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Motor speech final > chapter 15 differential dx > Flashcards

chapter 15 differential dx Flashcards

1
Q

what does differential dx mean?

A

the process of narrowing the possibilities and reaching conclusions about the nature of a defeceit

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2
Q

what are the guidelines for differential dx?

A
  • when doing a speech eval always try to make a dx
  • if you can’t make a def dx then you must describe what you find and state why a def dx cant be made
  • sometimes it is helpful to state what the dx is not (ex: it is not flaccid dys)
  • you might be able to establish that a dys is present but you may not be able to specify a type (this is still helpful)
  • if a dx is not determined, do not offer a dx
  • also make a statement of how confident you are in your dx (if you are not say possibly)
  • make the spch dx relate to the suspected site of lesion (it is helpful to the neurologist if they are not or are consistent with the site of lesion)
  • it is possible for more than one speech disorder to exist at the same time so determining just one dx might not always be sufficient (you must account for all deviant characteristics) if the disorder you identified does not do this there may be another disorder present.
  • an eval may not always find deviant speech it may indicate it is WNL
  • by providing a label for the dx you are providing a composite of info associated with that label
  • there is overlap among dysarthrias in terms of certain characteristics
  • there are also some characteristics that are unique to certain dys and can be used to distinguish btwn dysarthrias
  • look at anatomy and vascular lesions
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3
Q

what are some reasons for not being able to make a dx?

A

noncooperative ptnt

equivocal/uncertain findings

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4
Q

If you cannot figure out what type of dysarthria the ptnt has but you can determine if it is dysarthria is this still helpful?

A

yes

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5
Q

What are some etiologies that can help you make a diff dx?

A 
vascular
degenerative dz
tbi
surgical trauma
toxic metabolic
infectious and inflammatory
demyelinating diseases
anatomic malformations
neuromotor junction dz
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6
Q

what is the type of stroke that is the most common cause of dys?

A

hemorrhagic stroke

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7
Q

what kinds of dys can be caused by vascular?

A

can cause any type of dys

most common spastic, UUMN, and ataxic

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8
Q

what kinds of dys can cause degenerative dz?

A

can cause any type of dys
most often ataxic, spastic, hypokinetic and flaccid dys
ALS is frequent cause of flaccid and spastic but other types of dys are not usually seen in als

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9
Q

als is a frequent cause of what two dys?

A

flaccid spastic

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10
Q

what dysarthria is Parkinson’s dz only associated with?

A

hypokinetic

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11
Q

what kinds of dysarthrias can TBI cause?

A

can cause any type of dys

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12
Q

what type of dys does closed head injury most commonly cause?

A

spastic

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13
Q

do open head injuries normally cause flaccid dys?

A

no

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14
Q

what kind of dysarthrias are caused by open head injuries?

A

cns dysarthrias (spastic, ataxic, and UUMN)

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15
Q

what kind of trauma can cause flaccid dys?

A

skull fracture and neck traumas

but no other type of trauma causes flaccid

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16
Q

what kinds of dysarthrias are caused by surgical trauma?

A

can cause any type except hypokinetic

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17
Q

surgeries that involve the ear, nose, throat, chest/cardiac areas are only associated with what type of dysarthria?

A

flaccid

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18
Q

what kind of dys can neurosurgery cause?

A

can cause cns dysarthrias as well as flaccid

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19
Q

what kinds of dysarthrias can toxic metabolic conditions cause?

A

do not typically cause flaccid or UUMN dysarthria but can cause other types.
toxic conditions caused by drugs/medications typically cause hyperkinetic and ataxic dys

20
Q

do infectious and inflammatory dz typically cause dys?

A

no although they sometimes do occur the type of dys depends on the condition

21
Q

what kinds of dys do demyelinating dz cause?

A

an cause any but hypokinetic is rare the dysarthria depends on the disorder
-gullain barre=flaccid
multiple sclerosis is ataxic

22
Q

what kind of dysarthria is Arnold chiari malformations cause?

A

most associated with flaccid

23
Q

what dys does neuromotor junction disorders cause?

A

flaccid only bc it is only pns diseases

24
Q

T or F. certain oral mech findings are not required for MSD but are used as confirmatory signs

A

True

25
Q

What are the confirmatory signs of flaccid dys?

A

atrophy and fasiculations often occur in flaccid dys and do not occur in other dysarthrias or apraxia.
hypotonia and a hypoactive gag reflex often occur in fd than other dys
-rapid loss of intelligibility is indicative of Myasthenia Gravis but not other MSD’s
-nasal regurgitation may be seen in FD

26
Q

what are the confirmatory signs of spastic dys?

A

pathological oral reflexes
-hyperactive gag reflex
pseudobulbar effect are found most often in this dys
-more problems with dysphagia and drooling occur with this dys that others but they may occur with others

27
Q

what are the confirmatory signs of ataxic dys?

A

may have dysmetria in nonspeech jaw, face and tongue movements
this isn’t seen in other dysarthrias typically
other oral mech findings may be normal

28
Q

what are the confirmatory signs of hypokinetic dys?

A

orofacial tremors, masked face is common and not seen in other msd’s

29
Q

what are the confirmatory signs of hyperkinetic dys?

A

abnormal movements may be seen both at rest and in speech that are not seen in other dysarthrias.

30
Q

what are the confirmatory signs of UUMN dys?

A

unilateral facial and lingual weakness without atrophy and fasciculation is common but not typically seen in other dysarthrias

31
Q

what are the speech characteristics seen in flaccid dys?

A

phonatory and resonatory abnormalities are most common distinguishing characteristics.
if the Xth nerve is affected you may see breathiness and diplophonia, audible inspiration and short phrases. These are not common in other dys.
breathiness does occur in hypokinetic dys but listen for greater hoarseness and the presence of diplophonia in FD which would differentiate the two
-hypernasality occurs in other dysarthrias most often spastic and hypokinetic but is still most pronounced in flaccid
-rapid deterioration of speech only occurs with MG which is only FD

32
Q

what are the speech characteristics seen in spastic dys?

A

slow rate combined with slow but regular AMR’s, strained voice quality are most common features and aren’t typically seen in other dys.

33
Q

what are the speech characteristics seen in ataxic dys?

A

irregular articulatory breakdowns, irregular amr’s and dysprosody (primary dist, characteristics)
can be seen in hyperkinetic and uumn but look for abnormal movements in hyper and look for unilateral lower facial and tongue weakness in uumn

34
Q

what are the speech characteristics seen in hypokinetic?

A

the only dys tin which rapid and blurred speech and AMR’s occur
-if palilalia occurs it only ocurrs with hypokinetic dys

35
Q

what are the speech characteristics in hyperkinetic dys?

A

abnormal movements

36
Q

what are the speech characteristics of UUMN?

A

mildness and transient duration helps to differentiate UUMN
-it may be confused with ataxic bc irregular breakdowns but amr’s are usually normal but can be mildly irregular.
-

37
Q

dysarthria vs. apraxia?

A

apraxia occurs with left hemisphere damage lesions (if the l is dominant)
it occurs with supratentorial damage
-dys occurs with damage to supratentorial, posterior fossa, spinal or peripheral lessions
-apraxia typically occurs primarily with lesions of the carotid system
-dys occurs not only with carotid but other vascular systems lesions

38
Q

T or F. UUMN is the hardest to differentiate from AOS

A

true

39
Q

what are the speech characteristics that differentiate aos and dysarthria?>

A

oral mech exams indicate the neuromuscular problem associated with dys
-in dys all subsystems affected
in aos only artic and prosody
-aos is more commonly associated with aphasia than dys
-artic errors are usually distortions in dys and apraxia but aos are more predictable errors
-apraxic speakers grope dys do not

40
Q

what are the differences btwn aphasia and dyspting

A

aphasia ptnts can have normal oral mechs dys usually do not

dys do not have lang problems

41
Q

forms of neurogenic mutism

A

conditions that have diffuse or more multifocal damage are more likely to be associated with mutism due to cognitive-affective disturbances that with anarthria, aos, aphasia

42
Q

what is anarthria

A

lack of speech
-usually have significant neuromotor deficits in bulbar muscles that cause mutism its sometimes present without limb or motor def.
usually has significant dysphagia and othor oromotor abnormalities and this helps in dx.
-rarely does anarthric mutism occur in absence of nonspeech oromotor abnormalities
when attempting to speak their restricted articulatory rom, reduced loudness and strained, groaning quality is diagnositc

43
Q

mutism due to aphasia

A

similar to mute apraxics except they may have problems following instructions.
if mutism is present, aphasia is usually severe so they do poorly on lang tests

44
Q

mutism due to apraxia

A

can be associated with normal oral mech findings mute apraxics usually try to speak and show frustration when they cant

45
Q

what are cognitive affective disturbances?

A

may be due to reduced arousal and alertness if speech does eventually occur, there are delays with brief unelaborated speech

Motor speech final (5 decks)

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