Ataxic dysarthria Flashcards
1
Q
Why is it important to make a differential diagnosis?
A
Therapy is different for each dysarthria.
2
Q
What is ataxic dysarthria?
A
A problem with coordination (in-coordination) so it is worthless to work on oral motor strengthening exercises.
3
Q
Why is it worthless to work on oral motor strengthening with patients who have ataxic dysarthria?
A
The problem is with incoordination
4
Q
If you don’t know what the diagnosis is, what do you write in your diagnosis statement?
A
Diagnosis is undetermined
5
Q
Ataxic dysarthria is a ______ _______ ______ dysfunction.
A
cerebellar control circuit
6
Q
________ ________ is a cerebellar control circuit dysfunction.
A
Ataxic dysarthria
7
Q
What subsystems does ataxic dysarthria primarily affect?
A
articulation and prosody
8
Q
What are the three functions of the cerebellum?
A
- Imposes control on posture and movement initiated elsewhere.
- coordinates posture, locomotion, and coordinated activities by adjusting activities of the indirect & direct motor systems and through them the activities of the LMN system.
- Major function is error control
9
Q
The ______ imposes control on posture and movement initiated elsewhere.
A
cerebellum
10
Q
The cerebellum imposes control on _____ and _____ initiated elsewhere.
A
posture
movement
11
Q
The cerebellum coordinates _______, ______, and coordinated activities by ______ activities of the indirect & direct motor systems and through them the activities of the LMN system.
A
posture
locomotion
adjusting
12
Q
How does the cerebellum coordinate posture, locomotion, and coordinated activities?
A
By adjusting activities of the indirect & direct motor systems and through them the activities of the LMN system.
13
Q
What is the major function of the cerebellum?
A
error control
14
Q
cerebellum receives input primarily from _____ ______ and provides output to _____ (through ______) and then to _______ system.
A
motor cortex
cortex
thalamus
peripheral
15
Q
Lesions in the cerebellum can cause:
A
- hypotonia
- errors in force, speed, timing, range , and direction of movements.
16
Q
The reduced muscle tone and in-coordination of muscles results in:
A
slow rate of speech and inaccuracy in speech movements.
17
Q
What happens when there is reduced muscle tone and incoordination of muscles?
A
slow rate of speech and inaccuracy in speech movements.
18
Q
What causes slow rate of speech and inaccuracy in speech movements?
A
Reduced muscle tone and in-coordination of muscles.
19
Q
In observing ataxic dysarthria you can see the reflection of the role of the ______ in breakdown in ______ ______ and _______.
A
cerebellum
motor control
organization
20
Q
In ataxic dysarthria, speech doesn’t reflect the ______ as seen in other dysarthrias, but rather _______ _____ and _______ speech.
A
weakness
poorly controlled
coordinated
21
Q
What are the three loves in the cerebellum?
A
- anterior
- posterior
- flocculonodular
22
Q
What does the anterior lobe consists of?
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.
23
Q
The _____ lobe consists of 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.
A
anterior
24
Q
The anterior lobe consists of most of the ____ and the anterior aspect of the _____ _______. It is important in regulating _____, ______, and ______ _____ of the trunk of the body.
A
vermis cerebellar hemispheres posture gait muscle tone
25
The ____ lobe makes up the greater part of the cerebellum and is located between the ______ lobe and the _______ lobe. It is important for coordinating skilled, voluntary muscle activity and muscle tone.
posterior
anterior
flocculonodular
26
Posterior lobe:
makes up the greater part of the cerebellum and is located between the anterior and flocculonodular lobe.
27
Why is the posterior lobe important?
It is important for coordinating skilled, voluntary muscle activity and muscle tone.
28
_______ lobe is important for coordinating skilled, voluntary muscle activity and muscle tone.
posterior
29
The _______ lobe includes the inferior part of the vermis and the attached flocculi (small appendages in the posterior inferior region).
flocculonodular
30
What does the flocculonodular lobe include?
The inferior part of the vermis and the attached flocculi
31
What is the vermis?
The middle of the cerebellum.
32
The ______ is the middle of the cerebellum.
vermis
33
There are two hemispheres to each side of the ______ and each of these is connected to the _______ thalamus and _______ cerebral hemispheres.
vermis
opposite
opposite
34
There are two hemispheres to each side of the vermis and each of these is connected to the opposite ______ and opposite ______ ______.
thalamus
| cerebral hemispheres
35
Each of the cerebral hemispheres controls function on the ______ or ____ side of the body.
ipsilateral
| same
36
The right side of the cerebellum controls the _____ side of the body and connects to the _____ cerebral hemisphere.
right
| left
37
what does the right side of the cerebellum control and what does it connect to?
It controls the right side of the body and connects to the left cerebral hemisphere.
38
The right side of the body is controlled by the ____ cerebral hemisphere and the _____ cerebellar hemisphere.
left
| right
39
There are cells in the cortex o f the cerebellum called _____ cells.
purkinje
40
Where are the purkinje cells located?
cortex of the cerebellum
41
There are about _____ purkinje cells in the cerebellum.
15 million
42
The purkinje cells make up the ____ part of the _______ ______.
middle
| cerebellar cortex
43
The purkinje cells connect to other __ deep in the _______. _______ is passed through these connections.
nuclei
cerebellum
Information
44
What is the nuclei that is very important in speech control as it aids in initiating movement and regulating posture?
dentate nucleus
45
What is dentate nucleus?
The nuclei that is very important in speech control as it aids in initiating movement and regulating posture
46
______ _______ is very important in speech control as it aids in initiating movement and regulating posture.
dentate nucleus
47
Dentate nucleus is very important in speech control as it aids in initiating _______ and regulating _______.
movement
| posture
48
There are tracts of nerve fibers that enter an leave the cerebellum through three structures:
- inferior cerebellar peduncle
- middle cerebellar peduncle
- superior cerebellar peduncle
49
Each cerebellar hemisphere connects to the rest of the _____ _____ through these three bundles of nerve fibers- superior, middle and inferior peduncles.
nervous system
50
Each cerebellar hemisphere connects to the rest of the nervous system through these three bundles of nerve fibers:
- inferior cerebellar peduncle
- middle cerebellar peduncle
- superior cerebellar peduncle
51
The _______ peduncle is a bridge between the midbrain and cerebellum. It is _____ pathway.
superior
52
The ______ peduncle is a bridge between the pons and cerebellum. It is ____ pathway.
middle
| afferent
53
The ______ peduncle coordinates information between the medulla and cerebellum. it is mainly an ______ pathway.
inferior
| efferent
54
The superior peduncle is a bridge between the ______ and ______.
midbrain
| cerebellum
55
The middle peduncle is a bridge between the _____ and ______.
pons
| cerebellum
56
What does the inferior peduncle do?
It coordinates information between the medulla and cerebellum.
57
The superior peduncle is ______ pathway.
efferent
58
The inferior peduncles is mainly an _____ pathway.
efferent
59
The middle peduncle is an _____ pathway.
afferent
60
Not a lot is known about _______ lesions, but lesions causing speech problems are usually _____, or in or near the _____ (midline) or involving the ____ _____.
cerebellar
bilateral
vermis
dendate nucleus
61
Where are the lesions that cause speech problems?
- bilateral
- near or in the vermis
- involving the dantate nucleus
62
Do lesions that cause ataxic dysarthria have to be confined to the cerebellum?
No, it can result from damage to the superior cerebellar peduncle or along the frontopontoacerebellar pathways.
63
Etiologies for ataxic dysarthria:
```
Anything that damages cerebellum including:
degenerative disease
inflammation
neoplastic problems
toxicity
metabolic
traumatic
vascular diseases
```
64
Name two degenerative diseases:
- Frederick's ataxia
| - multiple sclerosis
65
What is Frederick's ataxia?
Symptoms shown in childhood and progress over time. It's hereditary. 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.
66
Symptoms shown in childhood and progress over time. It's hereditary. 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.
Frederick's ataxia
67
Frederick's ataxia is due to an ______ _______ pattern.
autosomal recessive
68
Multiple sclerosis may result in ________ lesions and _____ ______.
cerebellar
| ataxic dysarthria
69
______ _______ may result in cerebellar lesions and ataxic dysarthria.
Multiple sclerosis
70
Ataxic dysarthria is common in ______ _______ but usually not first sign.
Frederich's ataxia
71
In Multiple sclerosis the lesions aren't just in the _______.
cerebellum
72
In _____ ______ the lesions aren't just in the cerebellum.
multiple sclerosis
73
Lesions in the _____ system can impact on cerebellar function and cause ataxic dysarthria.
Vascular
74
What happens when there are lesions in the vascular system?
It can impact the cerebellar function and cause ataxic dysarthria.
75
What are the etiologies of ataxic dysarthria?
Anything that damages the cerebellum including:
- degenerative disease
- inflammation
- neoplastic problems
- toxicity
- metabolic
- traumatic
- vascular diseases
76
What causes vascular diseases?
- aneurysms
- arteriovenous malformations (AVM)
- cerebellar hemorrhage
77
Aneurysms, arteriovenous malformation, and cerebellar hemorrhage cause ______ ______.
vascular disease
78
______ in the cerebellum can lead to ataxic dysarthria.
Tumors
79
What is a neoplastic disorder that can lead to ataxic dysarthria?
Tumors
80
______ of metastatic brain tumors develop in the cerebellum?
25%
81
_______ often results in ataxic dysarthria and limb ataxia.
TBI
82
Boxers who have sustained hits to the head may develop _____ ______ or ______ _____ _____ which involves cerebellar dysfunction. These people may develop ataxic dysarthria.
dementia pugilistica
| punch drunk encepalopathy
83
Both acute and chronic _____ _____ can produce ataxic symptoms.
alcohol abuse
84
_______ alcohol can produce ataxic dysarthria, but it usually isn't permanent.
Acute
85
Acute alcohol can produce ataxic dysarthria. Can this cause permanent damage?
It usually doesn't cause permanent damage.
86
_______ alcoholism results in ataxic dysarthria sometimes but it may be more due to _____ problems rather than the affect of alcohol.
Chronic
| nutritional
87
Severe _____ with _____ _______ may result in cerebellar damage and ataxic dysarthria.
malnutrition
| vitamin deficiencies
88
Severe malnutrition with vitamin deficiencies may result in ______ damage and ______ dysarthria.
cerebellar
| ataxic
89
_______ (harmful to nerve tissue) levels of certain drugs may result in cerebellar symptoms. Name some of these medications.
Neurotoxic
| lithium, dilantin, valium
90
Neurotoxic (harmful to nerve tissue) levels of certain drugs may result in _________ symptoms. For example:
cerebellar
| lithium, dilantin, valium
91
What is hypothyroidism?
Endocrine imbalance and when severe may lead to ataxic dysarthria. Caused by not enough secretion of thryoxin by thyroid glands. Ataxic dysarthria may be accompanied by hoarse, gravely and excessively low pitched voice.
92
Hypothyroidism is an ________ _______ and when severe may lead to ______ dysarthria. Caused by not enough secretion of _________ by thyroid glands.
endocrine imbalance
ataxic
thyroxin
93
Symptoms of ataxic dysarthria caused by hypothyroidism are:
hoarse
| gravely and excessively low pitched voice
94
What causes hypothyroidism?
Not enough secretion of thyroxin by thyroid glands.
95
What is normal pressure hydrocephalus?
Ventricles may be enlarged but CSF pressure is normal. Often result in ataxic dysarthria.
96
______ ______ ______ is when ventricles may be enlarged but CSF pressure is normal and it often results in ataxic dysarthria.
Normal Pressure hydrocephalus
97
See Distribution of etiologies
page 146
98
Ataxic dysarthria patients mainly complain of _____ _____.
slurred speech
99
Slurred speech is the main characteristic of _______ dysarthria.
ataxic
100
Even limited _______ intake results in quick deterioration of speech in ataxic dysarthria.
alcohol
101
Only patients with ataxic dysarthria refer to their speech as _______ _______.
drunken spech
102
Only patients with ______ dysarthria refer tot their speech as drunken speech.
ataxic
103
Patients with ataxic dysarthria tend to bite their _____ when eating.
cheek
104
Patients with _____ dysarthria tend to bite their cheek when eating.
ataxic
105
Patients with ataxic dysarthria can't coordinate their _______ with ________.
breathing
| speaking
106
Patients with _______ dysarthria can't coordinate their breathing with speaking.
ataxic
107
Patients with ataxic dysarthria have less _______ complaints than in flaccid or spastic dysarthria.
swallowing
108
Patients with ataxic dysarthria report that slowing speech improves _______.
inteligibility
109
Patients with ______ dysarthria report that slowing speech improves ineligibility.
ataxic
110
Does the cerebellum play an important role in swallowing?
No, which is why ataxic dysarthria doesn't have many swallowing difficulties.
111
Ataxic dysarthria usually occurs with other signs of _______ disease, but it might the first or only sign.
cerebellar
112
Problems standing and walking are most prominent signs of ______ dysarthria.
ataxic
113
What are the prominent signs of ataxic dysarthria?
-problems standing and walking
| Broad based gait (feet far apart) to counter imbalance. May lift legs too high when walking.
114
What is titubation in ataxic dysarthria?
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.
115
__________ in ataxic dysarthria are 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.
Titubation
116
Abnormal eye movement such as (1) nystagmus-jerking back and forth of eyes at rest and (2) oculodysmetria- rapid eye movements as the patient tries to fix eyes ona visual target occurs in _______ dysarthria.
dysarthria
117
Nystagmus and oculodysmetria occurs in ______ dysarthria.
ataxic
118
What type of abnormal movement occurs during ataxic dysarthria?
Nystagmus-jerking back and forth of eyes at rest
| oculodysmetria - rapid eye movements as the patient tries to fix eyes on a visual target
119
_______ also found in LMN disorders is present in ataxic dysarthria. It can be associated with excessive pendulousness- if let arm swing freely it continues for longer period of time swinging than normal.
Hypotonia
120
What is excessive pendulousness asosciated with?
Hypotonia in ataxic dysarthria
121
What is excessive pendulousnees and why does it happen?
if let arm swing freely it continuous for longer period of time swinging than normal. This is due to decreased resistance to movement.
122
What is a related phenomenon to excessive pendulousness?
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.
123
Excessive pendulousness can be present in ______ dysarthria.
ataxic
124
What is a common sign of cerebellar problems?
Dysmetria - person is not able to control range of movement and is seen typically by over or undershooting a target
125
Dysmetria is a common sign of _______ problems.
cerebellar
126
What is dysmetria?
When a person is not able to control range of movement and is seen typically by over or undershooting a target
127
Ataxia is the product of ______, ________, and ________ of ________.
dysmetria
dysdiadochokinesis
decomposition of movement
128
Dysmetria, dysdiadochokinesis, and decomposition of movement result in ______.
ataxia
129
How are ataxic movements described?
```
halting
imprecise
jerky
poorly coordinated
lacking in speed and fluidity
```
130
What are cerebellar disorders often associated with?
Intention or kinetic tremor- seen in movements but sometimes in sustained postures. Tremor usually worsens the closer one gets to target.
131
What is dysdiadochokinesis?
It is decomposition of movement occurring in cerebellar problems. It results errors in sequence and speed of the component parts of a movement-produces in coordination.
132
How can dysdiadochokinesis be assessed?
Having the patient perform tasks, such as side to side tongue wiggling & patting floor with ball of foot. These are analogous to speech AMRs.
133
How is the oral mechanism during ataxic dysarthria?
size, strength, symmetry of jaw, face, tongue and palate normal at rest and is sustained postures.
- gag reflex usually normal
- no pathological reflexes
- drooling is not common
134
How do you asses spastic ataxic dysarthria?
-AMRs
conversational speech
reading
vowel prolongation
135
Irregular speech AMRs are a distinguishing characteristic of _______ dysarthria.
ataxic
136
How are the AMrs in ataxic dysarthira
Irregular speech AMRs are a distinguishing characteristic
137
Do repetition of sentences with multisyllabic words such as "The municipal judge sentenced the criminal" may result in distinctive irregular _____ ______ and ______ abnormalities.
articulatory breakdowns
| prosodic
138
What do repetition of sentences with multisyllanic words such as "The municipal judge sentenced the criminal" may result in?
Distinctive irregular articulatory breakdowns and prosodic abnormalities.
139
Because _______ dysarthria is a problem with impaired coordination of movement patterns rather than with deficits in individual muscles, it has a distinctive character.
ataxic
140
Ataxic dysarthria is a problem with ________ _______ of movement patterns rather that with ________ in individual muscles, it has a distinctive character.
impaired coordination
| deficits
141
Ataxic dysarthria is primarily a problem with ________ and ________. Rarely do you see problems with ______. Sometimes (rarely) you may see _____ due to improper timing of VP function and articulatory gestures for nasal consonants.
articulation
prosody
resonance
hyponasality
142
What are the primary problems with ataxic dysarthria?
articulation
| prosody
143
You rarely see what type of problems with ataxic dysarthria?
resonance
144
You might see sometimes (rarely) ______ due to improper timing of __________ and articulatory gestures for ______ consonants.
hyponasality
VP function
nasal
145
What are the best distinguishing features in speech of patients with ataxic dysarthria?
- excess and equal stress
- excess loudness variations
- dysprosody
- vowel distortions
- voice tremor - noticed especially on vowel prolongations
- irregular & transient articulatory breakdowns
- Irregular AMRs
146
What is one of the most important distinguishing characteristics of ataxic dysarhtira?
AMRs, they are irregular. Normal Amrs are about 6 per second and are regular.
147
Normal AMRs are about ____ per second and are regular.
6
148
How do you test for irregular & transient articulatory breakdowns?
Test by having patients say sentences containing multi syllable words and look for irregular breakdowns. What you see is telescoping - a collapsing of syllables-where syllables run together and speech sounds accelerated.
149
______ can happen in irregular & transient articulatory breakdowns.
Telescoping
150
What is telescoping in irregular & transient articulatory breakdowns?
a collapsing of syllables - where syllables run together and speech sounds accelerated.
151
Look at table 6.4 page 154
case study 6-1
| 6-2
