DYSARTHRIA

⇓
⇑
🗸
⇒
⇐

Spastic D. Flaccid D Ataxic Hyperkinetic Hypokinetic UUMN AOS

Site of Upper Motor Lower Motor Damage to Extrapyramidal Extrapyramidal Unilateral Damage to
lesion Neuron lesion Neuron Cerebellum system system damage to Upper Broca’s area
- Cortex - Cranial Motor Neuron
- Pyramidal nerves Damage to Damage to: Left cerebral
tract - Basal - Substantia Disorders hemisphere
(corticobulba Disorders ganglia nigra - Unilateral (specifically the
r& - Degenerativ - Caudate stroke frontal lobe)
corticospinal e disease - Putamen - Occlusion
tracts) - Neurologica of left/right May co-exists
- Extrapyrami l disease Disorders Disorders carotid or with other types
dal tract - - middle of apraxia
Vascular lesions to cerebral - Limb
- Internal artery apraxia
carotid artery - Oral
- Middle & apraxia
posterior - Swallowin
cerebral g apraxia
artery - Verbal
- Vertebra- apraxia
basilar artery
in brainstem

Characterize Extremely poor Poor articulation Uncoordinated Irregularities in Very weak voice Most prominent No
d by arctic. voluntary - Rate - Many characteristics is neuromuscular
 movements - Pitch hesitations in articulation characteristics
Strained voice A breathy voice - Loudness - Intermixed
quality (characteristic sign) - Frequent with brief Oral groping
stoppages rushes of behavior
Hyper-nasal of speech speech
Low-pitched voice speech - tics (not Delay in voice
controlled) onset time

Severely affected
articulation

The person knows

exactly what they
want to say, the
problem comes in
when trying to plan
the movements

Respiration Shallow Shallow Shallow Shallow Shallow Slow (possible NORMAL

inhalations inhalations inhalation inhalation inhalation shallow
inhalation)
Reduced Reduced Problem with Reduced Reduced
exhalation control exhalation control exhalation control exhalation control exhalation
control
Slow breaths Low breaths **Rapid breathing **Rapid breathing
Rapid breathing Slow
Antagonistic Pitch ⇓ = softer Irregular + Irregular + Imprecise
muscular voice sudden formed sudden formed
contractions = not patterns may be breathing Irregular +
able - take - deep Reduced pressure present patterns sudden forced Irregular
breaths generation patterns
Antagonistic
muscular
Airflow ⇓
contractions = not
able - take - deep
Audible inhalation
breaths
Phonation Strained - Soft, hoarse - Hoarse - breathy Strained - harsh Harsh-hoarse Harshness Delay in onset of
strangled breathy voice q. voice voice q. voice quality (Strained voice when asked
Harsh harshness) to produce a
specific sound /
Pitch ⇓ - mono Pitch + loudness Pitch & loudness Mono-pitch Mono-pitch word. Can make
(ranges between variation ⇓ variation ⇓ Loudness ⇓ the sound
decreased pitch & Mono-loudness or Mono-loudness or spontaneously but
mono-loudness) Mono-loudness or excessive soft voice not when asked to
excessive loudness do it
Pitch & loudness variation variation
variations ⇓ (problem with
Mono-pitch or Tremor planning to
Intermittent rests excessive produce speech)
variation Sudden tic-like
grunts / barks
Coarse voice (coprolalia)

Tremor

Resonance Hyper-nasal Hyper-nasal Normal Episodes of Usually normal / Hyper-nasal NORMAL

hypernasality Hyper-nasal
*nasal air
emissions Normal

Articulation Slow - laboured Slow - laboured Slow + irregular Variable Variable + Irregular arctic Imprecise arctic.
fluctuating breakdowns Of
Imprecise / unclear Imprecise Imprecise Imprecise - VOWELS &
consonant consonant consonant consonant Imprecise Imprecise - Consonant
production production production production intelligibility consonant s
production And inaccurate in
Dysrhythmia Irregular Short rushes of terms of
articulation speech - Place
Syllable repetition breakdown - Manner
 - Voicing
Not smooth / Distorted vowels
steady
Distorted
substitutions

Distorted
Perseverative
subst. e.g.,
“nanana” for
“banana”

Distorted
anticipatory subst.
e.g., “popado” for
“Potato”

Distorted Additions

Distorted sound
prolongations

Distorted voicing
distinctions

Varying degrees of
trial-to-trial error
type

Errors tend to
reflect
simplification of
target sounds

Prosody Reduced BGL Reduced BGL Slow Inappropriate Slow ⇒ fast ⇒ slow Slow SLOW
(Short phrases) silences ⇒ fast bursts (Especially for
 Slow speech rate Can – mono-pitch Excess + equal multisyllabic
Excess / equal Prolongations Ability to vary/ stress utterances)
syllable stress Mono-loudness Mono-loudness (sounds + produce stress ⇓
intervals) ⇑ Rate in specific Syllable
Mono-pitch Prolongations + Pauses + segment segmentation
pausing Variable unsteady prolongations of
rate syllables Monotonous Phonetic accuracy
Outbursts - ⇓ when rate ⇑
excessive pitch Unsteady rate Not consistent
range Errors of stress
assignment

Articulatory
prolongation

ASSESSME DDK DDK DDK DDK DDK DDK DDK

NT - Slow & - Slow & - Slow and - Slow & AMR AMR
regular AMR regular irregular irregular - Rapid - Possible
- SMR = AMR AMR AMR - Limited that - able
problem with - SMR = - SMR = - SMR = range of to perform
rate, rhythm, problem problem problem movement task in a
arctic with rate, with rate, with rate, - Facial normal
rhythm, rhythm, rhythm, masking manner
artic artic artic SMR = problem after -
with rate, rhythm, number of
artic repetitions
SMR
- X
Observation Observation Observation Observation Observation Observation - Phoneme
- Delay in - Delay in - Delay in - Delay in - Delay in - Delay in substitution
trying to trying to trying to trying to trying to trying to s
phonate & phonate & phonate & phonate & phonate & phonate & - Arctic.
sound that sound that sound that sound that sound that sound that Groping
comes out comes out comes out comes out comes out comes out - Delays in
beginning
 Resonance test Resonance test Resonance test Resonance Test to phonate
- Hypernasalit - Hypernasali - Hyper- - Hyper-
y (nasal ty (nasal nasal(som nasal
emission) emission) etimes) -

Arctic. Test (NB) Arctic. Test Artic. Test Artic. Test Arctic. Test
Artic. Test (NB)
Cranial nerves Test Cranial Cranial Nerves Cranial Nerves Cranial Nerves
- Pathologic nerves (NB!) - OSME
oral reflexes - Hypoactive usually
- Hyperactive gag reflex normal BUT
gag reflex - Nasal - Dysmetric
- Pseudobulba regurgitatio jaw, face,
r affect n is and lingual
possible nonspeech
movements

Neuromuscular characteristics

Spastic D. Flaccid D. Ataxic D. Hyperkinetic D. Hypokinetic D. UUMN

Muscle strength ⇓ ⇓ ⇓ ⇓ ⇓ SEVERELY

⇓
Muscle tone Hypertonia (⇑) Hypotonic (⇓) Abnormal Predominantly Affected Affected
Tendency quick and slow
DMT = direct Characterized towards hypotonia **Fluctuates
(pyramidal) motor by: (⇓) between hyper +
tract lesion - Flaccid hypotonic
paralysis
IMT = - Hyporeflex ⇑⇔⇓
extrapyramidal / ia Tends to be
 indirect motor hypertonic
tract lesion Will always see
- Muscle
DMT atrophy
- Hypotonia - Fasciculati
- Hyporeflex ons
ia - Fibrillation
- Babinski s
sign - Muscle
weakness
IMT (⇑) with
- Hypertonia
use, but
with
recovers
- Spastic
fast during
paralysis
rest
- Hyperrefle
xia
- clonus

Range of ⇓ or limited ✅ to ⇓ Between normal ✅ to ⇓ Reduced + limited Affected

movement (Normal to & reduced (Normal to ⇓
reduced) reduced)
(⇔
⇔ ⇓)
Speed of Slow (⇓) Normal to slow (✅ Reduced to slow Slow to very fast Slow Affected
movement to ⇓) ⇓ ⇓ OR Very ⇑ ⇓
(more on the slow
side when more
severe)

Accuracy of ✅ (normal) ✅ (normal) Most affected Abnormal Abnormal Incoordination of

movement -timing face + tongue on
(direction = ✅ but -direction the opposite side
not timing) of lesion
 Overshooting (CONTRECOUP!)

Undershooting

Steadiness of ✅ (regular) Normal to slow (✅ Tends to be slow Predominantly Perform repetitive Affected
repetitive to ⇓) ⇓ quick: movements ⟳ at
movement -Quick, variable speeds
involuntary
movements

-OR sustained
posture

-OR writhing +
twisting

Vs

Predominantly
Slow:
-Slow, involuntary

-Purposeless

TESTS FOR SPEECH CHARACTERISTICS

Shape of structures Triangle 1: Volume Triangle 2: Pressure Triangle 3: Control of

involved & Function airflow
Respiration Best tested Sniff test Maximum Phonation Water bubble
- Max together because Time (/aaaaa/) manometry
Expirator they are Maximum Expiratory
yP interdependent Pressure (SEAL FOR Water Bubble Cough vs glottal
- Max. LIPS / TONGUE) Manometry coup
phonation Step 1: (blowing up of balloon)
time Visual & auditory Speech tasks / S/Z ratio
- Water observation activities
bubble M Maximum Expiratory
- S/Z ratio Pressure
- Cough vs
Glottal
coup
- Speech
tasks

Phonation Step 1: Pitch variation Loudness variation Loudness variation

(laryngeal level) Describe / assess the (singing up a scale &
- S/Z ratio following of phonation: singing down a scale) S/Z ratio Maximum Phonation
- Pitch - Quality Duration (length of time
variation - Pitch Phonation Volume Maximum Fricative for sustained vowel in
- Phonation - loudness (PV) = the max. Duration (sustained the /a/, /e/, /u/)
volume amount of air used phonation)
- Loudness during a task
variation Maximum Vocal
- Max. Intensity / Sound
fricative Pressure Level
duration
- Max.
phonation
duration
- Max. vocal
intensity

Resonance Assessment OSME Flutter Test

(all about focuses on (listen to velar function (ask - patient to say /oe/
hypernasality or velopharyngeal while performing for as long as possible
hypo-nasality) competence OSME) while you open and
- OSME close their nostrils & see
- Flutter test if there is a difference)
- Party
Blower Party Blower Test
Test

Articulation Articulation Test Maximum intra-oral

- Arctic. (normal articulation pressure
Test test) (want - patient to
- Max. intra- produce plosives)
oral Maximum Fricative
pressure Duration + S/Z ratio Maximum force of
- Max. (sustained closure (articulation?)
fricative phonation)
duration
- S/Z ratio MRR / DDK
- Max. force
of closure
- DDK

Prosody Describe the following Fundamental Speech rate

- Fundamen of prosody: Frequency Range
tal - Rate, (modal register + Stress contrasts
frequency - Contrasts vocal intensity - Ability to change
- Speech - intonation measured) pitch, loudness,
rate duration of
- Stress production to
contrasts express stress
- intonation contrasts

Intonation
- Ask questions,
 make assertions,
produce
exclamations

OTHER - Diadochokinesis (DDK) = complexity of combined and sequential systems

- Alternating Motion Rate (AMR)
- Sequential Motion Rate (SMR)

- Connected speech = more general speech abilities

- Speech intelligibility
- Reading tasks
- Descriptions
- Spontaneous Speech

- Stress Testing = complexity of speech

- Increased phonemic complexity
- Monosyllabic vs. Multisyllabic words
- Increased Utterance Length

Differential Diagnosis
❖ General Guidelines
➢ Speech examination should always lead to an attempt at diagnosis
➢ When examination results cannot go beyond description, the reasons should be stated explicitly
➢ Even when under difficult assessment circumstances, or with equivocal or atypical findings, some valuable interpretations often can be made
➢ A diagnosis should not be made if one cannot be determined
➢ The speech diagnosis should be related to the suspected or known neurologic diagnosis or lesion localization
➢ Different speech disturbances can co-occur
➢ Examination sometimes leads to a conclusion that speech is normal
➢ A diagnosis of normal speech sometimes requires explanation
■ Speech may have changed but is still in the normal range
■ A change has occurred outside the motor system
■ Speech is normal, but psychological factors have triggered a perception of abnormality by the patient
■ Speech is normal, but a physically or psychologically traumatic event has generated a complaint of speech change
 ■ The referring individual has misidentified a long-standing “developmental” speech abnormality
➢ Fixing a diagnostic label is convenient shorthand for communicating information

Characteristic Dysarthria vs AOS

OSME - Abnormal OSME findings (except for - Can have normal OSME findings
ataxic & hyperkinetic D)
- Only UUMN that has right central - Right central facial weakness
facial weakness
- No NVOA - Presence of non-verbal oral apraxia
(NVOA)

Speech - All subsystems of speech can be - Only articulation & prosody affected
affected

- Neuromuscular characteristics - No neuromuscular characteristics

- Rarely associated with Aphasia - Often associated with Aphasia

- Abnormal speech characteristics - - Abnormal speech characteristics -

generally consistent across variable across
- Speech modality (reading vs - Repetition of identical
spontaneous speech) utterances
- Utterance type - Automatic speech slightly
- Language variables better than propositional
speech
- Error rate influenced by
language variables

- Artic. Abnormalities = distortions or - Artic. Abnormalities =

simplification of speech gestures - Distorted substitutions
- Distorted additions
- Distorted repetitions
- Distorted prolongations
 - Rarely show groping behaviour - Presents with groping behaviour

Specific distinctions

Spastic D vs AOS Deviant speech features Deviant speech features

- Highly consistent - Usually less predictable
- Strained-harsh dysphonia - NO strained-harsh dysphonia
- Hypernasality - NO hypernasality

OSME OSME
- Drooling - Can be normal
- Dysphagia
- Pseudobulbs affect
- Hyperactive oro-motor reflexes

Doesn’t co-occur with aphasia frequently Frequently co-occurs with aphasia

Hyperkinetic D. vs AOS Predominantly Predominantly

- Articulatory - Articulatory
- Prosodic - Prosodic

Movement Movement
- Visible involuntary movements - NO visible involuntary movements
present present

Influences Influences
- NOT influenced by stimulus or - Influenced by stimulus or response
response parameters parameters

Ataxic D vs AOS Features Features

- Irregular nature of arctic. Breakdowns - Irregular nature of arctic. Breakdowns
- Predominance of arctic. & prosodic - Predominance of arctic. & prosodic
abnormalities abnormalities

OSME OSME
 - Can be normal - Can be normal

DDK DDK
1. AMR 1. AMR
- irregular - regular
2. SMR 2. SMR
- Normal - Abnormal

Articulation Articulation
- More irregular articulation - More regular articulation breakdowns
breakdowns

Prosodic Prosodic
- Variable prosodic abnormalities more - Variable prosodic abnormalities LESS
pervasive pervasive

Correction Correction
- Do not self-correct - Attempts to self-correct