokes)

• Trauma

• Tumor

• Stroke

• MS

• Primary progressive aphasia

• CNS degenerative disease (rare)

• Sensorimotor integration
• Lesion in this area results in muscle weakness

• Movement control
• Maintaining constant force (steadiness) during movement
• Integrating info for speech motor processing

• “last link” in the system of neural activities that result in movment 
• paired cranial nerves that innervate the muscles involved in phonation, resonance, articulation & prosody. 
• paired spinal nerves--respiratory and prosody activities 
• integrates information from direct activation pathway, indirect activation pathway, and peripheral sensory system

• Direct Activation Pathway: skilled voluntary movements, facilitatory pathway

• Indirect Activation Pathway: regulates reflexes, maintains posture and tone  

• production of smooth, well-timed, co-ordinated speech movements

• provides corrective modifications to the cortical motor speech output

Task 1: Maximum vowel prolongation

Task 2: Exhaling at a steady state for several seconds

Task 3: Pulling, pushing, & bearing down during speech tasks

 Task 4: Postural Adjustments

Producing several syllables on exhalation & increase respiratory capacity

 Establish optimal breath group

 Number of syllables that a patient can comfortably produce on one breath

May increase respiratory drive for speech

Not for all patients

• Abdominal binder (corset)
• Expiratory Board or Paddle

• Corset
• Enhance posture, support the weak abdominal muscles, improves respiratory support & airflow
• Medical approval & supervision is necessary 
• Positive effects: increase utterance duration, syllables per utterance, & and pausing at appropriate locations

• Leaning on a flat surface during expiration
• Increase expiratory forces

• Task 1: Inspiratory checking
• Task 2: Inhaling more deeply or use more force when exhaling during speech
• Task 3: Stabilizing Respiratory Patterns
• Task 4: Teach natural stress patterning

• Reduce excessive airflow through larynx when speaking
• Inspiratory muscles are used to counter the elastic recoil forces of the respiratory system
• Gradual release of air supply to support speech
• “Take a deep breath and release it out slowly when speaking”
• Helps to increase syllables per breath group & intelligibility (Netsell)

• Reduce maladaptive compensatory breathing strategies (Clue: if patient can sustain vowels longer than syllable per breath group)
• Practice strategy for increasing breath group length:
• Read aloud paragraphs where respiratory breaks are marked
• Progress to marked conversational scripts
• Noncued conversation & narration tasks
• Reduce neck breathing, glossopharyngeal breathing pattern
• Increasing Respiratory Flexibility

1. more substitutions, additons & groping

2. less consistency

3. greater susceptibility to nonphonetic & linguistic variability (e.g., length)

4. mismatch between automatic and volitional speech

5. normal cranial nerve examination

6. infrequent respiratory, phonatory, resonance problems

7. dominant hemisphere pathology only

1. higher proportion of on-target errors

2. more predictable substitutions

3. distortions of vowels and consonants

4. non-English phonemes

5. disturbed suprasegmentals

6. more attempts to correct and grope for position

* work with Broca’s before Apraxia*