Dysarthria Flashcards
dysarthria definition
a group of neurological speech disorders that reflects abnormalities in the strength, speed, range, steadiness, tone or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production
sensorimotor problems seen in dysarthria
- weakness or paralysis
- incoordination
- involuntary movements
- excessive, reduced, or variable muscle tone
subsystems of speech
- prosody
- resonance
- articulation
- phonation
- respiration
prosody definition
stress and pitch (how alive you sound)
resonance definition
- voice quality due to sound vibrations
- irregular: hyper/hyponasality voice quality
articulation definition
the ability to form clear and distinct speech sounds
phonation definition
- production of speech sounds
- irregular: creaky/strained voice
respiration definition
the ability to full and expel air from lungs
causes of dysarthria
- congenital
- degenerative diseases
- demyelinating and inflammatory diseases
- infectious diseases
- neoplastic diseases
- other neurological conditions
- toxic/metabolic diseases
congenital diseases causing dysarthria
- cerebral palsy
- chiari malformation
- congenital suprabulbar palsy
- syringomyelia
- syringobulba
degenerative diseases causing dysarthria
- Parkinson’s disease
- Huntington’s disease
- amyotrophic lateral sclerosis
- progressive supranuclear palsy
- cerebellar degeneration
- corticobasal degeneration
- multiple system atrophy
- olivopontocerebellar atrophy
- Friedrich’s ataxia
- spinocerebellar ataxia
- ataxia telangiectasia
demyelinating and inflammatory diseases causing dysarthria
- multiple sclerosis
- meningitis
- encephalitis
- Guillain-Barré (and associated autoimmune) syndrome
- multifocal leukoencephalopathy
infectious diseases causing dysarthria
- acquired immune deficiency syndrome (AIDS)
- Creutzfeldt-Jakob disease
- herpes zoster
- infectious encephalopathy
- central nervous system tuberculosis
- poliomyelitis
neoplastic diseases causing dysarthria
- central nervous system tumors
- cerebral, cerebellar, or brainstem tumors
- paraneoplastic cerebellar degeneration
other neurological conditions causing dysarthria
- radiation necrosis
- Tourette’s syndrome
- hydrocephalus
- Meige syndrome
- myoclonic epilepsy
- neuroacanthocytosis
- sarcoidosis
- seizure disorder
- chorea gravidarum
toxic/metabolic diseases causing dysarthria
- botulism
- carbon monoxide poisoning
- central pontine myelinolysis
- heavy metal/chemical toxicity
- hepatocerebral degeneration
- hypothyroidism
- hypoxic encephalopathy
- lithium toxicity
- Wilson’s disease
different courses of acquired dysarthria
- transient
- progressive
- non-progressive
- static
which causes of dysarthria might lead to progressive dysarthria
- Parkinson’s disease
- motor neuron disease
which cause of dysarthria might lead to non-progressive dysarthria
- tbi
- stroke
differential diagnosis definition
process of narrowing diagnostic possibilities and findings to guide the next steps taken
types of dysarthria
- flaccid
- spastic
- ataxic
- hypokinetic
- hyperkinetic
- unilateral upper motor neuron
- mixed
- undetermined
damage to lower motor neurons leads to…
flaccidity
flaccid dysarthria location of breakdown
- lower motor neurons
- neuromuscular junction in peripheral nervous system
flaccid dysarthria perceptual speech characteristics
- continuous breathiness
- diplophonia
- audible inspiration or stridor
- nasal emission
- short phrases
- hypernasality
- rapid deterioration or recovery with rest
- imprecise alternating motion rate (AMRs)
flaccid dysarthria distinguishing physical characteristics
- weakness
- flaccidity
- atrophy
- fasciculations (of tongue)
- hypoactive gag reflex
- facial myokymia
- rapid deterioration and recovery with rest
- synkinesis
- nasal backflow while swallowing (low velum strength)
flaccid dysarthria common causes
- stroke (brainstem)
- motor neuron disease
- myasthenia gravis
- tumors (brainstem)
- surgery
- TBI
upper motor neurons location
- cerebral cortex (CNS)
- brainstem
upper motor neuron function
carry information down to activate interneurons and lower motor neurons
damage to upper motor neurons lead to…
spasticity
lower motor neurons location
from brainstem/spinal cord to skeletal muscle
lower motor neuron function
voluntary movement
spastic dysarthria perceptual speech characteristics
- slow rate
- strained or harsh voice quality
- pitch breaks
- monopitch/loudness
- imprecise articulation
- slow and irregular alternating motion rates (AMRs)
spastic dysarthria distinguishing physical characteristics
- pathological oral reflex (sucking, snout, jaw jerk)
- liability of affect/emotional liability
- hypertonia
- hyperactive gag reflex
- sialorrhea
- bilateral positive Babinski sign
diplophonia definition
when a voice is perceived as having two concurrent pitches
sialorrhea definition
hypersalivation
Babinski sign definition and normal sign
- neuropathological cue embedded within the plantar reflex
- downward flexion of toes toward stimulus source
spastic dysarthria typical causes
- stroke
- tbi
- tumor
- cerebral anoxia
- viral/bacterial infection
- motor neuron disease
cerebral anoxia definition and causes
- lack of oxygen to brain
- strangling, drowning
damage to cerebellum leads to…
incoordination or ataxia
ataxic meaning
cerebellar damage
cerebellum function
control coordination
ataxic dysarthria perceptual speech characteristics
- irregular articulatory breakdowns
- excess and equal stress distorted vowels
- excessive loudness
- variation
- irregular AMRs
- scanning speech
ataxic dysarthria distinguishing physical characteristics
- dysmetric jaw, face, and tongue AMRs
- head tremor
ataxic dysarthria typical causes
- cerebellar stroke
- multiple sclerosis
- Friedrich’s ataxia
- toxicity
- TBI
- tumor
hypokinetic definition
reduced movement
hyperkinetic definition
increased movement
hypophonia definition and presentation
- inability to utilize vocal musculature
- whispering
hypokinetic dysarthria perceptual speech characteristics
- monopitch/loudness
- reduced loudness/stress
- breathy voice
- tendency for rapid/accelerated rate
- inappropriate silences
- rapidly repeated phonemes
- palilalia
- rapid, blurred AMRs
palilalia meaning
involuntary repetition of words and phrases during speech
hypokinetic dysarthria distinguishing physical characteristics
- masked facial expression (frozen-looking)
- tremulous jaw, lips, tongue
- reduced range of motion on AMR tasks
- resting tremor
- rigidity
hypokinetic dysarthria typical causes
Parkinson’s disease
hyperkinetic dysarthria perceptual speech characteristics
- prolonged intervals
- sudden forced inspiration/expiration
- transient breathiness
- transient vocal strain/harshness
- voice stoppage/arrests
- voice tremor
- myoclonic vowel prolongation
- intermittent hypernasality
- marked deterioration with increased rate
- inappropriate vocal noises
- intermittent breathy/aphonic segments
- distorted vowels
- excessive loudness variation
- slow and irregular AMRs
hyperkinetic dysarthria distinguishing physical characteristics
- involuntary head, jaw, face, tongue, velar, laryngeal, and respiratory movement
- relatively sustained deviation of head position
- multiple motor tics
- myoclonus of palate, pharynx, larynx, lips, nares, tongue, or respiratory muscles
- jaw, lip, tongue, pharyngeal, or palatal tremor
- facial grimacing during speech
hyperkinetic dysarthria common causes
- Huntington’s disease
- syndenham chorea
Parkinson’s Plus typical facial expression
fear-filled
unilateral upper motor neuron dysarthria mainly affects muscles of…
contralateral lower face and tongue
unilateral upper motor neuron dysarthria perceptual speech characteristics
- slow rate
- imprecise articulation
- irregular articulatory breakdowns
- strained voice quality
- reduced loudness
- slow imprecise AMRs
unilateral upper motor neuron dysarthria distinguishing physical characteristics
- unilateral lower face weakness
- unilateral lingual weakness without atrophy/fasciculations
- pseudobulbar affect
- nonverbal oral apraxia
- hemiparesis/hemiplegia
- unilateral sialorrhea
- positive Babinski sign (contralateral to lesion)
unilateral upper motor neuron dysarthria common causes
- stroke (91%)
- lacunar stroke
- brain tumor
- surgical trauma
ELMS model
- Etiology (subsystems affected)
- Lesions site (brain tumor, etc.)
- Motor signs
- Speech signs
- lead to differential diagnosis
models of speech motor control
- stages in motor speech production (Darley Aronson Brown)
- Four Level Framework (Van der Merwe)
stages in motor speech production (Darley Aronson Brown)
use memory knowledge, sentence planning, proper prosody, move tongue, and listening to yourself (self-monitorization)
Four Level Framework (Van der Merwe)
dysarthrias constitute a breakdown in programming and execution (or solely execution)
paresis definition
weakness
damage to a nerve may lead to…
paresis or paralysis if muscle loses innervation from LMNs that supply it
case history questions
- when did it start (they know day, etc. with stroke)
- sudden or gradual onset
- course (static, progressive, fluctuating)
- what makes it better/worse (fatigue, anxiety, time of day, medications)
- features (low volume, excessive loudness)
- impact on person
- feedback from family/colleagues
- compensation to date
- other symptoms reported (communication, swallowing)
- other medical diagnosis (vision, etc.)
- medications
- social support
