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Part I. Primary Topics 1.


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Nonspeech Assessment of the Speech Production Mechanism 4. Acoustic Analysis of Motor Speech Disorders 5. Aerodynamic Assessment of Motor Speech Disorders 6. Flaccid Dysarthria 9. Ataxic Dysarthria Hyperkinetic Dysarthria Hypokinetic Dysarthria Spastic Dysarthria Speech Impairment Secondary to Hearing Loss Adult-Onset Neurogenic Stuttering Apraxia of Speech Pathology Alport Syndrome Amyotrophic Lateral Sclerosis Angelman Syndrome Apraxia of Speech in Childhood Athetoid Cerebral Palsy Cerebellar Mutism Corticobasal Degeneration Creutzfeldt-Jakob Disease Deletion Syndrome Duchenne Muscular Dystrophy Ehlers-Danlos Syndrome Encephalitis Fragile X Syndrome Hashimoto's Encephalopathy Huntington's Disease Klippel-Feil Syndrome Landau-Kleffner Syndrome Moyamoya Multiple Sclerosis Myasthenia Gravis Neurofibromatosis Type 1 Neurofibromatosis Type 2 Oromandibular Dystonia Parkinson's Disease Pick's Disease Postpolio Syndrome Minett 3.

Postdoctoral Fellow in Neuroscience. Dysfunction in the basal ganglia circuits is a determining factor in the physiopathology of the classic signs of Parkinson's disease PD and hypokinetic dysarthria is commonly related to PD. Regarding speech disorders associated with PD, the latest four-level framework of speech complicates the traditional view of dysarthria as a motor execution disorder. Based on findings that dysfunctions in basal ganglia can cause speech disorders, and on the premise that the speech deficits seen in PD are not related to an execution motor disorder alone but also to a disorder at the motor programming level, the main objective of this study was to investigate the presence of sensorimotor disorders of programming besides the execution disorders previously described in PD patients.

A cross-sectional study was conducted in a sample of 60 adults matched for gender, age and education: 30 adult patients diagnosed with idiopathic PD PDG and 30 healthy adults CG. All types of articulation errors were reanalyzed to investigate the nature of these errors. Interjections, hesitations and repetitions of words or sentences during discourse were considered typical disfluencies; blocking, episodes of palilalia words or syllables were analyzed as atypical disfluencies.

Orofacial agility was also investigated. The PDG had worse performance on all sensorimotor speech tasks. All PD patients had hypokinetic dysarthria. The clinical characteristics found suggest both execution and programming sensorimotor speech disorders in PD patients. O grupo com DP obteve pior desempenho em todas as tarefas de fala. Parkinson's disease PD is characterized by a degeneration of neurons in the substantia nigra of the mesencephalon, leading to a fall in dopamine production.

Dysfunction in the basal ganglia circuits is a determining factor in the physiopathology of the classic signs, and hypokinetic dysarthria is commonly related to PD. Regarding speech disorders associated with PD, the latest four-level framework of speech sensorimotor control 2 proposed complicates the traditional view of dysarthria as just a motor execution disorder. This model proposes different phases of the transformation of speech code involving the different neural structures. These phases are identified as linguistic-symbolic planning, which is a nonmotor or premotor process, motor planning, motor programming and execution.

According to the cited author, 2 Linguistic Symbolic Planning is the phase where linguistic rules of language are involved and this level of processing is nonmotor in nature so typical symptoms are aphasia signs. During the Motor planning phase a gradual transformation of symbolic units phonemes into a code that can be handled by the motor system takes place. Speech signs and symptoms resulting from disorders in motor planning can include slow, struggling speech with distortions and even apparent substitutions. Motor programming is a phase that determines the spatiotemporal and force dimensions such as the amount of muscle tension needed, velocity, direction and range.

A disorder at this level can result in impairment in these aspects and repeated initiation. Finally, during the execution phase, the hierarchy of plans and programs is finally transformed into non-learned automatic motor adjustments.

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The role of the structures such as the basal ganglia and the lateral cerebellum in both motor programming and execution suggests the possibility of dual symptomatology in certain types of dysarthria, particularly in the parkinsonian hypokinetic type. It is well known that the circuits in the basal ganglia play a fundamental role in the mechanisms of stuttering commonly present in these patients. Disfluencies in PD patients may be analogous to limb motor symptoms such as difficulty with the initiation of motor movements and festination of gait observed in walking.

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In a previous study, 5 a Speech Fluency Assessment Protocol 6 was applied to classify typology of disruptions into typical or atypical disfluencies. The atypical disfluencies such as repetitions of syllables; repetition of sounds; prolongation; blocking; pauses over two seconds and intrusions of sounds or segments and episodes of palilalia, characterized by the presence of repetitions of syllables over four times and words over three times , with or without acceleration of speech rate were analysed.

The authors found that PD subjects had a significantly higher number of speech disfluencies overall compared to control subjects. In light of this, most of the characteristics described by the authors might be related to motor programming problems, especially considering the current view that the most prominent disfluency type in PD is sound repetition, followed by initial syllable and word repetitions and some prolongations.

Apraxia of speech is believed to result from a motor planning deficit. In a previous study on apraxia of speech in PD, the authors found that half of the PD patients presenting dysarthria also had apraxia of speech. Another approach is the use of Nonspeech Assessment for understanding the speech production mechanism.

Darley et al. There is continuing debate over the utility of nonspeech tasks for informing clinical diagnosis. The authors stated that, nonspeech tasks can provide useful information about the functioning of the motor system. Based on findings that dysfunctions in basal ganglia can cause fluency of speech deficits, and on the premise that the speech deficits seen in PD are not related to an execution motor disorder alone but also to a disorder at the motor programming level, the main objective of this study was to investigate the presence of sensorimotor disorders of programming besides the execution disorders previously described in PD patients.

All participants signed a free and informed consent form. The patients participating in the study were diagnosed with PD, had not undergone neurosurgery, were at stages 2, 2.

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Thus, subjects at initial or advanced stages of the disease were excluded from the sample because individuals at the initial stage may not have impaired speech while, in advanced cases, speech samples may be unintelligible or insufficient. First, the patients were submitted to the Protocol for Dysarthria Assessment. For the sensorimotor speech disorders assessment, the subjects told a story based on sequences of pictures composed of seven drawings and also described a typical day to produce a sufficient speech sample for subsequent analysis.

The orofacial agility task comprises oral commands such as tongue to alternate corners of the mouth, protrude and retract tongue, tongue alternately to upper and lower teeth, purse lips and release, open and close mouth, retract and release lips. The subject must perform the movements correctly in terms of programming and timing. On the speech agility task, the subject has to repeat words as fast as they can in a correct fashion. The score is given according to correct repetition and timing.

Speech errors were analysed using the same criteria as presented below. Data collection was carried out on an individual basis. The data were obtained from a sample of a previous study 5 in which fluency disorders were analysed. In that study, episodes of palilalia, number of hesitations; interjections; revisions; unfinished words; repetition of words, segments and sentences, repetitions of syllables; repetition of sounds; prolongation; blocking; pauses and intrusions of sounds or segments and also speech rate, were analyzed as fluency disorders.

In the present study, all types of articulation errors were reanalyzed to investigate the nature of these errors. In this new analysis, interjections, hesitations, repetitions of words or sentences during discourse were considered typical disfluencies; blocking, episodes of palilalia words or syllables were analysed as atypical disfluencies. We analysed features including successive self-initiated trial, phoneme distortions, self-correction, repetition of sounds and syllables, prolonged movement transitions, addition or omissions of sounds and syllables, all of which can be related to programming disorders of sensorimotor control of speech.

It is noteworthy that successive self-initiated trial, phoneme distortions, addition and omission can also been found in planning disorders. The features present on each test were scored with 1 point. Total score was calculated by summing all feature scores. Statistical analysis. Categorical data were compared using the Chi-squared c 2 test without Yates comparison with application of Fisher's exact test when Cochran's restrictions were present. A probability p of less than 0.

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Of this total, 10 were not included in the sample because they did not attend the scheduled session. Thus, a total of 30 patients followed the protocol, in addition to 30 controls. The data from these 60 subjects were considered in the subsequent analyses. General characteristics.

The age of subjects in the sample ranged from 50 to 75 years, with a mean age Clinical characteristics of PD patients. Of the single users, five used levodopa and one pramipexole. Dysarthria assessment results. The distribution of changes, according to study group: face rigidity, tremor of tongue, increased respiration, decreased maximum phonation time MPT , altered resonance, reduced articulation strength, slow alternate motion rate AMR , reduced articulation amplitude and change in voice quality are shown in Figure 1. Assessment of non-verbal and verbal praxis.

For the purposes of intragroup comparison of two types of apraxia, we calculated the proportion of correct responses on the oral agility tests of each individual to standardize the results. This comparison revealed that the proportion of correct responses on the task assessing verbal praxis was significantly higher than on the tasks assessing non-verbal praxis in both groups. CG: 0. The most relevant finding of this study was that analysis of all features of speech clearly suggested impairments at the motor programming and execution level in the patients with Parkinson's disease.

The idea of reanalyzing separately all types of errors had the principal goal of identifying the occurrence of programming disorders. The finding of these alterations in a few individuals may be related to aging.

Clinical Management of Sensorimotor Speech Disorders - كتب Google

In the PD group, alterations were observed in all motor bases and it was clearly possible to statistically differentiate the two groups. All PD patients presented dysarthria. In Table 1 , it can be observed that different speech errors were more evident in the PD group. Speech errors were identified in three speech samples: telling the story, describing a day, and the agility task of the Boston test.

An analysis of errors committed on the oral agility task showed that eight of the 30 patients from the PDG had motor programming of speech deficits, not observed in the control group. During this task, syllable repetition was the only feature present in the PDG.


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  4. Although the syllable repetition featured by the PDG patients can be present in both neurogenic stuttering and speech apraxia nowadays regarded as a motor planning disorder , making it hard to differentiate between the conditions, some considerations should be taken into account. First, stuttering associated with acquired neurological disorders can mask the presence of other communication problems.

    However, accurately distinguishing between these syndromes remains challenging.