chapter 5 Flashcards
neurologic basis of spastic dysarthria
bilateral damage to umn tracts
umns are in the
CNS
-descending motor tract, terminates at level of brainstem
role of umn in spastic dysarthria
-bilateral damage to umns of pyramidal/extrapyramidal neural pathways
pyramidal system damage spastic
can result in weak/slow skilled movements
extrapyramidal system damage spastic
can result in weakness, increased muscle tone (spasticity), and abnormal reflexes
onset may mimic
flaccid dysarthria, however very quickly spasticity sets in
significance of bilateral damage
damage must be bilateral, affecting both left and right tracts of pyramidal and extrapyramidal systems
-weakness and slowness, particularly in tongue and lips
-spasticity most noticeable in laryngeal muscles
-abnormal reflexes (primitive reflexes)
causes of spastic dysarthria
strokes, degenerative diseases, traumatic head injury, infections of brain tissue, tumors
stroke
most common cause of spastic; will only result in spastic when two or more strokes occur in certain combos in the cerebrum or a single stroke occurs in the brainstem (before the cranial nuclei)
amyotrophic lateral sclerosis (ALS)
degenerative neurologic disease of unknown cause; terminal, average life expectancy 22 months from time of onset, causes spastic when UMN involvement predominant
traumatic head injury
can produce widepsread injury to brain, causing bilateral damage to pyramidal and extrapyramidal systems
multiple sclerosis
suspected immunological disorder resulting in inflammation or complete destruction of myelin sheath covering axons - bilateral involvement of umns results in spastic
other causes
brainstem tumor, cerebral anoxia, viral infection in cerebral tissue, bacterial infection in cerebral tissue
speech characteristics of spastic dysarthria
-speech errors are a result of spasticity, slowness, weakness in vocal-tract muscles
respiration less effected in spastic because
the phrenic nerve
articulation
-very common
-impercise consonant production
-vowel distortions
imprecise consonant productions spastic
result of abnormally short voice onset time for voiceless consonants, incomplete articulatory contact, incomplete consonant clusters
phonation spastic
harsh vocal quality, strained-strangled voice quality, low pitch
harsh vocal quality spastic
most common phonatory error, occurs when air leaks through partially open glottis during phonation
strained-strangled vocal quality
tight hyperadduction of VFs
low pitc spastic
result of increased muscle tone in larynx
resonance spastic
hypernasality - caused by spasticity in velar muscles which slows and reduces range of soft palate movement and results in incomplete velopharyngeal closure during non-nasal speech sounds; does not include nasal emissions
prosody spastic
monopitch, monoloudness, short phrases, slow rate of speech
monopitch spastic
caused by overall tenseness of laryngeal muscles, resulting in reduced ability to contract/relax to vary pitch
monoloudness spastic
caused by overall increased muscle tone in laryngeal muscles
short phrases prosody
natural consequence of speaking through abnormally tight larynx, making it difficult to use longer utterances
slow rate of speech spastic
caused by reduced speed and range of movement
pseudobulbar affect
uncontrollable crying or laughing that can accompany damage to umn’s brainstem, appears to be caused by damage to part of brain important in inhibiting emotions; pretty specific to spastic
drooling spastic
due to impaired control of saliva or less frequent swallowing
bulbar palsy
atrophy and weakness in muscles innervated through medulla, including tongue, velum, larynx, and pharynx
pseudobulbar palsy
weakness and slowness in same muscles
key evaluation tasks for spastic dysarthria
conversational speech and reading, alternate motion rate (AMR) task, vowel prolongation
treatment of phonation deficits
harsh or strained-strangled voice quality caused by hyperadduction of VFs
exercises for phonation deficits
head and neck relaxation; easy onset phonation; DO NOT work on strengthening
symptoms of phonation deficits
weakness, reduced speed of movement, reduced rom
imprecise consonant production
primary articulation error in spastic dysarthria; stretching exercises: tongue-stretching, lip-stretching; traditional artic. exercises
traditional artic. treatments
concentrate on increasing patient awareness of articulation errors and practicing best phoneme production; intelligibility drills, phonetic placement, exaggerating consonants, minimal contrast drills
treatment of prosody deficits
activities that help patient regain vocal-tract flexibility needed to appropriately vary pitch and loudness: pitch range exercises, intonation profiles, contrastive stress drills, chunking utterances into syntactic units
treatment of resonance deficits
hypernasality caused by slowness and reduced rom, surgical and prosthetic treatments: pharyngeal flap procedure, teflon injections, palatal life; decreasing verlar hypertonicity, behavioral-based treatments
