6.1 - Ataxic Dysarthria Flashcards
What are the hallmarks of Ataxic Dysarthria?
Irregular articulatory breakdown
What is the cause of Ataxic Dysarthria?
Injury or malfunction to the Cerebellar Control Circuit
Where is Ataxic Dysarthria most evident?
2
In articulation
In prosody
Where does the Cerebellum receive input?
What does it plan and initiate?
Regions of the cerebral cortex
Complex and highly skilled movement
From where does the Cerebellum receive innervations?
From the sensory systems that monitor the course of movements
How does the Cerebellum influence movement?
By modifying activity patterns of the UMNs
Prominent projections to most UMNs
What is the primary function of the Cerebellum?
2
To detect difference or “motor error” between intended movement and actual movement and through its projections to the UMN’s
To reduce error
What does the Cerebellum correct?
Motor error in real time and over longer periods (such as in motor learning)
What are the major INPUTS to the cerebellum from the cortex?
3
Parietal Cortex
Cingulate Cortex
Frontal Cortex
What are the major INPUTS to the cerebellum from other areas of the brain?
(4)
Red nucleus
Superior colliculus
Spinal cord
Reticular formation
What are the major OUTPUTS from the cerebellum?
5
Motor Cortex (via relay in VL nuclei of thalamus)
Red nucleus
Vestibular nuclei
Superior colliculus
Reticular formation
When the cortex is injured, the effects are seen _________. When the cerebellum is injured, the effects are seen _______.
(Think directionality)
Contralaterally
Ipsilaterally
What is the Pathophysiology of Ataxic Dysarthria?
2
Bilateral or generalized disease
Focal lesions
What is involved in bilateral or generalized disease that causes Ataxia Dysarthria?
Both cerebellar hemispheres
What kinds of Focal Lesions can cause Ataxic Dysarthria?
2
Superior cerebellar peduncle (major cerebellar-cortical pathway for voluntary movement)
Possibly other focal lesion(s)
What are 7 distinguishing signs of Ataxia Dysarthria?
Disordered stance, gait, and head posture
Truncal titubation (rocking of head/neck/trunk)
Nystagmus (rapid oscillation of eyes)
Dysmetria (past-pointing)
Dysdiadochokinesis
Intention tremor (tremor apparent during movement or sustained postures)
Hypotonia associated with excessive pendulousness (extremity, allowed to swing freely in a pendular manner)
What are the two types of tremors?
Resting/Involuntary
Action
What disorder is associated with Resting/Involuntary Tremors?
Parkinson’s disease
What are the 3 types of Action Tremors?
Postural
Isometric
Kinetic
What is an example of a Postural Tremor?
Essential Tremor
When might Isometic Tremors be experienced?
After or during exercise
What are the 2 types of Kinetic Tremors?
Simple
Intention
What is an example of a Simple Tremor?
Essential Tremor
What is an example of an Intention Tremor?
Cerebellar Tremor
What is an Essential Tremor?
3
Action tremor
Affects upper extreme ties asymmetrically
Primarily affects hands
When does the tremor begin in patients with Cerebellar Tremor?
As the finger nears the target
When does the tremor begin in patients with Parkinson’s Disease?
As the beginning of movement but will lessen as it reaches its target
When does the tremor begin in patients with Essential Tremor?
(2)
At the beginning of movement
As finger nears the target
What do patients often complain about with tremors?
4
Difficulty during meals when trying to bring food to mouth or when drinking from a cup
Unsteady gait
Slurred speech
Abnormal eye movements
What is often seen in an oral motor exam in patients with Ataxic Dysarthria?
Usually nothing unusual
What is seen in AMRs in patients with Ataxia Dysarthria?
Irregularities (in both speech and non speech)
What are the most useful AMRs when testing for Ataxia Dysarthria?
(3)
Conversational speech
Reading
Speech
What is the most distinguishing characteristic of Ataxia Dysarthria?
Irregular AMRs
What is seen in Direction of Movement in Ataxia Dysarthria?
Inaccuracy
What is seen in Rhythm of Movement in Ataxia Dysarthria?
Repetitive movements are irregular
What is seen in Rate of Movement in Ataxia Dysarthria?
2
Repetitive movements are slow
Individual movements are slow
What is seen in Range of Movement in Ataxia Dysarthria?
2
Repetitive movements are excessive to normal
Individual movements are excessive to normal
What is seen in Force of Movement in Ataxia Dysarthria?
Individual movements are normal to excessive
What is seen in Muscle Tone in Ataxia Dysarthria?
Reduced
What Articulatory-Resonatory characteristics are seen in Ataxic Dysarthria?
(3)
Imprecise consonants
Distorted vowels
Irregular articulatory breakdown
What Prosodic characteristics are seen in Ataxic Dysarthria?
4
Excess + equal stress – or – reduced stress variation
Prolonged phonemes
Prolonged intervals
Slow rate
What Phonatory-Prosodic characteristics are seen in Ataxic Dysarthria?
(3)
Harshness
Monopitch
Monoloudness
How is Naturalness affects in Ataxic Dysarthria?
Impaired
What kind of loudness may be seen in Ataxic Dysarthria?
Explosive
What do patients often complain about with Ataxic Dysarthria?
(5)
They sound drunk or intoxicated
They stumble over words
They bite cheek when they eat or speak
Their speech becomes worse with alcohol
They have difficulty coordinating breathing and speech
What 4 terms are associated with Ataxic Dysarthria?
Scanning
Telescoping
Prosodic excess (scanning speech)
Articulatory inaccuracy (telescoping)
What does Scanning mean in regard to Ataxic Dysarthria?
3
Measured
Excess and equal stress (word-by- word)
Slow
What does Telescoping mean in regard to Ataxic Dysarthria?
2
Inconsistent articulatory breakdown
“A syllable or series of syllables are suddenly or unpredictably run together… transient accelerated character”
What does Prosodic excess (scanning speech) mean in regard to Ataxic Dysarthria?
(3)
Excess and equal stress
Prolonged phonemes
SMRs tend to be slow and even
What does Articulatory inaccuracy (telescoping) mean in regard to Ataxic Dysarthria?
(2)
Equalization of stress
SMRs irregular
In FRIEDREICH’S ATAXIA, what is the….
- Locus?
- Pathology? (2)
- Effect? (2)
- Signs? (2)
– LOCUS –
Spinocerebellar
– PATHOLOGY –
Metabolic
Hereditary
– EFFECT –
Begins in adolescence
Degeneration over 20 years
– SIGNS –
Ataxic-Spastic Dysarthria
Spasticity increases over time as disease affects the spinal cord
In MULTIPLE SYSTEMS ATROPHY (MSA) / OLIVOPONTOCEREBELLAR ATROPHY (OPCA), what is the….
- Locus?
- Pathology?
- Effect? (2)
- Signs?
– LOCUS –
Olivopontocerebellar
– PATHOLOGY –
Hereditary
– EFFECT –
Onset between 20-40
Gradual widespread neurological impairment
– SIGNS –
Mixed Dysarthria
In PAROXYSMAL ATAXIC DYSARTHRIA (PAD), what is the….
- Locus?
- Pathology?
- Effect? (2)
- Signs?
– LOCUS –
Cerebellum
– PATHOLOGY –
Paroxyms triggered by changes in oxygen supply
– EFFECT –
Brief episodes
May signal MS or familial cerebellar ataxia
– SIGNS –
Ataxic Dysarthria
In CEREBELLOPONTINE ANGLE (CPA) TUMORS (e.g., acoustic neuroma), what is the….
- Locus? (2)
- Pathology?
- Effect? (2)
- Signs?
– LOCUS –
Cerebellopontine Angle
Involves meninges of CNs
– PATHOLOGY –
Mass effect on cerebellar circuit
– EFFECT –
Impairment of CN function
Cerebellar signs
– SIGNS –
Ataxic-Flaccid Dysarthria
(Due to CN involvement)
(Severe weakness and error detection issues)
What other 4 disorders can cause Ataxic Dysarthria?
Trauma, e.g., dementia pugilistica (“punch-drunk” encephalopathy)
Toxic/metabolic, e.g., alcohol abuse; other substances
Hypothyroidism
Normal pressure hydrocephalus (NPH)
What Resonatory Characteristics are seen in Ataxic Dysarthria?
(4)
Hypernasality
Imprecise consonants
Nasal emission
Short phrases
What Phonatory Characteristics are seen in Ataxic Dysarthria?
(3)
Breathiness
Short phrases
Audible inspiration
