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Vocal quality Pitch Volume Breath control Speed Strength Steadiness Range Tone[1][4] Examples of specific observations include a continuous breathy voice, irregular breakdown of articulation, monopitch, distorted vowels, word flow without pauses, and hypernasality. Treatment Articulation problems resulting from dysarthria are treated by speech language pathologists, using a variety of techniques. Techniques used depend on the effect the dysarthria has on control of the articulators. Traditional treatments target the correction of deficits in rate (of articulation), prosody (appropriate emphasis and inflection, affected e.g. by apraxia of speech, right hemisphere brain damage, etc.), intensity (loudness of the voice,
affected e.g. in hypokinetic dysarthrias such as in Parkinson's), resonance (ability to alter the vocal tract and resonating spaces for correct speech sounds) and phonation (control of the vocal folds for appropriate voice quality and valving of the airway). These treatments have usually involved exercises to increase strength and control over articulator muscles (which may be flaccid and weak, or overly tight and difficult to move), and using alternate speaking techniques to increase speaker intelligibility (how well someone's speech is understood by peers). With the speech language pathologist, 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, and techniques to deal with the frustration while speaking. Depending on the severity of the dysarthria, another possibility includes learning how to use a computer or flip cards in order to communicate more effectively.



More recent techniques based on the principles of motor learning (PML), such as LSVT (Lee Silverman voice treatment)[15] speech therapy and specifically LSVT may improve voice and speech function in PD.[16] For Parkinson's, aim to retrain speech skills through building new generalised motor programs, and attach great importance to regular practice, through peer/partner support and self-management. Regularity of practice, and when to practice, are the main issues in PML treatments, as they may determine the likelihood of generalization of new motor skills, and therefore how effective a treatment is. Augmentative and alternative communication (AAC) devices that make coping with a dysarthria easier include speech synthesis and text-based telephones. These allow people who are unintelligible, or may be in the later stages of a progressive illness, to continue to be able to communicate without the need for fully intelligible speech. Agnosia is the inability to process sensory information. Often there is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss.[1] It is usually associated with brain injury or neurological illness, particularly after damage to the occipitotemporal border, which is part of the ventral stream.[2] Agnosia only affects a single modality,[3] such as vision or hearing.[4] More recently, a top-down interruption is considered to cause the disturbance of handling perceptual information.[5] Contents 1 Types 1.1 Visual agnosia 1.2 Speech agnosia 2 Causes 3 Diagnosis 3.1 Pure alexia 3.2 Prosopagnosia 4 Treatment 4.1 Verbal strategies 4.2 Alternate cues 4.3 Organizational strategies 4.4 Alternative medicine 4.5 Current research 5 History 6 References 7 External links Types Name Description Akinetopsia Also known as cerebral akinetopsia, this is associated with the inability to perceive visual motion. One cause of cerebral akinetopsia is lesions outside the striate cortex.[6] Allotopagnosia Patients cannot point at external targets located outside their own body, whether other persons' body parts or objects, but they perfectly point at their own body parts. Anosognosia This is the inability to gain feedback about one's own condition and can be confused with lack of insight but is caused by problems in the feedback mechanisms in the brain. It is caused by neurological damage and can occur in connection with a range of neurological impairments but is most commonly referred to in cases of paralysis following stroke. Those with Anosognosia with multiple impairments may even be aware of some of their impairments but completely unable to perceive others. Apperceptive visual agnosia Patients are unable to distinguish visual shapes and so have trouble recognizing, copying, or discriminating between different visual stimuli. Unlike patients suffering from associative agnosia, those with apperceptive agnosia are unable to copy images.[7] Associative visual agnosia Patients can describe visual scenes and classes of objects but still fail to recognize them. They may, for example, know that a fork is something you eat with but may mistake it for a spoon. Patients suffering from associative agnosia are still able to reproduce an image through copying. Astereognosis Also known as somatosensory agnosia, it is connected to tactile sense—that is, touch. Patient finds it difficult to recognize objects by touch based on its texture, size and weight. However, they may be able to describe it verbally or recognize same kind of objects from pictures or draw pictures of them. Thought to be connected to lesions or damage in somatosensory cortex. Auditory agnosia Auditory agnosia has been recognized since 1877.[8] With auditory agnosia, there is difficulty distinguishing environmental and non-verbal auditory cues including difficulty distinguishing speech from non-speech sounds even though hearing is usually normal. There are two types of auditory agnosia: semantic associative and discriminative agnosia. Semantic associative agnosia is associated with lesions to the left hemisphere, whereas discriminative agnosia is associated with lesions to the right hemisphere.[9] Auditory verbal agnosia Also known as pure word deafness (PWD). This presents as a form of meaning 'deafness' in which hearing is intact but there is significant difficulty recognising spoken words as semantically meaningful. Autotopagnosia Is associated with the inability to orient parts of the body, and is often caused by a lesion in the parietal part of the posterior thalmic radiations. Cerebral achromatopsia A difficulty in perceiving colors in which the world may appear drab or in shades of gray. Cerebral achromatopsia is caused by neurological damage.[10][11] There are two regions of the brain which specialize for color recognition, areas V4 and V8. If there is a unilateral lesion to area V4, a loss of color perception in only half of the visual field may result known as hemiachromatopsia.[3] Similar, but distinct, is color agnosia, which involves having difficulty recognizing colors, while still being able to perceive them as measured by a color matching or categorizing task.[12] Cortical deafness Refers to people who do not perceive any auditory information but whose hearing is intact. Environmental agnosia It is the inability to locate a specific room or building that one is familiar with, as well as the inability to provide directions for how to arrive at a particular location. These individuals experience difficulty with learning routes. This form of agnosia is often associated with lesions to the bilateral or right hemisphere posterior regions. It is also associated with prosopagnosia and Parkinson's disease.[3] Finger agnosia Is the inability to distinguish the fingers on the hand. It is present in lesions of the dominant parietal lobe, and is a component of Gerstmann syndrome. Form agnosia Patients perceive only parts of details, not the whole object. Heterotopagnosia Patients cannot point at another person's body parts, but can point at their own body parts. Integrative agnosia Usually a patient has a form of associative agnosia or apperceptive agnosia. However, in the case of integrative agnosia a patient falls in between a form of associative and apperceptive agnosia. This is where one has the ability to recognize elements of something but yet be unable to integrate these elements together into comprehensible perceptual wholes. Pain agnosia Also referred to as congenital analgesia, this is the difficulty perceiving and processing pain; thought to underpin some forms of self injury. Phonagnosia Is the inability to recognize familiar voices, even though the hearer can understand the words used.[13] Prosopagnosia Also known as faceblindness and facial agnosia: Patients cannot consciously


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