Differential diagnosis Flashcards
What is differential diagnosis?
The process of narrowing possibilities and reaching conclusions about the nature of a deficit.
When doing a speech evaluation, what should do you always try to make?
A diagnosis
What should a clinician do if clinician can’t make a definitive diagnosis?
You must describe what you find and state why a definitive diagnosis can’t be made.
What are reasons for not being able to make a diagnosis?
- Non-cooperative patient
- equivocal/uncertain findings
If you cannot make a diagnosis, what would be helpful?
It is helpful to state what it is not or even be able to establish that a dysarthria is present but that can’t specify the type.
What should the clinician do if a diagnosis is not determined?
Do not offer a diagnosis. You can state that the diagnosis is undetermined. Also, using words such as “equivocal, probably”, “possible” give indications of how confident you are in your diagnosis.
Is it possible for more than one speech disorder to exist at the same time?
Yes, identifying a single disorder isn’t always sufficient. You must be able to account for all of the deviant characteristics- if the disorder you identified does not do this, then another disorder may be present.
An evaluation does not always have to find _____ _____ – it may indicate ______ ____ or speech within normal range.
deviant speech
normal speech
In the initial stages of some _______, speech may have changed but not significantly enough to be judges _____.
diseases
deviant
It is also possible that the clinician may be incorrectly identifying a ________ problem of articulation as related to a ________ ________.
developmental problem
neurological disease
What happens when the clinician provides a label for a diagnosis?
Clinician is providing a composite of information associated with that label. It is a kind of shorthand for communicating information about disorders.
There is ______ among dysarthrias in terms of certain characteristics. For example, many have _____ ______ as a characteristic, so the presence of ______ ____ doesn’t help you in distinguishing between dysarthrias.
overlap
imprecise articulation
imprecise articulation
Look for anatomy and vascular lesions in book.
Table 15-1 pg 137
What etiologies can cause any type of dysarthria?
- vascular
- degenerative disease
- TBI
- demyelinating diseases
______ can cause any type of dysarthria, but most often causes spastic, UUMN, and ataxic dysarthria.
Vascular
Vascular can cause any type of dysarthria, but most often causes which dysarthrias?
spastic dysarthria
UUMN
ataxic dysarthria
_______ ________ is the most common cause of dysarthrias.
Hemorrhagic stroke
Degenerative disease can cause any type of dysarthria, but most often causes which dysarthrias?
spastic
ataxic
hypokinetic
flaccid
_______ disease can cause any type of dysarthria, but most often causes spastic, ataxic, hypokinetic and flaccid dysarthrias.
Degenerative
Parkinson’s diesease is only associated with what type of dysarthria?
Hypokinetic dysarthira
What is a frequent cause of flaccid & spastic dysarthria?
ALS
______ is a frequent cause of flaccid & spastic but other types of dysarthrias are not usually seen in ____, so if there is another type of dysarthria existing, there may be another disease or the diagnosis may be in error.
ALS
ALS
_____ can cause any type of dysarthria but in closed head injury the most common type is spastic.
TBI
What is the most common type of dysarthria in a closed head injury?
spastic dysarthria
Open head injuries do not usually cause ______ _____ but can cause the other ______ dysarthrias. Name them.
Flaccid
CNS: spastic, ataxic, UUMN
What kind of dysarthrias can skull fracture and neck trauma injuries causes?
flaccid dysarthrias
What dysarthrias can surgical trauma cause?
Any type of dysarthrias except hypokinetic
Which surgeries are only involved with flaccid dysarthria?
Surgeries involved with ear, nose, throat, chest/cardiac areas.
Surgeries involved with ear, nose throat, chest/cardiac areas are only associated with what type of dysarthria?
flaccid dysarthria
What kind of dysarthrias can a neurosurgery cause?
CNS dysarthrias as well as flaccid dysarthria
Toxic and metabolic conditions typically do not causes which dysarthrias?
flaccid or UUMN
________ and _______ conditions typically do not cause flaccid or UUMN dysarthria but can cause other types.
Toxic and metabolic conditions
Toxic conditions associated with drugs/medications cause _____ and _____ dysarthrias most often.
hyperkinetic
ataxic
Toxic conditions associated with _________ cause hyperkinetic and ataxic dysarthrias most often.
drugs/medications
_________ and _________ conditions– rarely cause dysarthrias although they sometimes occur. The type of dysarthria depends on the condition.
Infectious
inflammatory
Which condition rarely causes dysarthrias?
Infectious and inflammatory
_______ diseases can cause any type of dysarthria but hypokinetic is rare. The type of disorder depends on the disorder.
Demyelinating
Name two demyelinating diseases.
Guillian Barre disease
multiple sclerosis
Which dysarthria is Guillian Barre disease usually associated with?
flaccid
Multiple Sclerosis is usually associated with which dysarthria?
ataxic
Which dysarthria is most often associated with Anatomic malformations such as Arnold-Chiari (malformation of the brain)?
Flaccid dysarthria
Why do neuromotor junction disorders, muscle disease and neuropathies only cause flaccid dysarthria?
Neuromomtor junction disorders are PNS diseases
Neuromotor junction disorders only cause what type of dysarthria?
flaccid dysarthria
______ can be present in the absence of a neurologic diagnosis.
Dysarthria
Dysarthria can be present in the absence of what?
A neurologic diagnosis
Sometimes the etiology of a dysarthria is undetermined particularly for which dysarthrias?
- hyperkinetic
- spastic
- ataxic
Certain findings in the _____ _____ are not required for MSD but are used as confirmatory signs.
oral mechanism
Oral mechanism findings that are not required for MSD, may be used as what?
confirmatory signs
What are the two characteristics that often occur in flaccid dysarthria and do not occur in other dysarthrias or apraxia?
atrophy and fasiculations
_____ and a ______ gag reflex occur more often in flaccid dysarthria than other dysarthrias.
hypotonia
hypoactive
Rapid loss of intelligibility is indicative of what?
Myasthenia gravis
Nasal regurgitaion may be seen in what kind of dysarthria?
flaccid dysarthria
Name oral mechanism findings for flaccid dysarthria:
- atrophy and fasiculations
- hypotonia
- hypoactive gag reflex
- nasal regurgitation
Oral mechanism findings of spastic dysarthira:
- pathological oral reflexes
- hyperactive gag reflex
- pseudobulbar effect
- more problems exists with dysphagia and drooling than other MSDs
Pathological oral reflexes, hyperactive gag reflex and pesudobulbar effect are found most often in what kind of dysarthria?
Spastic dysarthria
In _____ dysarthria, more problems exist with dysphagia and drooling than other MSDs.
Spastic
What are the oral mechanism findings of ataxic dysarthria?
- May have dysmetria in non-speech, jaw, face, and tongue movements
- other oral mechanism findings may be normal
What are the oral mechanism findings of hypokinetic dysarthria?
orofacial tremors
-masked face is common and not seen with other MSDs
What are the oral mechanism findings of hyperkinetic dysarthria?
Abnormal movements may be seen both at rest and in speech that are not seen in other dysarthrias.
What are the oral mechanism findings of UUMN?
unilateral facial and lingual weakness without atrophy or fasiculations is common, but not typically seen in other dysarthrias.
What are the most common distinguishing speech characteristics of flaccid dysarthria?
Phonatory and resonatory abnormalities
Which characteristics may be more prominent in flaccid dysarthria if the Xth nerve is affectes?
breathiness
diplophonia
audible inspiration
short phrases
Breathiness occurs in what two dysarthrias?
flaccid and hypokinetic
What can differentiate flaccid dysarthria from hypokinetic dysarthria?
There is greater hoarseness and the presence of diplophonia in flaccid dysarthria.
Hypernasality occurs in other dysarthrias, most often ____ and _____, but still is most pronounced in _____ dysarthria.
spastic
hypokinetic
flaccid
________ occurs in other dysarthrias, most often in spastic and hypokinetic but still is most pronounced in flaccid dysarthria.
Hypernasality
What occurs only in connections with flaccid dysarthria in myasthenia gravis?
rapid deterioration of speech
Rapid deterioration of speech occurs only in connection with ____ dysarthria in _____ ______.
flaccid
myasthenia gravis
What are the most common features of spastic dysarthria that aren’t typically seen in other dysarthrias?
Slow rate combined with slow but regular AMRs, strained voice quality.
A client may have a strained voice quality in hyperkinetic dysarthria but it usually isn’t accompanied by the ____ ______.
slow rate
A strained voice quality may also be present in what other dysarthria besides spastic?
hyperkinetic
What differentiates spastic dysarthria from hyperkinetic?
Spastic will have a combination of slow rate with slow regular AMRs and strained voice quality, while hyperkinetic will only have one of those features, strained voice quality.
What are the primary distinguishing speech characteristics of ataxic dysarthria?
- irregular articulatory breakdowns
- irregular AMRs
- dysprosody
Irregular articulatory breakdowns, irregular AMRs, and dysprosody are the main speech characteristics of _____ dysarthria but may also be present in ______ and ______ dysarthria.
ataxic
UUMN
hyperkinetic
How does a clinician distinguish between ataxic dysarthria and UUMN dysarthria?
Patient with UUMN will have unilateral lower facial and tongue weakness
How does a clinician distinguish between ataxic dysarthria and hyperkinetic dysarthria?
Patient with hyperkinetic dysarthria will have abnormal movements
______ dysarthira is the only dysarthira in which rapid and blurred speech and AMRs occur but it doesn’t have to occur, but it doesn’t have to occur.
Hypokinetic
What are speech characteristics that can be present in hypokinetic dysarthria?
rapid and blurred speech and AMRs
Palialia only occurs in what kind of dysarthria?
Hypokinetic
______ only occurs in hypokinetic dysarthria/
Palialia
What is particular to hyperkinetic dysarthria?
abnormal movements
What helps differentiate UUMN?
Its mildness and transient duration
Why is UUMN confused for ataxic dysarthria?
Irregular breakdowns
What are speech characteristics of UUMN?
- AMRs are usually normal but can be mildly irregular
- voice may sound somewhat spastic because of strained voice, but it is usually milder in degree than spastic dysarthria.
- It rarely has hypernasality.
What are the differences between dysarthria and apraxia in regards to location of lesion?
- Apraxia
- Dysarthria occurs with damage to supratentorial, posterior fossa, spinal or peripheral lesion.
_______ occurs with left hemisphere lesions except when there is right hemisphere language dominance or mixed dominance, It occurs with supratentorial damage.
Apraxia
_______ occurs with damage to supratentorial, posterior fossa, spinal or peripheral lesion.
Dysarthria
Dysarthria occurs with damage in what structures?
- supratentorial
- posterior fossa
- spinal
- peripheral lesion
______ occurs primarily with lesions to the carotid system.
Apraxia
________ occurs not only with carotid lesions but with other vascular system lesions.
Dysarthria
Dysarthria occurs not only with carotid lesions but with other ______ ______ lesions.
vascular system
Which dysarthria is the most difficult to differentiate from apraxia of speech?
UUMN
Look at oral mech findings in book that differentiate apraxia and dysarthria.
See table 15-3 pg 361
Name the 3 speech characteristics that differentiate AOS and dysarthria.
- In dysarthria, all subsystems are affected. AOS - mainly articulation and prosody are affected.
- AOS is more often associated with aphasia than dysarthria.
- Apraxic speakers grope, dysarthria speakers do not.
_______ speakers grope, _______ speakers do not. Patients with _______ _____ may also present with groping behaviors.
Apraxic
dysarthria
phonemic paraphasias
_____ is more often associated with aphasia than dysarthria.
AOS
What subsystems are affected in dysarthria?
All sub-systems
What subsystems are affected in apraxia?
mainly articulation and prosody
_______ patients can have normal oral mech exam, _______ usually do not.
Aphasia
dysarthria
________ patients do not have language problems, _____ patients do.
Dysarthria
aphasia
AOS vs Aphasia see book.
pg 366 table 15-6
Write down main diagnostic indicators from handout 18.
Six indicators
Write down main diagnostic indicators for apraxia.
six indicators
________ related to apraxia can be associated with normal findings in oral mech exam.
Mutism
_____ ____ patients usually try to speak and show frustration when they can’t.
Mute apraxic
What is anarthria?
lack of speech. Usually have significant neuromotor deficits in bulbar muscles that cause mutism. It’s sometimes present without limb motor deficits.
_______ is lack of speech.
Anarthria
Anarthria usually has significant _______ and other _____ abnormalities and this helps in dx.
dysphagia
oromotor
What happens when people with anarthria attempt to speak?
Their restricted articulatory ROM, reduced loudness and strained, groaning quality is diagnostic.
What type of conditions are more likely to be associated with mutism due to cognitive-affective disturbances than with anarthria, AOS, aphasia?
Conditions that have diffuse or multifocal damage
What difficulties do people with mutism due to aphasia present?
Similar to mute apraxic pts except they may have problems following instructions. If mutism is present, aphasia is usually severe so they do poorly on language tests.
What is cognitive-affective disturbances?
May be due to reduced arousal and alertness. If speech does eventually occur, there are delays with brief unelaborated speech.
Distinguishing motor speech disorders from other neurologic speech disorders. See book.
pg 369 15-7
Review handouts of differential diagnosis of dysarthria and apraxia
three handouts.
