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Motor speech disorders > Ataxic dysarthria > Flashcards

Ataxic dysarthria Flashcards

1
Q

Why is it important to make a differential diagnosis?

A

Therapy is different for each dysarthria.

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2
Q

What is ataxic dysarthria?

A

A problem with coordination (in-coordination) so it is worthless to work on oral motor strengthening exercises.

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3
Q

Why is it worthless to work on oral motor strengthening with patients who have ataxic dysarthria?

A

The problem is with incoordination

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4
Q

If you don’t know what the diagnosis is, what do you write in your diagnosis statement?

A

Diagnosis is undetermined

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5
Q

Ataxic dysarthria is a ______ _______ ______ dysfunction.

A

cerebellar control circuit

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6
Q

________ ________ is a cerebellar control circuit dysfunction.

A

Ataxic dysarthria

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7
Q

What subsystems does ataxic dysarthria primarily affect?

A

articulation and prosody

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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
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9
Q

The ______ imposes control on posture and movement initiated elsewhere.

A

cerebellum

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10
Q

The cerebellum imposes control on _____ and _____ initiated elsewhere.

A

posture

movement

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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

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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.

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13
Q

What is the major function of the cerebellum?

A

error control

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14
Q

cerebellum receives input primarily from _____ ______ and provides output to _____ (through ______) and then to _______ system.

A

motor cortex
cortex
thalamus
peripheral

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15
Q

Lesions in the cerebellum can cause:

A
  • hypotonia

- errors in force, speed, timing, range , and direction of movements.

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16
Q

The reduced muscle tone and in-coordination of muscles results in:

A

slow rate of speech and inaccuracy in speech movements.

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17
Q

What happens when there is reduced muscle tone and incoordination of muscles?

A

slow rate of speech and inaccuracy in speech movements.

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18
Q

What causes slow rate of speech and inaccuracy in speech movements?

A

Reduced muscle tone and in-coordination of muscles.

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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

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20
Q

In ataxic dysarthria, speech doesn’t reflect the ______ as seen in other dysarthrias, but rather _______ _____ and _______ speech.

A

weakness
poorly controlled
coordinated

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21
Q

What are the three loves in the cerebellum?

A
  • anterior
  • posterior
  • flocculonodular
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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.

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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

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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
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25
Q

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.

A

posterior
anterior
flocculonodular

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26
Q

Posterior lobe:

A

makes up the greater part of the cerebellum and is located between the anterior and flocculonodular lobe.

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27
Q

Why is the posterior lobe important?

A

It is important for coordinating skilled, voluntary muscle activity and muscle tone.

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28
Q

_______ lobe is important for coordinating skilled, voluntary muscle activity and muscle tone.

A

posterior

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29
Q

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

A

flocculonodular

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30
Q

What does the flocculonodular lobe include?

A

The inferior part of the vermis and the attached flocculi

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31
Q

What is the vermis?

A

The middle of the cerebellum.

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32
Q

The ______ is the middle of the cerebellum.

A

vermis

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33
Q

There are two hemispheres to each side of the ______ and each of these is connected to the _______ thalamus and _______ cerebral hemispheres.

A

vermis
opposite
opposite

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34
Q

There are two hemispheres to each side of the vermis and each of these is connected to the opposite ______ and opposite ______ ______.

A

thalamus

cerebral hemispheres

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35
Q

Each of the cerebral hemispheres controls function on the ______ or ____ side of the body.

A

ipsilateral

same

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36
Q

The right side of the cerebellum controls the _____ side of the body and connects to the _____ cerebral hemisphere.

A

right

left

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37
Q

what does the right side of the cerebellum control and what does it connect to?

A

It controls the right side of the body and connects to the left cerebral hemisphere.

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38
Q

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

A

left

right

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39
Q

There are cells in the cortex o f the cerebellum called _____ cells.

A

purkinje

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40
Q

Where are the purkinje cells located?

A

cortex of the cerebellum

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41
Q

There are about _____ purkinje cells in the cerebellum.

A

15 million

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42
Q

The purkinje cells make up the ____ part of the _______ ______.

A

middle

cerebellar cortex

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43
Q

The purkinje cells connect to other __ deep in the _______. _______ is passed through these connections.

A

nuclei
cerebellum
Information

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44
Q

What is the nuclei that is very important in speech control as it aids in initiating movement and regulating posture?

A

dentate nucleus

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45
Q

What is dentate nucleus?

A

The nuclei that is very important in speech control as it aids in initiating movement and regulating posture

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46
Q

______ _______ is very important in speech control as it aids in initiating movement and regulating posture.

A

dentate nucleus

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47
Q

Dentate nucleus is very important in speech control as it aids in initiating _______ and regulating _______.

A

movement

posture

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48
Q

There are tracts of nerve fibers that enter an leave the cerebellum through three structures:

A
  • inferior cerebellar peduncle
  • middle cerebellar peduncle
  • superior cerebellar peduncle
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49
Q

Each cerebellar hemisphere connects to the rest of the _____ _____ through these three bundles of nerve fibers- superior, middle and inferior peduncles.

A

nervous system

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50
Q

Each cerebellar hemisphere connects to the rest of the nervous system through these three bundles of nerve fibers:

A
  • inferior cerebellar peduncle
  • middle cerebellar peduncle
  • superior cerebellar peduncle
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51
Q

The _______ peduncle is a bridge between the midbrain and cerebellum. It is _____ pathway.

A

superior

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52
Q

The ______ peduncle is a bridge between the pons and cerebellum. It is ____ pathway.

A

middle

afferent

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53
Q

The ______ peduncle coordinates information between the medulla and cerebellum. it is mainly an ______ pathway.

A

inferior

efferent

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54
Q

The superior peduncle is a bridge between the ______ and ______.

A

midbrain

cerebellum

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55
Q

The middle peduncle is a bridge between the _____ and ______.

A

pons

cerebellum

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56
Q

What does the inferior peduncle do?

A

It coordinates information between the medulla and cerebellum.

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57
Q

The superior peduncle is ______ pathway.

A

efferent

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58
Q

The inferior peduncles is mainly an _____ pathway.

A

efferent

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59
Q

The middle peduncle is an _____ pathway.

A

afferent

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60
Q

Not a lot is known about _______ lesions, but lesions causing speech problems are usually _____, or in or near the _____ (midline) or involving the ____ _____.

A

cerebellar
bilateral
vermis
dendate nucleus

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61
Q

Where are the lesions that cause speech problems?

A
  • bilateral
  • near or in the vermis
  • involving the dantate nucleus
62
Q

Do lesions that cause ataxic dysarthria have to be confined to the cerebellum?

A

No, it can result from damage to the superior cerebellar peduncle or along the frontopontoacerebellar pathways.

63
Q

Etiologies for ataxic dysarthria:

A 
Anything that damages cerebellum including:
degenerative disease
inflammation
neoplastic problems
toxicity 
metabolic
traumatic
vascular diseases
64
Q

Name two degenerative diseases:

A
  • Frederick’s ataxia

- multiple sclerosis

65
Q

What is Frederick’s ataxia?

A

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
Q

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.

A

Frederick’s ataxia

67
Q

Frederick’s ataxia is due to an ______ _______ pattern.

A

autosomal recessive

68
Q

Multiple sclerosis may result in ________ lesions and _____ ______.

A

cerebellar

ataxic dysarthria

69
Q

______ _______ may result in cerebellar lesions and ataxic dysarthria.

A

Multiple sclerosis

70
Q

Ataxic dysarthria is common in ______ _______ but usually not first sign.

A

Frederich’s ataxia

71
Q

In Multiple sclerosis the lesions aren’t just in the _______.

A

cerebellum

72
Q

In _____ ______ the lesions aren’t just in the cerebellum.

A

multiple sclerosis

73
Q

Lesions in the _____ system can impact on cerebellar function and cause ataxic dysarthria.

A

Vascular

74
Q

What happens when there are lesions in the vascular system?

A

It can impact the cerebellar function and cause ataxic dysarthria.

75
Q

What are the etiologies of ataxic dysarthria?

A

Anything that damages the cerebellum including:

  • degenerative disease
  • inflammation
  • neoplastic problems
  • toxicity
  • metabolic
  • traumatic
  • vascular diseases
76
Q

What causes vascular diseases?

A
  • aneurysms
  • arteriovenous malformations (AVM)
  • cerebellar hemorrhage
77
Q

Aneurysms, arteriovenous malformation, and cerebellar hemorrhage cause ______ ______.

A

vascular disease

78
Q

______ in the cerebellum can lead to ataxic dysarthria.

A

Tumors

79
Q

What is a neoplastic disorder that can lead to ataxic dysarthria?

A

Tumors

80
Q

______ of metastatic brain tumors develop in the cerebellum?

A

25%

81
Q

_______ often results in ataxic dysarthria and limb ataxia.

A

TBI

82
Q

Boxers who have sustained hits to the head may develop _____ ______ or ______ _____ _____ which involves cerebellar dysfunction. These people may develop ataxic dysarthria.

A

dementia pugilistica

punch drunk encepalopathy

83
Q

Both acute and chronic _____ _____ can produce ataxic symptoms.

A

alcohol abuse

84
Q

_______ alcohol can produce ataxic dysarthria, but it usually isn’t permanent.

A

Acute

85
Q

Acute alcohol can produce ataxic dysarthria. Can this cause permanent damage?

A

It usually doesn’t cause permanent damage.

86
Q

_______ alcoholism results in ataxic dysarthria sometimes but it may be more due to _____ problems rather than the affect of alcohol.

A

Chronic

nutritional

87
Q

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

A

malnutrition

vitamin deficiencies

88
Q

Severe malnutrition with vitamin deficiencies may result in ______ damage and ______ dysarthria.

A

cerebellar

ataxic

89
Q

_______ (harmful to nerve tissue) levels of certain drugs may result in cerebellar symptoms. Name some of these medications.

A

Neurotoxic

lithium, dilantin, valium

90
Q

Neurotoxic (harmful to nerve tissue) levels of certain drugs may result in _________ symptoms. For example:

A

cerebellar

lithium, dilantin, valium

91
Q

What is hypothyroidism?

A

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
Q

Hypothyroidism is an ________ _______ and when severe may lead to ______ dysarthria. Caused by not enough secretion of _________ by thyroid glands.

A

endocrine imbalance
ataxic
thyroxin

93
Q

Symptoms of ataxic dysarthria caused by hypothyroidism are:

A

hoarse

gravely and excessively low pitched voice

94
Q

What causes hypothyroidism?

A

Not enough secretion of thyroxin by thyroid glands.

95
Q

What is normal pressure hydrocephalus?

A

Ventricles may be enlarged but CSF pressure is normal. Often result in ataxic dysarthria.

96
Q

______ ______ ______ is when ventricles may be enlarged but CSF pressure is normal and it often results in ataxic dysarthria.

A

Normal Pressure hydrocephalus

97
Q

See Distribution of etiologies

A

page 146

98
Q

Ataxic dysarthria patients mainly complain of _____ _____.

A

slurred speech

99
Q

Slurred speech is the main characteristic of _______ dysarthria.

A

ataxic

100
Q

Even limited _______ intake results in quick deterioration of speech in ataxic dysarthria.

A

alcohol

101
Q

Only patients with ataxic dysarthria refer to their speech as _______ _______.

A

drunken spech

102
Q

Only patients with ______ dysarthria refer tot their speech as drunken speech.

A

ataxic

103
Q

Patients with ataxic dysarthria tend to bite their _____ when eating.

A

cheek

104
Q

Patients with _____ dysarthria tend to bite their cheek when eating.

A

ataxic

105
Q

Patients with ataxic dysarthria can’t coordinate their _______ with ________.

A

breathing

speaking

106
Q

Patients with _______ dysarthria can’t coordinate their breathing with speaking.

A

ataxic

107
Q

Patients with ataxic dysarthria have less _______ complaints than in flaccid or spastic dysarthria.

A

swallowing

108
Q

Patients with ataxic dysarthria report that slowing speech improves _______.

A

inteligibility

109
Q

Patients with ______ dysarthria report that slowing speech improves ineligibility.

A

ataxic

110
Q

Does the cerebellum play an important role in swallowing?

A

No, which is why ataxic dysarthria doesn’t have many swallowing difficulties.

111
Q

Ataxic dysarthria usually occurs with other signs of _______ disease, but it might the first or only sign.

A

cerebellar

112
Q

Problems standing and walking are most prominent signs of ______ dysarthria.

A

ataxic

113
Q

What are the prominent signs of ataxic dysarthria?

A

-problems standing and walking

Broad based gait (feet far apart) to counter imbalance. May lift legs too high when walking.

114
Q

What is titubation in ataxic dysarthria?

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.

115
Q

__________ 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.

A

Titubation

116
Q

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.

A

dysarthria

117
Q

Nystagmus and oculodysmetria occurs in ______ dysarthria.

A

ataxic

118
Q

What type of abnormal movement occurs during ataxic dysarthria?

A

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
Q

_______ 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.

A

Hypotonia

120
Q

What is excessive pendulousness asosciated with?

A

Hypotonia in ataxic dysarthria

121
Q

What is excessive pendulousnees and why does it happen?

A

if let arm swing freely it continuous for longer period of time swinging than normal. This is due to decreased resistance to movement.

122
Q

What is a related phenomenon to excessive pendulousness?

A

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
Q

Excessive pendulousness can be present in ______ dysarthria.

A

ataxic

124
Q

What is a common sign of cerebellar problems?

A

Dysmetria - person is not able to control range of movement and is seen typically by over or undershooting a target

125
Q

Dysmetria is a common sign of _______ problems.

A

cerebellar

126
Q

What is dysmetria?

A

When a person is not able to control range of movement and is seen typically by over or undershooting a target

127
Q

Ataxia is the product of ______, ________, and ________ of ________.

A

dysmetria
dysdiadochokinesis
decomposition of movement

128
Q

Dysmetria, dysdiadochokinesis, and decomposition of movement result in ______.

A

ataxia

129
Q

How are ataxic movements described?

A 
halting
imprecise
jerky
poorly coordinated
lacking in speed and fluidity
130
Q

What are cerebellar disorders often associated with?

A

Intention or kinetic tremor- seen in movements but sometimes in sustained postures. Tremor usually worsens the closer one gets to target.

131
Q

What is dysdiadochokinesis?

A

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
Q

How can dysdiadochokinesis be assessed?

A

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
Q

How is the oral mechanism during ataxic dysarthria?

A

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
Q

How do you asses spastic ataxic dysarthria?

A

-AMRs
conversational speech
reading
vowel prolongation

135
Q

Irregular speech AMRs are a distinguishing characteristic of _______ dysarthria.

A

ataxic

136
Q

How are the AMrs in ataxic dysarthira

A

Irregular speech AMRs are a distinguishing characteristic

137
Q

Do repetition of sentences with multisyllabic words such as “The municipal judge sentenced the criminal” may result in distinctive irregular _____ ______ and ______ abnormalities.

A

articulatory breakdowns

prosodic

138
Q

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

A

Distinctive irregular articulatory breakdowns and prosodic abnormalities.

139
Q

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

A

ataxic

140
Q

Ataxic dysarthria is a problem with ________ _______ of movement patterns rather that with ________ in individual muscles, it has a distinctive character.

A

impaired coordination

deficits

141
Q

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.

A

articulation
prosody
resonance
hyponasality

142
Q

What are the primary problems with ataxic dysarthria?

A

articulation

prosody

143
Q

You rarely see what type of problems with ataxic dysarthria?

A

resonance

144
Q

You might see sometimes (rarely) ______ due to improper timing of __________ and articulatory gestures for ______ consonants.

A

hyponasality
VP function
nasal

145
Q

What are the best distinguishing features in speech of patients with ataxic dysarthria?

A
  • excess and equal stress
  • excess loudness variations
  • dysprosody
  • vowel distortions
  • voice tremor - noticed especially on vowel prolongations
  • irregular & transient articulatory breakdowns
  • Irregular AMRs
146
Q

What is one of the most important distinguishing characteristics of ataxic dysarhtira?

A

AMRs, they are irregular. Normal Amrs are about 6 per second and are regular.

147
Q

Normal AMRs are about ____ per second and are regular.

A

6

148
Q

How do you test for irregular & transient articulatory breakdowns?

A

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
Q

______ can happen in irregular & transient articulatory breakdowns.

A

Telescoping

150
Q

What is telescoping in irregular & transient articulatory breakdowns?

A

a collapsing of syllables - where syllables run together and speech sounds accelerated.

151
Q

Look at table 6.4 page 154

A

case study 6-1

6-2

Motor speech disorders (8 decks)

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