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Motor Speech Disorders

Motor coordination can be difficult

Theophilus Thadeus Thistledown,

The successful thistle-sifter,

While sifting a sieve-full of unsifted thistles,

Thrust three thousand thistles through the thick of his thumb.

Now, if Theophilus Thadeus Thistledown,

The successful thistle-sifter,

Thrust three thousand thistles through the thick of his thumb,

See that thou, while sifting a sieve-full of unsifted thistles,

Thrust not three thousand thistles through the thick of thy thumb.

Think about all of the separate targets you have to hit and how quickly your tongue needs to move in order to say this fluently– it is not always the easiest thing in the world and at times, we miss our targets

The more difficult the task, the harder motor coordination is

Dearest creature in creation 

Studying English pronunciation, 

I will teach you in my verse 

Sounds like corpse, corps, horse and worse.

I will keep you, Susy, busy, 

Make your head with heat grow dizzy; 

Tear in eye, your dress you'll tear; 

Queer, fair seer, hear my prayer.

Pray, console your loving poet, 

Make my coat look new, dear, sew it! 

Just compare heart, hear and heard, 

Dies and diet, lord and word.

“The Chaos” (1922)

Gerard Nolst Trinité

1870-1946

His poem features 800 of the worst irregularities in English spelling & pronunciation

Pronunciation can also become difficult due to the irregularities of the English language

Motor Speech Control

Individual control over muscular coordination involved in producing speech

3 areas of deficits:

Planning

Programming

Execution

The motor plan specifies the movement goals with respect to the articulators; the motor program specifies which muscles will be used in moving the relevant articulators specified in the motor plan. So in order to make the /s/ sound, for example, you have to move your tongue up to the alveolar ridge. It's a tongue-tip movement where contact is made between one articulator, the front of the tongue, and another articulator, the alveolar ridge. So, planning the movement at that level is motor planning. But specifying which particular muscles are going to make the tongue move to that location is done at the speech motor programming level. There is what is called motor equivalence, which means that you can achieve the same movement goal with potentially infinite number of muscle contractions. Once you know what the goal is at the anatomic structure level, then you need to figure out how to make it more concrete and specific in terms of the muscles involved.

Execution depends on the actual integrity of those muslces

Motor Speech Disorder

Speech production deficit resulting from a problem in speech motor control

Deficit in speech, not language

Other oral movement impairment (eating, facial emotion) can co-occur

Ability to build your message; know what you want to say in intact—the ability to appropriately plan/program and execute the muscle movements to adequately achieve speech is impaired

You know you want to complete an activity-such as walk across the room– and your plan is to pick one leg up and then put it down, so on and so forth; the programming is the actual building of which message to send to which muscles in order to complete the plan—the execution is carrying out the plan (if the muscles in your leg is weak, you will not be able to carry out movements

Systems involving speech

Which system specifically involves the brain, spinal cord, cranial nerves, spinal nerves?

Respiratory System

Phonatory System

Articulatory System

Resonatory System

Central & Peripheral Nervous System

Systems involving speech

Which system specifically involves the brain, spinal cord, cranial nerves, spinal nerves?

Respiratory System

Phonatory System

Articulatory System

Resonatory System

Central & Peripheral Nervous System

Systems involving speech

Which system specifically involves head and neck cavities and the velopharyngeal port amongst others?

Central & Peripheral Nervous System

Respiratory System

Resonatory System

Phonatory System

Articulatory System

Systems involving speech

Which system specifically involves head and neck cavities and the velopharyngeal port amongst others?

Central & Peripheral Nervous System

Respiratory System

Resonatory System

Phonatory System

Articulatory System

Systems involving speech

Which system specifically involves the larynx, pharynx, & trachea?

Central & Peripheral Nervous System

Respiratory System

Phonatory System

Articulatory System

Resonatory System

Systems involving speech

Which system specifically involves the larynx, pharynx, & trachea?

Central & Peripheral Nervous System

Respiratory System

Phonatory System

Articulatory System

Resonatory System

Systems involving speech

Central & Peripheral Nervous System

Brain, spinal cord, cranial nerves, spinal nerves

Respiratory System

Trachea, lungs, diaphragm, abdominal muscles

Phonatory System

Larynx, pharynx, trachea

Articulatory System

Articulators

Resonatory System

Head and neck cavities, velopharyngeal port

Central Vs. Peripheral

1. Brain

2. ????

3. ????

????? Nerves

Spinal Nerves

Central Vs. Peripheral

1. Brain

2. Brain Stem

3. Spinal Cord

Cranial Nerves

Spinal Nerves

Speech Sound Disorders

Anatomic/sensory—ankyglossia or tongue time, when frenulum—piece of skin between the tongue is either too thick, too short or both, affecting ability to articulate; cleft palate in the incomplete closure of the hard/soft palate affecting one’s resonance and ability to build enough pressure in order to adequately produce a speech sound.

Execution—problem with muscle tone / could be due to paresis (muscle weakness) or paralysis (complete inability to move)-- may be due to difficulty in programming/accurately coordinating muscles

Planning/programming-difficulty in the conceptual planning of the sequence of movements needed to complete speech (able to build the message with language and cognition but cannot plan the movements correctly)—determines, tone, range of movement

Speech Motor Control

Muscles must coordinate:

Breathing

Voicing

Appropriate “shunting” of sound

Coordination of the articulators

Need to be able to take in an adequate breath as well as exhale in a consistent even and slow manner to sustain voice and loudness

Need to “turn on” vocal folds as soon as the exhaled breath reaches the level of your vocal folds in order to optimize the amount of words/speech you can get out of each breath

You need to be able to “turn on” and “turn off” voice as necessary—adequate control of your vocal folds

You need to coordinate all of your articulators in time and space in order to produce accurate sounds– remember coarticulation and assimilation-the coordination and movement required for each sound will be different depending on which environment/ which word you are producing it in (pool vs peel)

Speech motor Control

Ability to maintain speed, fluency and accuracy of movements

Motor Unit: “abstract representation of relatively invariant movement patterns that can be scaled in size and time to meet demands of a particular situation.

Seem to be planned/executed as a whole

Timing and force can vary

Ex: everyday motor movements such as running a race– pace changes as you’re approaching the finish line

Motor unit– nerve cell that innervates multiple muscle fibers—may want more information on this

Planning, Programming & Execution

https://basicmedicalkey.com/wp-content/uploads/2017/03/978-1-60406-395-0_009_001.tif_epub1.jpg

Cognitive linguistic process--difficulty building your message (finding the correct words, utilizing the correct syntax, responding appropriately and on topic, ability to maintain coherence and cohesion in answers

Motor Speech

Planning: processes that define and sequence articulatory goals

Motor Programming: processes responsible for establishing and preparing the flow of motor information across muscles for speech production and specifying the timing & force

Execution: processes responsible for activating relevant muscles for speech production

Prevalence & Incidence

Incidence is unknown/complicated

Dependent on what’s causing the problem

148,000 diagnoses of motor speech disorder (2008 estimate)

Prevalence

Motor speech disorders (MSD) compose 51% of acquired communication disorders

Etiology

Brain Injury

Stroke, TBI, Anoxia, Cerebral Palsy

Progressive Neurological Disorders

Parkinson’s, ALS, Huntington’s Disease, MS

MSDs are called either Developmental or Acquired

Anoxia-loss of oxygen to the brain; if the brain is cut off from oxygen for 5 minutes, permanent damage can occur

CP- caused by damage to the brain before or at birth

Apraxia of Speech

Motor planning/programming disorder

Difficulty grouping and sequencing the correct muscles

Can be both acquired or developmental

“Simply, it is a disconnection between the brain and mouth-the brain cannot plan the movement needed by the speech articulators to accurately produce sounds and words…”

http://nspt4kids.com/therapy/phonological-process-disorder-vs-childhood-apraxia-of-speech-north-shore-pediatric-therapy/

Ability to linguistically represent a word/phrase, but are unable to map it out ensuring appropriate execution

Apraxia of Speech

Looks like

Slow, effortful speech

Distorted Sounds

Groping of articulators

Impaired prosody

Difficulty with initiation

Errors vary between utterances

Often caused by

Damage to Broca’s Area

Premotor Areas

**often add different sounds, leave sounds out– some sound distortions; Can co-occur with other motor speech disorders (dysarthria) or language disorders (aphasia); Automatic speech often easier (hello, how are you, counting to 10) May have more difficulty when asked to do something

Childhood Apraxia of Speech

Difficulty with translation of linguistic representation and motor movement

Difficulty learning motor behaviors

Same characteristics as AoS

Limited sound inventory, delayed speech development, unintelligibility and slow progress in therapy

**Causes are not well understood**

Delayed first word, can only say a few vowels/consonants, limited number of spoken word, difficulty getting lips/jaws/tongue in correct position to produce a sound, difficulty transitioning spmoothly from one sound to another

Videos

CAS

https://youtu.be/cEOy3APLA-g***

https://www.youtube.com/watch?v=cyb7esLHr7A (spontaneous speech sample)

https://www.youtube.com/watch?v=rlciHHC0uT4

(spontaneous speech sample)

AoS:

https://www.youtube.com/watch?v=XVgzzoRBaVY **

https://www.youtube.com/watch?v=Ye2R86QLjYs

Dysarthria

Motor execution disorder

Disturbances in neuromuscular control

abnormal movement of muscles

Can be acquired or developmental

Many different types

Often caused by

Progressive disease or trauma

Progressive disease (ALS/parkinsons)

Trauma (TBI/stroke)

Results in Disturbances of:

Muscle tone: postural support

Muscle strength: ability to contract to desired level

Movement Steadiness: ability to generate steady movements

Movement speed: maintenance of appropriate speed

Movement range: how far structure can move

Movement coordination: appropriate timing of muscle contractions

Low muscle tone—decreased resistance/tension within the muscles may affect how you produce certain sounds

Breakdowns of Dysarthrias

Spastic

Flaccid

Ataxic

Unilateral Upper Motor Neuron (UUMN)

Hyperkinetic

Hypokinetic

https://upload.wikimedia.org/wikipedia/commons/5/55/Blausen_0076_BasalGanglia.png

Need further information!!

CorticoSpinal Tract

#1 Function: Mediating Voluntary Movements

Aka pyramidal tract

White matter tract (made up of axons)

Descends from cortex or brainstem

Made up of Upper Motor

Neurons(UPM): UPM generally arise from premotor cortex & motor cortex)

Signal from UPM are transmitted to Lower Motor Neurons (LMN)

LMN transmit signal to the muscle

Basics:

Pyramidal System: voluntary pathway for all movement

Upper Motor Neurons (UMN): contained within the CNS; paralysis causes spasticity

Lower Motor Neuron (LMN): second order/communication; damage causes flaccid

Neuroscience!!

https://www.youtube.com/watch?v=Ma4i6nH3qMQ

Spastic Dysarthria

Hypertoniticity, reduced speed/range

Causes:

Bilateral damage to motor regions of the brain

Results in muscle contraction

Presentation:

Reduced speech rate

Distorted consonants and vowels

Reduced/exaggerated stress

Breathy/Harsh/Strained/strangled voice

https://www.youtube.com/watch?v=IXxruuFwue8

Damage to upper motor neurons

Increasd tone and limited range of movement

Flaccid Dysarthria

Hypotonicity, atrophy, muscle weakness

Causes:

Damage to Cranial Nerves, LMN, some areas brainstem/midbrain

deficit depends on which CN is damaged

Presentation:

Reduced breath support

Breathy voice quality

Monoloudness & monopitch

Reduced articulatory precision

https://www.youtube.com/watch?v=dy8WvykiLto

Ataxic Dysarthria

Ataxic

Associated with cerebellar damage primarily impacting articulation and prosody.

Can impact respiration, phonation, resonance and articulation.

Speech Characteristics:

Hoarse, breathy vocal quality

Tremors

Irregular/reduced articulatory pattern

Irregular speech rhythm

Unilateral Upper Motor Neuron (UUMN)

Damage to UMN pathway carrying impulses to CNs and spinal nerves.

Deficits most apparent in articulation, phonation and prosody.

Speech Characteristics:

Harsh vocal quality

Reduced loudness

Reduced articulatory precision

Irregular alternating rates

Hyperkinetic Dysarthria

Hyperkinetic

Typically associated with disorders of basal ganglia control circuit (indirect motor loop), cerebellar control circuit or extrapyramidal system.

Primary effects on rate and prosody

Speech Characteristics:

Sudden, irregular breathing patterns

Rapid bursts of speech

Sudden changes of pitch, loudness, and quality

Variable breakdowns of articulatory precision

Hypokinetic

“The dysarthria of Parkinson’s.”

Associated with impairments in basal ganglia control circuit disorders.

Movements are “dampened.”

Speech Characteristics:

Reduced breath support, loudness

Reduced articulatory precision

Rapid bursts of speech with long pauses

https://www.youtube.com/watch?v=ZXJ-khivLrU

Major Differences Across Disorders, I

Verbal Apraxia	Dysarthria	Severe Phonological Disorder
No weakness, incoordination or paralysis of speech musculature	Decreased strength and coordination (leads to imprecise production/slurring)	No weakness, incoordination or paralysis of speech musculature
Inconsistencies in articulation performance	Articulation may be noticeably “different” due to imprecision, but errors generally consistent	Consistent errors that can usually be grouped into categories (fronting, gliding, etc)

https://www.apraxia-kids.org/library/a-comparison-of-childhood-apraxia-of-speech-dysarthria-and-severe-phonological-disorder/

Major Differences Across Disorders, II

Verbal Apraxia	Dysarthria	Severe Phonological Disorder
“Automatic” or well-rehearsed speech is easiest to produce, “on demand” speech most difficult	No difference in how easily speech is produced based on situation	No difference in how easily speech is produced based on situation
Number of errors increases as length of word/phrase increases	May be less precise in connected speech than in single words	Errors are generally consistent as length of words/phrases increases

https://www.apraxia-kids.org/library/a-comparison-of-childhood-apraxia-of-speech-dysarthria-and-severe-phonological-disorder/