Dysarthrias Flashcards
1
Q
What are the most distinguishing PERCEPTUAL speech characteristics of Flaccid dysarthria?
A
- Continuous breathiness
- Audible inspiratory stridor
- Short phrases
- Hyper nasality
- Intelligibility is affected
2
Q
What is Flaccid dysarthria classified as primarily?
A
Muscle weakness
3
Q
What are the most distinguishing PERCEPTUAL speech characteristics of Spastic dysarthria?
A
- Strained or harsh vocal quality (phonation)
- Hyper-nasality
- Excessive prosody
4
Q
What are the most distinguishing PERCEPTUAL speech characteristics of Hypokinetic dysarthria?
A
- Breathy
- Rough
- Mono pitch and mono loudness
- reduced loudness
- reduced stress
- short rushes of speech
- imprecise consonants
- variable speed
5
Q
What is Spastic dysarthria classified as primarily?
A
- Spasticity
- Muscle rigidity
6
Q
What is Ataxic dysarthria classified as primarily?
A
- Reduced movement control
7
Q
What is Hypokinetic dysarthria classified as primarily?
A
Reduced movement
8
Q
What are the most distinguishing PERCEPTUAL speech characteristics of Ataxic dysarthria?
A
- Sounds drunk
- Excessive prosody
- Excess and equal stress
- Excessive loudness
- distorted vowels
9
Q
What are the most distinguishing PERCEPTUAL speech characteristics of Hyperkinetic dysarthria?
A
- Voice sounds shaky
- sudden forced inspiration/expiration
- voice tremor
- marked deterioration with increased rates
10
Q
ALS has a natural and very common association with which type of dysarthria?
A
mixed spastic-flaccid dysarthria
11
Q
What are usually the initial signs of ALS and mixed spastic-flaccid dysarthria?
A
- hyper nasality
- slowed speech (slower than 250 words per minute)
12
Q
What is Hyperkinetic dysarthria classified as primarily?
A
- Excess movement
- Visibly abnormal orofacial, head, and respiratory movements
- Bizarre involuntary movements
- Possibly psychogenic etiology
13
Q
Distinguishing physical characteristics of Flaccid dysarthria?
A
- Hypotonia
- Weakness
- Atrophy
- Diminished reflexes
- Negative babinksi
- rapid deterioration and recovery with rest
14
Q
Distinguishing physical characteristics of Spastic dysarthria?
A
- Hyperactive reflexes (gag, Babinksi)
- Pathological oral reflexes (sucking, snout, jaw)
- Reduced ROM
- Loss of fine skilled movements
- Poor control of emotion
- Hypertonia
15
Q
Distinguishing physical characteristics of Ataxic dysarthria?
A
- Dysmetric jaw, face, tongue AMRs
- Head tremor
- incoordination
- Gait is off (waddle)
- Falling back
16
Q
Distinguishing physical characteristics of Hypokinetic dysarthria?
A
- Masked facial expression
- resting tremor (head, limbs, pill rolling), Tremulous jaw, lips and. tongue
- slowed onset of movements
- drooling - swallowing infrequency
- Reduced ROM on AMR tasks
17
Q
Distinguishing physical characteristics of Hyperkinetic dysarthria?
A
- Involuntary head, jaw, face, tongue, velar, laryngeal, and respiratory movements
- relatively sustained deviation of head position
- multiple motor tics
- myoclonus of palate, pharynx, larynx, lips, nares, tongue or respiratory movements
- jaw, lip, tongue, pharyngeal or palatal tremor
- facial grimacing during speech
18
Q
Distinguishing physical characteristics of UUMN dysarthria?
A
- unilateral lower face weakness
- unilateral lingual weakness with atrophy/fasciculations
- nonverbal oral apraxia
19
Q
Cause of Flaccid dysarthria?
A
LMN damage (final common pathway, motor unit)
* Distinctive because it is produced by injury or malfunction of one or more of the cranial or spinal nerves
20
Q
Cause of Spastic dysarthria?
A
- Bilateral damage to the direct and indirect activation pathways of the CNs
- Upper motor neuron
21
Q
Cause of UUMN dysarthria?
A
- associated with damage to the UMN
pathways that carry impulses to the cranial and spinal nerves that supply the speech muscles - usually temporary and mild
22
Q
Cause of Ataxic dysarthria?
A
Damage to the cerebellar control circuit
23
Q
Cause of Hypokinetic dysarthria?
A
- Damage to the basal ganglia control circuit
- Imbalances among neurotransmitters are responsible for many motor problems associated with basal ganglia control circuit malfunction.
24
Q
Cause of hyperkinetic dysarthria?
A
- Damage to the basal ganglia control circuit
- Afferent pathway
- Product of abnormal, rhythmic or irregular and unpredictable, rapid
or slow movements
25
Cause of AOS?
- Damage to the left cerebral hemisphere, particularly the frontal-parietal and related subcortical circuits
26
Etiologies on Flaccid dysarthria
- ALS
- MD (often mistaken for PD)
- Progressive bulbar palsy
- Polio
- Neurological complications of AIDS
27
Etiologies for Spastic dysarthria
* Vascular: strokes in the internal carotid and middle and posterior cerebral artery
distributions, lesions in both left and right hemisphere, single brainstem stroke
* Degenerative: primary lateral sclerosis
* Inflammatory: leukoencephalitis
* Congenital: cerebral palsy
28
Etiologies for Ataxic dysarthria?
- Degenerative disease (Friedreich’s ataxia Shy-- - - Drager syndrome
- Progressive supranuclear palsy (PSP)
- Multiple system atrophy
- MS
29
Etiologies for Hypokinetic dysarthria
* Degenerative: Parkinson’s, Parkinsonism’s
* Vascular: nonhemorrhagic stroke, vascular parkinsonism, hypoxia
* Toxic metabolic conditions: antipsychotics, antidepressants (long-term use), radiation
* exposure
* Trauma: deep brain stimulation for PD, tumor resection, postoperative, closed head
* injury
* Infectious conditions: encephalitis
30
Etiologies for Hyperkinetic dysarthria?
* Idiopathic: orofacial dyskinesia, dystonia, or tremor; essential tremor, spasmodic torticollis, chorea
* Toxic metabolic conditions: Heavy metals
* Degenerative diseases: Huntington's Disease
* Infectious processes
* Traumatic: PPM (secondary to posterior fossa tumor removal)
* Vascular disorders: Brainstem or BG stroke, Neoplasm
* Other: Tourette's syndrome
31
What are some of the patient complaints for Flaccid dysarthria?
- Slurred speech
- Tongue feels thick
- Sudden brief periods of pain
- Specific to affected CN's
32
What are some of the patient complaints for Spastic dysarthria?
- Slowed speech
- Gets tired when talking (fatigue)
- Increased efforts to speak
- Poor control of emotions
- Drooling
33
What are patient complaints for UUMN?
- Slurred thick slow speech
- Deterioration under fatigue
- Drooling because of lack of swallow frequency
- Facial droop
34
What are patient complaints for Ataxic dysarthria?
- Sounds drunk
- Feels as if they are stumbling over words
- Bite tongue or cheek while eating
- Speech deteriorates with alcohol intake
35
What are the patient complaints for Hypokinetic dysarthria?
- Quiet or weak vocal quality however they often deny it
- Voice cannot be heard in a loud environment
- Voice lacks emotion
- Speech rate is too fast
- Hard to get speech started
- "stutter" for sound, syllable or word repetitions
36
What are the patient complaints for hyperkinetic dysarthria?
- Voice sounds shaky
- Short of breath
- Not aware of tremor
- Tremor gets worse with fatigue or stress
- Tremor improves with alcohol
37
Wha are the patient complaints for AOS?
"I have words I want to say but they don't come out the right way"
"I am not as fluent as I was before
38
What are subcategories of Hyperkinetic dysarthria?
- Tourette's
- Dystonia (strained harsh vocal quality)
- Spasmodic torticollis
- Essential tremor (rhythmic)
- Chorea (speech sounds slurred and slow, hard to talk, difficulty with chewing and swallowing)
- Myoclonus (adductor voice arrests, slow rate, imprecise speech)
39
Hyperkinetic dysarthria can manifest in all subsystems but is prominent in?
- Prosody
- Rate
40
Hyperkinetic dysarthria: Essential Tremor
- Rhythmic
- Vertical laryngeal movements
- Tremor.. especially during phonation in the jaw, lips, tongue, palate and pharynx
- adductor and abductor oscillations of the TVF
- Normal pitch and loudness
41
Hyperkinetic dysarthria: Myoclonus
- Ear clicks
- Usually no speech complaints
- Myoclonic movements in palate, pharynx, larynx, lips, nares, tongue, respiratory muscles, beneath neck muscles (can see)
- no issues with respiration and phonation
- articulation and prosody normal but could have brief silent intervals
42
Hyperkinetic dysarthria: Spasmodic Torticollis
- Reduced pitch and pitch variability
- reduced rate, delayed speech initiation and slow AMRs
- Patient says speech is normal
- Complaints relate to neck movements and pain
- Dysphagia
- Sensory tricks that reduce spasms temporarily and abnormal posturing
- Sustained deviation of head to right or left forward and back
43
Hyperkinetic dysarthria: Dystonia
- waxing and waning head and neck, face, tongue, palate, pharyngeal, laryngeal, thoracic-abdominal movements (present at rest, sustained phonation)
- Slow effortful speech
- Strained and harsh vocal quality
- voice tremor
- Involuntary orofacial movement
- "tricks" improve speech temporally
- Chewing and swallowing problems
44
Hyperkinetic dysarthria: Tourette's
- Vocal tics
- Motor tics (eye blinks, head twitch, facial grimacing, jumping, touching, obscene gestures)
- inability to inhibit the tics for sustained periods of time
- often associated with behavioral and psychiatric disorders (OCD, phobia, hyperactivity, ADD, LD)
- humming, whistling, lip smacking, echolalia, palilalia, sniffling, coughing grunting, throat clearing, screaming, moaning
45
Hyperkinetic dysarthria: Myoclonus
- Mostly respiration and phonation affected
- quick, gross, or fine jerky movements
- inability or reluctance to seat at normal or rapid rates
- adductor voice arrests
- slow rate / increased rate
- decreased precision
- deterioration of AMR regularity with increased rate
46
Hyperkinetic dysarthria: Chorea (slurred, hard to talk, difficulty with chewing and swallowing)
- Respiration and phonation (sudden forced inspriation-expiration, voice stoppages, transient breathiness, strained harsh voice quality, excessive loudness)
- Resonance and articulation (distortions and irregular breakdown, and slow and irregular AMRs)
- Prosody (prolonged intervals and phonemes, variable rate, inappropriate rate, inappropriate
silences, and excessive-inefficient variable patterns of stress)
- Quick, un patterned involuntary movements
- Effortful speech
- Involuntary orofacial movements
- Chewing and swallowing problems
47
Hyperkinetic dysarthria: Tremor
- Voice sounds shaky and tight
- Short of breath
- Not aware of tremor
- Tremor gets worse with fatigue or stress
- Improves with alcohol
