الفهرس 
Basic Neuroanatomy
At the organ levelOnly 14 pages are availabe for public view
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Abstract
Speech is the final expresssion of concepts and emotions
translated through linguistic pathways that involve lexical,
syntactic, phonological, phonetic and prosody stages.
While, Language is a human system of communication that
uses arbitrary signals, Such as voice, sounds, gestures, or
written symbols, The study of language is called linguistics.
Motor speech disorders include: Dysarthria, Apraxia or
Dyspraxia of speech, Developmental apraxia of speech,
stuttering and Cluttering.
Dysarthria is a motor-speech disorder. It causes the
inability to coordinate or control the muscles in the face,
mouth, and respiratory system. It usually occurs when a
brain injury causes the muscles to become weak or
immobile. People with dysarthria can’t control the muscles
used to make normal sounds. Speech becomes slow or
slurred. It becomes difficult for others to understand what
the person is trying to say. Dysarthria can affect many
aspects of speech. Patient may lose the ability to pronounce
sounds correctly or speak at a normal level. Patient may
also be unable to control the quality, intonation, and pace at
which he speaks. Individual speech difficulties will vary
depending on the location and severity of the brain injury,
Dysarthria may be the result of a brain damage, Dysarthria
may result from damage to the nerves that supply the
muscles of articulation, or to the muscles themselves, Dysarthria may be caused by diseases that affect nerves and
muscles (neuromuscular diseases).
The types of dysarthriais: Flaccid dysarthria (bulbar,
LMN dysarthria), Spastic dysarthria (pseudobulbar, UMN
dysarthria), Ataxic dysarthria (cerebellar), Hyperkinetic
dysarthria: (which is either Quick hyperkinetic dysarthria
or slow hyperkinetic dysarthria), Quick hyperkinetic
dysarthria include: Chorea, Myoclonic Jerks, Tics and
Hemiballismus but Slow Hyperkinetic dysarthria include:
Athetosis and Dystonia, Hypokinetic dysarthria
(parkinsonian dysarthria), Mixed dysarthria which include:
Amytrophic lateral sclerosis (ALS), Multiple sclerosis
(MS), Wilson’s disease.
Articulation problems resulting from dysarthria are
treated by speech language pathologists, using a variety of
techniques. There are several skills that are important to
learn: Safe chewing and swallowing techniques, Avoiding
conversations when feeling tired, Repeat words and
syllables over and over in order to learn the proper mouth
movements, Maintain a relaxed, calm environment, Reduce
noise, music, and other stimuli during communication,
Modification of muscle tone, posture and strength,
Modification of resonance, Modification of prosody,
Modification of articulation, Modification of respiration,
Modification of phonatory deficits: (Pitch, Loudness, Vocal
quality), Providing alternative methods of communication.Apraxia is defined as a deficit in the ability to
perform an action in response to verbal command or
imitation in the absence of sensory or motor impairment,
Apraxia of speech is not the result of language disturbances
or an impairment of neuromuscular system, but rather is an
impairment of the ability to plan and program the relevant
articulatory movements.
Types of apraxia: Ideational or Conceptual apraxia,
Ideomotor apraxia, Callosal apraxia, Dressing apraxia,
magnetic apraxia, Limb-Kinetic apraxia, Apraxia of speech
(AOS).
Apraxia of speech can affect timing, rate, or range of
movement of the articulators, and selection of articulatory
contact points along the vocal tract. Features include
disturbed articulation (inconsistent trial and error
misarticulations) and prosody (hesitations, slowness,
groping, difficulty initiating speech, dysprosody) with
pockets of correct speech. Most offen, patients are aware of
their errors and can become frustrated when they cannot
correct themselves.
The treatments fell into one of four categories
according to the Committee of the Academy of Neurologic
Communication Disorders and Sciences (ANCDS):
Articulatory-Kinematic treatments, Rate/rhythm control
treatments, Intersystemic facilitation/ reorganization
treatments, Alternative and Augmentative communication approaches., Another programs for treatment of AOS:
Articulatory Methods, Integral Stimulation, Multiple Input
Phoneme Therapy (MIPT), Sound production treatment
(SPT), Prosodic Approaches, Tactile/Gestural Methods.
Prompts for Restructuring Oral and Muscular
Phonetic Targets (PROMPT): This approach uses to
improve sound production in children with speech
impairments that uses tactile cues to support and shape
movements of the oral articulators in order to improve the
production of individual sounds, syllables, words, and
eventually connected speech.
Stuttering is an involuntary disruption in fluency,
characterized by abnormal frequency or duration of
interruptions in the flow of speech, namely repetitions,
prolongations, and blocks, It more than likely has
neurological deficit origins due to its involuntary and
potentially socially problematic nature, stuttering has been
found to have a potentially negative influence on emotional
and mental health.
Stuttering therapy is any of the various treatment
methods that attempt to reduce stuttering to some degree in
an individual, There are many different approaches to
stuttering therapy, the successfulness of speech therapy
depends on the combination of education, training, and
individualized treatment provide: Fluency shaping,
Stuttering modification (Motivation, Identification,Desensitization, Variation, Appproximation, Stabilization,
Maintenance, Generalization), Integrative approaches,
Regulated breathing therapy, Self therapy for the stutterer,
Support groups, Camperdown program, Speech motor plan
assembly, Speech construction concept in stuttering
therapy, Phonological priming, Repetition priming,
Cognitive behavioural therapy, Contemporary devices in
treatment of stuttering, Pharmacologic therapy, Therapy for
children, Lidcombe program.
Cluttering refers to a speech disorder in which a
person’s speech is either too fast, too jerky, or both,
cluttered person fails to maintain normally expected sound,
syllable, phrase, and pausing patterns, cluttering is caused
by atypical brain structure or function as it relates to speech
rate control, speech-language planning and execution, and
other fluency-related behavior, Cluttering is a fluency
disorder characterized by a rate that is perceived to be
abnormally rapid, irregular, or both for the speaker
(although measured syllable rates may not exceed normal
limits). These rate abnormalities further are manifest in: (1)
an excessive number of disfluencies, the majority of which
are not typical of people who stutter; (2) the frequent
placement of pauses and use of prosodic patterns that do
not conform to syntactic and semantic constraints; and/ or
(3) inappropriate (usually excessive) degrees of
coarticulation among sounds, especially in multisyllabic
words”.Therapy for cluttering should be tailored to the
client’s unique difficulties since there are few data
available suggesting standard procedures for treatment.
Nevertheless, a number of therapeutic strategies have been
recommended over the years, many of which might be
effective with specific clutterers. Importantly, these include
speech, language, and other skills that may affect the
clutterer’s ability to communicate effectively: Slowing
Rate, Heightening Monitoring, Using Clear Articulation,
Using Acceptable, Organized Language, Interacting with
Listeners, Speaking Naturally, Reducing Excessive
Disfluencies.