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Case report on speech treatment of a young adult with Down syndrome
Published in Margaret Walshe, Nick Miller, Clinical Cases in Dysarthria, 2021
DS demonstrated language and cognitive deficits as well as dysarthria, in her initial evaluation. She received a 76.2 Aphasia Quotient on the Western Aphasia Battery-Revised (Kertesz, 2006), and results of subtests of the Repeatable Battery for the Assessment of Neurological Status were 16/40 on list learning and naming five items in one minute on semantic fluency. DS’s speech characteristics were consistent with a diagnosis of moderate flaccid dysarthria. Her speech included imprecise consonants, irregular vowels, decreased vocal intensity, an intermittent breathy vocal quality, reduced pitch variation and mild hypernasality. Speech sound errors consisted of consonant substitutions, medial and final consonant deletions and consonant blend simplifications. DS’s speech intelligibility for single words was 62.67% at her initial evaluation. The Goldman Fristoe 2, Test of Articulation (Goldman & Fristoe, 2000) was administered to identify patterns of phoneme errors that could be targeted in treatment.
Signs and Symptoms in Psychiatry
Published in Mohamed Ahmed Abd El-Hay, Essentials of Psychiatric Assessment, 2018
Flaccid dysarthria results from lower motor neurons damage; i.e., affection of cranial nerves, or spinal nerves to diaphragm and abdominal muscles. The chief muscles responsible for speech production, namely, the jaw, lips, larynx, and palate, and tongue are supplied by cranial nerves V, VII, X, and XII respectively. The diaphragm is innervated by the cervical spinal nerves, and the chest and abdominal wall muscles are innervated by the thoracic spinal nerves. regardless of the cause or severity of flaccid dysarthria, the most common speech signs observed include articulation imprecision, hypernasal voice, hoarse and breathy vocal quality, and slow-labored speech rate.
Vocal Motor Disorders *
Published in Rolland S. Parker, Concussive Brain Trauma, 2016
Extrapyramidal disorders are involved in sighing, forced expiration, inability to alter the respiratory rhythm voluntarily, and so on. Limbic stimulation causes inhibition of ventilation, resulting in apnea and hypoxia, with cardiac slowing and hypotension. Laryngeal dysfunction is vulnerable to bilateral lesions of the UMNs, LMNs that supply laryngeal musculature, the extrapyramidal system, the cerebellum and their connections, and the vagus nerve, that is, the superior laryngeal and recurrent laryngeal nerves. Damage to LMNs (spinal and cranial) that supply the muscles of respiration causes a change in speech described as flaccid dysarthria. Unilateral or bilateral damage to the vagus nerve alters displacement of the vocal folds (adduction of the glottis), depending upon whether the lesion is in the brainstem (aphonia due to soft palate paralysis), vagus nerve (aphonia), or its recurrent laryngeal branch (Rosenfield & Barroso, 2000). Abduction or adduction displacement in the vocal folds and supraglottic musculature changes the quality of the voice.
Characteristics of amyotrophic lateral sclerosis in Lebanon-a chart review
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2020
Elia Malek, Helen Ismail, Hassan Doumiati, Johnny Salameh
The mean age of patients with classic ALS at symptom onset was 55.5 years, ranging from 21 to 82 years. 66 (58%) of these patients were males. Most of our male patients were in the age group of 60 to 69 at disease onset and most of the females were in the age group of 50 to 59 at disease onset (Figure 1). 9 (8%) patients had a positive family history of ALS. The mean duration from symptom onset to diagnosis was 10 months. In regard to the site of disease onset, 91 (80%) had a spinal onset while 22 (20%) had a bulbar onset. Patients with spinal onset, 38 (42%) had a cervical onset while 53 (58%) had a lumbar onset. Patients with bulbar onset, only 2 had lower bulbar onset (i.e. respiratory manifestations and flaccid dysarthria) while 20 patients had upper bulbar onset (dysphagia, dysphonia, and spastic dysarthria). During the data collection period, 23 patients died with a median duration from disease onset to demise of 32 months (ranging from 8 to 114 months). Figure 2 shows the distribution of all ALSFRS-R recorded scores over 45months (approximately 4 years) in subjects with classic ALS, where a significant negative correlation (p < 0.0001) was noted between symptom duration and ALS-FRS-R score. According to the ALSFRS-R score progression, 8 (10%) subjects were slow progressors, 44 (57%) were moderate progressors, and 26 (33%) were fast progressors. Figure 3 shows the progression curves of each of the above-mentioned categories.
Role of Constant, Random and Blocked Practice in an Electromyography-Based Oral Motor Learning Task
Published in Journal of Motor Behavior, 2018
Ramesh Kaipa, Roha Mariam Kaipa
On the other hand, a growing body of research suggests that there is no clear dichotomy between nonspeech and speech activities but rather they are on a continuum (Ballard, Robin, & Folkins, 2003; Kent, 2015). Kent mentioned that as the effector (craniofacial and oralfacial) muscles do not transform themselves when alternating between speech and nonspeech tasks, there is certain overlap of biomechanical and motor properties between the two tasks. Ballard et al. proposed an integrative model of speech production to make a case for the clinical utility of nonspeech oral tasks. According to this model speech and volitional nonspeech motor control are integrated into the functioning of a more general motor system where neural and behavioural systems demonstrate areas of overlap. The researchers argued that speech and nonspeech motor control share resources at the lower level of the nervous system as the final output goes through the brainstem and spinal cord. Thus, motor speech disorders such as flaccid dysarthria result in difficulty in tongue movement not only for food bolus manipulation but also for consonant and vowel productions. An additional body of neuroimaging literature has found overlapping cortical areas during vocal and nonvocal tasks (Brown et al., 2009; Brown, Ngan, & Liotti, 2007).
A scoping review of interventions for adults with dysarthria following traumatic brain injury
Published in Brain Injury, 2020
Pooja Gandhi, Shilagh Tobin, Monrada Vongphakdi, Anna Copley, Kerrin Watter
The type of dysarthria, according to conventional dysarthria classification guidelines (54) was mentioned in all but five studies. Of these five studies, three studies described their patients as presenting with “velopharyngeal incompetence,” while the remaining two studies did not specify the dysarthria subtype. All dysarthria subtypes were present across the participants in the included studies, with the exception of hyperkinetic dysarthria. Mixed dysarthria constituted just over 30% of the sample, with spastic-ataxic dysarthria noted to be the most common form, followed by spastic-flaccid dysarthria. Velopharyngeal incompetence was the most frequently occurring characteristic of dysarthria.