0 Motor Speech Disorders 1021 20 BB

COMS 5483-1X
Session 9
Motor Speech Disorders: Dysarthria vs. Apraxia
June Levitt, Ph.D., LDT, CCC-SLP

Our plan for today
ü Review basic neurological functions for Speech.
ü Learn different communication disorders with
dysarthria.
ü Learn communication disorders with Apraxia.
ü Gain basic knowledge on Spasmodic Dysphonia
and its types.
ü Know different characteristics of MTD and SD
voice issues.
3
Topics
Ø Overview
Ø Dysarthria
Ø Apraxia
Ø Summary
Ø In-Class Activity 8
4
Speech Chain again
5
Speech: Initiation to Production
1. Cognitive-Linguistic processes:
Thoughts, feelings, emotions generate/integrate an
intent to communicate verbally.
2. Motor speech planning, programming, and control
Selection, sequencing, and regulation to activate
speech muscles at appropriate times, durations, and
intensities
3. Neuromuscular Execution
CNS and PNS work together to execute speech
motor programs by activating breathing, phonatory,
resonatory, and articulatory structures.
Duffy, 2013: p. 3
Motor Speech Disorders (MSDs)
• Speech disorders resulting from neurologic
impairments affecting one or more of the
following acts required for verbal communication.
– Planning
– Programming
– Control
– Execution
• MSDs include the dysarthrias and Apraxia of
Speech (AOS).
Proper Movements
• The contribution of sensory input is
indispensable. Motoric behavior is
“sensorimotor” in nature.
• Four vital elements of movements.
– Mobility
– Balance
– Coordination
– Stability
Dysarthria
• A group of neurologic speech disorders that reflect
abnormalities required for verbal communication.
– Strength
– Speed
– Range
– Steadiness
– Tone
– Accuracy of movements for the breathing,
phonatory, resonatory, articulatory, or prosodic
aspects.
Duffy, 2013: p.4
Apraxia of Speech
• A neurologic speech disorder that reflects an
impaired capacity to plan or program
sensorimotor commands necessary for
directing movements that result in
phonetically and prosodically normal speech.
Duffy, 2013: p. 4
Non-Neurologic Speech Disturbances
• Musculoskeletal defects
EXAMPLES: Laryngectomy, Cleft lip/palate,
Fractures, structural anomalies for verbal
communication.
• Non-neurologic voice disorders
EXAMPLES: Dysphonia associated with head or neck
neoplasms, Vocal abuse, or Hormonal disturbances.
• Psychogenic and related non-organic speech
disorders
EXAMPLES: Schizophrenia, depression, conversion
disorder.
Normal Variations in Speech
Production
• Age-related changes in speech
• Gender/sex
• Variation in style
CNS
Pyramidal and Extrapyramidal Tracts
Pyramidal tract
• Largely responsible for the initiation of
voluntary motor acts.
Extrapyramidal system
• Responsible for the background tone and
movement supporting the primary acts.
• Projecting to the basal ganglia and reticular
formation.
Neurologic communication disorders: Mayo Clinic
Distribution among 14,235 people with a primary communication disorder diagnosis

of acquired neurologic communication disorders at Mayo Clinic, 1993-2008.
(Duffy, 2013).
Motor speech disorders
Distribution
Distribution of
of neurologic
neurologic communication
communication disorders,
disorders, Speech
Speech pathology,
pathology, Department
Department
of Neurology, Mayo Clinic, 1987-1990 and 1993-2001. (Duffy,
of Neurology, Mayo Clinic, 1993-2008. (Duffy, 2013). 2005).
Role of SLP
• Describe symptoms
• Provide intervention
– Facilitating technique
– Physiological technique
• Measure changes
• Efficiency of entire system must be addressed
– Respiration
– Phonation
– Resonance
– Articulation
Dysarthria: Localization and Neuromotor bases
TYPE LOCALIZATION NEUROMOTOR BASES-

GNERAL/SPECIFIC
Flaccid Lower Motor Neuron Execution: weakness
Spastic Bilateral Upper Motor Execution: Spasticity

Neuron
Ataxic Cerebellum Control: Incoordination,
dyscoordination
Hypokinetic Basal ganglia control Control: Rigidity, Reduced range of
circuit (Extrapyramidal) movement; scaling problems.
Hyperkinetic Basal ganglia control

circuit (Extrapyramidal) Control: Involuntary movements
Unilateral Unilateral Upper motor Execution/control: Upper Motor
Upper Motor neuron Neuron weakness, incoordination, or
Neuron spasticity
Mixed More than one Execution and/or control: More than

one
Undetermined ? ?
Duffy, J. R. (2013)
Apraxia of Speech (AOS): Localization and Neuromotor bases
NEUROMOTOR BASES-
TYPE LOCALIZATION
GNERAL/SPECIFIC
Left (dominant)
hemisphere
The posterior frontal lobe
(in, around, or under Motor
Broca’s area). planning/programming:
AOS
Sometimes in the parietal planning/programming
lobe. errors
Occasionally in both the
frontal and parietal lobes
Subcortical areas.
Duffy, J. R. (2013)
Topics
Ø Overview
Ø Dysarthria
Ø Apraxia
Ø Summary
19

GNERAL/SPECIFIC

Neuron
dyscoordination

Neuron spasticity

one
Undetermined ? ?
Duffy, J. R. (2013)
Flaccid Dysarthria: Etiologies
(Source: 171 cases of the Mayo clinic from 1999-2008)
• Degenerative (40%)
• Traumatic (22%)
• Muscle Disease (9%)
• Vascular (9%)
• Myasthenia Gravis (4%)
• Infectious (4%)
• Tumor (3%)
• Demyelinating (2%)
• Anatomic malformation (1%)
• Radiation therapy, drug toxicity, and others (5%)
21
Duffy, J. R. (2013)
Neuromuscular Deficits associated with
Flaccid Dysarthria
Direction Individual Movements Normal

Repetitive Movements Regular
Rhythm
Individual Movements Normal or Slow
Repetitive Movements Normal or Slow
Rate
Individual Movements Reduced
Range Repetitive Movements Reduced
Force Individual Movements Weak
Tone Muscle Tone Reduced
22
Duffy, J. R. (2013)
Lower Motor Neuron Lesions
Flaccid Dysarthria
• Damage to the LMN system – cranial nerve damage (unilateral
or bilateral) or Spinal nerves
– CNs: V, VII, X, or XII
– Spinal respiratory nerves
• Often CN X involvement.
• Oral Musculature: Flaccid or hypotonic; weak
• Jaws:
– Unilateral: careful observation reveals that the jaw deviates
to the side of weakness.
– Bilateral: the jaw obviously sags.
• The tongue is atonic or flabby
• The gag reflex is reduced or absent.
23
Lower Motor Neuron Lesions
Flaccid Dysarthria
• VF problems: Voice may be harsh (adduction
problem) or breathy (abduction problem).
• Mono-pitch and mono-loudness
• Often hypernasality with nasal emissions
• Nasal emission of air is also found in many cases.
• Imprecise consonant production (consonants
requiring firm contact from tongue tip elevation and
plosives are particularly vulnerable)
http://library.med.utah.edu/neurologicexam/html/mentalstatus_resources.html
24
Flaccid Dysarthria
Myasthenia Gravis
• Neuromuscular disease.
• ACh receptors are blocked by abnormal
antibodies è information from neuron cannot
be transmitted to the muscles normally.
• As they keep executing motor actions,
individuals with MG experience:
– Muscle weakness
– No stamina
– Low energy
– Fatigue
Neurotransmitters
• Chemicals used for neuronal communication in
the body and the brain
• 50 different neurotransmitters have been
identified
• Classified chemically and functionally
– Chemically:
• Acetylcholine (Ach), Biogenic amines, Peptides,
Amino acids…
– Functionally:
• Excitatory or inhibitory
• Direct/indirect effects on cellular activities
• Pre-synaptic neuron = neuron sending impulse
• Post-synaptic neuron = neuron receiving impulse
https://www.dreamstime.com/stock-illustration-synapse-labeled-diagram-image42236157
Flaccid Dysarthria
Myasthenia Gravis-cont.
• The primary symptom of weakness often
affects the speech muscle.
– Weakened vocal folds: breathy and weaker
voice over time as the person with
Myasthenia Gravis continues talking.
– Hypernasal voice: weakness of the soft
palate.
– Swallowing problems.
Flaccid Dysarthria
Myasthenia Gravis-cont.
• Examination:
– Normal laryngeal appearance early in day;
hypernasality/nasal emission as voicing continues.
– Weakened VF: breathy and weak voice
– Swallowing issues.
• Treatment:
– Respiratory control of voicing
– Intonation therapy
– Reduce laryngeal strain/hyperfunction
– Palatal lifts to reduce hypernasality
– Medications to control muscle weakness
http://www.youtube.com/watch?v=ekhdckujXME&feature=related
Nasalized speech
Flaccid Dysarthria
Guillain-Barré
• The onset of the disease is often expressed in
dysphonia and dysphagia.
• Unknown cause.
• Frequently preceded by viral infection.
• The focal demyelination of PNS.
• The patient often requires a tracheostomy and
ventilatory support.
• Could result in dysarthria or anarthria.
http://www.youtube.com/watch?v=kDspLPFhkS4

GNERAL/SPECIFIC

Neuron
dyscoordination

Neuron spasticity

one
Undetermined ? ?
Duffy, J. R. (2013)
Spastic Dysarthria: Etiologies
• Vascular (17%)
• Undetermined (10%)
• Congenital (8%)
• Traumatic (4%)
32
Duffy, J. R. (2013)
Spastic Dysarthria

Rhythm Repetitive Movements Regular
Repetitive Movements Slow
Rate
Individual Movements Slow
Repetitive Movements Reduced (biased)
Range
Individual Movements Reduced (weak)
Force Individual Movements Reduced
Tone Muscle Tone Excessive
33
Duffy, J. R. (2013)
Spastic Dysarthria: Etiologies
DAMAGE TO
DIRECT ACTIVATION PATHWAY INDIRECT ACTIVATION PATHWAY
(PYRAMIDAL TRACTS) (EXTRAPYRAMIDAL TRACTS)
• Loss or impairment of fine, • Increased muscle tone

discrete movement • Spasticity
• Hypotonia and weakness • Clonus
initially. • Decorticate or Decerebrate
posture
• Generally evolve to increased • Hyperactive stretch reflexes
tone and weakness. • Hyperactive gag reflex
• Babinski sign
• Hyporeflexia, initially but
become more pronounced
over time.
Duffy, J. R. (2013) 34
Upper Motor Neuron Lesions
UNILATERAL (UUMN)
• Imprecise articulation
• Many cases: slowed rate and irregular
articulatory breakdown
• Some cases: harshness, reduced loudness and
hypernasality of voice
• Often mild to moderate in severity
Duffy, J. R. (2013)
Bilateral: Spastic Dysarthria
• Oral musculature: It is common to
present with severe impairments of
range & rate of movement
– Limited tongue ROM and palatal movement
– Limited and slow lip ROM
– Under-reactive or over-reactive gag reflex
– Chewing and swallowing difficulties with
drooling
36
Duffy, J. R. (2013)
Bilateral: Spastic Dysarthria-cont.
• Speech is harsh, strained-strangled quality
• Very little variation in loudness (monoloudness) and
reduced stress
• Often hypernasality
• Articulation: Imprecise consonant production and
Vowel distortion
37
Duffy, J. R. (2013)

GNERAL/SPECIFIC

Neuron
dyscoordination

Neuron spasticity

one
Undetermined ? ?
Duffy, J. R. (2013)
Ataxic Dysarthria: Etiologies
• Vascular (11%)
• Tumor (6%)
• Traumatic (5%)
• Toxic/Metabolic/Endocrine (3%)
• Multiple Possible Causes (3%)
• Other (4%)
39
Duffy, J. R. (2013)
Ataxic Dysarthria
Direction Individual Movements Inaccurate

Rhythm Repetitive Movements Irregular
Repetitive Movements Slow
Rate
Repetitive Movements Excessive to Normal
Range
Individual Movements Excessive to Normal
Force Individual Movements Normal to Excessive
Tone Muscle Tone Reduced
40
Duffy, J. R. (2013)
Cerebellum and Cerebellar pathway Lesions
Ataxic Dysarthrias
• Equilibrium is affected and gait may be

impaired
• Slow initiation of movement and slow
through range
• Repetitive movements may be irregular and
poorly timed (dysdiadochokinesia)
• Intention or kinetic tremor is also present
41
Ataxic Dysarthrias
• A breakdown in the timing of onset of

respiration and phonation leading to air
wastage.
• Respiratory speech functions can be disturbed.
• Some cases, hoarse voice, abnormal variability
in F0 and intensity during vowel prolongation.
• Tremor may also be noted.
42
Ataxic Dysarthrias
• Resonance is generally normal although some

patients may experience hypernasality.
• Articulation: Trouble fine tuning speech
• Prosody: Excess and equal stress. Explosive
speech
43

GNERAL/SPECIFIC

Neuron
dyscoordination

Neuron spasticity

one
Undetermined ? ?
Duffy, J. R. (2013)
Hypokinetic Dysarthria: Etiologies
• Vascular (4%)
• Multiple possible causes (3%)
• Traumatic (2%)
• Infectious (1%)
• Other (1%)
45
Duffy, J. R. (2013)
Hypokinetic Dysarthria

Rhythm Repetitive Movements Regular
Repetitive Movements Fast
Rate
Repetitive Movements Very reduced
Range
Individual Movements Reduced
Force Individual Movements Reduced
Tone Muscle Tone Excessive (balanced)
46
Duffy, J. R. (2013)
Different terms about PD?
• Parkinsonian (Parkinsonism): The signs and
symptoms result from a known insult or injury
such as carbon monoxide poisoning (Norden,
2007).
• Idiopathic Parkinson’s disease (PD): The cause
of PD is not known.
Note: Some researchers/physicians refer both of the
above cases collectively as “Parkinsonism.”
Norden, 2007 47
Parkinsonism and Parkinson’s Disease (PD)
• First, James Parkinson described

it in 1817.
• 15% of cases: family history of
the disease.
• With some genes, autosomal
dominant, and with some others,
autosomal recessive
development of PD.
Bayles, K., McCullough, K., & Tomoeda C., 2018

FOUR major symptoms
• Tremor: hands, arms, other signs
legs, jaw and face

• Bradykinesia: slowness
of movement
• Rigidity: stiffness of the
limbs and trunk
• Postural instability:
impaired balance and
coordination
49
Other signs commonly reported
• Swinging only one arm, while
walking.
• Recognize hand-writing much

smaller than one’s usual style.
• Things do not smell as they

used to.
50
PD: Diagnosis
• No standard test.
• Diagnosis made by neurologist specialized in
“movement disorder”
• Typically, neurologists seek for two of the
three cardinal features (tremor, bradykinesia,
and rigidity) and other supportive features
such as unilateral onset, persistent
asymmetry, response to the PD medication.
51
Parkinson’s disease (PD)
• SECOND most common neurodegenerative
disorder (Phani, Loike & Przedborski, 2012).
• Prevalence: more than 10 million worldwide. In
the U.S.A., approximately 1 million, and 60,000
Americans are diagnosed with PD each year.
• Incidence of Parkinson’s disease increases with age,
but an estimated four percent of people with PD
are diagnosed before age 50.
• Men are 1.5 times more likely to have Parkinson's
disease than women.
Phani, Loike & Przedborski, 2012；Parkinson’s Disease Foundation, 2014
52
PD: Hoehn and Yahr scale (1967)
• Stage 1: Unilateral involvement only with minimal
or no functional disability.
• Stage 2: Bilateral or midline involvement without
impairment of balance.
• Stage 3: Bilateral disease: mild to moderate
disability with impaired postural reflexes;
physically independent.
• Stage 4: Severely disabled, but able to walk or
stand unassisted.
• Stage 5: Confinement to bed or wheelchair unless
aided.
Issues with PD
• Not a fatal disease by itself, but it is
degenerative.
• Impact on the quality of life.
• Depression: 40-60%
• Cognitive issues: 40%
• Sensory/motoric deficits
– Mobility
– Voice: 90%
– Swallowing: 40%
Duffy, 2013
54
DBS: Potential Benefit
• Reports from the DBS cases:

– Address slowness
– Reduce/eliminate tremor
– Manage rigidity
– Reduce medications and lessen their side
effects
– Better sleep
– More involvement in physical activity
– Improved quality of life
http://www.mayfieldclinic.com/PE-DBS.htm#.VgW4533Rbfc 55
DBS: Potential Risks
• Complications:
– Seizures
– Infection,
– Bleeding in the brain
• The battery will need to be replaced every 2 to 5
years (new rechargeable battery may last up to 9
years).
• Could cause worsening of some symptoms:
– Speech
– Balance
– Depression
http://www.mayfieldclinic.com/PE-DBS.htm#.VgW4533Rbfc 56
Non-Pharmacologic Behavioral Management
General approach
• Improve sensory awareness.
• Increase movement amplitude.
• Interactions/participation to the community.
• Bring the effect of therapy (in the clinic) to the
real life situations.
57
Extrapyramidal -- Basal Ganglia Lesions
Dyskinetic Dysarthrias
Hypokinetic Dysarthria: Parkinsonism
• Oral musculature: Slow rate of movement of the
lips and tongue with some reduced range of
movement.
• Phonation: Hoarseness, roughness, breathiness
and tremulousness, Dysphonia, Monopitch, and
monoloudness.
• Speech: Varied across patients depending on
stage of disease and treatment.
58
Hypokinetic Dysarthria: Parkinsonism
• Articulation: Articulatory imprecision and
articulatory undershoot due to inadequate
tongue elevation
• Resonance: Hypernasality in small percentage
(10%)
• Prosody:
– Prosodic insufficiency: variable rate, short
rushes of speech, long pauses
– Palilalia: repetitions that usually involve words,
phrases, or sentences
59
Lee Silverman Voice Treatment (LSVT)®
• REDUCED VOCAL LOUDNESS + MONOTONOUS SPEECH
(Reduced drive to respiratory and laryngeal muscles)
Speak LOUD!
Think LOUD!
LSVT®: increase drive to respiratory

and laryngeal muscles

GNERAL/SPECIFIC

Neuron
dyscoordination

Neuron spasticity

one
Undetermined ? ?
Duffy, J. R. (2013)
Hyperkinetic Dysarthria: Etiologies
• Toxic or Metabolic (3%)
• Trauma (1%)
• Vascular (1%)
• Other (4%)
62
Duffy, J. R. (2013)
Hyperkinetic Dysarthria
Dystonia Chorea
Individual Inaccurate due to Inaccurate due to quick
Direction Movements slow involuntary > slow involuntary
movements movements
Repetitive
Rhythm Movements Irregular Irregular
Repetitive
Movements Slow Slow
Rate
Individual
Movements Slow Slow
Repetitive Reduced to normal Reduced to excessive
Movements
Range
Individual Reduced to normal Reduced to excessive
Movements
Individual
Force Movements Normal Reduced to Excessive
Tone Muscle Tone Excessive Often Excessive

63
Duffy, J. R. (2013)
Hyperkinetic Dysarthria
• Increased involuntary movement / tremors

• Voice tremors caused by tremors in the laryngeal
musculature
• Two major diseases in the disorder group known
as chorea:
– Sydenham’s chorea
– Huntington's chorea
64
Huntington’s disease
• Huntington's disease is an inherited disease that
causes the progressive breakdown (degeneration) of
nerve cells in the brain.
• Most people with Huntington's disease develop signs
and symptoms in their 30s or 40s. But the disease
may emerge earlier or later in life. When the disease
develops before age 20, the condition is called
juvenile Huntington's disease.
• Symptoms include movement, cognitive and
psychiatric disorders.
https://www.mayoclinic.org/diseases-conditions/huntingtons-disease/symptoms-causes/syc-20356117
Movement disorders
• Involuntary movements and impairments in
voluntary movements.
• Muscle problems, such as rigidity or muscle
contracture (dystonia).
• Slow or abnormal eye movements
• Impaired gait, posture and balance
• Difficulty with speech or swallowing
• Impairments in voluntary movements
Cognitive disorders
• Difficulty organizing, prioritizing or focusing on tasks
• Lack of flexibility or the tendency to get stuck on a
thought, behavior or action (perseveration).
• Lack of impulse control that can result in outbursts,
acting without thinking and sexual promiscuity
• Lack of awareness of one's own behaviors and abilities
• Slowness in processing thoughts or ''finding'' words
• Difficulty in learning new information.
Psychiatric disorders
• Depression caused by the changes in brain
function.
• Signs and symptoms may include:
– Feelings of irritability, sadness or apathy
– Social withdrawal
– Insomnia
– Fatigue and loss of energy
– Frequent thoughts of death, dying or suicide
Psychiatric disorders – cont.
• Obsessive-compulsive disorder — a condition
marked by recurrent, intrusive thoughts and
repetitive behaviors
• Mania, which can cause elevated mood,
overactivity, impulsive behavior and inflated self-
esteem
• Bipolar disorder — a condition with alternating
episodes of depression and mania
Symptoms of juvenile Huntington's disease
• Behavioral changes
– Loss of previously learned academic or physical
skills
– Rapid, significant drop in overall school
performance
– Behavioral problems
• Physical changes
– Contracted and rigid muscles that affect gait
– Changes in fine motor skills that might be
noticeable in skills such as handwriting
– Tremors or slight involuntary movements
– Seizures
Hyperkinetic Dysarthria: Chorea
• Huntington’s Chorea: autosomal dominantly
inherited
• Results in loss of neurons from the caudate
nucleus, pallidum, and cerebral cortex
Hyperkinetic Dysarthria: Chorea
• Oral musculature control: Huntington’s: patient

cannot keep tongue protruded for more than a
few seconds.
• Speech can be affected by movements of other
parts of the body.
• Harsh voice quality and/or a strained-strangled
sound; voice/pitch breaks; breathiness; poor
control of intensity.
• Hypernasality in 43% of patients
73
Hyperkinetic Dysarthria: Spasmodic Dysphonia (SD)
Adductor, Abductor, and Mix types
Three types:
§ Adductor type
§ Abductor type
§ Mixed type
74

GNERAL/SPECIFIC

Neuron
dyscoordination

Neuron spasticity

one
Undetermined ? ?
Duffy, J. R. (2013)
Mixed Dysarthria: Etiologies
• Vascular (7%)
• Trauma (<1%)
• Toxic or Metabolic (<1%)
• Neoplastic (<1%)
• Multiple causes (1%)
• Other (9%)
76
Duffy, J. R. (2013)
Mixed UMN and LMN Lesions
Amyotrophic Lateral Sclerosis (ALS)
• Etiology is unknown
• Progressive, degenerative disease
affecting both UMN and LMN systems
• Not confined itself to one motor system –
affect both upper and lower motor
neuron systems.
77
• Muscles are weak but reflexes are
hyperactive.
• Spasticity is usually present unless the
lower motor neuron damage is well
advanced.
https://www.youtube.com/watch?v=nNLKPaThYkE 78
• Oral musculature: Weakness in lips,
tongue, and palate
• Reduced range of movement; sometimes
one side is slightly more affected than
other
• The tongue may show fasciculation's and
atrophy
79
• Voice/Speech is harsh in general: often have

a wet quality, or similar signs with other
dysarthria with poor VF adduction resulting
in breathiness and short phrases
– Monotony and loudness
– Reduction of stress
http://www.youtube.com/watch?v=QIe_5X-6kqY&feature=related
80
Other Mixed Dysarthrias with Diverse Lesions
Multiple Sclerosis
• Unknown etiology causes demyelination in the

central nervous system
• Can be progressive or progressive-regressive
81
Multiple Sclerosis
• Significant muscle weakness

• Difficulty with gait
• Visual (diplopia) and perceptual disturbances
• Cognitive problems
• dysarthria
82
Multiple Sclerosis
• Speech: Mixed spastic-ataxic dysarthria is

most common, but many different
dysarthrias can occur.
• Phonation: Impaired loudness control,
harsh vocal quality and breathiness;
inappropriate pitch levels
83
Multiple Sclerosis
• Articulation: Defective articulation and

articulatory breakdown
• Resonance: 25% have some degree of
hypernasality
• Prosody: Impaired judgments of rate;
appropriateness of phrasing, pitch and
loudness variation for emphasis; and
increased stress on unstressed words and
syllables
84
Topics
Ø Overview
Ø Dysarthria
Ø Apraxia
Ø Summary
85
Apraxia: subtypes
• limb-kinetic apraxia
• Ideomotor apraxia
• Ideational apraxia
• constructional apraxia
• oculomotor apraxia
• buccofacial, oral, or facial apraxia
• Apraxia of speech (AOS)
• Childhood apraxia of speech (CAS) è later
Apraxia: subtypes
• limb-kinetic apraxia
• Ideomotor apraxia
• Ideational apraxia
• Constructional apraxia
• oculomotor apraxia
• buccofacial, oral, or facial apraxia
• Apraxia of speech (AOS)
• Childhood apraxia of speech (CAS) è later
Apraxia
Oral Apraxia (Buccofacial Apraxia)
• Inability to consciously perform
oral/facial movements.
• Reflexive/automatic performance is not
impaired.
• Paralysis, significant weakness, or
incoordination of oral musculature not
noted on examination.
Oral Apraxia assessment
(Examples from ABA-2 Subtest 3, pt. B)
• “stick out your tongue”
• “whistle”
• “puff out your cheeks”
• “kiss a baby”
• “clear your throat”
• “bite your lower lip”
• “show me your teeth”
• “take a deep breath and hold it”
• “lick your lips”
• “open your mouth”
Apraxia
Apraxia of speech (AOS)
See p. 195 for Duffy’s (2005) definition
• Inability to voluntarily execute the complex

motor patterns involved in speech production.
• May occur with oral apraxia
• Effortful groping in attempts to produce
articulatory movements
– Errors are inconsistent (unlike dysarthria)
• Phonation, respiration, and resonance are
usually intact.
AOS: Etiologies
• Vascular (28%)
• Neoplastic (5%)
• Trauma (3%)
• Other (10%)
91
Duffy, J. R. (2013)
Apraxia
McNeil, Robin, & Schmidt (1997)
• Slow speech rate (lengthened segments and
intersegment durations)
• Sound distortions
• Distorted sound substitutions (consonant/vowels)
• Sound errors that are relatively consistent in type
and location on repeated productions
• Prosodic abnormalities.
Apraxia
Duffy (2013)
Articulation:
• Consonant & Vowel distortions (imprecise
articulation)
• Distorted substitutions, additions, sound
prolongations, voicing features.
Apraxia
Duffy (2013)
Rate and Prosody:
• Slow overall rate.
• Prolonged but variable vowel duration,
interwork intervals.
• Syllable segregation
• Errors of stress placement.
Apraxia
Duffy (2013)
Other characteristics:
• Successful or unsuccessful attempts to self-correct
articulatory errors that cross phonemic boundaries.
• False articulatory starts and restarts.
• Effortful visible and audible trial-and-error groping for
articulatory postures.
• Sound and syllable repetitions.
• Error rates higher for volitional/purposeful vs.
automatic/reactive utterance.
Topics
Ø Overview
Ø Dysarthria
Ø Apraxia
Ø Summary
96
Now we know…
• Motor speech disorders.

• Dysarthria types.
• Apraxia of speech and Oral Apraxia.
• Compare and contrast Dysarthria and
Apraxia.
Topics
Ø Overview
Ø Dysarthria
Ø Apraxia
Ø Summary
98
Speech Production: Simple Summary
Ideation Communicative intent Cognitive
Word retrieval
Language Phonological mapping Linguistic
Syntactic/grammatical ordering
Motor Planning Specify movement parameters
Range of motion
Strength Motor: Praxis
Motor
Speed
Programming Direction
Degree of muscle contraction
Acoustic Motor-
Execution/Control of movements
Output Execution
Adapted from Duffy, 2013 and Lecture slide set by Dr. E. Strand: 10/18/2012
Adapted from Duffy, 2013 and Yorkston, Beukelman, Strand, & Hakel, 2010: p. 407

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COMS 5483-1X

June Levitt, Ph.D., LDT, CCC-SLP

• Age-related changes in speech

Distribution among 14,235 people with a primary communication disorder diagnosis

TYPE LOCALIZATION NEUROMOTOR BASES-

Spastic Bilateral Upper Motor Execution: Spasticity

Hyperkinetic Basal ganglia control

Mixed More than one Execution and/or control: More than

TYPE LOCALIZATION NEUROMOTOR BASES-

Spastic Bilateral Upper Motor Execution: Spasticity

Hyperkinetic Basal ganglia control

Mixed More than one Execution and/or control: More than

Direction Individual Movements Normal

TYPE LOCALIZATION NEUROMOTOR BASES-

Spastic Bilateral Upper Motor Execution: Spasticity

Hyperkinetic Basal ganglia control

Mixed More than one Execution and/or control: More than

Direction Individual Movements Normal

• Loss or impairment of fine, • Increased muscle tone

TYPE LOCALIZATION NEUROMOTOR BASES-

Spastic Bilateral Upper Motor Execution: Spasticity

Hyperkinetic Basal ganglia control

Mixed More than one Execution and/or control: More than

Direction Individual Movements Inaccurate

• Equilibrium is affected and gait may be

• A breakdown in the timing of onset of

• Resonance is generally normal although some

TYPE LOCALIZATION NEUROMOTOR BASES-

Spastic Bilateral Upper Motor Execution: Spasticity

Hyperkinetic Basal ganglia control

Mixed More than one Execution and/or control: More than

Direction Individual Movements Normal

• First, James Parkinson described

Bayles, K., McCullough, K., & Tomoeda C., 2018

legs, jaw and face

• Recognize hand-writing much

• Things do not smell as they

• Reports from the DBS cases:

LSVT®: increase drive to respiratory

TYPE LOCALIZATION NEUROMOTOR BASES-

Spastic Bilateral Upper Motor Execution: Spasticity

Hyperkinetic Basal ganglia control

Mixed More than one Execution and/or control: More than

Tone Muscle Tone Excessive Often Excessive

• Increased involuntary movement / tremors

• Oral musculature control: Huntington’s: patient

TYPE LOCALIZATION NEUROMOTOR BASES-

Spastic Bilateral Upper Motor Execution: Spasticity

Hyperkinetic Basal ganglia control

Mixed More than one Execution and/or control: More than

• Voice/Speech is harsh in general: often have

• Unknown etiology causes demyelination in the

• Significant muscle weakness

• Speech: Mixed spastic-ataxic dysarthria is

• Articulation: Defective articulation and

• Inability to voluntarily execute the complex

• Motor speech disorders.

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