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Motor Speech Disorders > Exam 2 - Flaccid Dysarthria > Flashcards

Exam 2 - Flaccid Dysarthria Flashcards

1
Q

caused by:

A

impairments of LMNs in cranial or spinal nerves

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2
Q

weakness + low tone in:

A

speech or respiratory musculature results in distinctive qualities

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3
Q

flaccid dysarthria is characterized by:

A

slow, labored articulation
marked degrees of hypernasality
hoarse-breathy phonation

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4
Q

flaccid dysarthria is caused by;

A

paralysis, weakness, hypotonicity, atrophy, and hypoactive reflexes

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5
Q

LMN =

A

CNS (cranial/spinal nerves)

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6
Q

flaccid dysarthria occurs from damage to:

A

LMN system
cranial and spinal nerves + neuromuscular junction

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7
Q

flaccid dysarthria is NOT due to what type of stroke?

A

cortical

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8
Q

six pairs of CNs play a vital role in speech production

A

trigeminal V
facial VII
glossopharyngeal IX
Vagus X
Accessory XI
Hypoglossal XII

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9
Q

damage to CNs that cause flaccid dysarthria could be from:

A

brainstem stroke
growing tumor
viral or bacterial infections
physical trauma
surgical accidents

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10
Q

trigeminal nerve

A

V
jaw + facial sensation

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11
Q

facial nerve

A

VII
branches out from brainstem just below the trigeminal (V) nerve

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11
Q

3 main branches of CN V:

A

trigeminal:
ophthalmic, maxillary, and mandibular

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11
Q

most important CN V branch for speech?

A

mandibular

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11
Q

nerve attached to brainstem at level of pons:

A

trigeminal (V)

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12
Q

branches of CN VII:

A

facial nerve
temporofacial (upper) and cervicofacial (lower)

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13
Q

cranial nerve IX

A

glossopharyngeal
originates in brainstem at medulla, coursing out to pharynx

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14
Q

damage to CN IX also usually affects which nerve?

A

vagus (X)

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15
Q

CN that likely plays role in speech resonance and phonation by shaping pharynx into appropriate positions needed to produce various phonemes correctly:

A

glossopharyngeal (IX)

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16
Q

Vagus nerve

A

X
controls velum and intrinsic laryngeal muscles

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17
Q

one of the most important CNs for speech production

A

X

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18
Q

originates in the brainstem at the medulla

A

vagus (X)

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19
Q

3 branches of CN X that are important for speech:

A

pharyngeal
external superior laryngeal nerve branch
recurrent nerve branch

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20
Q

damage to pharyngeal branch of CN X can affect:

A

movement of velum and resonance

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21
Q

damage to external superior laryngeal nerve branch of CN X can affect:

A

pitch

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22
Q

damage to recurrent nerve branch of CN X can cause:

A

breathy phonation

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23
Q

symptom of damage to CN X:

A

hypernasality

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24
Q

CN XI:

A

accessory
originates in medulla just below the vagus nerve

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25
Q

this CN works in conjunction with CN X helping innervate intrinsic muscles of velum, pharynx, and larynx

A

CN XI - accessory

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26
Q

velum deviates to:

A

STRONG SIDE

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27
Q

most muscles deviate to:

A

WEAK SIDE

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28
Q

originates in the medulla

A

CN XII - hypoglossal

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29
Q

CN XII

A

hypoglossal - tongue

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30
Q

which CN provides motor innervation for all intrinsic and most extrinsic muscles of the tongue?

A

CN XII

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31
Q

damage to hypoglossal nerve results in:

A

weakness of tongue or paralysis

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32
Q

primary characteristics of hypoglossal nerve damage:

A

imprecise articulation
phoneme distortion
slow lingual movements

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33
Q

lingual twitches (fasciculations) are a sign of:

A

LMN damage

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34
Q

why are the spinal nerves important for speech?

A

provide motor innervation for the muscles of respiration

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35
Q

damage to spinal nerves generally must be widespread to significantly impair:

A

respiration

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36
Q

injury to phrenic nerve

A

provides motor innervation to the diaphragm

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37
Q

causes of flaccid dysarthria:

A

physical trauma
neuropathies of undetermined origin
muscular diseases
tumors

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38
Q

flaccid dysarthria: disruption of motor impulses along cranial or spinal nerves (LMNs) that innervate

A

muscles of speech production

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39
Q

physical trauma

A

surgical trauma with accidental stretching or cut of cranial nerve
head and neck injury

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40
Q

brainstem stroke or tumor

A

occurs with interruption of blood flow to the brain or when there is a growth on or near the brainstem

41
Q

hemorrhagic

A

artery breaks

42
Q

ischemic

A

artery is blocked

43
Q

myasthenia gravis

A

affects neuromuscular junction
Sx are rapid fatigue of muscular contractions over short time w/ recovery after rest

44
Q

myasthenia gravis is caused by:

A

antibodies that block/damage muscle tissue that receives the neurotransmitter acetylcholine

45
Q

neurotransmitter that causes muscle contractions

A

acetylcholine

46
Q

when acetylcholine is blocked,

A

LESS muscle contractions occur

47
Q

symptoms of myasthenia gravis are often chiefly:

A

velar inadequacy (hypernasality)
ptosis

48
Q

Ax of myasthenia gravis should include:

A

stress testing

49
Q

stress testing

A

count from 1 to 100 or read lengthy paragraph

50
Q

Guillain-Barre syndrome

A

demyelination usually occurring in the PNS (LMN damage)

51
Q

the cause of GB syndrome is:

A

unknown but frequently occurs after certain kinds of infections and immunizations

52
Q

progression of GB:

A

rapid w/ Sx including weakness/numbness in limbs then flaccid dysarthria and dysphagia if CNs affected

53
Q

GB recovery rate:

A

high, lasting weeks or months

54
Q

other causes of flaccid dysarhtira;

A

muscular dystrophy
progressive bulbar palsy
palsy and neuralgia
anatomic anomalies
ALS
MS
Polio

55
Q

muscular dystrophy causes:

A

progressive degeneration of muscle tissue

56
Q

progressive bulbar palsy can affect:

A

both UMNs and LMNs, although often present only in LMN

57
Q

palsy and neuralgia

A

inflammation and degeneration of cranial nerves

58
Q

masticator palsy

A

CN V

59
Q

important non speech symptoms of flaccid dysarthria

A

diminish/absent reflexes
muscle atrophy
inhalatory stridor
fasciculations
deviation of jaw

60
Q

inhalatory stridor

A

audible phonation/wheezing sound

61
Q

flaccid dysarthria - look for:

A

cluster of symptoms

62
Q

flaccid dysarthria - severity level:

A

within each area varies for each patient

63
Q

flaccid dysarthria - resonance:

A

reflects damage to the pharyngeal branch of CN X because innervates most muscles of velum

64
Q

hypernasality
nasal emission
weak pressure consonants
shortened phrases

A

resonance

65
Q

most noticeable resonance error

A

hypernasality

66
Q

nasal emission

A

weak velopharyngeal closure

67
Q

weak pressure consonants

A

decreased intraoral air pressure (trouble with stops)

68
Q

shortened phrases

A

wasted air that escapes through nasal cavity during speech

69
Q

flaccid dysarthria - articulation:

A

imprecise consonant production

70
Q

articulation range of severity

A

mild distortion to complete unintelligibility

71
Q

reason for imprecise consonant production is damage to:

A

facial and hypoglossal nerves

72
Q

damage to trigeminal nerve (V) could also affect articulators because:

A

it could cause difficulty elevating jaw sufficiently to bring articulators into contact with each other

73
Q

phonatory incompetence

A

incomplete adduction of vocal folds during phonation

74
Q

phonatory incompetence with flaccid dysarthria caused by:

A

damage to recurrent branch of CN X

75
Q

**strongest confirmatory sign of flaccid dysarthria as correct diagnosis:

A

combined presence of HYPERNASALITY and PHONATORY INCOMPETENCE

76
Q

hypernasality + phonatory incompetence =

A

flaccid dysarthria

77
Q

may or may not be a component of flaccid dysarthria:

A

weakened respiration

78
Q

weakened respiration symptoms of flaccid dysarthria:

A

reduced loudness
shortened phrase length
strained vocal quality if speaking on residual air to prolong phrase length

79
Q

symptoms of prosody

A

monopitch
monoloudness

80
Q

not unique to flaccid dysarthria so NOT a definite diagnostic marker

A

prosody

81
Q

flaccid dysarthria - prosody:

A

weakened laryngeal muscles that are unable to make fine vocal fold adjustments necessary for normal pitch and loudness variations

82
Q

key evaluation tasks for flaccid dysarthria:

A

oral mech exam
conversational speech and reading
DDKs
prolonged vowel
speech stress test

83
Q

conversational speech and reading task

A

can evoke hypernasality, imprecise consonants, shortened phrase length, mono-pitch and -loudness

84
Q

DDKs

A

will highlight slowed rate of phoneme production

85
Q

prolonged vowel

A

helpful in eliciting breathy voice quality heard in phonatory incompetence and useful for observing respiratory weakness

86
Q

speech stress test

A

necessary in suspected cases of myasthenia gravis

87
Q

**if you want to improve speech, work on:

A

SPEECH in therapy

88
Q

treatments for flaccid dysarthria are presented according to:

A

which cranial nerve or combination of nerves are damaged

89
Q

if improving speech production is the goal, treatment activities should concentrate directly on:

A

speech production

90
Q

unilateral damage to CN V

A

trigeminal nerve
typically minimal - no effect on speech production

91
Q

bilateral damage to CN V

A

trigeminal nerve
rare but can leave jaw muscles very weak or, in severe cases, cause inability to close jaw

92
Q

treatment for resonance due to damage to vagus nerve

A

CN X
pharyngeal flap procedure
PPW augmentation
palatal lift

93
Q

most frequent treatment for resonance in flaccid dysarthria:

A

palatal lift

94
Q

what treatment can be effective for mild hypernasality?

A

modification of speech
reduced rate; more open position mouth; increased loudness

95
Q

treatments for phonation:

A

conscious effort into speaking more loudly
pushing and pulling procedures
hard glottal attack
head turning and sideways pressure on the larynx

96
Q

treatments for prosodic deficits

A

pitch range exercises
intonation profiles
contrastive stress drills
chunking utterances into syntactic units

97
Q

damage to facial (VII) and hypoglossal (XII) CNs, affects:

A

speech production primarily by decreasing lip or tongue strength and ROM
traditional articulation drills often used

98
Q

traditional articulation drills

A

intelligibility drills, phonetic placement, exaggerating consonants, minimal contrast drills

99
Q

treatment for respiratory weakness:

A

correct posture
compensatory prosthetic devices
speaking immediately on exhalation
cueing for complete inhalation

100
Q

flaccid dysarthria is caused by:

A

any process that damages LMNs used in speech production

101
Q

primary speech characteristics of flaccid dysarthria include:

A

hypernasality
imprecise consonants
breathy voice quality

102
Q

Tx for flaccid dysarthria:

A

WORK ON SPEECH

Motor Speech Disorders (14 decks)

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