Chapter 15 Flashcards
What is differential dx?
The process of narrowing possibilities and reaching conclusions about the nature of a deficit.
What are two reasons that may interfere with making a definitive diagnosis?
1) noncooperative client
2) equivocal/uncertain findings
What are some etiologies of MSD (10)
1) Vascular
2) Degenerative (ALS,PD)
3) TBI
4) Surgical Trauma
5) Toxic and metabolic conditions
6) Infections and metabolic conditions (rare)
What kind of stroke is the most common cause for dysarthria?
Hemorrhagic.
What kind of the dysarthria most commonly occurs w/ closed head injuries (TBI) ?
Spastic.
T/F In an open head injury (TBI), flaccid dysarthria is likely to occur.
False; it is more common for it to cause the CNS dysarthrias (spastic, UUMN, & ataxic)
If there is a skull fracture or neck trauma, which dysarthria is likely to occur?
Flaccid.
T/F Surgeries involved w/ ENT, chest/cardiac areas are only associated with flaccid dysarthria.
True.
The only dysarthria that does not occur from surgical trauma is ______________.
Hypokinetic.
Which two dysarthrias are associated with toxic conditions?
Ataxic and hyperkinetic.
Guillian barre is what kind of d/o and what kind of dysarthria does it typically cause?
demylenating dz, typically causes flaccid dysarthria.
Which demylenating dz is usually associated w/ ataxic dysarthria?
Multiple Sclerosis (MS).
What is Arnold Chiari? Which dysarthria is typically associated with it?
An anatomic malformation of the brain. Flaccid Dysarthria.
Neuromotor junction d/o typically cause which kind of dysarthria?
Flaccid.
What are the confirmatory signs for flaccid dysarthria?
Fasciculations, atrophy, hypoactive gag reflex, hypotonia, MAYBE nasal regurgitation.
What are the confirmatory signs for spastic dysarthria?
Pathological oral reflexes, hyperactive gag reflex, dysphagia, drooling, psuedobulbar affect.
What are the confirmatory signs for ataxic dysarthria?
Dysmetria for non-speech jaw, face, tongue.
What are the confirmatory signs for hypokinetic dysarthria?
orofacial tremors, masked facies
What are the confirmatory signs for hyperkinetic dysarthria?
Abnormal or unwanted mvmts at rest and in speech
What are the confirmatory signs for UUMN?
Unilateral facial and tongue weakness (w/o atrophy).
Which two subsystems of speech are affected in flaccid dysarthria?
Resonatory and phonatory abnormalities.
What are the main VOICE characteristic seen in flaccid dysarthria and which CN is damaged?
Breathiness, diplophonia, short phrases, inspiratory stridor.
CNX (VAGUS)
What are the 3 main speech characteristics in spastic dysarthria?
Slow rate combined with slow, but regular AMRs.
Strained voice.
What are the speech characteristics in ataxic dysarthria?
Irregular artic. breakdowns, irregular AMRs, dysprosody.
What are the speech characteristics for hypokinetic dysarthria?
Rapid, blurred speech and AMRs, palilalia.
What are the speech charcteristics for hyperkinetic dysarthria?
unwanted speech movements.
What are the speech characteristics of UUMN?
Mild & transient duration. (may be confused w/ ataxic due to irregular breakdowns and mild irregular AMRs).
-rarely hypernasal, sometimes strained.
Apraxia = damage to which areas of the brain ?
LH (typically); supratentorial.
Dysarthria = damage to which areas of the brain ?
Supratentorial, posterior fossa, spinal or peripheral lesions.
Which vascular systems are typically affected in apraxia?
Carotid.
Which vascular systems are typically affected in dysarthria?
May be any, not only carotid.
Which type of dysarthria is most commonly confused with Apraxia (AOS) ?
UUMN.
How can you differentiate b/w dysarthria & apraxia?
1) oral mech exam indicates neuromuscular problem for dysarthria and NOT for apraxia.
2) In dysarthria, all subsystems are affected. In apraxia, articulation and prosody are mainly affected.
3) AOS is more often linked to Aphasia than dysarthria.
4) Distortions in apraxia are predictable and in dysarthria they are not.
5) Apraxia speakers grope.
How can you differentiate dysarthria and aphasia?
1) Oral mech = normal for aphasia and not normal for dysarthria (muscle problems).
2) Dysarthria do not have LANGUAGE problems, aphasia pt’s DO.
What is anarthria?
Lack of speech.
T/F Anarthria is typically is present with limb motor deficit.
False; usually occurs without it.
What other abnormalities are present in a pt with anarthria that can help w/ dx?
Dysphagia and oromotor abnormalities.
What are other characteristic found in anarthria?
Restricted artic ROM, reduced loudness, strained, goaning quality.
TYPICALLY have oromotor deficits.
T/F Mute apraxic pt’s usually try to speak and show frustration when they can’t.
True.
T/F Mute apraxic pt’s typically show an abnormal oral mech exam.
False; they may show normal oral mech structures.
What is one difference b/w mutism present in aphasia vs. mutism present in apraxia?
Pt’s w/ mutism present in aphasia typically have problems following directions.
What are three reasons a pt can have a neurogenic mutism?
1) due to aphasia
2) due to apraxia
3) due to cognitive-affective disturbances = not enough stimulationof brain; may be severely delayed if they do start to speak.
