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Speech Disorder

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Wayne Chen

on 12 May 2011

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Transcript of Speech Disorder

Speech
Disorder Apraxia Communication Disorder Speech Disorder Language Disorder Aphasia Dysarthria Dysprosody Motor Speech Disorder Motor Speech Disorder Neurological Speech Disorder Sub-Category Symptoms Inconsistent errors; repetitions and transpositions
Consistent errors; distortions and omissions Melody alterations
Etiology Impaired planning/programming problem
Muscle control problem
Impaired articulator problem
Dysarthia Dysarthria is a collective name for a group of speech disorders resulting from disturbances in muscular control over the speech mechanisms, due to damage to the central or peripheral nervous system.
It is restricted to those speech disorders which have neurogenic origin.

Dysarthia Symptoms Characterised by speech that is: slurred
slow
difficult to enunciate
breathing
rhythm
pitch
volume
tone
resonance Also Affected: The characteristic signs are caused by paralysis or incoordination of the speech musculature. These symptoms can range from mild to severe depending upon the extent of neuron damage.
Types of Dysarthia There are different types of dysarthria each characterised by an altered type of motor function.
These patterns can be differentiated as they sound different and can be used to aid with diagnosis of neurologic disorders. Dysarthia Brain Areas Affected Most patients are diagnosed as having mixed dysarthria as damage is rarely contained to one specific part of the nervous system. Both lower and upper motor neurons are often affected.

Dysarthia Treatment For each type of dysarthria different programmes are designed by speech pathologists. Exercise's are usually involved to increase strength and control over articulator muscles:
Rate: of articulation
Prosody: emphasis and inflection- usually indicates right hemisphere issue
Intensity: volume – seen in hypokinetic (Parkinsonism)
Resonance: ability to alter vocal tract and resonating spaces for correct speech sounds
Phonation: control of vocal folds for appropriate voice quality and valving of the airway
Alternative methods of communication: such as mechanical devises or communication books
Biofeedback: EMG used to reduce lip/ facial spasms
Future Research in Dysarthia Future research regarding dysarthria mainly revolves around finding new methods of treatment
Many new devices have been designed such as phonation detectors which detect the volume of the speaker and works as an artificial larynx Dysprosody Definition: “alterations in intensity, in the timing of utterance segments, and in rhythm, cadency, and intonation of words” (Pinto et al, 2004)
Also known as pseudo-foreign dialect syndrome
The rarest neurological speech disorder
Causes of Dysprosody Brain Trauma
Brain vascular accidents
Craniocephalic traumatisms
Brain Tumors
Motor manifestations; dysarthria, apraxia, aphasia
Symptoms Alterations in the melody of speech: loudness, frequencies, pauses, duration, pitch and breathing
Patient starts to involuntarily alter their accent or pronunciation
According to Sidtis et al (2005), damage to the right hemisphere leads to difficulties in processing pitch and damage to the left hemisphere leads to difficulties in the timing of speech
With further research Sidtis has suggested that damage to the nuclei in the basal ganglia affects fluency and the rate of speech


Dysprosody Neurology Treatment for Dysprosody According to Sidtis et al (2005), damage to the right hemisphere leads to difficulties in processing pitch and damage to the left hemisphere leads to difficulties in the timing of speech
With further research Sidtis has suggested that damage to the nuclei in the basal ganglia affects fluency and the rate of speech


Dysprosody: Future Directions Many speech disorders are closely associated with Parkinson’s disease.
New research is underway – Principles of Motor Learning (PML) e.g. LSVT (Lee Silverman Voice Treatment) Speech therapy
Dysprosody is rare, thus research is limited Group 14
Yin-Ling Ngan, Ann-Marie Rachwan, Wayne Chen, Sara Rankin, Jeena K C, Tanya Dedich, Tanya Dedich, Bernard Saliba, Piergiorgio Valiante, David Gordon, Ebony Elliot, Sara Merhebi Conclsuion Speech disorders can be both neurological and acquired.
There is an overlapping of symptoms and brain areas involved.
To improve treatments, identification of abnormalities needs to be improved.
References Ackermann, H. and Hertrich, I. 1994, ‘Speech rate and rhythm in cerebella dysarthria: An acoustic analysis of syllabic timing’, Folia Phoniatrica et Logopaedica, vol. 46, no. 2,pp. 70–78.
Berthier, M.L., Ruiz, A., Massone, M.I., et al. 1991, ‘Foreign accent syndrome: Behavioural and anatomical findings in recovered and non‑recovered patients’, Aphasiology, vol. 5, no. 2, pp. 129–147.
Cercy, S.P. and Kuluva, J.E. 2009, ‘Gelastic epilepsy and dysprosodia in a case of late‑onset right frontal seizures’, Epilepsy and Behavior, vol. 16, no. 2, pp. 360–365.
Darley, F.L., Aronson, A.E. and Brown, J.R. 1969, ‘Differential diagnostic patterns of dysarthria’, Journal of Speech and Hearing Research, vol. 12, no. 2, pp. 246–269.
Hillis, A.E., Work, M., Barker, P.B., et al. 2004, ‘Re‑examining the brain regions crucial for orchestrating speech articulation’, Brain, vol. 127, no. 7, pp. 1479–1487.
Iuzzini, J. and Forrest, K. 2010, ‘Evaluation of a combined treatment approach for childhood apraxia of speech’, Clinical Linguistics and Phonetics, vol. 24, no. 4–5, pp. 335–345.
Josephs, K.A., Duffy, J.R., Strand, E.A., 2006, ‘Clinicopathological and imaging correlates of progressive aphasia and apraxia of speech’, Brain, vol. 129, no. 6, pp. 1385–1398.
Kent, R.D., Netsell, R. and Abbs, J.H. 1979, ‘Acoustic characteristics of dysarthria associated with cerebella disease’, Journal of Speech and Hearing Research, vol. 22, no. 3, pp. 627–648.
Lebrum, Y. (ed.) 1997, From the Brain to the Mouth: Acquired Dysarthria and Dysfluency in Adults, Kluwer Academic Publishers, Dordrecht, Netherlands.
Murdoch, B. 1998, Dysarthria: A Physiological Approach to Assessment and Treatment, Stanley Thornes Ltd, Cheltenham.
Netsell, R. and Daniel, B. 1979, ‘Dysarthria in adults: Physiologic approach to rehabilitation’, Archives of Physical Medicine and Rehabilitation, vol. 60, no. 11, pp. 502–508.
Ogar, J., Slama, H., Dronkers, N., et al. 2005, ‘Apraxia of speech: An overview’, Neurocase, vol. 11, no. 6, pp. 427–432.
Pinto, J.A., Corso, R.J., Guilherme, A.C., et al. 2004, ‘Dysprosody nonassociated with neurological diseases — A case report’, Journal of Voice, vol. 18, no. 1, pp. 90–96.
Rosenbek, J., Hansen, R., Baughman, C.H., et al. 1974, ‘Treatment of developmental apraxia of speech: A case study’ in Shewan, C.M. (ed.) Speech and Language Disorders: Selected Readings, Harper & Row, New York, pp. 56–65.
Selnes, O. 2006, ‘Apraxia, handedness and language laterality’ Encyclopedia of Language and Linguistics, 2nd edn., Elsevier, Amsterdam, pp. 420–423.

Introduction A type of communication disorder
Normal speech is disrupted
It is different to language disorder (eg aphasia)
Only about 5-10% of the population has completely normal manner of speaking.
Examples of speech disorder
Stutter
Muteness
Dysprosody
Dysarthria
Apraxia Dysprosody Apraxia Dysarthria Apraxia Means 'no action' in Greek
Apraxia is an inability to carry out symbolic or purposeful motor actions.
Apraxia of Speech – Motor speech disorder – inability to execute voluntary movements for speech. Inconsistent articulatory errors
Repetitions
Additions
Transpositions
Prolongations
Omissions
Distortions
Inappropriate prosody
The patient knows exactly what they want to say,
it’s just “how do I make my mouth to say those words”. Area of the Brain Specific implicated areas
Broca’s area
Left frontal and temporoparietal cortex
Left superior, anterior region of the insula
Left subcortical structures
Left superior precentral gyrus of the insula Left Hemisphere Occurs in children and is present at birth
Illness, damage to the brain by accident during early childhood Causes of Apraxia Developmental Apraxia of Speech Acquired Apraxia of Speech Can occur to anyone at any age
Strokes, tumor, trauma, head injury Patient with apraxia frequently have other speech disorders or language disorders Speech therapy for apraxia targets at the inconsistent errors by using: Treatment of Apraxia Emphasis movement sequences
Enunciation emphasis Facilitate the speech therapy for individuals need
Melodic Intonation Therapy Stimulates the creation of more neuronal connections in the right hemisphere Possibility of genetic predisposition
Effect of frequent ear infections
Abnormalities in the brain and other parts of the nervous system Early distinguish between apraxia and late development of speech ability
Distinguish aparaxia from other communication disorders.
Pinpoint specific areas of brain that are involved in the disorder. Future Directions Research on diagnoses and identification Research on causes and natural history Symptoms
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