Midterm

• What are the 5 components of the motor speech examination?

   History

  2) Examination of the oral mechanism at rest or during nonspeech activities

  3) Perceptual assessment of speech characteristics

  4) Assessment of intelligibility, comprehensibility and efficiency

  5) Estimates of functional communication, communication effectiveness, and psychosocial impact of the MSD
• Communicative Participation Item Bank (CPIB) helps gain insights into the effect their condition has on their participation in a variety of communication situations
• Components of the speech motor system:

  • Respiration
  • Phonation
  • Resonance
  • Articulation
  • Prosody
• Causes of acquired AOS:

  • CVA (most common)
  • Neurodegenerative diseases
  • Primary progressive apraxia of speech (PPAOS)
  • Corticobasal syndrome (CBS)
  • Progressive supranuclear palsy syndrome (PSPS)
  • Amyotrophic lateral sclerosis (ALS)
  • Co-occur with primary progressive aphasia, Creutzfeldt-Jakob disease, tumor, trauma of left hemisphere
• Intrasystemic reorganization:

  • Emphasizes a more primitive or automatic level of function or a higher level of control
  • Making speech more volitional or conscious is an example of higher-level control (e.g., through imitation)
• Intersystemic reorganization:

  • Uses nonspeech activity to facilitate speech
  • Gestural reorganization includes hand or finger tapping, foot tapping, head movements, or the use of a pacing board
• Techniques for mute or severely impaired patients

  • Includes automatic speech tasks, carrier phrases, gestures to trigger speech, nonspeech oromotor movements, and artificial larynx
• What Motor learning principles are considered

  
  

     Drill

     Self-learning

    Instruction

    Feedback and feedback schedules,

     Specificity of training

     Blocked and random practice 

   Speed-accuracy trade-offs are important.

   Most speaker-oriented approaches employ concepts of intersystemic or intrasystemic reorganization.
• Control circuits

  • Help control/coordinate diverse activities of the structures and pathways involved in motor performance.
  • Unlike the direct and indirect activation pathways, the control circuits do not have direct contact with the LMN (a.k.a. FCP)
• • Cerebellar damage: Ataxic dysarthria(incoordination of speech movements)
• What does control circuits help control?

  coordinate diverse activities of the structures and pathways
• • Damage to the basil ganglia: Causes hypokinesia (too little movement) or hyperkinesia (excessive movement). Speech – hypokinetic dysarthria or hyperkinetic dysarthria.
• “Hypokinesia is often associated with disease of the SN, which results in a deficiency of dopamine in the basal ganglia.”
• Hyperkinesia can result from excessive activity in dopaminergic nerve fibers, thereby reducing the circuit’s damping effect on cortical release of unwanted, competing motor programs. This results in involuntary movements….”
• The type of motor speech disorder that may show excessive speech rate would is called Hypokinetic dysarthria
• Corticobulbar tracts are  Direct activation pathways
• Hypokinetic dysarthria results from damage to   Basal ganglia control circuit 
• 1. Goals of MSD management: restore, compensate, adjust. 
  2. Restore lost function
  3. Promote the use of residual function (compensate)
  4. Reduce the need for lost function (adjust)
• Techniques for mute or severely impaired patients. 

  • Automatic speech tasks
  •  Carrier phrases
  •  Gestures to trigger speech
  •  Nonspeech oromotor movements
  •  Artificial larynx
• Techniques for mute or severely impaired patients. 

  • Automatic speech tasks
  •  Carrier phrases
  •  Gestures to trigger speech
  •  Nonspeech oromotor movements
  •  Artificial larynx
• AOS assessment

  When the patient’s speech is mild-to-moderately impaired:

  • SMRs 
  • Repetition of complex multisyllabic words and sentences.
  • If the patient has minimal ability to speak:
  • Singing a familiar song
  • Counting
  • Imitation of CVC syllables with identical initial and final consonants
• Articulatory-Kinematic Approaches:

  Strategies such as PROMPT, Sound Production Treatment, and Melodic Intonation Therapy. 

  Articulation Focused
• What is the goal of Articulatory-Kinematic therapy?

  Create or retrieve motor plans for speech. AK approach relies on motor learning theory and on the principle of neuroplasticity to attempt to reestablish motor planning abilities for speech. Assuming the brain is changeable (plastic) and that it can rearrange itself to regain lost function after damage.
• Apraxia of Speech =  “Verbal Apraxia”
• Three reasons to think about communication rather than speech when it comes to management of MSDs?   1.It places the ultimate goal where it belongs – on the ability to convey thoughts and feelings. 2. It broadens the goals of management.3. It broadens the criteria by which treatment effectiveness is judged and implicitly recognizes that the degree of speech abnormality may not share a one-on-one relationship with the degree to which affected people are disabled or limited in their ability to participate in social or work activities.
• Per van der Merwe (2020), Apraxia of speech (AOS) is a  Speech Motor 
• Hypoglossal nerve is cranial nerve # XII
• In AOS there are phonemic paraphasias. This statement is  False 
• Examination of the oral mechanism at rest and during nonspeech activities = Look for size, strength, symmetry, range, tone, steadiness, speed, and accuracy of orofacial movements
• The observations Of oral mechanism at rest and during nonspeech activities can be made;At rest During sustained postures During movement Reflex testing (e.g., gag reflex, jaw jerk reflex, sucking reflex, snout reflex, palmomental reflex)
• Perceptual assessment of speech characteristics

  • Vowel prolongation
  •  Alternating motion rates (AMRs) or diadochokinetic (DDK) rates
  • Sequential motion rates (SMRs)
  •  Contextual speech (e.g., conversation/narratives, reading aloud)
  • Stress testing
  •  Assessing motor speech planning/programming capacity (e.g., SMR, repetition of multisyllabic words, singing a familiar song, counting, imitation of CVC syllables with identical initial and final consonants)
• 1. Describe the four A-K approaches covered in the lecture. Eight-step (integral stimulation) continuum Sound Production Treatment (SPT) Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) Motor Learning Guided (MLG) Treatment
• Involuntary movements happen in hypokinetic
• "praxis" meaning “action”
• In AOS assessment If the patient has minimal ability to speak then one can Sing a familiar song, count, Imitate of CVC syllables with identical initial and final consonants
• “Intelligibility is the degree to which a listener understands the acoustic signal produced by a speaker”
• “Comprehensibility is the degree to which a listener understands speech on the basis of the auditory signal plus all other information that may contribute to understanding what has been said.”
• “Efficiency refers to the rate at which intelligible or comprehensible information is conveyed.”