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Motor Speech Disorders

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Rhiannon White

on 27 March 2013

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Transcript of Motor Speech Disorders

-Some conditions have been shown to enhance acquisition but impede learning and vice versa
-Better when practice sessions are spaced out but with a greater number of practice trials
-Benefit to variable and random practice
(changing the words or mixing up the order)
-Frequent feedback helps acquisitions but hinders retention
-Delaying feedback a few seconds results in greater learning Motor Speech Disorders Rhiannon and Marnie What is a motor speech disorder? are impairments of speech production caused by defects on the neuromuscular system, the motor control system or both.
Deficits in planning, programming and executing speech = unintelligible or non-fluent speech The Resonatory System regulates the resonation or vibration of the airflow as it moves from the pharynx into the oral or nasal cavities
Resonance refers to the effect of the shape and size of the vocal tract on sound quality Systems of Speech Production 1. Respiratory
2. Phonatory
3. Articulatory
4. Resonatory All the systems must work seamlessly together
to produce well-articulated speech -Motor unit is a single control unit that controls more than one degree of freedom
Motor Units: sometimes called motor programs or muscle synergy is an abstract representation of a relatively invariant movement pattern that can be scaled in size to meet the demands of the particular situation Classification Acquired or developmental? Gumball Activity relate to gumball activity Characteristics -Motor planning and programming disorders are caused by an inability to group and sequence the relevant muscles in order to plan or program a movement
-Motor execution are caused by deficits or inefficiencies in basic physiological or movement characteristics of the musculature (muscle tone, movement speed and movement range) Apraxia of Speech: impairment of motor programming and planning that involves an inability to transform a linguistic representation into the appropriate coordinated movements of the articulators (not due to muscle weakness) Apraxia Have effortful slow speech
Increased pauses between syllables and sounds
Sound prolongations
Distortions of speech sounds
Impaired prosody
Reduction of differences in pitch, duration and loudness between stressed and unstressed syllables
Errors that are consistent in type and location Childhood Apraxia of Speech Motor Speech Disorders: Motor Planning are aspects of motor control that occur before initiation of movement Motor Programming Motor Execution the processes that define and sequence articulatory goals (lip closure etc.) prior to their occurrence Planning: refers to the process responsible for establishing and preparing the flow of motor information across muscles for speech production.

It also specifies the timing and force required for the movement Programming: refers to the process responsible for activating relevant muscles during the movements used in speech production Execution: Acquired comes from damage to a previously intact nervous system Developmental: abnormal development of the nervous system or damage to nervous system in early development Severity of Motor Disorders World Health Organization: 4 aspects of disorder: 1. Body Structure 2. Body Function 3. Activity/Participation 4. Contextual Factors Mild Severe What characteristics of abnormal speech do you notice? Characteristics of Apraxia A phonetic-motoric disorder of speech production where children are:
~unable to translate linguistic or phonetic information concerning speech production into accurate motor behaviours
~unable to learn the behaviours to plan speech
~have delays in development of speech production
~have a limited sound inventory. Acquired Dysarthria ~ Caused by disturbances of neuromuscular control of the speech production systems
~Disruption in execution
-Results from underlying muscle tone, reflexes and kinematic aspects of movement such as speed, range, accuracy and steadiness
Dyskinetic Dysarthria: impaired coordination of muscles and involuntary movements including choria (sudden fast flailing, jerking movements) and athetosis (slow writhing movements). Normally all four limbs are also affected and producing speech is hard, strained harsh and low including abnormally large jaw movements which equal imprecise/unintelligible speech Diagnosis
-Assessment should include motor control tasks that involve speech and non-speech movements to determine how much the language and motor systems contribute to observed speech difficulties
-Professions assess them on every level (respiration, phonation, resonation, articulation and prosody) to determine impact on daily life Treatments Treatment Goals -Effortful slow speech
-Prolonged durations of speech sounds
-Speech-sound distortions
- Reduced prosody
-Severe unintelligibility
-Slow progress in therapy Symptoms: -Present at birth
-Usually accompanies a known disturbance of neuromuscular functioning
-Cerebral Palsy is often accompanied by it Developmental Dysarthria Types of Acquired Dysarthria Causes/ Risk Factors Pre/peri/postnatal damage to the nervous system Spastic Dysarthria
Flaccid Dysarthria
Hypokinetic Dysarthria
Hyperkinetic Dysarthria
Ataxic Dysarthria ~Genetic factors
~Deficient oxygen supply
~Exposure to chemicals
~Trauma in delivery
~Premature birth
~Brain abscesses
~Head injuries Measurement Methods ~The most common tool used to diagnose
~Involve judgements of intelligibility, accuracy and speech in speech production
~Help distinguish between motor speech disorders Perceptual Measures ~Involve visual representation of the speech sound wave (spectrogram)
~Allows for detailed examination of speech abnormalities that may not normally be perceptual
~Provides information on pitch, loudness and rate, segmental aspects of vowel accuracy and consonant accuracy and coarticulation Acoustic Measures ~Measurement of physiological aspects of the speech motor system such as muscle strength, endurance and airflow Physiological Measures is an aspect of motor control that occurs at or after the initiation of movement Suggestions to Talk About: Easter Weekend Exams St. Patty's Day Summer Jobs How did this make you feel?
How would this affect someone socially? Comprehensive Motor Speech Evaluation -The goal is to learn or relearn accurate production of speech for improved speech intelligibility
-Motor learning: practice/experience leads to relatively permanent changes in the capability of movement
-Measures of retention as well as acquisitions must occur
-Treatment should aim to facilitate an individual’s underlying capability for movement so that it is possible to complete untrained tasks Treatment Strategies
-Goal is to improve accuracy, stability, and intelligibility of speech and its fluency
-2 primary therapeutic strategies: improve the impaired system and teach compensatory strategies
-Compensatory strategies may include slowing down rate of speech, gestures, writing or alternative and augmentative communication devices (may involve environmental modification) Conditions of Practice and Feedback Summer Vacation Perceptual, acoustic and physiological measures are used Works Cited Hanson, E., Yorkston, D. M. & Britton, D. (2011). Dysarthria in amyotrophic lateral sclerosis: A systematic review of characteristics, and speech treatment, and augmentative and alternative communication options. Journal of Medical Speech-Language Pathology, 19(3), 12-30.

Justice, L. M. (2010). Communication Sciences and Disorders: A Contemporary Perspective (2nd Ed.). Boston: Allyn and Bacon.

Teverovsky, E. G., Ogonowski Bickel, J., & Feldman, H. M. (2009). Functional characteristics of children diagnosed with childhood apraxia of speech. Disability and Rehabilitation, 31(2), 94-102. (Teverovsky, Ogonowski & Feldman. 2009) ~9 years of speech therapy
~Therapy can improve the articulation of target phonemes
~Children with CAS often suffer in social situations (starting and continuing conversations was difficult for 77% of children and 44% had difficulty building peer relationships)
~Children with CAS do worse in school than other children with speech disorders
-Any type of communication other than natural speech or written that meets a person’s needs on either a permanent or temporary basis.
-AAC intervention encompasses communication strategies that require little to no external aids such as: sign language and any portable electronic speech generating devices.
- Benefits: It allows patients to communicate with health care providers as well as friends and family to limit social exclusion. Augmentative and Alternative Communication (AAC)
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