By

Disease Types
Flaccid Spastic UUMN Ataxic Hypokinetic Hyperkinetic Mixed
Vascular diseases/ ~
√ √ √ ~
Stroke Brainstem stroke
Degenerative Closed head Parkinson’s Huntington’s ALS

diseases injury (most √) Disease Disease à spastic-flaccid
Traumatic brain Skull fracture/ Penetrating head

injury (TBI) Neck trauma1 injury à CNS2
Demyelinating Multiple
Guillain-Barré √ 3 √ 3
diseases sclerosis4
Neuromuscular,
muscle disease and √
neuropathies
Surgical trauma 1. ENT surgery/
Cervical Spinal
surgery5
Neurosurgery (e.g. tumor removal) à all types possible depending on the location of surgery
2. Cardiac/ chest
surgeries6
Toxic and √ √
metabolic (e.g. drugs/ (e.g. drugs/
disturbance medication) medication)
Infection/ Botulism, herpes

inflammation zoster, polio etc.

1 5
TBI or surgical trauma: Damage to cranial nerves à Flaccid dysarthria
2
CNS dysarthria à Spastic dysarthria: Occurred as a result of damage to the motor neurons in the central nervous system (CNS)
3
Demyelinating diseases: If Basal Ganglia has been affected, it may lead to hypokinetic or hyperkinetic dysarthria
4
Multiple scleroses: Mixed dysarthria? à it changes over time from ataxic to spastic dysarthria
6
Surgical trauma: Damage to recurrent laryngeal nerves (Vagus nerve) à Flaccid dysarthria

1
By Cranial nerves/ Lesion sites
Dysarthria Apraxia of
Others
Flaccid Spastic UUMN Ataxic Hypokinetic Hyperkinetic Mixed Speech
Cortical lesions √ √ Aphasia
Basal ganglia
√7 (√)
damage
Cerebellar
√
damage

Brain stem
√ √ (√)
damage
Premotor Limb & body
cortex (BA6) apraxia:

Limb-kinetic/
gait/dressing
Primary motor √
cortex (BA4) (Damage to
UMN)
Brainstem
√ √
nuclei
Cranial nerves √
Cerebellum √
√ (Spastic-
ataxic dys.)
Broca’s area √ Broca’s

Aphasia
Insula cortex √

7
Reduced dopamine leads to reduced dampening effect on motor movement à muscles become rigid, explosive or rhythmic involuntary movements à
Parkinson’s disease, Huntington’s Disease or Tourette’s Syndrome

2
Other Confirmatory Signs of Neurological Injury
Flaccid Spastic UUMN Ataxic Hypokinetic Hyperkinetic Apraxia
Muscle 1. Atrophy Increased Hypotonia 1. Rigidity 1. Dyskinesias 1. Spasticity à
tone 2. Fasciculation muscle tone 2. Bradykinesia 2. Dystonia Hyperactive stretch
3. Hypotonia (reduced speed à jaw to larynx reflex
= decreased tone of muscles)
Reflex Hypoactive Hyperactive jaw/ 2. Bilateral UMN à
(absent) gag sucking/ gag Hyperactive gag/
reflex reflexes Babinski/ pathologic
Respiration Poor breathing- Poor respiration- oral reflexes (suck,
speaking coordination phonation timing snout, jaw jerk)
Speech/ Rapid 1. Fatigue with Nonverbal oral 1. Mixed speech Facial grimacing
Voice deterioration/ speaking apraxia (NOVA) characteristics during speech
weakness of 2. Hypophonia 2. Normal OME = twisting face
strength of 3. Slow speech rate
speech muscles (improved
intelligibility)
4. Slurred or drunken
quality speech
Swallowing 1. Anterior loss Swallow Mild dysphagia
2. Bolus complaints
containment/
mastication and
propulsion issues
3. Nasal
regurgitation
Body/ 1. Bilateral 1. Lability 1. Dysmetric (lack of 1. Postural 1. Sustained 1. Right sided
limbs hemiparesis =instability coordination) instability deviation head weakness
2. Incontinence 2. Hemiplegia/ 2. Asthenia (Physical 2. Tremor of position 2. Limb apraxia may
= paresis weakness/ lack of limbs/ jaw/ lips 2. Tremors (jaw to co-occur
energy) and tongue larynx)
à Worse at rest 3. Involuntary
movements
Emotions Emotional lability
3
Oromotor signs and presentation
Flaccid Spastic UUMN Ataxic Hypokinetic Hyperkinetic
CN V 1. Chewing difficulty 1. Slow rate Drooling Irregular Variable and Normal size,
Trigeminal nerve movement reduced strength and
2. Drooling 2. Drooling movement symmetry

3. Difficulty in moving or closing
jaw

4. Decreased face/ cheek/
tongue/ teeth/ palate sensation
CN VII 1. Biting cheek or lip when 1. Decreased ROM Unilateral lower 1. Irregular Variable and Normal size,
Facial nerve chewing or speaking (non-speech) weakness movement reduced strength and
*No atrophy movement symmetry
2. Anterior spillage 2. Slow rate 2. Biting cheek/
tongue when
3. Reduced movement of lips eating or talking
during speech
CN IX + X 1. Reduced gag reflex and 1. Hypernasality Occasionally Poor intonation Reduced 1. Reduced
Glossopharyngeal sensation unilateral palatal and phonation phonation, intonation and
+ Vagus nerves 2. Poor phonation weakness and intonation and volume (with
2. Severe pain beginning at or intonation vocal folds paresis volume excessive loudness)
throat and radiating down back
(Brief attack) 3. Reduced 2. Harsh quality
maintenance
palatal elevation
CN XII 1. Unable to manipulate bolus 1. Reduced rate, Unilateral Poor movement in Reduced ROM Normal size,
Hypoglossal strength and weakness *No speech and (e.g. tongue strength and
nerve 2. Tongue heaviness movements atrophy or irregular elevation) symmetry
fasciculation movement in non-
3. Drooping speech

Apraxia of Speech (AOS) à Usually no significant weakness or paralysis à May have Facial nerve UMN Lesions
May have co-occurring nonverbal oral apraxia (NVOA) à Impaired volitional tasks; not associated with comprehension, sensory or neuromuscular deficits
4
Speech Characteristics of Different MSD
Flaccid Spastic UUMN Ataxic Hypokinetic Hyperkinetic AOS
Resonance - Hypernasality (V) - Hypernasality - Hypernasality - Hypernasality - Hypernasality - Hypernasality
- Nasal emissions (C) (Vowels) (Infrequent) (may occur)
- Weak pressure (C)
- Shortened phrases
Phonation - Breathiness - Strained-strangled - Harshness - Variable loudness - Hoarseness - Strained-
- Inhalatory stridor - Low pitch - Strained - Low pitch - Variable pitch strangled voice
- Harsh quality (Occasional breaks) - loudness - Harsh voice and volume - Excess loudness
- Mono-pitch - Harsh quality - Explosive - Vocal - Harsh, tremor
- Mono-loudness (partially opened loudness intensity - Breathy
glottis) - Intelligibility - Voice stoppages
Articulation - Imprecise - Imprecise - Imprecise - Imprecise - Initiation issues - Imprecise - Consonant and
consonants consonants consonants consonants à - Imprecise consonants vowel distortion
- Mild to - Incomplete - AMRs: Slow, slurred, errors: consonants - Distorted vowels - Errors: target-
unintelligible contact and clusters imprecise and irregular and - Pitch variability - Prolonged like + inconsistent
- phoneme-to- irregular inconsistent and festinating phonemes - Frequency and
phoneme - Irregular - Vowel distortions length effects
transitions breakdowns - Irregular AMRs (phonemes)
Prosody - Mono-pitch - Mono-pitch - Slow speech - Equal/ excess - Mono-pitch - Prolonged - Mono-pitch
- Mono-loudness - Mono-loudness rate ( Speed & stress - Mono-loudness intervals - Mono-loudness
- Short phrases ROM, weakness) - Prolonged - Syllable - Variable speech - Prolonged and
- Slow speech rate phonemes and repetition rate variable vowels
( Speed & ROM) intervals - Slow speech - Mono-pitch - Syllable
- Slow speech rate rate - Mono-loudness segregation
- Mono-pitch - Inappropriate - Prolonged
- Mono-loudness silences interword interval
- Harshness - Slow rate
Others - loudness - Dysfluency Fluency:
(Respiratory/ - Mono-pitch - Initiation and - False starts/
Fluency) - Mono-loudness prolonged restarts
- Harsh voice quality intervals - Groping
- phrase length - Phoneme - Repeat sound &
- May affect prosody repetitions syllable
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