Strategies to improve Speech & Swallowing in Ataxia

MOTOR SPEECH &
SWALLOWING IN ATAXIA
KAREN J. KLUIN, MS, CCC, BC-ANCDS
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DISCLAIMER
The information provided by speakers in any presentation made as
part of the 2013 NAF Annual Membership Meeting is for
informational use only.
NAF encourages all attendees to consult with their primary care
provider, neurologist, or other health care provider about any advice,
exercise, therapies, medication, treatment, nutritional supplement, or
regimen that may have been mentioned as part of any presentation.
Products or services mentioned during these presentations does not
imply endorsement by NAF.
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PRESENTER DISCLOSURES
Karen Kluin, MS, CCC, BC-ANCDS
No relationships to disclose or list
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COMMUNICATION
Dependent on the smooth sequencing:
1. Motor
2. Programming & sequencing in
voluntary production
3. Language
4. Thought/Cognition & Memory
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BREAKDOWN RESULTS IN DISTINCT
COMMUNICATION DISORDERS
1. DYSARTHRIA
2. VERBAL APRAXIA/APRAXIA OF
SPEECH
3. APHASIA/DYSPHASIA
4. LANGUAGE OF GENERALIZED
INTELLECTUAL IMPAIRMENT
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NORMAL MOTOR SPEECH
Requires rapid & smooth fine motor movements of
the speech mechanism:
• Head/Neck
• Face & Lips
• Jaw
• Tongue
• Palatal-Pharyngeal
• Respiratory
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NORMAL MOTOR SPEECH
Involves the motor speech processes of:
•Breathing (Respiration)
•Voicing (Phonation)
•Pronunciation (Articulation)
•Melody or rate of speaking & stress
patterns (Prosody)
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DYSARTHRIA
Motor speech disorder due to central nervous
system or peripheral system dysfunction
resulting in slowness, weakness,
incoordination or change in tone of the speech
musculature
Includes disorders of respiration, voice,
resonance, articulation, and prosody of
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MOTOR SPEECH EVALUATION
•Cranial Nerve/Oral Motor Exam
•Oral Diadochokinetic Rates of
PA, TA, KA, PATAKA
•Perceptual Speech Analysis
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ATAXIA
Disturbances in the timing, speed,
force, range & direction of motion
of the speech mechanism & motor
speech processes results in an
ATAXIC DYSARTHRIA.
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ATAXIC DEVIANT SPEECH
DIMENSIONS
• Excess and Equal Stress
• Irregular Articulatory Breakdown
• Alternating Loudness Variation
• Fluctuating Pitch Levels
• Variable Rate
• Harsh Voice – Transient
• Breathy Voice – Transient
• Altered Nasality – Transient
• Voice Tremors
• Audible Inspiration
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COMMON DEVIANT SPEECH
DIMENSIONS IN ATAXIC
• Respiration: Audible inspirations
• Phonation: Fluctuating pitch levels;
alternating loudness variation;
transient harsh quality; transient
breathy quality; voice tremors
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COMMON DEVIANT SPEECH
DIMENSIONS IN ATAXIC DYSARTHRIA
Resonance: Transient hypernasality;
transient hyponasality
Articulation: Irregular articulatory
breakdown
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COMMON DEVIANT SPEECH
Prosody: Variable speaking rate, excess &
equal stress patterns
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DYSARTHRIA TREATMENT
Goal: To improve the clarity of
speech via compensatory
strategies
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COMPENSATORY DYSARTHRIA
• Sit upright.
• Take a breath of air in prior to speaking.
• Speak slowly.
• Pause frequently. Limit the number of
words you say per breath.
• Say all the sounds in the words,
especially the final sounds of the word
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Dependent upon rapid neuromuscular
coordination of the structures and
muscles in the:
• Mouth/Oral Cavity
• Throat/Pharynx
• Voice Box/Larynx
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ANATOMY
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SWALLOWING
Divided in 3 phases:
• Oral Preparatory & Oral
• Pharyngeal
• Esophageal
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ORAL PREPARATORY
Eating is anticipated
Food is brought to the mouth
Bitten off
Taken from the utensil
Food is chewed and mixed with saliva
Liquids are sipped or sucked through a straw
©ASHA
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ORAL PHASE
The food is collected
Sealed between the roof of the mouth and
the tongue
The tongue moves the food back with a
stripping wave into the back of the
throat (pharynx)
This begins the actual swallow
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PHARYNGEAL PHASE
Soft palate elevates
Preventing food from escaping into the nose
Tongue base moves back to contact
pharyngeal wall
Larynx (voice box) moves up and forward
Epiglottis (top part of larynx) is tilted down
and back to guide the food past the
airway
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PHARYNGEAL PHASE
Breathing momentarily stops
Vocal folds come together to further
protect airway
Muscles of the pharynx contract
Move the food towards the esophagus (tube
leading to stomach)
Upper esophageal sphincter relaxes
Food passes into the esophagus
©ASHA
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ESOPHAGEAL PHASE
Peristalsis (a wave of contraction) moves the
food through the esophagus
The lower esophageal sphincter relaxes to
allow the food to pass into the stomach
©ASHA
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WHAT IS DYSPHAGIA?
Difficulty with eating which may include one
or more of the following
Chewing food
Swallowing solids and/or liquids
Coughing or choking when eating
Food sticking in the throat or chest
It is estimated that more than 15 million
people in the United States have Dysphagia
©ASHA
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ATAXIA
Disturbances in:
• Timing & Speed
• Force
• Range of motion
• Direction of motion
can result in an abnormal swallow or
DYSPHAGIA
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ORAL PHASE
• Loss of bolus control especially of large
sizes due to disorganized anterior to
posterior tongue movements with
portions falling into throat before
ready to swallow
• Biting tongue or sides of mouth due to
discoordination
• Diminished chewing of solids
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PHARYNGEAL PHASE SYMPTOMS
• Sensation of food stuck in throat
after the swallow due to not
chewing solids well
• Episodes of coughing when
eating/drinking too quickly
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SWALLOWING GOAL
Facilitate safe swallowing via use of
basic swallowing suggestions or if
needed compensatory strategies
and/or modification of diet.
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BASIC SWALLOWING SUGGESTIONS
• Sit upright.
• Bring liquid/solid up to mouth.
• Take smaller sips/bites.
• Drink/eat more slowly.
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BASIC SWALLOWING
• Swallow everything in mouth prior to
the next bite or sip.
• Alternate swallows of liquids & solids.
• Do not try to talk and swallow at the
same time.
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• Individualized recommendations based upon
evaluation by a certified speech
pathologist to address individual motor
speech and swallowing needs.
• Carry card with neurologic disorder &
symptoms such as speech, balance,
walking problems with contact information
for emergency situations.
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MOTOR SPEECH &
KAREN J. KLUIN, MS, CCC, BC-
ANCDS
SPEECH-LANGUAGE PATHOLOGY
UNIVERSITY OF MICHIGAN
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