Dysarthrias - Diff Dx Flashcards
Dysarthria
a speech disorder resulting from weakness, paralysis, or incoordination of the muscles of the speech mechanism
Motor Speech Disorder
- disorders of speech resulting from neurological impairment affecting the motor programming or neuromuscular execution of speech (Duffy, 1995, p.5)
- includes dysarthria & apraxia of speech
Flaccid dysarthria - Neural basis?
Final common pathway (spinal & cranial nerves) (aka LMN)
Spastic dysarthria- Neural basis?
Bilateral direct & indirect activation pathways (pyramidal and extrapyramidal systems) (aka UMN)
Ataxic dysarthria - Neural basis?
Cerebellum
Hypokinetic dysarthria - Neural basis?
Basal Ganglia
Hyperkinetic dysarthria - Neural basis?
Basal Ganglia
Mixed Dysarthria - Neural basis
?
Flaccid Dysarthria - Physiology?
Weakness
Spastic Dysarthria - Physiology?
Spasticity
Ataxic Dysarthria - Physiology?
Incoordination
Hypokinetic Dysarthria - Physiology?
Rigidity, Reduced ROM
Hyperkinetic Dysarthria - Physiology?
involuntary movements
Mixed dysarthria - Physiology?
?
Unilateral UMN - neural basis & physiology?
Neural basis: unilateral UMN
Physiology - Weakness & possibly incoordination
Often ______ ______ are the 1st sign of a neurological disease
speech symptoms
Identification of speech symptoms can assist w/ medical dx and care (T/F)
True
Flaccid dysarthria - Symptoms
Can vary widely depending on what cranial nerves are involved. Unlike most dysarthria types, this dysarthria sometimes reflects involvement of only a single muscle group (e.g., tongue) or speech subsystem (e.g., phonatory).
Flaccid dysarthria - clinical characteristics?
- Weakness
- Hypotonia & Reduced Reflexes
- Muscle Atrophy
- Fasciculations & fibrillations
- Progressive weakness with use, when damage is at the neuromuscular junction as in Myasthenia Gravis (Rapid weakening w/ use and Recovery with rest)
Flaccid dysarthria - General oral motor exam would look like?
Expect to see
- Weakness & Reduced ROM for articulators
- Jaw deviates to weak side when opening (unilateral mandibular lesions)
- Tongue deviates to weak side when protruded
- Drooling
Flaccid dysarthria - Articulation?
imprecise articulation
Flaccid dysarthria - Resonance?
- Hypernasality
- Nasal Emission
Flaccid dysarthria - Prosody?
- Short Phrases
- Monoloudness & mono pitch
Flaccid dysarthria - Phonation?
- Breathy voice
- Audible inspiration
Flaccid dysarthria - Commonly associated neurological diagnoses?
- Brainstem stroke (could lead to locked-in syndrome)
- Gullain - Barre Syndrome (GB)
- Mysathenia Gravis (MG)
- Muscular Dystrophy (MD) (Duchenne, Myotonic)
Flaccid dysarthria - Trigeminal Sensory Neuropathy
- Viral etiology is common, but also associated w/ diabetes, sarcoidosis, and connective tissue disease.
- Facial numbness is occasionally a presenting symptom of Multiple Sclerosis (MS).
Flaccid dysarthria - Trigeminal Nerve (V) lesions - Nonspeech oral mech exam - - In cases of bilateral weakness what would be pt complaints & what would you expect to see?
can include chewing difficulty, drooling, and recognition that the jaw is difficult to close or move
Flaccid dysarthria - Trigeminal Nerve (V) lesions - Nonspeech oral mech exam - - if sensory branches are affected, what would be pt complaints & what would you expect to see?
pt may complain of decreased face, cheek, tongue, teeth, or palate sensation. (Assess during OME by having pt close eyes and indicate when light touch or pressure is applied to the affected area)
Flaccid dysarthria - Trigeminal Nerve (V) lesions - Nonspeech oral mech exam - - In pts with unilateral mandibular branch lesions, what would be pt complaints & what would you expect to see?
- jaw will deviate to weak side when opened
- partly opened jaw may be pushed easily to the weak side by the examiner
- degree of master or temporals contraction felt on palpation when the pt bites down may be decreased on the weak side
