Dysarthria Types Flashcards by Britney Krausman

Flaccid Dysarthria results from:

damage to one or more cranial or spinal nerves (LMN system)

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Neurologic basis flaccid

Weakness, reduced muscle tone

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LMN system also known as

final common pathway

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6 characteristics of LMN damage

weakness, hypotonia, diminished reflexes, atrophy, fasciculations, rapid weakening w/ use and recovery w/ rest

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Flaccid caused by anything that damages the _____ of cranial/spinal nerves

nuclei, axons, NM junctions

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7 etiologies of flaccid

NM junction diseases (Myasthenia Gravis), vascular (brainstem stroke), infectious (polio, herpes), demyelinating diseases (Gillain-Barre syndrome), degenerative (ALS, progressive bulbar palsy), physical trauma (surgery), muscle disease (muscular dystrophy), tumor

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T/F- It is rare that only CN V is involved in flaccid dysarthriasrsrssssrsss at

True

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with a CNV lesion, jaw deviates to ___ side

weak

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CN V Function

Motor- jaw

Sensory- midface, inside cheek, front tongue, chin, lower lip

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CN VII function

motor and sensory (gag) face

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Damage to CN VII can affect muscles of entire face _____ to the lesion

Ipsilateral

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Glossopharyngeal nerve function

motor (stylopharyngeus, pharynx muscles); sensory (pharynx and posterior tongue)

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CN X pharyngeal branch function

constricts pharynx, elevates/retracts palate

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CN X superior laryngeal

sensory (larynx, epiglottis, base of tongue); motor (inferior constrictor and cricothyroid)

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CN X RLN function

all intrinsic muscles of larynx; sensory (larynx)

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If CNX lesion, palate could hang low on ____

side of lesion

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Multiple CN lesions is referred to as

Bulbar Palsy

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Phonotory incompetence (breathy voice, audible inspiration, AND short phrases) only seen in

Flaccid

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Resonatory incompetence (hypernasality, nasal emission, imprecise consonants, AND short phrases) only seen in

Flaccid

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BEST distinguishing speech characteristics of Flaccid dysarthria

hypernasality 
nasal emission 
continuous breathiness 
audible inhalation/stridor
short phrases

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T/F: Typically, damage to LMN system will result in damage on ipsilateral side of body

True

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Involvement with which CN would result in jaw deviating to weak side?

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Involvement with which CN would result in an asymmetric smile?

VII

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Involvement with which CN would result in a breathy voice?

X (RLN/SLN)

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Involvement with which CN would result in the palate pulling towards the nonparalyzed side upon phonation?

X (pharyngeal branch)

Involvement with which CN would result in weakened head turning?

Involvement with which CN would result in tongue atrophy/fasciculations?

XII

The most common motor neuron disease; affects the bulbar, limb, and respiratory muscles

ALS

Characterized by progressive weakness with use and improved function after a period of rest

Myasthenia Gravis

A vascular disorder that most commonly impacts IX and X

Brainstem stroke

A mostly demyelinating disease that can impact the facial and orofacial muscles and can cause neuromuscular

Gullain-Barre syndrome

A type of cranial mononeuropathy that impacts the facial nerve

Bell's Palsy

T/F: If CN XII is damaged, the tongue will deviate to the side contralateral to the damage

False

Neurologic basis for spastic

weakness and excessive muscle tone (spasticity)

Spasticity

slows movement and reduces the range and the force of motion

Patients tend to be ____ in one direction and ____ in the other

Spastic; weak

Spastic damage to...

BL damage to UMN

``` spasticity weakness reduce ROM slow movement pathogenic/hyperactive reflexes emotional liability dysphagia ```

Characteristics of BL UMN damage

4 etiologies of spastic

Vascular disorder tumors TBI degenerative diseases

low rate slow, regular AMRs strained-harsh voice monopitch/loudness

More distinguishing speech characteristics for spastic

The corticobulbar and corticospinal tracts are part of the _____ activation pathway

Direct

The direct activation pathway...

controls skilled, discrete muscle movements

The indirect activation pathway...

maintains muscle tone and posture

T/F: UMN lesions almost always disrupt both the direct and indirect activation pathways

True

Portions of which CNs primarily receive contralateral input from the UMNs?

Facial, Hypoglossal

T/F: asymmetrical presentation of the lips is a confirmatory sign of spastic dysarthria

FALSE

Most common cause of spastic

Vascular disorders

T/F: a single lesion in the brainstem can result in spastic dysarthria

True

Ataxic dysarthria caused by

Damage to cerebellar control circuit

Neurologic basis for ataxic

Incoordination (and perhaps reduced muscle tone)

Each cerebellar hemisphere controls movement on the _____ side of the body

Ipsilateral

4 primary functions of cerebellum:

Timing movement Scaling size of muscle actions Coordinating sequences of muscle contractions Error control

2 Important terms under ataxia

Dysmetria and Dysdiadochokinesis

Dysmetria

over/undershooting of movement

Dysdiadochokinesis

Inability to perform rapid, alternating movements

Characteristics of cerebellar lesions

``` Ataxia Difficulty w/ stance and gait Intention tremor; titubation Abnormal eye movements Hypotonia ```

Titubation

a nervous system disorder that causes uncontrollable, rhythmic shaking

Etiologies of ataxic dysarthria

Degenerative, vascular, tumors, TBI, toxic/metabolic conditions

Friedreich's ataxia is a _____ ataxia that affects the ______ in addition to the cerebellum. It usually begins before age ____ and is sometimes mixed with ____.

hereditary spinal tract 20 spastic dysarthria

____ ataxic dysarthria is very suggestive of Multiple Sclerosis

Paroxysmal

2 subgroups of speech deviation for ataxic dysarthria

Predominant prosodic excess; predominant articulatory inaccuracy

``` Excess loudness variations Irregular artic breakdowns Irregular AMRs Distorted vowels Excess & equal stress Prolonged phonemes Trouble coordinating breathing w/ speaking ```

More distinguishing speech characteristics of ataxic

Nonspeech findings consistent with ataxic dysarthria

Ataxic gait Over/under shooting Intention tremor Mestagmis (eye movement thng) Titubation (shaking or swaying of body/head) Normal symmetry and structures on oral mec

T/F: The cerebellum plays a role in learning and memory

True

Most common cause of ataxic dysarthria

Degenerative diseases

T/F: Cerebellar damage can impact one's ability to coordinate breathing and speaking

True

T/F: Ataxic dysarthria reflects a breakdown in motor control

True

Hypokinetic dysarthria is caused by damage to

Basal Ganglia Control Circuit

Neurologic basis for hypokinetic dysarthria

Rigidity & reduced ROM

Prototypic disease for hypokinetic dysarthria

Parkinson's!

PD characteristics

``` Mask-like face Asymmetric resting tremor Postural instability Shuffling steps Parkinson's gait Slowed movement Reduced arm swing Rigidity Freezing ```

Striatum (in BG)'s function

Recieves info from cortex, thalamus, and substantia nigra and sends info to substantia nigra and globus pallidus

Globus Pallidus (in BG)'s function

sends info to thalamus, subthalamic nucleus, red nucleus, and reticular formation

Some functions of BG control circuit

- Control postural adjustments during skilled movement - Regulates movements for goal-directed activities - Assists in motor learning - Helps regulate muscle tone - Participates in motor programming - Contributes to sensory-motor integration - Contributes to cognitive and emotional function

Normal BG function depends on integrity of connections & proper balance of NTs...

Dopamine | Acetylcholine

2 main things that happen when damage to BG control circuit

- Reduced movement (hypokinesia) | - Failure to inhibit voluntary movement (hyperkinesia)

Etiologies of hypokinetic

** PD vascular (uncommon) toxic-metabolic (antipsych meds) infectious conditions

Demonstrate many characteristics of PD but they don’t respond to Tx for PD (then they think maybe its Lewy Body dementia, etc.

Parkinsonism

Parkinson's Plus Syndromes

- Multiple systems atrophy - Progressive supranuclear palsy - Corticobasal degeneration

T/F: PD is thought to have genetic susceptibility in combination with certain undetermined environmental factors

True

For PD, cell loss in the _____ and the associated loss of _____ in the striatum is accepted as the primary explanation for motor symptoms

Substantia nigra | dopamine

4 classic motor signs of PD

Tremor Rigidity Akinesia Postural Instability

Cognitive changes associated with PD

executive dysfunction, problems with working memory, attention, memory, visuospatial...

Hypokinetic dysarthria nonspeech oral mec findings

Stoic (masked face); symmetrical face, small size of movement; tremor of tongue; movement slow to initiate Tongue lateralization perceived as fast

Most distinguishing speech characteristics hypokinetic

- Reduced loudness - Monopitch - Monoloudness - Reduced stress - Inappropriate silences - Repeated phonemes - Variable rate - Short rushes of speech - Increased overall rate

Respiratory-phonatory in hypokinetic

Breathiness, short phrases

Articulation in hypokinetic

Imprecise

T/F: too much dopamine causes the body to make involuntary movements

True

Hyperkinesia

Muscle spasms

Which 2 neural structures are damaged in corticobasal degeneration

- Basal Ganglia | - UMNs in cerebral cortex

A classic sign of Progressive Supranuclear Palsy (PSP) is

Eye movement problems

Nonspeech AMRs in pw/ hypokinetic will be

fast and reduced in range

Hyperkinetic dysarthria is caused by disruptions in

Basal Ganglia control circuit

Neurologic basis for hyperkinetic dysarthria

Involuntary movements that are heterogeneous

Many hyperkinesias result from failure of _____ pathways to _____ cortical motor discharges

BG-thalamic | inhibit

A group of disorders characterized by involuntary movements of muscles

Dyskinesia

5 types of dyskinesias

``` Myoclonus Chorea Athetosis Dystonia Tremor ```

Tardive (late onset) dyskinesia results from

prolonged use of antipsychotics

Single/repetitive involuntary brief jerks of a muscle or group of muscles (rhythmic or non-rhythmic)

Myoclonus

Rapid, random, purposeless movements that are brief, abrupt, irregular, unpredictable

Chorea

Relatively slow, writhing movements

Athetosis

Athetosis is associated with what disease

Athentoid Cerebral Palsy

Uncontrollable muscle contractions and abnormal postures

Dystonia

Rhythmic movements of body part (most common involuntary movement)

Tremor

Hyperkinetic dysarthrias usually the result of ____ rather than structural

Neurochemical abnormalities

Hyperkinetic Etiologies

Degenerative (Huntington's); Toxic-metabolic conditions (antipsychotic); infectious processes (sydenham's chorea)

Hyperkinetic nonspeech oral mec findings

size, strength and symmetry of orofacial muscles normal - dysphagia - drooling - abnormal movements

Hyperkinetic respiration/phonation

- sudden forced inspiration/expiration - strained-harsh voice - voice stoppages - excess loudness variations

Hyperkinetic Resonance

intermittent hypernasality

Hyperkinetic articulation

irregular artic distortions, slow irregular AMRs, distorted vowels

Hyperkinetic prosody

inappropriate silences, prolonged phonemes, variable stress/loudness patterns

Most common etiology of hyperkinetic dysarthria

Toxic-metabolic conditions

T/F: pw hyperkinetic dysarthria may exhibit sudden, forced inhalation or exhalation; a finding not usually encountered with any other dysarthria type

True

Nonspeech AMRs in pw hyperkinetic dysarthria may be

slow and irregular

T/F: accelerated rate is a characteristic of hyperkinetic

FALSE

Hiccups and sleep starts are examples of

Myoclonus

UUMN is caused by damage to

the UMNs unilaterally

UUMN dysarthria primarily results in a disorder of ____ and to a lesser degree, _____ and ____

Articulation | -phonation and prosody

The neurologic basis for UUMN dysarthria is

weakness and perhaps incoordination

UUMN dysarthria often co-occurs with _____ (4)

aphasia RHD Aprosodia Apraxia of speech

T/F: UUMN dysarthria can be masked and may take a back seat to co-occurring conditions

True

for UUMN, the bottom of face is affected on one side

For LMN damage, the whole side of face is affected

Most common cause of UUMN dysarthria

stroke

T/F: UUMN dysarthria is NOT from degenerative, inflammatory, toxic-metabolic, or traumatic conditions b/c those produce diffuse effects

TRUE

Physical findings of UUMN dysarthria

- contralateral lower facial weakness - contralateral tongue weakness (25-50%) - contralateral hemiparesis/hemiplegia

in UUMN dysarthria, if the _______ is spared, you may see a mismatch btw emotional and volitional smiling

indirect pathway

T/F: you will see a mismatch btw emotional and volitional smiling in Flaccid dysarthia

FALSE, only in UUMN dysarthria

- imprecise articulation - mildly slow rate - irregular articulatory breakdowns - slow and sometimes irregular AMRs - voice harsh (but should go away) - loudness reduced occasionally

Primary speech characteristics of UUMN dysarthria

UUMN dysarthria is ___ more than moderately severe

rarely

UUMN dysarthria is almost always accompanied by

central facial weakness, and frequently lingual weakness

dysphagia and emotional liability occur much more frequently and dramatically in pw _____

BL UMN lesions

In patients with UUMN dysarthria resulting from damage to the right cortical hemisphere, the tongue will deviate to the ____

left side

Mixed dysarthrias result from damage to

more than one part of the motor system

most common etiology for mixed dysarthria

Degenerative diseases

Common etiologies causing mixed dysarthria

ALS, MS, TBI, PSP, Multiple systems atrophy

ALS is a degenerative motor neuron disease affecting the ____.

UMNs and LMNs

What muscles does ALS affect

limbs and bulbar

Most common presenting symptom of ALS is

focal weakness, usually on one of the limbs

ALS causes either _____ or ____ dysarthria

Flaccid or spastic | usually a mixed flaccid-spastic

ALS speech

-Imprecise consonants, hypernasality, harshness, slow rate, monopitch, excess equal stress, breathiness

Multiple Sclerosis is the most common _____ CNS disease

Demyelinating

MS affects ____, the brainstem, spinal cord, and optic nerves

white matter

4 types of MS

A. Relapsing-remitting B- Progressive-relapsing C- Secondary-progressive D- Primary-progressive

Most common type of MS

Secondary progressive

MS can produce signs such as

``` -Gait disturbance cerebellar dysfunction CN abnormalities Psychiatric disturbance cognitive deficits dysarthria ```

Dysarthria occurs in ____% of MS cases

40-50

MS typically causes what kind of dysarthria

ataxic, spastic, or mixed spastic-ataxic

MS speech characteristics

- impaired control of loudness - harshness - imprecise artic - impaired emphasis - impaired control of pitch

Types of deficits common after TBI

Cognitive Dysarthria Dysphagia

With TBI, dysarthria occurs in approximately ____ of cases

1/3

Diffuse or multifocal lesions in TBI can result in virtually _____ of mixed dysarthrias

any combo

more common TBI caused dysarthrias

combos of flaccid, spastic, ataxic, hypokinetic

This is associated with cell loss, particularly of structures such as the subthalamic nucleus, substantia nigra, globus pallidus, thalamus, midbrain and cerebellum

Progressive Supranuclear Palsy

Primary symptoms of Progressive Supranuclear Palsy

- Vertical gaze palsy - postural instability - Parkinsonian symptoms

Progressive Supranuclear Palsy and speech

-Dysarthria -Palilalia and dysfluencies AOS -combos of hypokinetic, spastic, and ataxic

Vertical gaze palsy

peripheral vision isn't working: they need to turn head to see something

PSP versis PD

PD: flexed neck posture, expressionless face, hypokinetic PSP: neck extension, worried face, pseudobulbar affect, hypernasality, nasal emission, excess equal stress, slow rate

Multiple Systems Atrophy also called

Shy Drager Syndrome

A rare and sporadic neurodegenerative condition that affects involuntary functions, including blood pressure, breathing, bladder, and muscle control

Multiple Systems Atrophy

Multiple Systems Atrophy is a varying combo of

parkinsonism, ataxia, spasticity, and autonomic dysfunction

2 MSA subtypes:

MSA-P (when parkinsonian features predominate) | MSA-C (when cerebellar features predominate)

most common etiology for mixed dysarthria is

Degenerative disease

Speech characterized by imprecise consonants, hypernasality, slow rate, and nasal emissions would likely be a combo of

spastic-flaccid