1. Chapter 6: Motor Speech Disorders: Apraxia and Dysarthria
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

2. Focus Questions What is a motor speech disorder?
6.1
Focus Questions
What is a motor speech disorder?
How are motor speech disorders classified?
What are the characteristics of prevalent types of motor speech disorders?
How are motor speech disorders identified?
How are motor speech disorders treated?
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

3. 6.2
Introduction
Speech production is one of the most “impressive motor skills”
Control of speech movements follows a course of development up to age 12; humans acquire adult-like speech motor control by adolescence
Childhood motor speech problems most likely caused by neurological difficulties, and adults can experience also after injuries or illnesses
Two major categories: apraxia and dysarthria
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

4. 6.3
Case Study #1: Bob
42-year old bilingual, married with four children, travels, coaches soccer, involved in community activities
Diagnosed with cerebellar tumor, removed successfully, but effects from surgery…
Severely ataxic, difficulties coordinating voluntary movements, under- and over-shooting movements, and tremor
Now requires wheelchair and only about 30% of speech is intelligible
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

5. 6.4
Case Study #1 Questions
What are some ways Bob’s communicative difficulties affect his participation in life?
What types of strategies might you suggest to improve Bob’s participation in life?
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

6. 6.5
Case Study #2: Walter
60-year old professor, likes to read, play tennis, improve the house, and play piano
Age 59, left hemisphere stroke – now slow, effortful, and inconsistently distorted speech and weakness in right side of body, including oral structures (e.g. lips)
SLP diagnosed him with mild aphasia and mild apraxia of speech – 95% intelligible
Justice Communication Sciences and Disorders: An Introduction
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7. 6.6
Case Study #2 Questions
On which of Walter’s strengths might you attempt to capitalize in developing a treatment plan?
Discuss some specific ways in which Walter’s participation in life is affected by his speech problems.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

8. 6.7
Case Study #3: Hikaru
5-year old came to U.S. from Japan at 2, primarily English speaker, but understands Japanese also
Referred to evaluation by mother – fewer sounds during babbling stage, history of drooling and hypotonia, asymmetries between L and R hemispheres (cerebral palsy), delays in syntax and phonology, speech is imprecise and weak
Weakness limited to articulatory system, and does not show characteristics consistent with apraxia of speech
Mother wants to hold back in kindergarten
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

9. 6.8
Case Study #3 Questions
Japanese is a language that does not have consonant clusters and syllable-final consonants (“truck”). Why is this important information for evaluation and diagnosis? What other differences between Japanese and English might be relevant for fully understanding Hikaru’s problems?
What are some pro’s and con’s of holding Hikaru back for a second year of kindergarten?
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

10. I. What is a Motor Speech Disorder?
6.9
I. What is a Motor Speech Disorder?
Speech production deficit that results from impairment of the neuromuscular and/or motor control system
May co-occur with other language impairments
Other oral movements (besides speech) may be impaired, including chewing and smiling
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

11. Terminology Four Subsystems of Speech Production: Respiratory
6.10
Terminology
Four Subsystems of Speech Production:
Respiratory
Phonatory
Resonatory
Articulatory
The muscles and muscle groups in these subsystems must be coordinated in time and space
Justice Communication Sciences and Disorders: An Introduction
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12. Respiratory System Speech production requires airflow
6.11
Respiratory System
Speech production requires airflow
Pulmonary airstream mechanism: pushes air out of lungs through trachea (windpipe) to produce airflow
Ingressive – inhalation
Egressive – exhalation
-1:6 inhalation:exhalation ratio during speech production
Exhalation cycle needs to be extended in time (for completion of utterance) and modulation (to reflect stress)
Justice Communication Sciences and Disorders: An Introduction
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13. 6.12
Phonatory System
Includes various muscles and structures in the larynx, and regulates the production of voice and the intonational aspects of speech
Vocal folds are brought closely together, and the airflow builds up to set the vocal folds into vibration
Vocal folds are stretched lengthwise to manipulate the frequency or pitch of the voice
Justice Communication Sciences and Disorders: An Introduction
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14. 6.13
Resonatory System
Regulates the vibration of the airflow as it moves from the pharynx into the oral and nasal cavity
Manipulates shape and size of vocal tract for maintaining normal sound quality
Manipulates the velo-pharyngeal port, (whether nasal cavity is used as a vibrating chamber) for determining nasality of sounds
oral vs. nasal sounds – b and p vs. m and n
Justice Communication Sciences and Disorders: An Introduction
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15. 6.14
Articulatory System
Control of the articulators within the oral cavity to manipulate the outgoing airflow
Major structures: lower jaw, lips, tongue (most important)
Tongue: intrinsic muscles (fine-tuned movements) and extrinsic muscles (coarse movements – protrusion, retraction, elevation, depression)
Muscles contract to create constrictions in the oral cavity to produce varying sounds
Justice Communication Sciences and Disorders: An Introduction
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16. 6.15
Motor Control
To maintain speed and fluency, the sequences of movements are programmed together as a single movement unit
Degrees of freedom: the number of elements that can be independently controlled
The greater the degrees of freedom, the greater the challenge to the speaker
Speakers reduce the number of degrees of freedom by organizing motor actions into motor units
Justice Communication Sciences and Disorders: An Introduction
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17. 6.16
Motor Units
Motor unit: single control mechanism that controls more than one degree of freedom
Basic pattern of movement components remains constant, while more specific aspects of movements are influenced by specific circumstances
Producing speech involves producing both linguistic units and acoustic events
This requires coordination of muscle groups and programming muscle activities into single motor units to ensure fluent and accurate articulation
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

18. Planning, Programming, and Execution
6.17
Planning, Programming, and Execution
Motor planning: processes that define and sequence articulatory goals (prior to initiation of movement)
Motor programming: processes that establish and prepare the flow of motor info across muscle, as well as control timing and force of movement (prior to initiation of movement)
Motor Execution: processes that activate relevant muscles (during and after initiation of movement)
Justice Communication Sciences and Disorders: An Introduction
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19. 6.18
Motor Learning
Extensive practice and experience producing speech leads to motor learning (“permanent changes in capability of movement”)
Schema Theory: memory representations of motor specifications needed to reach a desired speech outcome (schemas)
become stronger with experience
person uses stored schema to produce desired speech outcomes
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

20. Prevalence and Incidence
6.19
Prevalence and Incidence
Reliable estimates are rare, however…
Among adults with acquired communication disorders, 51% have motor speech disorders (46% dysarthria, 5% apraxia of speech)
Among children with developmental communication disorders, about 5% have motor speech disorders
-Difficulty to find estimates because of difficulties in identification and long standing debates about diagnosing motor speech problems in children
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

21. II. How are Motor Speech Disorders Classified?
6.20
II. How are Motor Speech Disorders Classified?
ETIOLOGY:
Acquired: damage to a previously intact nervous system
-caused by cerebrovascular accidents (strokes) degenerative diseases, brain tumors or traumatic brain injury
Developmental: abnormal development of or damage to the nervous system
-caused by congenital diseases, or damage to the developing nervous system (different effects than damage to an already intact system)
Justice Communication Sciences and Disorders: An Introduction
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22. 6.21
MANIFESTATION:
Impairments of Planning/Programming: coordination of relevant muscles and muscle groups is disrupted (muscle physiology and movement is intact)
Impairments of Execution: disruptions in muscle physiology – affected by involuntary movements and reductions in movement abilities (whether speech is programmed normally or not)
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

23. World Health Organization (WHO):
6.22
SEVERITY:
World Health Organization (WHO):
Disease: underlying physiological condition or psychological cause
Activity: actual behavioral or performance deficits that result from the disease
Participation in life: how the disease impacts upon quality of life of individual at home, school, work, and in the community
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

24. INDIVIDUAL DIFFERENCES: Differences occur between individuals in:
6.23
INDIVIDUAL DIFFERENCES:
Differences occur between individuals in:
-ability to compensate
-ability to use unimpaired systems
-general life response
-response to treatment
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

25. 6.24
III. Defining Characteristics of Prevalent Types of Motor Speech Disorders
Motor Planning/Programming Disorders: inability to group and sequence the relevant muscle with respect to each other
-apraxia of speech (AOS) – acquired and developmental
Motor Execution Disorders: deficits in physiology and movement abilities of muscles
-dysarthria – acquired and developmental
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

26. 6.25
Acquired AOS
Inability to transform an intact linguistic representation into coordinated movements of the articulators
Characteristics: slow speech, sound distortions, prolonged durations of sounds, reduced prosody, consistent errors within an utterance, difficulties initiating speech, groping of articulators
Caused by neurological damage to the left frontal cortex surrounding Broca’s Area – due to stroke, brain injuries, illness, and infections
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

27. 6.26
Childhood AOS
Salient characteristics of this disorder is the same as acquired AOS
Considerable delay in speech production, limited sound inventory, unintelligibility, and progress slowly in speech therapy
Causes are not well understood; some research points to hereditary component, not clear there is specific neurological damage
Some cases caused by stroke or traumatic brain injury
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

28. 6.27
Acquired Dysarthria
Disruption in the execution of speech movements resulting from neuromuscular disturbances to muscle tone, reflexes, and kinematic aspects of movement
Speech sounds slow, slurred, harsh or quiet, or uneven depending on the type of dysarthria
Three concepts: spasticity, dyskinesia, ataxia
Typically occurs because of a progressive disease or trauma
Justice Communication Sciences and Disorders: An Introduction
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29. Types of Acquired Dysarthria
6.28
Types of Acquired Dysarthria
Spastic
Flaccid
Hypokinetic
Hyperkinetic
Ataxic
Unilateral Upper Motor Neuron (UUMN)
Justice Communication Sciences and Disorders: An Introduction
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30. Developmental Dysarthria
6.29
Developmental Dysarthria
Present at birth
Usually occurs along with known disturbance to neuromotor functioning
Can be caused by pre-, peri-, or post-natal damage to the nervous system
Most common types:
-spastic
-dyskinetic
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

31. IV. How are Motor Speech Disorders Identified?
6.30
IV. How are Motor Speech Disorders Identified?
The Assessment Process:
-professionals consider how the disorder affects the individual’s life to determine the impairment and the course for treatment
-assessment of motor speech disorders should include measures of nonspeech oral motor skills and should isolate particular motor subsystems to determine impairment
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

32. 6.31
Measurement Methods
Perceptual measures – perceptual judgments of intelligibility, accuracy, and speed of speech production (most common)
Acoustic measures – visual representation of the speech sound wave (e.g., spectogram) for more detailed and objective view of speech problems
Physiologic measures – measurement of physiologic aspects of speech motor system not easily perceived otherwise (e.g., muscle strength)
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

33. Referral and Screening
6.32
Referral and Screening
Referral – typically from a hospital, school, or parents of child – depending on whether acquired or developmental disorder
Screening – includes interviews with patient and family and review of medical history
Justice Communication Sciences and Disorders: An Introduction
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34. Comprehensive Motor Speech Evaluation
6.33
Comprehensive Motor Speech Evaluation
Should involve motor control tasks that involve speech and nonspeech motor activities
Should assess the motor speech problems at each of the levels of functioning – disease, activity, and participation in life
Should include assessment of each of the subsystems separately – respiration, phonation, resonation, articulation, and also include prosody
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

35. 6.34
Diagnosis
After assessment, findings are interpreted to come up with a speech diagnosis
In current practice, differential diagnosis is based largely on auditory perceptual measures (the professional’s perceptual observations), not yet on objective acoustic and physiologic indicators
Diagnosis involves understanding the hit rate, miss rate, false positive rate, and the correct rejection rate
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

36. V. How are Motor Speech Disorders Treated?
6.35
V. How are Motor Speech Disorders Treated?
Treatment focuses on (re)learning motor aspects of speech production, which requires acquisition, retention, and generalization
Acquisition: temporary improvements during treatment
Retention: lasting performance enhancements
Generalization: improvements in either related but untrained behaviors (response) or in targeted behaviors in different contexts, tasks, or settings (stimulus)
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

37. 6.36
Treatment Targets
Use of nonspeech tasks (e.g., pursing the lips, smiling, moving the tongue) in assessment does not mean that nonspeech tasks should be used in treatment
Little research supports “oral motor activities” to strengthen the articulators or improve their movements
Focusing on more complex targets results in greater learning than focusing on simpler targets
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

38. Treatment Strategies Primary Strategies: Two Approaches
6.37
Treatment Strategies
Primary Strategies: Two Approaches
Improve impaired subsystem – focus on specific functions in relevant speech tasks
e.g., improve respiratory support for speech
Compensatory strategies
… for the affected individual
… for the environment
… for the communication partners
Justice Communication Sciences and Disorders: An Introduction
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39. 6.38
Treatment Contexts
Important indicator of treatment effectiveness is generalization
Speech production in other tasks and with different conversational partners should be included the routine assessment process
Justice Communication Sciences and Disorders: An Introduction
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40. 6.39
The Treatment Plan
Pre-practice considerations – several conditions should be considered and discussed prior to treatment:
-memory
-attention
-motivation
-goal setting
-establishing a reference of correctness
Justice Communication Sciences and Disorders: An Introduction
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41. Treatment of Respiratory System
6.40
Treatment of Respiratory System
Establishing respiratory support (e.g., making postural adjustments)
Modifying inhalation (e.g., increasing duration of air intake)
Modifying exhalation (e.g., vowel prolongation)
Improving inhalation/exhalation relationship
Increasing respiratory flexibility (e.g., producing words with a variety of stress patterns)
Justice Communication Sciences and Disorders: An Introduction
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42. Treatment of Phonatory System
6.41
Treatment of Phonatory System
Improving voice quality (e.g., postural adjustments, relaxation therapy)
Controlling vocal folds to enhance naturalness of speech
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

43. Treatment of Phonatory System
6.42
Treatment of Phonatory System
Improvement of strength and control of velo-pharyngeal port (e.g., practicing nasal vs. oral airflow patterns)
Might be necessary to use a palatal lift – a device that helps raise the velum – depending on severity of subsystem impairment
Justice Communication Sciences and Disorders: An Introduction
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44. Treatment of Articulatory System
6.43
Treatment of Articulatory System
Focus the patient’s attention to the accuracy, range, and direction of movement during speech
Feedback from the clinician can include articulatory placement cues (e.g., modeling speech production)
Justice Communication Sciences and Disorders: An Introduction
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45. Treatment of Prosody and Rate Control
6.44
Treatment of Prosody and Rate Control
Prosody involves manipulation of three factors: loudness, pitch, and duration
Each of these factors should be focused on during treatment
Approaches to reducing the rate of speech:
-rigid control techniques
-non-rigid control techniques
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.