Slpa Motor Speech Disorders - Exam 2

Front 1

What perceptual measures might be used to assess the respiratory ability of a person with motor speech disorder?

Back 1

-Level of speech loudness
-Consistency of loudness
-Uncontrolled alternations
-Increased loudness
-Quiet phonation
-Breathing pattern (Inspiratory: expiratory ratio for speakers in 1:6)
-Loci of inhalations (sentences, phrases, middle of word)

Front 2

What objective measures might be used to assess the respiratory ability of a person with motor speech disorder?

Back 2

-Estimation of subglottal air pressure (cmH2O) respiratory drive for speech
- Air flow measured by air volume entering and exiting the respiratory system
- Lung volume level (percent of vital capacity)
- Respiratory shape (rib cage and abdominal size)
-Alveolar air pressure
-# of syllables during a breath group
-Respritrace
-Straw-glass

Front 3

What is a phonatory diary?

Back 3

-entries when reflexive phonation (stimulus, body position, assistance provided, and associated activity)
-e.g., response to pain or discomfort

Front 4

What are the reasons for keeping a phonatory diary?

Back 4

-shows gradual change over time and when they phonate (e.g., voicing only during discomfort, in supine position, seat, etc.)

Front 5

What phonatory impairments does one expect with flaccid dysarthria?

Back 5

breathy voice, inspiratory stridor, hypernasality, nasal emission, imprecise articulation, short breath groups

Front 6

What phonatory impairments does one expect with spastic dysarthria?

Back 6

rough, strained-strangled phonation, short breath groups, hypernasality, imprecise articulation

Front 7

What phonatory impairments does one expect with ataxic dysarthria?

Back 7

-normal resonance
-unsteady
-excessive loudness
-voice tremor
-irregular articulatory breakdowns

Front 8

What phonatory impairments does one expect with hyperkinetic dysarthria?

Back 8

monoloudness, reduced loudness, monopitch, breathy/rough phonation, excessive rate, rushes of speech, difficulty initiating speech

Front 9

What phonatory impairments does one expect with hypokinetic dysarthria?

Back 9

excessive loudness, variable speech rate, rapid breath groups, harsh and breathy voice quality, strained-strangled vocal quality, voice stoppages

Front 10

What intervention would you use to reduce breathiness with someone who has flaccid dysarthria ?

Back 10

-Increase medial compression (adduction force) of VFs
-Effortful closure techniques: pushing, pulling, lifting, grunting and controlled coughs
-can also benefit from respiratory support and control to increase subglottal air pressure and overall effortful speech.
-also surgical options; laryngoplasty (implant) and rinnervation of muscles and nerves to the laryngeal mechanism.

Front 11

What intervention would you use to reduce roughness with someone who has spastic dysarthria?

Back 11

-prone to overdriving laryngeal mechanism with excessive loudness/effort
- treat behaviorally with feedback, sound-level measuring devices, or monitoring oral pressure during speech
-can also be treated with localized botox injections (effects seen 24-72 hours after injection and can last up to 3-4 months)

Front 12

What adjustments in subglottal air pressure might be helpful to improve the phonatory quality of someone with reduced medial compression due to a paralyzed vocal fold? Why?

Back 12

-back off/soften the subglottal air pressure to avoid overdriving respiratory system and prevent blowing the vocal folds further apart. Too much subglottal pressure with a paralyzed VF will blow the VF further apart & result in harsher voice.

Front 13

Describe the respiratory shape history (rib cage and abdomen) of a young woman who inhales to 65% of lung volume level and then counts to twenty-five without taking an additional breath.

Back 13

-relaxed: rib cage is pulled down by gravity, abdomen is distended out by weight of abdominal mass (shaped like a pear)
-talking: rib cage is pushed to expanded position, abdominal wall is moved in (about 1/4 of the way and continues to move in)

Front 14

What intervention procedures would you use to increase the medial compression of the vocal folds in a person who had bowed vocal folds due to Parkinson’s Disease?

Back 14

Lee Silverman voice treatment
-designed for parkinsons patients
-first intervention strategy of the program is to increase vocal fold closure time (recallibrates the level of effort the patient uses when speaking causing them to clamp vocal folds together more forcefully)

Front 15

Describe neural innervations of the muscles of respiration. Trace the neural tracts from the cortex (Area 4) to the motor end plate.

Back 15

Area 4 --- Phrenic Nerves --- Diaphragm
Area 4 --- Accessory Nerve (XI) --- Sternomastoid (elevate rib cage)
Area 4 --- Internal & External Intercostals --- Internal Intercostal Nerve (T2-T12)
Area 4 --- Internal & External Oblique --- Intercostal Nerve (T6-T12)
Area 4 ---Transverse Abdominis --- Intercostal Nerve (T7-T12)

Front 16

Describe neural innervations of the muscles of phonation. Trace the neural tracts from the cortex (Area 4) to the motor end plate.

Back 16

Area 4 --- Vagus Nerve (X) (Superior Laryngeal Nerve & Recurrent Nerve Branches) --- Laryngeal Muscles (move VFs together and serves for production of voice)

Front 17

What perceptual measures might be used to assess velopharyngeal function of someone with a motor speech disorder?

Back 17

Questions to ask perceptually
1. Is there evidence of VP dysfunction? Hypernasality or nasal emission
a. Rate nasality perceptually (none, mil, moderate, severe)
2. What is the extent and pattern? Sounds and circumstances. Patterns may include
3. Does VP dysfunction influence other aspects of speech performance? In most cases it will drain the pressure from the respiratory system.

Front 18

What objective measures might be used to assess velopharyngeal function of someone with a motor speech disorder?

Back 18

-Check nasal emission using Aerodynamic measures (significant air escape in pressure consonants--If they can seal during plosives, they have the mechanism)
-Endoscopic Evaluation (visual image of the closure)
-Collect speech sample (vary speaking rate and phonetic context)
-Radiographic Techniques (MBS for function)

Front 19

What is the laryngeal performance of a person with flaccid dysarthria?

Back 19

Unilateral damage
Paralyzed in adductor position voice will sound harsh and have low volume
Paralyzed in abductor position there will be breathiness and reduction in loudness
Bilateral damage (more common)
breathy, inspiratory stridor
hypernasality, monopitch and monoloudness may both result from vocal fold paralysis, atrophy

Front 20

What is the laryngeal performance of a person with spastic dysarthria?

Back 20

Dysophonia, harsh, strained, strangled, low pitch (occasional pitch breaks), hypernasality, occasionally bursts of loudness

Front 21

What is the laryngeal performance of a person with hypokinetic dysarthria?

Back 21

• Vocal folds do not adduct
• monopitch, monoloudness, short rushes of speech
• Myasthenia Gravis: hypernasility, stridor, “vocal weakness”
• Peripheral Nerve
Recurrent Laryngeal Nerve (unilateral): hoarse voice, breathy voice, reduced loudness, voice may be normal
Superior Laryngeal Nerve: mild hoarseness, vocal fatigue
• Nuclear (injury to lower motor neurons of 10th nerve)
laryngeal paralysis, hypoadduction
• Brainstem Stroke: flaccidity
• Parkinson’s Disease: reduced loudness, monotone, hoarseness, tremor
• Closed head injury: hypophonia (weak voice)

Front 22

What muscles are involved in VP closure?

Back 22

levator veli palatini
tensor palatini

Front 23

What is the role of the levator veli palatini muscle in VP closure?

Back 23

elevate palate bilaterally (A-G)

Front 24

What is the role of the tensor palatini muscle in VP closure?

Back 24

-Broaden the palate
-particularly active during swallow
(A,B,C)

Front 25

What is the neurological basis for velopharyngeal closure?

Back 25

-Vagus (X) innervates: palatoglossal and levator veli palatini (raise velum)
-Trigeminal (V) innervates: tensor veil palatine (tenses velum)
-Spinal accessory (XI) innervates: palatopharyngus (depresses velum and constricts pharynx) and uvula (shortens velum)

Front 26

What is a nasal obturator?

Back 26

-one-way device
-fits the nares
-allows speaker to generate oral pressure adequate for speech production (still able to intake air through their nose)
-allows build up of oral air pressure for speech by blocking nares

Front 27

When would you recommend a nasal obturator instead of a palatal lift?

Back 27

recommended for people who are NOT palatal lift candidates due to motor complications, dental complications, cognitive issues, and sensory issues (gag, discomfort, or increased saliva production)

Front 28

When would you recommend a palatal lift instead of a nasal obturator?

Back 28

attempted before obturator because:
-more visually appealing
-more natural phonation.

Front 29

What is the impact of severe velopharyngeal incompetence on articulatory performance for stop consonants, fricatives, nasals, and vowels?

Back 29

Nasal emission for sounds that require complete velopharyngeal closure: stop consonants and fricatives
Some nasal emission for sounds with partial VP closure: /r/, /l/, /j/
No effect on sounds with substantial VP opening: nasals and vowels

Front 30

How does a Delay Auditory Feedback Device potentially control speaking rate?

Back 30

-user speaks into a microphone and then hears his or her voice a fraction of a second later
-commonly used with Parkinson’s