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Ataxic Dysarthria > Ataxic Dysarthria > Flashcards

Ataxic Dysarthria Flashcards

1
Q

T/F: In order to understand the specific dysarthrias it is important to make a differential diagnosis.

A

True

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2
Q

Why is it important to make a differential diagnosis?

A

Therapy is different of every dysarthria.

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3
Q

Ataxic dyarthria is a __________ problem.

a. coordination
b. weakness
c. rigidity
d. involuntary movement

A

A. coordination

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4
Q

T/F: If diagnosis is undetermined you do not have to make a diagnostic statement in you evaluation.

A

False. You should always give a diagnostic statement in your evaluation report even if diagnosis is undetermined.

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5
Q

Ataxic dysarthria is __________ _______ _______ dysfunction.

A

Cerebellar Control Circuit

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6
Q

Ataxic dyarthria primarily affects ____________ and _______.

A

articulation and prosody

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7
Q

What are the functions of the cerebellum?

A
  • Impose control on posture and movement initiated elsewhere.
  • Coordinates posture, locomotion, and coordinates activities by adjusting activities of the indirect & direct motor systems and through them the activities of the LMN system.
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8
Q

What is the major function of the cerebellum?

A

Error control

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9
Q

The cerebellum receives input primarily from ___________.

A

motor cortex and provides output to cortex (through thalamus) and then to peripheral system.

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10
Q

What do lesions in the cerebellum cause?

A
  • hypotonia
  • errors in force, speed, timing, range
  • errors in direction of movements
  • incoordination
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11
Q

What does reduced muscle tone and incoordination of muscles result in?

A

Slow rate of speech and inaccuracy in speech movements.

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12
Q

T/F: In observing ataxic dysarthria you can see the reflection of the role of the cerebellum in breakdown in motor control and organization. Speech doesn’t reflect the weakness as seen in other dysarthrias, but rather poorly controlled and coordinated speech.

A

True

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13
Q

What are the 3 lobes in the cerebellum?

A

(1) anterior
(2) posterior
(3) flocculonodular

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14
Q

What does the anterior lobe consist of? Why is it important?

A

Most of the vermis and the anterior aspect of the cerebellar hemispheres. It is important in regulating posture, gait and muscle tone of the trunk of the body.

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15
Q

Where is the posteriors lobe located? Why is it important?

A

The posterior lobe makes up the greater part of the cerebellum and is located between the anterior lobe and the flocculonodular lobe. It is important for coordinating skilled, voluntary muscle activity and muscle tone.

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16
Q

What does the flocculonodular lobe include?

A

The flocculonodular lobe includes the inferior part of the vermis and the attached flocculi ( small appendages in the posterior inferior region).

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17
Q

The middle of the cerebellum is called the ______.

A

vermis

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18
Q

There are 2 hemispheres to each side of the vermis and each of these is connected to _____________.

A

the opposite thalamus and opposite cerebral hemispheres.

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19
Q

T/F: Each of these hemispheres controls function on the contralateral side of the body.

A

False. Each of these hemispheres controls function on the ipsilateral or same side of the body. So the right side of the cerebellum controls the right side of the body and connects to the left cerebral hemisphere.

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20
Q

Therefore the right side of the body is controlled by the ____ cerebral hemisphere and the _____ cerebellar hemisphere.

A

Left; right.

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21
Q

Which cells make up the middle part of the cerebellar cortex?

A

Purkinje cells.

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22
Q

Which nuclei is important in speech control? What does it aid in?

A

Dentate nucleus. Aids in initiating movement and regulating posture.

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23
Q

There are tracts of nerve fibers that enter and leave the cerebellum through three structures. What are the three structures?

A

The inferior cerebellar peduncle, the middle cerebellar peduncle, and the superior cerebellar peduncle.

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24
Q

The superior peduncle is a bridge between the ________ and __________.

Is it efferent or afferent?

A

The superior peduncle is a bridge between the midbrain and cerebellum. It is efferent.

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25
Q

The middle peduncle is a bridge between the ____ and __________.

Is it efferent or afferent?

A

The middle peduncle is a bridge between the pons and cerebellum. It is afferent.

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26
Q

The inferior pedunlce coordinates information between the _______ and __________.

Is it efferent and afferent?

A

The inferior peduncle coordinates information between the medulla and cerebellum. It is mainly an efferent pathway.

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27
Q

Not a lot is known about cerebellar lesions, but lesions causing speech problems are usually ____________.

A

bilateral, or in the vermis (midline) or generalized. But it can be due to a more focal lesion.

28
Q

What can cause ataxic dysarthria?

A

Anything that damages the cerebellum including degenerative disease, inflammation, neoplastic problems, toxicity, metabolic, traumatic and vascular diseases.

29
Q

What degenerative disease cause ataxic dysarthria?

A
  • Frederich’s ataxia

- Multiple Sclerosis

30
Q

What is Frederich’s ataxia?

A

It is a hereditary disease in which symptoms are shown during childhood and progress over time. It is due to an autosomal recessive pattern. It ends in death after a course of about 20 years. Ataxic dysarthria is common but usually not first sign.

31
Q

How does Multiple Sclerosis cause ataxic dysarthria?

A

May result in cerebellar lesions and ataxic dysarthria. But usually in MS the lesions aren’t just in cerebellum.

32
Q

Lesions in the vascular system can have impact on cerebellar function and cause ataxic dysarthria. This usually caused by _________.

A
  • aneurysms
  • arteriovenous malformations (AVM)
  • cerebellar hemorrhage.
33
Q

What neoplastic disorders cause ataxic dysarthria?

A

Tumors. (25% of metastatic brain tumors develop in the cerebellum) There may also be involvement of cranial nerves.

34
Q

TBI often results in ataxic dysarthria and limb ataxia. Boxers who have sustained hits to the head may develop _________________________.

A

dementia pugilistica or “punch-drunk encepalopathy” which involves cerebellar dysfunction. These people may develop ataxic dysarthria.

35
Q

Both acute and chronic alcohol abuse can produce ataxic symptoms. Acute alcohol can produce ataxic dysarthria, but it usually isn’t _________. (i.e. too much to drink has similar affect to cerebellar dysfunction in other diseases).

A

permanent

36
Q

Chronic alcoholism results in ataxic dysarthria sometimes but it may be more due to ___________.

A

nutritional problems rather than affect of alcohol.

37
Q

Severe malnutrition with _______ deficiencies may result in cerebellar damage and ataxic dysarthria.

a. oxygen
b. vitamin
c. protein
d. peptides

A

b. vitamin

38
Q

Neurotoxic (harmful to nerve tissue) levels of certain drugs may result in ______________. (Examples: Lithium, Dilantin, Valium)

A

cerebellar symptoms

39
Q

Hypothyroidism an endocrine imbalance when severe may lead to ataxic dysarthria accompanied by hoarse, gravely and excessively low pitched voice. What causes hypothyroidism?

A

It is caused by not enough secretion of thyroxin by thyroid glands.

40
Q

Normal pressure hydrocephalus (NPH) also results in ataxic dysarthria. What happens during NPH?

A

During NPH ventricles may be enlarged but CSF pressure is normal.

41
Q

FYI: Distributions of Etiologies (pg. 146)

A 
44%-Degenerative DIseases
13%- Undetermined
11%- Vascular
10%- Demyelinating
6%- Tumor
5%- Traumatic
3%- Toxic/Metabolic/Endocrine
3%- Multiple Possible Causes
4%- Other
42
Q

What are some patient complaints?

A

Patients complain of:

  • Friends asking them if they have been drinking.
  • Stumbling over words
  • Biting their cheek when eating
  • Inability to coordinate their breathing with speaking
  • Swallowing complaints are less often than in flaccid or spastic dysarthria (cerebellum doesn’t play an important role in swallowing)
43
Q

How do patients report their speech?

A

Patients report that their speech is slurred and sound as if they are drunk. Patients with other types of dysarthria may complain of slurred speech but typically only patients with ataxic dysarthria refer to their speech as “drunken” speech.

44
Q

What do patients report improves speech intelligibility?

A

Slowing speech.

45
Q

What results in quick deterioration of speech?

A

Limited alcohol intake.

46
Q

Ataxic dysarthria usually occurs with ____________.

A

other signs of cerebellar disease – may be the first or only sign, so diagnosing ataxia dysarthria can be valuable for neurologic localization.

47
Q

What are some general clinical characteristics of ataxia?

A
  • Problems standing and walking are most prominent signs. Broad based gait (feet far apart) – to counter imbalance. May lift legs too high when walking.
  • Titubation
  • Abnormal eye movement
  • Hypotonia
  • Dysmetria
  • Dysdiadochokinesis
48
Q

What is titubation?

A

-rhythmic tremors of body or head - looks like a rocking motion of trunk or head, can be rocking side to side or forward & back or in a rotary motion.

49
Q

What are two abnormal eye movements?

A

(1) nysgtagmus – jerking back and forth of eyes at rest and

(2) oculodysmetria – rapid eye movements as the patient tries to fix eyes on a visual target.

50
Q

Hypotonia

A

– also found in LMN disorders, can be associated with excessive pendulousness – if let arm swing freely it continuous for longer period of time swinging than normal. This is due to decreased resistance to movement. Related phenomenon – impaired check and excessive rebound – when arm is outstretched with eyes shut and a light tap is given on wrist, this results in large displacement of arm followed by overshooting of original position when arm returns.

51
Q

What is dysmetria?

A

– common sign of cerebellar problems – person is not able to control range of movement and is seen typically by over or undershooting a target.

52
Q

What is dysdiadochokinesis?

A

– it is decomposition of movement occurring in cerebellar problems. It results in errors in sequence and speed of the component parts of a movement

53
Q

What does dysdiadochokinesis produce?

A

– produces incoordination. This can be assessed by having pt perform tasks, such as side to side tongue wiggling & patting floor with ball of foot. These are analogous to speech AMRs.

54
Q

Ataxia is the product of dysmetira and ___________.

A

dysdiadochokinesis

55
Q

Ataxic movements are ______________________.

A
  • halting
  • imprecise
  • jerky
  • poorly coordinated
  • lacking in speed and fluidity.
56
Q

Cerebellar disorders are often associated with ______________.

A

intention or kinetic tremor – seen in movement but sometimes in sustained postures. Tremor usually worsens the closer one gets to target.

57
Q

T/F: Same clinical evidence is in limbs as in speech.

A

True.

58
Q

What are some non speech clinical findings?

A

(1) Oral mech exam is OK usually – size, strength, symmetry of jaw, face, tongue and palate normal at rest and in sustained postures.
(2) Gag reflex usually normal.
(3) No pathologic reflexes.
(4) Drooling is not common.

59
Q

What should you asses in people with ataxic dysarthria?

A

Assess conversational speech, reading and AMRs. Note that most people speak slower when reading so always listen to conversation as well as reading.

60
Q

What do repetition of sentences with multisyllabic words such as “The municipal judge sentenced the criminal” result in?

A

Results in distinctive irregular articulatory breakdowns and prosodic abnormalities.

61
Q

Why does ataxic dysarthria have a distinctive character of incoordination?

A

Because ataxic dysarthria is a problem with impaired coordination of movement patterns rather than with deficits in individual muscles, it has a distinctive character.

62
Q

Ataxic dysarthria is primary a problem with?

A

Primarily a problem with articulation and prosody. Rarely do you see resonance problems. Sometimes (rarely) you may see hyponasality due to improper timing of VP function and articulatory gestures for nasal consonants.

63
Q

What are the best distinguishing features in speech according to Duffy?

A

(1) AMRs are one of the most important distinguishing characteristics of ataxic dysarthria.
(2) Irregular & transient articulatory breakdowns
(3) Excess and equal stress
(4) Excess loudness variations – some have explosive loudness
(5) Dysprosody
(6) Vowel distortions

64
Q

How are AMRs in people with ataxic dysarthria?

A

They are irregular. Normal AMRs are about 6 per second and are regular.

65
Q

How do you test articulatory breakdowns?

A

Test by having patients say sentences containing multisyllabic words and look for irregular breakdowns. What you see is “telescoping” – a collapsing of syllables – where syllables run together and speech sounds accelerated.

Ataxic Dysarthria (1 decks)

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