2.  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

3.  http://www.youtube.com/watch?v=_Vc m596sUVU&feature=related http://www.youtube.com/watch?v=_Vc m596sUVU&feature=related  http://www.youtube.com/watch?v=cxvL nW5LHlc&feature=related http://www.youtube.com/watch?v=cxvL nW5LHlc&feature=related  http://www.youtube.com/watch?v=a4a 2kOkfQsI&feature=related http://www.youtube.com/watch?v=a4a 2kOkfQsI&feature=related

4.  Motor-speech programming disorder resulting in difficulty executing and/or coordinating (sequencing) the oral-motor movements necessary to produce and combine speech sounds (phonemes) to form syllables, words, phrases and sentences on voluntary (rather than only reflexive) control. oral-motor  Many children are able to hear words, and are able to understand what they mean, but they can’t change what they hear into the fine-motor skill of combining consonants and vowels to form words  Dysarthria is a neurogenic speech disorder caused by dysfunctional or damaged innervation to the speech musculature (tongue, lips, soft palate, facial muscles, larynx).  Results in oral motor weakness & possible voice changes

5.  http://www.youtube. com/watch?v=Vwbv 2X1fpSI&feature=rela ted http://www.youtube. com/watch?v=Vwbv 2X1fpSI&feature=rela ted  http://www.youtube. com/watch?v=EHNS Bo3SsmY&feature=rel ated http://www.youtube. com/watch?v=EHNS Bo3SsmY&feature=rel ated  http://www.youtube. com/watch?v=5AzX ELzqdyM http://www.youtube. com/watch?v=5AzX ELzqdyM

6.  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

7. Four Subsystems of Speech Production:  Respiratory  Phonatory  Resonatory  Articulatory The muscles and muscle groups in these subsystems must be coordinated in time and space – to produce effective speech

8.  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

9.  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)

10.  Extensive practice and experience producing speech leads to motor learning (“permanent changes in capability of movement”)  Many different tx approaches, but mostly all agree on repetition

11.  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

12.  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)

13.  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)

14.  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

15.  Differences occur between individuals in: -ability to compensate -ability to use unimpaired systems -general life response -response to treatment

16.  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

17.  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

18.  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

19.  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

20.  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 (very tight) -dyskinetic (difficulty with involuntary movements)

21. 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

22.  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)

23.  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

24.  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

26.  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

27.  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)

28.  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

29. 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

30.  Important indicator of treatment effectiveness is generalization  Speech production in other tasks and with different conversational partners should be included the routine assessment process

31.  Pre-practice considerations – several conditions should be considered and discussed prior to treatment: -memory -attention -motivation -goal setting -establishing a reference of correctness

32.  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)

33.  Improving voice quality (e.g., postural adjustments, relaxation therapy)  Controlling vocal folds to enhance naturalness of speech  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

34.  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)  Hierarchy of sounds taught (VC, CV)

35.  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