Motor Speech Disorders

Motor speech disorders are neurologically based problems including dysarthria and apraxia of speech.

Dysarthria- There are distinct patterns of speech owing to weakness, slowness, and uncoordination of speech muscles. Oral movements are disrupted and reflect different types of neuropathology.
Apraxia of Speech- There are articulation errors in the absence of muscle slowness, weakness, uncoordination, owing to disruption of cotical programming for the voluntary production of speech sounds.

SYMPTOMS:

Dysarthria-

  • oral peripheral defectiveness
    • slow, weak, and uncoordinated
    • vegetative functions (sucking, chewing), as well as speech movements are disturbed
  • articulation simplification
    • distortions
    • substitutions
    • errors are consistent
    • more complex units (clusters of consonants) are more difficult
    • more errors in final position
    • errors are consistent with neurological record
  • repeated utterances- same performance obtains
  • deterioration of performance with increased rate
  • slower rate of speech

Apraxia of Speech-

  • articulation complications
    • transpostions, reversals
    • perseverative and anticipatory errors
    • fewer distortions, more substitutions, intrusive additions
    • errors increase propotionate to word weight
    • fewer errors in spontaneous performance
      • inconsistency is a key sign
    • when repeating utterances, the person makes repeated attempts and may achieve correct performance
    • person appears to grope or struggle for correct production
    • performance improves at faster rate
    • disturbances of prosody
      • stuttering-like struggle reactions
      • slow, labored speech during voluntary attempts

ASSESSMENT:

Assessment Areas

  • lips and lip movement
  • jaw
  • teeth
  • tongue
  • hard palate
  • soft palate and velopharyngeal closure
  • fauces
  • breathing
  • facial muscles
  • facial features
  • motor assessment:
    • facial/limb praxis
    • oral apraxia on simple and complex tasks
    • lingua-mandibular and libial mandibular synkinesis
    • velar function
    • oral reflexes
    • facial mimicry tasks’
  • motor-speech assessment
    • diadochokinesis
    • nasal resonance
    • standard articulation tests
    • phonological analysis (distinctive features and phonological error processes)
  • prosody assessment
    • stress patterns
    • intonation patterns
    • general fluency and articulatory flow
  • language assessment(s)
    • auditory memory assessment
  • volitional oral movements
  • sequenced volitional oral movements: two items
  • sequenced volitional oral movements: three items

Interview Questions

  • Do you have any difficulty with your speech? If not, has anyone else commented on a change or problem with your speech?
  • Describe your current speech difficulty. How does it sound to you? 
  • Do people ever have trouble understanding you?
  • What have you done to compensate for your speech difficulty?

Formal Tests

  • Oral Speech Mechanism Screening Examination (OSME-3)
  • Screening Test for Developmental Apraxia of Speech- second edition (STDAS-2)
  • Assessment of Intelligibility of Dysarthric Speech (AIDS)
  • The Apraxia Profile
  • Verbal Dyspraxia Profile
  • Apraxia Battery for Adults- second edition (ABA-2)

Alternative Assessment Measures

  • spontaneous speech sample
  • informal oral motor exam
  • portfolio assessment

Initial Treatment Goals

  • The client will develop functional and intelligible speech and utilize compensatory strategies through the use of adequate labial and lingual function, increased articulatory precision and speech prosody.
  • The client will develop functional motor programming, articulatory proficiency and utilize compensatory strategies to express wants and needs for intelligible speech and functional prosody in the functional living environment.

CLIENT & FAMILY EDUCATION:

  • http://www.grhealth.org/cancer/media/file/health%20encyclopedia/patient%20education/Dysarthria.pdf
    • This page gives an overview of the speech disorder, dysarthria. It lists the causes of dysarthria. It provides the family and the client information about what a SLP does, including the evaluation and therapy. There is also a section specifically for the family on ways to help a person with dysarthria.
  • http://www.asha.org/public/speech/disorders/dysarthria/
    • This webpage, from the American Speech-Language-Hearing Association, provides information specifically about dysarthria. The page includes descriptions of the signs and symptoms of dysarthria, the common causes, the prevalence, as well as the different types. It also provides information regarding the diagnosis and treatment. The page provides families and caregivers with information on how to better communicate with someone who has dysarthria.
  • http://www.asha.org/public/speech/disorders/ApraxiaAdults/
    • This webpage, from the American Speech-Language-Hearing Association, provides information specifically about apraxia of speech (AOS) in adults. The page includes descriptions of the signs and symptoms of AOS, the common causes, and the prevalence. It also provides information regarding the diagnosis and treatment.

PROFESSIONAL MATERIALS & RESOURCES:

  • http://medicalspeechpathology.wordpress.com/student-handbook/treatment-of-dysarthria/
    • This blog is a resource for practicing SLPs and provides information about treatment of dysarthria. The blog focuses on eight specific goals including: help the patient become productive; modify abnormalities of posture, tone, and strength; modify respiration; modify phonation; modify resonance; modify articulation; modify prosody (suprasegmentals); provide alternative modes of communication. The goals of therapy are outlined in the blog.
  • Kaufman, B.A. (2002) Dysarthria treatment manual. Austin, TX: PRO ED., Inc.
    • This text is a useful tool for SLPs. It emphasizes self-monitoring and self-reliance. It provides dozens of exercises to use with clients who have dysarthria. It includes and introduction to dysarthria (definition, types, etiology, prognosis, therapy, and treatment goals), as well client and family educational handouts.
  • Kaufman, B.A. (2002) Apraxia treatment manual. Austin, TX: PRO, ED., Inc.
    • This text provides functional practice materials and activities for SLPs to use for treatment of AOS. The activities increase in length and complexity. There are introductory  sections that give a brief explanation of apraxia and how to remediate it.

REFERENCES:

Haynes, W. O., & Pindzola, R. H. (2012). Diagnostics and evaluation in speech pathology (8th ed., pp 215-237). Pearson.

(1997–2014) American Speech-Language-Hearing Association (ASHA)

SPAUD 501: Diagnostics notes; Heather Koole (Calvin College)

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