Dysarthria Flashcards
What is the definition of dysarthria from the literature?
“a group of neurogenic speech disorders resulting from abnormalities in the strength, speed, range, steadiness, tone or accuracy of movement required for the control of [different aspects] of speech production”
Who wrote the definition of dysarthria?
Murdoch, 2013
what is dysarthria made up of?
- several different types corresponding to damage to particular parts of the nervous system
- each type has different auditory perceptual characteristics
what is the lesion site for flaccid dysarthria?
lower motor neurons (LMN)
what is the lesion site for spastic dysarthria?
upper motor neurons (UMN)
what is the lesion site for hypokinetic & hyperkinetic dysarthria?
basal ganglia & associated brain stem nuclei
what is the lesion site for ataxic dysarthria?
cerebellum and/or its connections
what is the lesion site for unilateral UMN dysarthria?
unilateral upper motor neurons
what is the lesion site for mixed dysarthria?
both lower motor neurons and upper motor neurons
what parts of the central nervous system revolve around motor planning and control?
basal ganglia & cerebellum
what parts of the CNS & the PNS revolve around motor execution?
- UMN pathways such as the pyramidal system & extrapyramidal system
- LMN pathways such as the cranial and spinal nerves
what is the pyramidal system?
the network of nerve fibers that controls voluntary movement in the body
what is the extrapyramidal system?
controls involuntary actions, maintains posture and regulates muscle tone
what nerves control respiration in speech?
spinal-phrenic nerve and spinal intercostals
what nerve controls phonation in speech?
vagus (X)
what nerves control resonance in speech?
vagus (X), glossopharyngeal (IX), spinal accessory (XI)
what nerves control articulation in speech?
trigeminal (V), facial (VII) and hypoglossal (XII)
what are some characteristics of flaccid dysarthria?
- voluntary control of muscles lost
- muscles become flaccid (atrophy) which affects speed, range and accuracy
- diminished reflexes
- fasciculations (spontaneous twitches)
what are some conditions associated with flaccid dysarthria?
- myasthemia gravis (condition that causes muscle weakness)
- brain stem strokes
- brain stem tumours
- damage to the cranial nerves
in flaccid dysarthria, if the trigeminal nerve (V) is effected, what signs will show?
- jaw deviating to weak side on opening
- jaw hangs open at rest
in flaccid dysarthria, if the tongue’s nerve (XII) is effected, what signs will show?
- tongue deviates to weak side on protrusion
- fasciculations and atrophy
- distorted alveolar and velar sounds
in flaccid dysarthria, if the facial nerve (VII) is effected, what signs will show?
- facial droop
- reduced lip seal
- distorted bilabial and labiodental sounds
in flaccid dysarthria, if the laryngeal nerve (X) is effected, what signs will show?
- weak cough
- stridor on inhalation
- monopitch
- monoloudness
in flaccid dysarthria, if a velopharyngeal nerve (X, IX, XI) is effected, what signs will show?
- hangs lower on weak side at rest
- elevates towards normal side on phonation
- reduced gag reflex
hypernasality
what is the 3 most common distinctive features for flaccid dysarthria?
- hypernasality
- imprecise consonants
- breathless (constant)
what are some conditions associated with spastic dysarthria?
- progressive supra nuclear palsy (PSP) - like parkinson’s but affects balance and movement more
- traumatic brain injury
- bilateral brain stem strokes
what do upper motor neurons do?
- convey impulses from motor areas of the cerebral cortex to the lower motor neurons
what are some characteristics of spastic dysarthria?
- reflects combined effects of direct and indirect motor system involvement
- results in spasticity (causes muscle stiffness), weakness, reduced range of movement and slowness of movement
what are some respiratory/laryngeal characteristics of spastic dysarthria?
- strained/strangled voice
- harshness
- pitch and loudness variability
- pitch breaks
what is the resonance characteristic of spastic dysarthria?
- hypernasality
what are some articulation characteristics of spastic dysarthria?
- imprecise articulation
- vowels distorted (most common)
what are some prosody characteristics of spastic dysarthria?
- reduced rate
- excess stress
- prolonged phonemes
what is the cerebellar system responsible for?
- imposing control on movement
- coordinating timing and sequencing of movements
- maintaining steadiness
what are some conditions associated with ataxic dysarthria?
- multi systems atrophy (MSA)
- spinal cerebellar atrophy (genetic)
- multiple sclerosis
what are some characteristics for ataxic dysarthria?
- incoordination -> errors in force, speech, timing, range and direction of movements
- hypotonicity -> lack of muscle tone
what are some respiratory/laryngeal characteristics of ataxic dysarthria?
- monopitch
- monoloudness
- harsh voice
what is the resonance characteristic of ataxic dysarthria?
- normal to variable - including hyponasality
what are the articulation characteristics of ataxic dysarthria?
- imprecise articulation
- vowels distorted
- irregular breakdowns
what are the prosody characteristics of ataxic dysarthria?
- slow rate
- equal/excess stress
- prolonged phonemes
- inappropriate silences
what is hypokinetic dysarthria?
- not enough dopamine = too little movement
what are some conditions associated with hypokinetic dysarthria?
- parkinson’s disease
- parkinsonism
- progressive supranuclear palsy (PSP)
what are some characteristics of hypokinetic dysarthria?
- slow individual movements
- fast or slow repetitive movements
- reduced range of movement
- reduced force
- excessive tone (rigidity)
what are the respiratory/laryngeal characteristics of hypokinetic dysarthria?
- breathiness
- short phrases
- reduced volume
what is the resonance characteristic of hypokinetic dysarthria?
- hypernasality (hpk answer)
what is the articulation characteristic of hypokinetic dysarthria?
- imprecise articulation
what are the prosody characteristics of hypokinetic dysarthria?
- monopitch
- monoloudness
- short phrases
- variable rate
- reduced stress
what is hyperkinetic dysarthria?
- too much dopamine = too much movement
what are some conditions associated with hyperkinetic dysarthria?
- 70% have unknown diagnosis
- Huntington’s disease
- stroke
what are some characteristics of hyperkinetic dysarthria?
- action myodonus - episodes of involuntary muscle jerking
- chorea - causes involuntary, irregular & unpredictable muscle movements
- top of mouth uncontrollable movement
in what areas does hyperkinetic dysarthria affect?
- all areas
what is the dominant speech characteristic that hyperkinetic dysarthria affects?
- prosody - patterns of stress and intonation
what are some specific difficulties hyperkinetic dysarthria can cause, in terms of speech?
- prolonged intervals
- imprecise consonants
- distorted vowels
- monopitch
what types of stroke can cause unilateral UMN dysarthria?
- frontal lobe
- corona radiata
- internal capsule
- brainstem
what conditions are associated with unilateral UMN dysarthria?
- 90% stroke related
- traumatic brain injury
- tumour
what are some characteristics for unilateral UMN dysarthria?
- weaknesses
- incoordination
- spasticity
what are some speech characteristics for unilateral UMN dysarthria?
- imprecise articulation
- hoarseness
- slow & irregular AMRs
- reduced loudness
what mixed dysarthria is associated with MND?
- flaccid-spastic
what mixed dysarthria is associated with brainstem stroke, multiple sclerosis and traumatic brain injury?
- ataxic-spastic
what mixed dysarthria is associated with Parkinsonism and CBD?
- hypokinetic-spastic
what mixed dysarthria is associated with Parkinsonism and CBD?
- hypokinetic-spastic
what mixed dysarthria is associated with Parkinson’s disease?
- hypokinetic-hyperkinetic
