benchmark 1 Flashcards
What is dysarthria
acquired neurological motor weakness affecting changes movement; consistent mistakes; think Big 8
Big 8
SST SR SAC
symmetry, steadiness, tone (SST)
strength, ROM (SR)
speed, accuracy, coordination (SAC)
Volitional vs spontaneous vs reflexive speech
volitional: where we ask some to say something after (asking for planned speech response)
spontaneous: spontaneous speech
reflexive: saying “ouch” when hurt
what is anarthria
most severe dysarthria —> lost all ability to produce meaningful speech; all motor components breaking down; they know what they want to say but can’t get words out
apraxia of speech
neurogenic communication disorder affecting motor programming–> patient knows what they want to say but unsure how to get articulators in right position to make target speech sound; groping and inconsistent mistakes are salient feature
what is hypothesis
simple declarative statement that incorporates cause and effect and can be tested and measured
hypothesis guided management leads to ______
critical reasoning
what are the major differences between assumptions and hypotheses
assumptions are judgment and not testable (measureable)
T/F assessments are an ongoing process - making adjustment based on observation and client behavior
true
4 parameters of WHO model
- body function
- body structure
- activities and participation
- environmental factors
comprehensibility vs intelligibility
comprehensibility is the meaning of the message
intelligibility is the precision of the articulators forming target phonemes
3 main parts of clinical report
case history, direct observation, impression/recommendations
Restoration vs compensation
- restoration of lost function
- Compensation is the process of learning how to develop “work arounds” for a task, function, or process
- think goals, severeity, diagnosis, treatment timeline
what is the indirect component of assessment
case history such as background info, medial history, referral, observing patient in lobby
define pathophysiology
distinctive pattern of movement disorder
is the patient interview direct or indirect observation of communication
direct; the interview is open ended and broader than client intake which is specific and narrow
what is the most effective way to collect perceptual speech sample
conversational speech
the formal assessment is direct observation
true
t/f slp sets up environment to help facilitate ease of patient
true
rt/f reading aloud is a great way to record and measure rate of speech
true
4 subsystems of speech
respiration, phonation, resonation, articulation
how can the subsystems affect speech
intelligibility, fluency, speech rate, prosody, naturalness
AMR vs SMR
AMR: alternate motion rates ex: /pa pa pa/
SMR: sequential motion rates ex /pa ta ka/
palpate
to touch or feel part of the body to examine
paucity of movement
shortening of a movement, no extra embellishments
fasciculations
slight muscle twitches; most common in tongue
coup de glotte
forcing closure of VFs; grunt
flaccid
low muscle tone, weak
spastic
high muscle tone, tense
stilted
issue with fluency
diplophonia
two vocal pitches occurring at same time
hypothesis
is something you rationalize and can easily test; to determine if you are correct or incorrect
- underlying, pathological reasoning for what is happening
stimulability
assessing if a client can attempt to do what is being ask by clinician
what do we look at for determining prognosis
restore or compensate lost function, protect/maintain current function
what is flaccid dysarthria
damage in spinal/cranial nerves; lower neuron motor dysfunction; hypotonia
Lower motor neuron
lower motor neurons begin in the spinal cord (at medulla (CNS)) and go on to innervate muscles and glands throughout the body (PNS); symptoms are more flaccid
assess indivudal cranial nerves
injury to spinal cord gray matter
direct vs indirect system of bulbar spinal tracts
direct: fewer synapses, control of movement, faster movement
indirect: many synapses, balance/posture, slower movement
final common pathway
the motor route (efferent signals) a neural signal takes from the CNS and travels OUT until it reaches endpoint like the hand muscle or larynx; innervate individual strcutres or muscles
damage to FCP affects individual muscles or muscle groups
all nerves that have to do with movement (contracting muscles) pass along FCP
- message is sent out, no way of getting it back
- last chunk of neurons firing on that pathway
- flaccid dysarthria: damage to FCP affects individual muscles of muscle groups
efferent signals
motor only
- voluntary, reflexive, autonomic movements
damage to SPINAL nerves C3-C5 =
Phrenic nerve innervates diaphragm
Upper motor neuron
upper motor neurons originate in the cerebral cortex and travel down to the brain stem; damage is more spastic
assess each subsystem of speech separately (LMN assess individual cranial nerves)
injury to brain and injury to white matter in spinal cord
bulbar spinal tract
the nerves and tracts connected to the medulla, and also by association to the muscles thus innervated, those of the tongue, pharynx and larynx
- brainstem and medulla (CNS)
name the 4 CN passing through medulla
CN 9, 10, 11, 12
- not CN V or CN VII (because these innervate the face)
CN V
Trigeminal - sensory of face and motor innervation to the muscles of mastication
CN VII
Facial Nerve - motor innervation of facial muscles and sensory of anterior 2/3 tongue
Bell palsy is an idiopathic form of facial nerve palsy
CN IX
Glossopharyngeal - motor innervation to the stylopharyngeus muscle. This muscle is responsible for elevating the larynx and pharynx, especially during speaking and swallowing
sensory - posterior third of the tongue
CN X
SLN - innervates cricothyriod muscle, sensory above glottis
RLN - below the cord; sensory below glottis
The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It is innervated by the superior laryngeal nerve. Its action tilts the thyroid forward to help tense the vocal cords, thus increasing the pitch of the voice.
CN XII
Hypoglossal: motor only for tongue
Phases of muscle contraction:
- latent period
- contraction period
- relaxation period
Components of a Nerve
Neuron generates and conducts impulses
Neuron consists of cell body, dendrites, axon
Glia cells: myelination
astrocyte cells, oligiodendroglia cells, schwann cells
Synaptic cleft:
space between an axon terminal and muscle fiber or dendrite
acetycholine releases into the synaptic cleft, where the neurotransmitter is free to bind with receptors; all or nothing
(ie mysenthia gravis)
Myoneural junction
aka neuromuscular junction
space between an axon and a muscle
(MYO = muscle)
Myotonic
prolonged muscle contraction; delayed relaxation
flaccid dysartheia aka Bulbar palsy
signal hits muscle in a weakened way; doesn’t reach muscle as accurately as intended
signs of flaccid dysartheria/bulbar palsy
hypotonia (low muscle tone), hyporeflexia (reduced reflexes), limited ROM, changes in symmetry, lack of steadiness, atrophy, akinesia, flaccidity, reduced strength
unilateral bulbar palsy
damage to PNS is often unilateral and impairs individual muscles on one side
LMN polyneuropathies can be bilateral and affect more than 1 nerve (ie Guillain-Barre, muscular dystrophy, mysenthia gravis)
Flaccid dysartheria/Bulbar Palsy etiology
- idiopathic
- tumor
- TBI
- brain stem stroke
- infection
T/F all CNs are PNS
true
Bulbar Palsy : damage to Spinal Nerves
only changes seen in respiration/chest during motor assessment
- rapid shallow breathing
- reduced VC
-short MPT
- inadequate checking action
- weak cough
Bulbar Palsy: essential assessment for respiration (spinal nerves)
conversational speech
- reduced loudness
- short breath groups
- fade at end of sentence
- speak on residual air
- AMR/SMR: limited reperions
- Prolonged vowels: short duration
Flaccid Dysarthria: CN V Trigeminal
rarely occurs independently
damage must be bilateral for symptoms to emerge
Motor assessment of CN V
changes only seen in jaw
- weak mandibular valve
- jaw sags open
- reduced ROM
Essential assessment of CN V
conversational speech (artic) –> greatest difficulty
- severely reduced intelligibility
- imprecise consonants and vowels
- can be slow
AMR/SMR:
- limited ROM
- imprecise
- slow
Flaccid Dysarthria: CN VII Facial –> Bell’s Palsy
Facial paralysis from dysfunction/inflammation of CN VII
- unilateral weak unresponsive on affected side
- decreased facial expression
- food pocketing
- inability to close eye
- rapid onset of partial or complete paralysis
- can occur bilaterally –> total facial paralysis
- spontaneous recovery –> 75% have complete recovery w/i 2-3 weeks
Motor Assessment of CN VII –> Bell’s Palsy
- decreased facial expression
- changes only seen in lips –> weak pursing, rounding/retraction, weak labial seal for holding air in cheeks
AMR/SMR: imprecise
Essential assessment of CN VII –> Bell’s Palsy
Conversational Speech (Artic)
- imprecise bilabials/labiodentals/Labial vowels
- flutter of cheeks during speech
Absence of CN VII Facial –> Moebius Syndrome
- congenital neurological disorder
- complete facial paralysis
- no facial expression
- normal intelligence
Flaccid Dysarthria CN X Vagus - Motor assessment of 2 branches
Velopharynx: Velopharyngeal
- decreased elevation of soft palate
- uvula points to strong side
Larynx: Laryngeal
- weak cough/glottal coup
- paralysis of VFs (RLN)
Flaccid Dysarthria CN X Vagus - essential assessment of Velopharyngeal Branch
Conversational speech
-Resonance: HYPERnasal/nasal emission
- Artic: weak pressure consonants
AMR/SMR: weak artic of stops
Prolonger Vowels: short duration
Flaccid Dysarthria CN X Vagus - essential assessment of Recurrent Laryngeal Branch
Conversational speech
- Respiration: reduced loudness/stridor
- Phonation: breathy, rough, diplophonia (voice is perceived as being produced with two concurrent pitches)
- AMR/SMR: diplophonia
- Prolonged Vowels: short duration
Flaccid Dysarthria CN X Vagus - essential assessment of Superior Laryngeal Branch
conversational speech
- Phonation: monopitch, limited pitch range
- SLN responsible for lengthening VFs
Flaccid Dysarthria: CN XII Hypoglossal –> motor assessment
Tongue
- atrophy
- fasciculation (involnert mvmt)
- weak protrusion/lateralization/elevation/resistance
Flaccid Dysarthria: CN XII Hypoglossal –> essential assessment
conversational speech
- imprecise lingual consonants
- tense vowels (i, o, u)
- slow rate
AMR/SMR: imprecise, slow
Flaccid Dysarthria: Damage to Multiple Nerves –> 3 types
guillian-barre
muscular dystrophy
Myasthenia gravis
Flaccid Dysarthria: Damage to Multiple Nerves –> guillian-Barre
- quick onset; distal –> proximal
- can go away just as quick
- infection/autoimmune/idiopathic
everything shuts down; progressive paralysis - generalized flaccidity of entire body
- CNs and SNs are involved
- nerves loses myelin sheath
Flaccid Dysarthria: Damage to Multiple Nerves –> Muscular Dystrophy
- expressionless face - flat affect
- weakness of CNs and SNs
- AMR/SMR: pervasive bulbar weakness
- short breath groups
-rough breathy voice - mild hypernasality
- air leakage thru Velopharyngeal port
Flaccid Dysarthria: Damage to Multiple Nerves –> Myasthenia Gravis
- issue @ synaptic cleft and neuromuscular junction (acetylcholine issues)
- fatigue, fluctuating muscle weakness –> improves with rest (no drill practice)
- diminished facial expression
- waves of symptoms
- progressive fatigue from prolonged speaking
- reduced loudness, short breath groups
- weak breathy voice
- imprecise Consonants
therapy for flaccid dysarthria
- provide supports to reduce effort in the speech subsystems
- avoid fatigue
compensatory strategies for CN V and VII
jaw bra and hand support
compensatory strategies for CN XII
- thermal stimulation
- stroking
- increase awareness and reflexive movements
- increase ROM and strength
- functional speech/swallowing therapy
compensatory strategies for CN X
- surgery –> thyroplasty, injections, nerve transfer
- amplifiers
- SOVT exercises
- turn head to weak side
- palatal prosthesis
- thermal stimulation
- blowing exercises
- open mouth wider for oral resonance
palialia
occurs in PD –> repeating phrase over and over with increased speed and decreased intelligbility
Mostly occurs at end of sentence
motor physiology of speech –> 3 subsystems
motor control
sensation
reflexes
CN X Vagus RLN innervates muscles of larynx wcept cricothryoid
true
when looking at motor control start at symmetry
true
when to use sniff test
sniffinf cuases diaphragm to descend and flatten the most
use the sniff to observe how much air the indivial can inhale; also tests ROM
spirometer measures vital capacity
true
phonation quotient tells us how efffectivly patient is using the iar that they are moving
true
prognositc statement include excellent, good, or poor potential for improvement
true
the most logical way to oganize data from an assessment into a clinical report is based on he speech subsystems
true
spinal nerves: spinal intercostal, phrenic and thoracic control respiration
true
components of functional motor unit
cell body
axon
dendrite
myoneural junction
muscle fibers innervated by that cell body
goal of therapy: fatigue
to structure enviroment, communication so that client is using little effort to reduce fatigue
gray matter vs white matter
gray is made up of cell bodies -> functions to receive information and regulate outgoing information
white matter is made up of axons –> serves to transmit signals to other regions of the brain, spinal cord, and body
sensory function drives motor function
true –> increase sensory awareness to aid motor function
CN VII damage and AMR/SMR
/puh/ would be most damaged because of lip closure
What happens in RLN is damage during heart durgery
pt will have left VF paralysis
breathy rough voice
diplophonia
stridor
if velopharyngeal branch is damaged
damage seen in uvula –> points to strong
