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Dysarthria

1. Speaker-oriented treatment

Respiration (nonspeech respiratory exercises, such as blowing into a glass manometer to improve respiratory support and subglottal air pressure.).

Phonation (increase the utterance length per breath group and to obtain loudness levels that are appropriate to the social context. Patients with unilateral or bilateral vocal fold weakness would benefit from effort closure techniques)

Resonance (many believe that patients do not benefit from behavioral interventions)

Articulation (strength training, relaxation, stretching, and instrumental biofeedback. Traditional approaches can also be applied)

Rate (There are many ways to reduce rate, including prosthetic devices such as delayed auditory feedback (DAF), or natural methods, such as hand or finger tapping in pace with syllable production, using visual feedback from a screen, or rhythmic cueing).

Prosody and naturalness (working at the level of the breath group, including chunking utterances into natural syntactic units, and contrastive stress tasks)

2. Speaker-oriented for specific

a. Flaccid (examples include pushing/pulling exercises).

b. Spastic (relaxation exercises as well as stretching exercises)

c. Ataxic (modifying rate and prosody)

d. Hypokinetic (Lee silverman voice treatment).

e. Hyperkinetic (primarily surgical and pharmacological.)

f. Unilateral upper motor neuron (no formal reports of treatment)

g. Mixed (targeting the different dysarthrias present, however one must be conscious of contraindicated treatments)

3. Communication-oriented treatment

Apraxia of Speech

It is important to distinguish between the different types of Apraxia namely: Acquired versus developmental apraxia.

Therapy for developmental apraxia includes 1) traditional articulation training procedures and 2) special training techniques.

Therapy for DAS :

Adapted cueing technique, melodic intonation therapy, the prompt system (which uses prompts for restructuring oral muscular phonetic targets), total communication, touch cue system, and STP which is signed target phoneme approach. These methods use imitation, auditory-visual stimulation, phonetic placement, and motor repetition, as strategies to aid the patient.

Developmental AOS: acquisition of as normal volitional speech as physiological limitations will allow, emphasizing movement sequence, Generating tasks according to the phonetic principles, Limiting the number of stimuli presented to the patient

Acquired AOS: concentrated drill work, Imitation of sustained vowels and consonants followed by the production of simple syllable shapes, Movement patterns and sequences of sounds, Avoidance of auditory discrimination drills, Slow rate, self-monitoring, the use of core vocabulary words and carrier phrases

Therapy for both include: using mirror work and imitation of tongue and lip movements, Imitation of sustained vowels with exaggerated lip movements, Imitation of visible consonants, The use of diphthongs paired with consonants to introduce stress and intonation patterns, Imitation of CVC shapes

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References

Duffy, J. R. (2019). Motor speech disorders e-book: Substrates, differential diagnosis, and management. Elsevier Health Sciences.

Pannbacker, M. (1988). Management strategies for developmental apraxia of speech: A review of literature. Journal of Communication Disorders, 21(5), 363-371.

Knollman-Porter, K. (2008). Acquired apraxia of speech: a review. Topics in stroke rehabilitation, 15(5), 484-493.

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Hello again! Welcome back to our podcast. Today, we will be talking about assessment of MSDs.

Areas of general assessment include taking a case history, including onset, diagnosis, symptoms, and medications; patient and family report; review of previous assessments; educational, linguistic and cultural backgrounds; cognition; swallowing.

Dysarthria: .

One can use both standardised and non-standardized measures when assessing dysarthria.

Assessments of dysarthria generally are perceptually based, as stated in our previous podcast, and assess respiration, phonation, oral motor, and velopharyngeal function and articulation.

. An example of a formal assessment measure is the EAIS, which uses a sliding scale.

Prosody—

• Use connected speech (reading and spontaneous speech) to observe variations in pitch, loudness, and duration.
• Use targeted prosodic tasks, including asking and answering questions; contrastive stress tasks; and reading statements using prosodic variation to express different emotions.

Speech Intelligibility—

· Use material unknown to the listener and with low semantic predictability.

• Include words that provide a sampling of most of the phonemes.
• Tasks include single-word production and sentence production

Comprehensibility—

· Materials and tasks are similar to those used to assess speech intelligibility.

• Various cues are provided to the listener.

Efficiency—

• Sentence-level materials and tasks are similar to those used to assess speech intelligibility and comprehensibility.

Apraxia of Speech:

Assessment of AOS:

Assessment of AOS is vital for diagnosis and determining the severity of the impairment.

The errors that are common in AOS fall into two primary categories, namely, segmental errors affecting the quality of the speech sounds that are produced and/or distortions that may exist in consonants and vowels and secondly, suprasegmental errors that affect the prosody of speech which may include hesitations and pauses. The predominant method used for assessing the type, degree and presence of these errors is perceptual judgement of speech in both connected speech tasks and single words.

These perceptual tests include:

• Articulation tests
• Transcription of connected speech samples
• Comprehensive motor speech examinations that test speech production overy varying contexts
• Intelligibility tests- that reveal clusters or specific patterns of speech behaviours

Other perceptual measures include Token-to Token Inconsistency assessment tests. This is known as the DEAP inconsistency subtest. In this subtest, there is a standardised 25 word picture naming subtest to elicit word level token to token inconsistency. An ECI, which is a raw score calculated as the sum of the different errors, is then calculated. The ECI measure is correlated strongly to the token-to-token variability of productions at word level and measures of speech severity.

To conclude, assessment for AOS is broad and relies primarily on perceptual measures. Within incorporating these measures into the assessment, it is vital to use the ICF framework as a measure to ensure a functionally and contextually relevant assessment for your patient.

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References

Lowit, A., & Kent, R. D. (2010). Assessment of motor speech disorders. Plural pu

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Dysarthria is a speech disorder caused by a lack of muscle control that occurs when parts of the brain that control speaking are damaged. It cannot be cured or reversed; however therapy can improve one’s speech. This may result in slurred speech but can also cause atypical rhythm of speech and tone. This is dependent on the type of dysarthria.

Types include flaccid, spastic, unilateral upper motor neuron dysarthria, ataxic, hypokinetic, hyperkinetic, or mixed.

Apraxia of speech refers to a motor speech disorder that is characterised by an impairment in the ability to coordinate the articulatory and sequential movements needed to produce accurate speech sounds. AOS, however, is distinctive in terms of its motor component and impairment in the planning and programming of speech articulators to produce effective speech.

Articulatory errors and prosodic abnormalities are known as hallmarks of apraxia of speech.

Apraxic speakers struggle applying correct prosodic elements to speech. Pauses between words and syllables are also common and their speech is notably slow in rate.

It is firstly important to distinguish the disorder from conduction and broca’s aphasia as well as dysarthria. The confusion between AOS and Broca’s aphasia usually occurs since the disorders often co-occur. Additionally, conduction aphasia is often confused with AOS since both disorders present with additions, substitutions and/or omissions. However, the nature of these errors is distinguishable and differs across disorders. The sound errors in conduction aphasia show a deficit in the selection of phonemes which translates as a language deficit. Apraxics, however, correctly select phonemes yet struggle with their motor execution. Persons with conduction aphasia typically have normal prosody and effortful speech, whereas effortful speech and abnormal prosody are hallmarks of AOS. Patients with conduction aphasia are often unaware of their errors and the opposite is true for apraxics, who are well aware of their errors.

AOS differs from dysarthria as dysarthria is caused by an impairment of tone, muscle strength and range of motion while AOS is not caused by an impairment in these areas. The errors in dysarthric speech are typically predictable and consistent while the errors in AOS are irregular and inconsistent.