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MSD Exam Sarah > Ataxic Dysarthria > Flashcards

Ataxic Dysarthria Flashcards

1
Q

It is important to understand the specific dysarthrias in order to make a___

A

differential diagnosis

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2
Q

It is important to make a differential diagnosis because___

A

therapy is different for each dysarthria

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3
Q

In ataxic dysarthria it is a problem of:

A

coordination

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4
Q

Where is the lesion for ataxic dysarthria?

A

in the cerebellum

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5
Q

Is is helpful to work on oral motor strengthening exercises with ataxia?

A

No.

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6
Q

What is the defining characteristic of flaccid dysarthria?

A

weakness

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7
Q

What is the defining characteristic of spastic dysarthria?

A

spasticity

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8
Q

What is the defining characteristic of ataxic dysarthria?

A

incoordination

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9
Q

Why is it important to do a differential diagnosis (determine it is dysarthria AND what type)?

A

Because it helps you know where the lesion is. You can rule things in and rule things out.

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10
Q

In your evaluation report, do you need to make a diagnostic statement even if it is: Diagnosis is undetermined?

A

Yes

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11
Q

Ataxic dysarthria is a:

A

cerebellar control circuit dysfunction

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12
Q

Ataxic dysarthria primarily affects (2):

A
  1. articulation

2. prosody

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13
Q

Function of Cerebellum (3):

A
  1. Imposes control on posture and movement initiated elsewhere (in the motor cortex)
  2. Coordinates posture, locomotion, and coordinated activities by adjusting activities of the indirect & direct motor systems and through them the activities of the LMN system.
  3. Major function is error control
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14
Q

Cerebellum receives input primarily from __1___ and provides output to _____2______ and then to ___3_____.

A
  1. motor cortex
  2. cortex (through thalamus)
  3. peripheral system
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15
Q

Lesions in cerebellum cause (6):

A 
Hypotonia
Errors in force
               speed
               timing
               range
               direction of movements (i.e. incoordination)!!!!
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16
Q

Reduced muscle tone and incoordination of muscles (seen in ataxic dysarthria) results in:

A

slow rate of speech and inaccuracy in speech movements

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17
Q

Spastic dysarthria also has slow muscle movement. Which dysarthria creates slower speech (spastic dysarthria or ataxic dysarthria)

A

spastic dysarthria

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18
Q

In observing ataxic dysarthria your can see…

A

the reflection of the role of the cerebellum in breakdown in motor control and organization.

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19
Q

Is there muscle weakness for ataxic dysarthria?

A

Speech doesn’t reflect the weakness as seen in other dysarthrias, but rather poorly controlled and coordinated speech

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20
Q

How many lobes are in the cerebellum?

A

3

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21
Q

What are the 3 lobes in the cerebellum?

A

anterior, posterior and flocculonodular.

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22
Q

The anterior lobe of the cerebellum consists of:

A

Most of the vermis and the anterior aspect of the cerebellar hemispheres.

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23
Q

The anterior lobe of the cerebellum is important for:

A

Regulating posture, gait and muscle tone of the trunk of the body.

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24
Q

The posterior lobe of the cerebellum makes up:

A

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

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25
Q

The posterior lobe of the cerebellum is important for:

A

Coordinating skilled, voluntary muscle activity and muscle tone.

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26
Q

The flocculonodular lobe includes:

A

the inferior part of the vermis and the attached flocculi ( small appendages in the posterior inferior region)

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27
Q

What is the middle of the cerebellum called?

A

The vermis

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28
Q

How many hemispheres are there in the cerebellum?

A

2

29
Q

Each side(hemisphere) is connected to which side of the thalamus? and which cerebral hemisphere?

A

Opposite

Opposite

30
Q

Each of the hemispheres of the cerebellum controls function on which side of the body?

A

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

31
Q

For example:

The right side of the body is controlled by the _L/R___ cerebral hemisphere and the ____L/R____ cerebellar hemisphere

A

left cerebral hemisphere

right cerebellar hemisphere

32
Q

What are Purkinje cells?

A
  • cells in the cortex of the cerebellum
  • there are about 15 million Purkinje cells in the cerebellum
  • make up the middle part of the cerebellar cortex
33
Q

What is the function of Purkinje cells?

A

Connect to other nuclei deep in the cerebellum

Information is passed through these connections

One of those nuclei is called the dentate nucleus which is very important in speech control as it aids in initiating movement and regulating posture

34
Q

Tracts of nerve fibers enter and leave the cerebellum through which 3 structures?

A
  1. Inferior cerebellar peduncle
  2. Middle cerebellar peduncle
  3. Superior cerebellar peduncle
35
Q

Each cerebellar hemisphere connects to the rest of the nervous system through these 3 bundles of nerve fibers -

A

the superior, middle and inferior peduncles.

36
Q

The superior peduncle location:

A

Is a bridge between the midbrain and cerebellum

37
Q

Is the superior peduncle afferent or efferent?

A

Efferent

38
Q

The middle peduncle location:

A

A bridge between the pons and cerebellum

39
Q

Is the middle peduncle afferent or efferent?

A

Afferent

40
Q

The inferior peduncle location and function:

A

coordinates information between the medulla and cerebellum.

41
Q

Is the inferior peduncle afferent or efferent?

A

It is mainly an efferent pathway

42
Q

Is there a lot known about cerebellar lesions?

A

No.

43
Q

Cerebellar lesions causing speech problems are usually bilateral or unilateral?

A

Bilateral

44
Q

Cerebellar lesions causing speech problems are usually located:

A

In the vermis (midline)
or generalized

  • But it can be due to a more focal lesion
  • Usually bilateral
45
Q

ETIOLOGIES of ataxic dysarthria (7):

A 
Anything the damages cerebellum including:
1. degenerative disease
2. inflammation
3. neoplastic problems
4, toxicity
5. metabolic
6. traumatic
7. vascular diseases.
46
Q

Specific diseases that cause ataxic dysarthria (6):

A
  1. Degenerative diseases (Frederich’s ataxia and Multiple Sclerosis)
  2. Vascular diseases
  3. Neoplastic disorders
  4. Trauma
  5. Toxic-metabolic conditions
  6. Other diseases
47
Q

Frederich’s ataxia and ataxic dysarthria:

A

Degenerative Disease

  • Symptoms shown in childhood and progress over time
  • It is 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.
48
Q

Multiple Sclerosis and ataxic dysarthria:

A

Degenerative Disease

  • May result in cerebellar lesions and ataxic dysarthria
  • But usually in MS the lesions aren’t just in cerebellum
49
Q

Vascular diseases and ataxic dysarthria:

A

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

Usually caused by aneurysms, arteriovenous malformations (AVM), or cerebellar hemorrhage

50
Q

Neoplastic disorders and ataxic dysarthria:

A

Tumors in the cerebellum can lead to ataxic dysarthria.

There may be involvement of other cranial nerves.

25% of metastatic brain tumors develop in the cerebellum

51
Q

Trauma and ataxic dysarthria:

A

TBI often results in ataxic dysarthria and limb ataxia

Boxers who have sustained hits to the head may develop dementia pugilistica or “punch-drunk encepalopathy” which involves cerebellar dysfunction. These people may develop ataxic dysarthria.

52
Q

Toxic-metabolic conditions and ataxic dysarthria:

A
  • Both acute and chronic alcohol abuse can produce ataxic symptoms. Acute alcohol can produce ataxic dysarthria, but it usually isn’t permanent. (i.e. too much to drink has similar affect to cerebellar dysfunction in other diseases).
  • Chronic alcoholism results in ataxic dysarthria sometimes but it may be more due to nutritional problems rather than affect of alcohol.
  • Severe malnutrition with vitamin deficiencies may result in cerebellar damage and ataxic dysarthria.
  • Neurotoxic (harmful to nerve tissue) levels of certain drugs may result in cerebellar symptoms. (Examples: Lithium, Dilantin, Valium)
53
Q

Other diseases and ataxic dysarthria:

A
  • Hypothyroidism –endocrine imbalance and when severe may lead to ataxic dysarthria. Caused by not enough secretion of thyroxin by thyroid glands. Ataxic dysarthria may be accompanied by hoarse, gravely and excessively low pitched voice.
  • Normal pressure hydrocephalus (NPH) – ventricles may be enlarged but CSF pressure is normal. Often results in ataxic dysarthria.
54
Q

Patient complaints with ataxic dysarthria (9):

A
  • Slurred speech, sounds as if they are drunk.
  • Pts with other types of dysarthria may complain of slurred speech but typically only pts with ataxic dysarthria refer to their speech as “drunken” speech
  • Pts often say that friends ask them if they have been drinking.
  • Limited alcohol intake results in quick deterioration of speech
  • Stumble over words
  • Bite their cheek when eating
  • Can’t 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)
  • Patients report that slowing speech improves intelligibility
55
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

56
Q

GENERAL CLINICAL CHARACTERISTICS OF ATAXIA:

A
  1. Problems standing and walking
  2. Titubation (nodding movement of the head or body, especially as caused by a nervous disorder)
  3. Abnormal eye movement
  4. Hypotonia
  5. Dysmetria
  6. Dysdiadochokinesis
57
Q

Problems with standing or walking with ataxic dysarthria:

A

Most prominent signs of Ataxic dysarthria

Broad based gait (feet far apart) – to counter imbalance.

May lift legs too high when walking

58
Q

Titubation with 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

59
Q

Abnormal Eye Movements and ataxic dysarthria:

A

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

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

60
Q

Hypotonia and ataxic dysarthria:

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.

61
Q

Dysmetria and ataxic dysarthria:

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.

62
Q

Dysdiadochokinesis and ataxic dysarthria:

A

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

63
Q

Ataxia is the product of (3):

A
  1. dysmetria
  2. dysdiadochokinesis
  3. decomposition of movement
64
Q

Describe ataxic movements (5):

A
  1. halting
  2. imprecise
  3. jerky
  4. poorly coordinated
  5. lacking in speed and fluidity
65
Q

What are intention or kinetic tremors?

A
  • Cerebellar disorders are often associated with them
  • Seen in movement but sometimes in sustained postures
  • Tremor usually worsens the closer one gets to target
66
Q

T/F

Same clinical evidence seen in limbs as seen in speech for ataxic dysarthria

A

True

67
Q

Nonspeech clinical findings for ataxic dysarthria (4):

A
  • Oral mech exam is OK usually – size, strength, symmetry of jaw, face, tongue and palate normal at rest and in sustained postures.
  • Gag reflex usually normal.
  • No pathologic reflexes.
  • Drooling is not common.
68
Q

Assessing Speech for 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.
  • Do repetition of sentences with multisyllabic words such as “The municipal judge sentenced the criminal” may result in distinctive irregular articulatory breakdowns and prosodic abnormalities.
  • Because ataxic dysarthria is a problem with impaired coordination of movement patterns rather than with deficits in individual muscles, it has a distinctive character.
  • 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.
69
Q

Best distinguishing features in speech for ataxic dysarthria (6):

A
  1. AMRs are one of the most important distinguishing characteristics of ataxic dysarthria. They are irregular. Normal AMRs are about 6 per second and are regular.
  2. Irregular & transient articulatory breakdowns – test by having patients say sentences containing multisyllable words and look for irregular breakdowns. What you see is “telescoping” – a collapsing of syllables – where syllables run together and speech sounds accelerated.
  3. Excess and equal stress
  4. Excess loudness variations – some have explosive loudness
  5. Dysprosody
  6. Vowel distortions

MSD Exam Sarah (8 decks)

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