We are pleased to announce that Sandra L. Schneider, Ph.D., will lead us in a
chat tonight, Monday, April 22, 2002, about Motor Speech Disorders (Apraxia &
Dysarthria).  Dr. Schneider is an Assistant Professor in the Department of
Speech and Hearing Science at The Ohio State University.  Her areas of interest
include neurogenic communication disorders in adults which encompasses the
aphasias, motor speech disorders, right hemisphere disorders, TBI, dysphagia,
and the neurodegenerative disorders.  Dr. Schneider is also interested in
neurolinguistic and psycholinguistic aspects of agrammatic aphasia, and
diagnostic and research aspects of motor speech disorders.  Dr. Schneider has
published many professional articles on these topics.

<Robin>  Welcome! We are chatting tonight with Dr. Sandra Schneider about motor speech disorders
          (apraxia & dysarthria).
<Sandra Schneider>  Motor speech disorders emcompasses the dysarthrias and apraxia of speech.
<Sandra Schneider>  There are six major types of dysarthria, all are localized to different parts
          of the neurological system.
<Adrienne>  How common are motor speech disorders? More in the adult population?
<Sandra Schneider>  The exact prevalency figures are hard to estimate, but considering they
          usually accompany individuals that have had stroke, fairly common.
<Sandra Schneider>  Also, they announce the presence of any neuro degenerative disease process.
<Sandra Schneider>  They also are fairly common in children - cerebral palsy, muscular dystrophy,
          developmental apraxia of speech.
<Robin>  What are the major types of dysarthria?
<Sandra Schneider>  The types of dysarthria are flaccid, spastic, hypokinetic, hyperkinetic,
          unilateral upper motor and ataxic. I think I'm leaving one out.
<Adrienne>  "mixed"?
<Sandra Schneider>  thanks 
<Adrienne>  How important is it to distinguish or identify the type for treatment purposes?
<Sandra Schneider>  I think it is extremely important, both for localization of lesion and
<Adrienne>  So you would treat one differently than the other?
<Sandra Schneider>  Definitely. How you treat a flaccid dysarthria would be much different than
          a spastic or ataxic.
<Adrienne>  ok
<Sandra Schneider>  Hypokinetic is usually associated with Parkinson's disease which is
          different than ataxic.
<Sandra Schneider>  A common type of mixed dysarthria is associated with ALS - mixed flaccid
          spastic so you would treat this differently than Parkinsons.
<Robin>  What would the treatment entail for this type of dysarthria?
<Sandra Schneider>  ALS or Parkinson's
<Robin>  lets address both, if you don't mind!!!
<Sandra Schneider>  sure
<Sandra Schneider>  ALS or amyotrophic lateral sclerosis (Lou Gerig's disease) is a
          progressing neurodegenerative disease process.
<Sandra Schneider>  Our involvment as SLP is in stages.
<Sandra Schneider>  We see them initially to address general articulation and dysphagia issues.
<Sandra Schneider>  Towards the end of the disease process, we need to address augmentative
          systems with them.
<Sandra Schneider>  With individuals with Parkinson's disease, you usually are trying to get
          volume increases and rate control.
<rebecca>  A lot of speech people say oral motor exercises really help, do they?
<Sandra Schneider>  A good question and commonly asked.
<Sandra Schneider>  Oral motor excercises are commonly used; however very little is known about
          their effectiveness.
<Sandra Schneider>  I think it is always good to give the individuals something to do - sort of
          homework. It makes them think they are helping themselves.
<Sara>  I love speech therapy!
<Sandra Schneider>  I love speech pathology too. I've been in it for many years and have as yet
          to get bored with the field.
<rebecca>  In the case of developmental apraxia, does maturation help and at what age would you
          see improvement without speech therapy?
<Sandra Schneider>  Developmental apraxia is a tough one
<Sandra Schneider>  Usually children with DAOS (Developmental Apraxia of Speech) take years of
<Robin> Rebecca, we have had a few chats on this subject...make sure to check our chat archives!
<Sandra Schneider>  I've seen children who were in therapy until they were in junior high school
          and still had some articulation problems.
<Adrienne>  Does developmental apraxia only cause artic problems?
<Sandra Schneider>  No, it is usually accompanied by some language problems too.
<Sandra Schneider>  Obvious some academic problems too.
<Adrienne>  What sort of therapy do you do with developmental apraxia then?
<Adrienne> Rebecca, what are you doing with your client?
<rebecca>  Lots of different things so he doesn't get bored..
<rebecca>  We play go fish with target sounds.
<rebecca>  We have also been doing a lot of oral motor. 
<Sandra Schneider>  Usually I've always done intense one on one type therapy working on each
          individual sound - vowels and consonants.
<Sandra Schneider>  strictly drill work
<Sandra Schneider>  There are specific apraxia programs like the PROMPT program that seems to
          work well with children.
<Adrienne>  What about the language part?
<Sandra Schneider>  Depends on the age of the child.
<rebecca>  Neither one of these kids have language delays. They were tested upon entering the
<Adrienne>  Just treat it like other language disordered?
<Sandra Schneider>  Usually kids with DAOS have particular difficulty with reading due to the
          sound basis of the program.
<Robin>  What types of dysarthria would you see in the pediatric population?
<Sandra Schneider>  With the cerebral palsy population it can vary from spastic to ataxic to
<Sandra Schneider>  With cerebral palsy you can get spastic syndromes like spastic paraplegia or
<Sandra Schneider>  You can get dyskinesias such as athetoid and you can get ataxic syndromes.
<Sandra Schneider>  Muscular dystrophy youngsters usually have a type of flaccid dysarthria.
<Sandra Schneider>  Again as with all dysarthrias they type depends on the neuro system involved.
<Sandra Schneider>  A good text for children with motor speech disorders is Russell Love's book
          Childhood Motor Speech Disablities.
<Robin> rebecca, have you worked with any adult clients yet with dysarthria or apraxia?
<rebecca>  no
<rebecca>  only k-5th graders. 
<Sandra Schneider> Rebecca do you work with any special population kids?
<Sandra Schneider>  Mentally handicapped, physically handicapped, etc.
<rebecca>  all of the above
<Sandra Schneider>  Do you see any motor speech disorders with these youngsters?
<Sandra Schneider>  swallowing problems, difficulty chewing food?
<rebecca>  I had one child who had cerebral palsy but he has moved as of two months ago.
<rebecca>  Swallowing, a lot of drooling.
<Sandra Schneider>  Did you do oral motor excercises with him/her?
<Sandra Schneider>  Did it help?
<Robin>  What did you do to help him/her with the drooling?
<rebecca>  Yes and we practice a lot of closed mouth posture.
<Sandra Schneider>  So you've had some exposure to motor speech disorders. I think they are
          fairly common in both children and adults.
<rebecca>  I don't know if the oral motor is helping, that's why I wanted to get some input.
<Sandra Schneider>  It's interesting in graduate school, just how much time is spent (or not
          spent) on teaching motor speech disorders. I think they are important
<Sandra Schneider>  In our program our students get an entire course on motor speech disorders.
          In addition they somewhat cover it again in the dysphagia course.
<judy>  Dr. Schneider, Do you offer information regarding aphasia? 
<Sandra Schneider>  I do
<Sandra Schneider>  do you have a question?
<judy>  My mother had a stroke three months ago and suffers from it. The doctors have not given
          us much info on helping her, any suggestions?
<Robin> Judy, has she had any speech therapy or other interventions?
<Sandra Schneider>  Can you tell me a little bit more. How severe? what side is involved?
          Does she talk? What can she do?
<judy>  Yes, the speech therapist works with her. She recognizes people, but seems confused much
          of the time. The left side was effected. Her short term memory is effected also.
<Robin> Judy, is she able to speak?
<judy>  Yes, she can speak.
<Sandra Schneider>  Sounds like a right hemisphere stroke. Language should be okay, but
          confusion is present.
<Robin>  Is her speech clear?
<judy>  Speech is clear, but she has a very short attention span.
<Sandra Schneider>  Usually right hemisphere strokes have a unilateral upper motor dysarthria.
<Sandra Schneider>  Does she have difficulty with swallowing? Any left facial/tongue weakness?
<judy>  She can swallow, but she has not been eating solids because she will take a bite of food
          and forget it is in her mouth.
<Sandra Schneider>  Right hemiphere strokes a lot of time have neglect where they neglect
          information on the left side.
<judy>  Is it possible that she can regain this?
<Sandra Schneider>  Does she recognize information on her right?
<judy>  In what sense?
<Sandra Schneider>  Does she ignore people, stimuli on the left side of her body?
<judy>  At times she does ignore people. Stimuli seems o.k.
<Adrienne>  There are many strategies for people to remember to pay attention to the left side
          (especially when reading, writing, eating), but it sounds like she's not having much
<Sandra Schneider>  Individuals that have had right hemisphere strokes usually require a lot of
          therapy for an extended period of time.
<Sandra Schneider>  However they usually don't see a need for it (if you ask them). To them
          everything is okay.
<Sandra Schneider>  Since you mentioned that she forgets to chew food placed in her mouth, was
          the stroke more "frontal" ?
<judy>  Yes, actually she had an aneurism
<Sandra Schneider>  Sounds like she is having problems with initiation.
<Adrienne>  Do you notice many differences in her personality?
<Sandra Schneider>  Was she operated on? Or did she have a hemorrhage?
<judy>  She had a hemorrhage and was operated on the next day.
<Sandra Schneider>  Hemorrages are different than stroke a lot of times, plus she has had an
<Sandra Schneider>  Her brain has had a lot of trauma to it. How long ago are you talking?
<judy>  3 months
<Sandra Schneider>  She is seeing a SLP?
<judy>  yes
<Robin> Judy, is your mother in a rehab facility now or does she receive therapy as an
<judy>  rehab 
<Sandra Schneider>  any other therapists - OT, PT ?
<judy>  ot, pt, slp
<Adrienne>  Dr. Schneider, what would you do with someone forgetting to chew and swallow?
<Sandra Schneider>  I would think that they would be in jeopardy for aspiration? I would hope
          that they are monitoring her well.
<Robin>  good point
<judy>  Yes, that is why she does not eat solids. She is having a swallow test tomorrow.
<Sandra Schneider>  Does she do alright when someone is with her?
<judy>  At times, attention span again.
<Sandra Schneider>  Sometimes with direct "cuing" you can get a person to swallow and chew on
          command, but this can take a long time to complete a meal.
<Sandra Schneider>  You don't want her to loose too much weight. This just makes her weaker.
<Sandra Schneider>  Are they considering a feeding tube?
<judy>  Yes, they are supplementing nutrition through a peg tube.
<dubliff>  But why can't they chew or is it the swallowing issues?
<Sandra Schneider>  The feeding is more a problem with initiation than motor speech.
<dubliff>  ok
<Robin>  Good luck with everything, judy!
<judy>  Yeah, we'll keep working. Thanks for the help!
<rebecca>  Thank you Dr. Schneider, Best wishes to your mom,judy. Goodnight
<Sandra Schneider>  good luck judy.
<judy>  Thanks. good night.
<Robin>  It is getting late...any more questions for Dr. Schneider?
<Sandra Schneider>  Thanks for the chat. I enjoyed it.
<dubliff>  thank you
<Adrienne>  Thanks for the good info- it was fun to work through a case.
<Robin>  Thank you for sharing your expertise, Dr. Schneider.
<Robin> Goodnight everyone!