FINAL

• Direct activation pathway: These pathways Functions have a major influence on the cranial and spinal nerves.
• Damage: Bilateral damage to the direct and indirect activation pathways can cause spastic dysarthria (unilateral damage to these pathways can cause unilateral upper motor neuron dysarthria).
• Why are the Indirect activation pathways called “indirect”?: 

  These have multiple synapses (mostly in the brainstem) between the cortex and the FCP.
• Where do the IDP have multiple synapses ?

  mostly in the brain stem
• AOS is 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.
• AOS can occur in the absence of physiologic disturbances associated with the dysarthrias and in the absence of disturbance in any component of language.
• What are the five components of the speech motor system?  

  respiration, phonation, resonance, articulation, and prosody
• What are the major structures of FCP

  spinal and cranial nerves
• What are the FCP  Related designations?

  The lower motor neuron system
• Damage to the FCP Can cause flaccid dysarthria
• The most common cause of neurologic deficits and, probably, MSDs, is:   Vascular diseas
• A branch of this cranial nerve innervates  the tensor veli palatini, tensor tympani, jaw opening and lateralizing muscles (lateral pterygoids), and jaw closing muscles (temporalis, masseter, medial pterygoids).

  CN 5 
• Fasciculations are generally seen with disorder at which part of the neurological system?

  LMN
• When a single dysarthria type leads to anarthria, the most likely type of dysarthria present is the following:

    Spastic
• Though most of the cranial nerves originate in the brainstem, the nerve nuclei are considered part of the peripheral nervous system and lesions at their level are therefore classified differently from lesions in the supratentorial level regarding dysarthria type.

  True
• Of the arteries that lead to the brain, the left posterior cerebral artery is most likely to be related to apraxia of speech when there is vascular etiology.

  False 
• What are the goals of the motor speech evaluation? 

  1) Establish the implications of the speech diagnosis for localization and neurologic diagnosisDescribe the problem

  1. Establish diagnostic possibilities
  2. Establish a diagnosis
  3. Establish implications for localization and disease diagnosis
  4. Specify severity

  2) To formulate treatment recommendations
• Communication Effectiveness Survey (CES) is an 8-item questionnaire
• CES addresses communication across several conditions
• Estimates of functional communication, communication effectiveness, and psychosocial impact of the MSD

  
  

  When assessing the functional impact of the MSD, the clinician must consider its impact on:

  • Client's communication effectiveness
  • Life participation
  • Self-concept
• Final common pathway (FCP) for speech production includes:

  • Paired cranial nerves (CNs: V, VII, IX, X, XI, XII) that innervate muscles involved in phonation, resonance, articulation, and prosody
  • Paired spinal nerves contribute to speech breathing and prosody
  • Damage to FCP can cause flaccid dysarthria
• Direct activation pathway (DAP) related information:

  • Related designations: Pyramidal Tract, Direct Motor System
  • Subdivisions: Corticospinal Tract, Corticobulbar Tract
  • Damage to DAP can cause spastic dysarthria
• Indirect activation pathway (IAP) related details:

  • Related designations: Extrapyramidal tract, indirect motor system, brainstem motor pathways
  • Called "indirect" due to multiple synapses between the cortex and FCP
  • Divisions/parts involved: Corticorubral tract, rubrospinal tract, reticulospinal tract, vestibulospinal tract
  • Damage to IAP can cause dysarthria
• Upper motor neuron (UMN) innervation to speech musculature: Hypoglossal (XII)
• Goals of the motor speech evaluation:

  • Establish implications of speech diagnosis for localization and neurologic diagnosis:
  • Formulate treatment recommendations
• Components of the motor speech examination:

  • History
  • Identification of salient speech features
  • Identification of confirmatory signs
• Approaches to management:

  • Medical Intervention
  • Prosthetic Management
  • Behavioral Management
  • Augmentative and Alternative Communication
• Dysarthria communication-oriented management strategies:

  • Speaker strategies
  • Listener strategies
  • Interaction strategies
• Foundations for behavioral management:

  • Nervous system organization is not fixed
  • Neural adaptation occurs with muscle use
  • Nervous system is capable of recovery and reorganization after injury
• Treatment efficacy for MSDs:

  • Data mainly from individual case studies, aggregated case reports, and a small number of group studies
  • Management of MSDs is generally efficacious
  • Efforts needed to improve understanding of management effectiveness
• Principles of motor learning in the treatment of motor speech disorders:Maas,(2008)

  • Prepractice includes focus on motivation, understanding of the task, and stimulability for acceptable responses
  • Structure of Practice:
  • Practice amount: Large versus small amounts of practice
  • Practice distribution: Massed versus distributed practice
  • Practice variability: Variable versus constant practice
  • Practice schedule: Random versus blocked practice
  • Movement complexity: Simple (part) versus complex (whole)
  • Structure of Augmented Feedback:
• • Feedback type: Knowledge of results versus knowledge of performance
  • Feedback frequency: High versus low feedback frequency
  • Feedback timing: Immediate versus delayed
• AOS types:

  • Apraxia of Speech (also called as "Verbal Apraxia")
  • Childhood Apraxia of Speech (CAS)
  • Acquired Apraxia of Speech (a.k.a. Developmental Apraxia of Speech, Developmental Verbal Dyspraxia)
  • In children, the cause is usually unknown
• Speech Motor Planning:

  • Interface stage between phonological planning and preparation of impulses for motor system
  • Abstract phonological symbols assigned properties amenable to a motor code
  • Phonemes changed into sounds with discrete place and manner of articulation features
• Oral-mechanism exam:

  • Chewing/swallowing normal if dysarthria is not present
  • AOS can co-occur with right central face and sometimes lingual weakness and UUMN dysarthria
  • Tasks include imitating or following commands for nonspeech oro-motor movements
• AOS management:

  • No surgical or pharmacologic interventions that are clearly effective
  • Prosthetic interventions not appropriate, but prosthesis like rate control devices, biofeedback, and AAC can be relevant
  • Behavioral management is appropriate
  • Communication-oriented approaches are used
  • Motor learning principles considered in treatment
• Describe Rate/rhythm approaches to AOS treatment:

  • Modify rate and/or rhythm. play a significant role in multisyllabic word, phrase, or sentence level
  • recognize that rhythm (prosody) is a basic component of speech production, and they reflect an assumption that AOS includes problems in the timing of speech movements
  • Include contrastive stress tasks, metronome and related pacing techniques, metrical pacing therapy, singing, and melodic intonation therapy
• the basic function of FCP is to stimulate contraction of muscles and movements
• Communication Effectiveness Survey (CES) – 8-item questionnaire that addresses communication across several conditions