8c. Neurologically Based Communication Disorders and Dysphagia -- DYSARTHRIA Flashcards
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Dysarthrias
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- Group of neurologically based motor speech disorders
- Due to peripheral or CNS pathology, resulting in impaired muscular control of the speech mechanism
- Pts usu. have respiration, phonation, articulation, prosody, and resonance probs that are caused by weakness, incoordination, or paralysis of the speech musculature; Dx/Tx address these probs
- 7 types of dysarthria: ataxic, flaccid, hyperkinetic, hypokinetic, spastic, mixed, unilateral UMN
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Neuropathology of the Dysarthrias
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- Common etiological factors: degenerative neurological diseases, e.g., Parkinson’s, Wilson’s. progressive supranuclear palsy, dystonia, Huntington’s, ALS, MS, and myasthenia gravis
- Can also be caused by nonprogressive neurological conditions, e.g., stroke, infections, TBI, surgical trauma…as well as congenital conditions, e.g., cerebral palsy, encephalitis, toxic effects of drugs or alcohol, etc
- Common sites of lesion include the LMN, unilateral or bilateral UMN, cerebellum, and BG (extrapyramidal sys)
- Pathophysiology and neuromuscular probs incl. muscle weakness, spasticity, incoordination, and rigidity
- Usu. wide variety of movement disorders, incl. reduced or variable range and speed of movement, involuntary movements, reduced strength of movement, unsteady or inaccurate movement, and abnormal tone (increased, decreased, or variable)
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Communicative Disorders Associated w/ Dysarthria
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- Respiratory probs: forced inspirations/expirations that interrupt speech, audible breathy inspiration, and grunting at end of expiration
- Phonatory disorders (see next flashcard)
- Articulation disorders: imprecise production of Cs, prolongation and repetition of phonemes, distorted vowels, weak production of pressure Cs
- Prosodic disorders: slower, excessively faster, or variable rate of speech; shorter phrase lengths, stress probs, pauses, rushes of speech
- Resonance disorders: hypernasality, hyponasality, and nasal emission
- Other characteristics: slow, fast, or irregualr diadochokinetic rate and palilalia (compulsive repetition of one’s own utterance w/ increasing rate and decreasing loudness), as well as decreased intelligibilty
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Communicative Disorders Associated w/ Dysarthria: Phonatory Disorders
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- Pitch disorders characterized by abnormal pitch, pitch breaks, abrupt variations in pitch, monopitch, diplophonia, akd shaky tremulous voice
- Loudness disorders characterized by too sort or too loud speech, monoloudness, sudden and excessive variation in loudness, progressive decrease in loudness throughout utterance, or alternating loudness changes
- Vocal-quality problems characterized by harsh, rough, gravelly voice; a hoarse voice, esp “wet;” a continuously intermittently breathy voice; a strained or strangled voice; effortful phonation; or a sudden and uncontrolled cessation of voice
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Types of Dysarthria:
ATAXIC Dysarthria
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- Results from damage to cerebellar system
- Characterized predominantly by articulatory and prosodic probs
- Neuropathology includes: bilateral or generalized cerebellar lesions, degenerative ataxia, cerebellar vascular lesions, tumors, TBI, toxic conditions, and inflammatory conditions
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Ataxic Dysarthria: Major Characteristics
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- Gait disturbances: instability of trunk and head; tremors and rocking motions; rotated or tilted head posture; hypotonia
- Movement disorders: over- or undershooting targets; uncoordinated, jerky, inaccurate, slow, imprecise and halting movements
- Articulation disorders: imprecise production of Cs; irregular and articulatory breakdowns and distorted Vs
- Prosodic disturbances: excessive and even stress; prolonged phonemes and intervals between words or syllables; slow rate of speech
- Phonatory disorders: monopitch, monoloudness, and harshness
- Speech quality: impression of drunken speech
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FLACCID Dysarthria
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- Results from damage to motor units of cranial or spinal nerves that supply speech muscles (LMN involvement)
- Neuropathology includes: myasthenia gravis and botulism, vascular diseases and BS strokes, infections (e.g., polio), demyelinating diseases (e.g., guillian-barre syndrome), degenerative diseases (e.g., motor neuron diseases, ALS, progressive bulbar palsy), and surgical trauma during brain, laryngeal, facial, or chest surgury
- Specific SNs that may be involved include trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), and hypoglossal (XII)
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Flaccid Dysarthria: Major Characteristics
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- Various muscular disorders (e.g., weakness, hypotonia, atrophy, and diminished reflexes)
- Isolated twitches of resting muscles (fasciculations) and contractions of individual muscles (fibrillations)
- Rapid and progressive weakness w/ use of a muscle and recovery w/ rest
- Respiratory weakness in combo w/ CN weakness
- Phonatory disorders, incl. breathy voice, audible inspiration, and short phrases
- Resonance disorders, incl. hypernasality; imprecise Cs, nasal emission, and short phrases
- Phonatory-prosiodic disorders, incl. harsh voice, monopitch, and monoloudness
- Artic disorders, which are more pronounced w/ lesions of CNs V, VII, and XII
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HYPERKINETIC Dysarthria
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- Results from damage to the BG (extrapyramidal sys)
- Associated w/ involuntary movement and variable muscle tone; prosodic disturbances are prominant
- Causes: degenerative, vascular, traumatic, infectious, neoplastic, and metabolic factors; Such degenerative diseases as Huntington’s also may be associated w/ this type of dysarthria; Causes are unknown in a majority of cases; Muscles of face, jaw, tongue, palate, larynx, and respiration may be involved
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Hyperkinetic Dysarthria: Major Characteristics
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- Movement disorders (b/c damage to BG control circuit); abnormal and involuntary movements of orofacial muscles
- Myoclonus (involuntary jerks of body parts), tics of face and shoulders, tremor, chorea; abrupt severe contractions of the extremities; writhing, involuntary movements, often in hands (athetosis); spasms (sudden involuntary contractions of a muscle or group of muscles)
- Dystonia, which results from contractions of antagonistic muscles that cause abnormal postures; spasmodic torticollis (intermittent dystonia and spasms of neck muscles); blepharospasm (forceful and involuntary closure of eyes due to spasm of the orbicularis muscle)
- Communicative disorders, specific symptoms depend on dominant neurological condition (e.g., chorea, dystonia, athetosis, spasmodic torticollis)
- Phonatory disorders, incl. voice tremor, intermittently strained voice, voice stoppage, vocal noise, harsh voice
- Resonance disorders, mostly intermittent hypernasality
- Prosodic disorders, incl. slower rate, excess loudness variations, prolonged interword intervals, and equal stress
- Respiratory probs, incl. audible inspiration and forced and sudden inspiration or expiration
- Inconsistent artic. probs, incl. imprecise C productions and distortions of Vs
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HYPOKINETIC Dysarthria
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- Results from damage to BG (extrapyramidal sys)
- Causes incl such degenerative diseases as progressive supranuclear palsy, *Parkinson’s, Alzheimer’s, and Pick’s disease
- Can occur due to vascular disorders that cause multiple or bilateral strokes, repeated head trauma, inflammation, tumor, antipsychotic or neuroleptic drug toxicity, and normal-pressure hydrocephalus
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Hypokinetic Dysarthria: Major Characteristics
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- Tremors in the resting facial, mouth, and limb muscles that diminish when moved volunrarily
- Mask-like face w/ infrequent blinking and no smiling
- Micrographic writing (small print)
- Walking disorders (slow to begin, then short, rapid, shuffling steps)
- Postural disturbances (involuntary flexion of head, trunk, arm; difficulty changing positions)
- Decreased swallowing (saliva accumulation, drooling)
- Phonatory disorders, incl. monopitch, low pitch, monoloudness, and harsh, continuously breathy voice
- Prosodic disorders, incl. reduced stress, inappropriate silent intervals, short rushes of speech, variable and increased rate in segments, and short phrases
- Artic. disorders, incl. imprecise Cs, repeated phonemes, resonance disorders, and mild hypernasality (in ~25% cases)
- Respiratory probs, incl. reduced vital capacity, irregular breathing, and faster rate of respiration
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SPASTIC Dysarthria
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- Results from bilateral damage to UMNs (direct and indirect motor pathways)
- Lesions in multiple areas, incl. cortical areas, BG, internal capsule, pons, and medulla are common
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Spastic Dysarthria: Major Characteristics
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- Spasticity and weakness, esp. bilateral facial weakness, though jaw strength may be normal and lower face weakness may be less severe
- Movement disorders, incl. reduced range and slowness, loss of fine and skilled movement, and increased muscle tone
- Hyperactive gag reflex
- Hyperadduction of VFs, inadequate closure of VP port
- Prosodic disorders, incl. excess and equal stress, slow rate, monopitch, monoloudness, reduced stress, and short phrases
- Artic. disorders, incl. imprecise production of Cs and distorted Vs
- Phonatory disorders, incl. continuous breathy voice, harshness, low pitch, pitch breaks, strained-strangled voice quality, short phrases, and slow rate
- Resonance disorders w/ a predominant hypernasality
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MIXED Dysarthria
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- Combination of 2+ pure dysarthrias
- All combinations of pure dysarthrias are possible, but a combo of 2 types is more common than a combo of 3+
- The two most common mixed forms are flaccid-spastic dysarthria and ataxic-spastic dysarthria
