Final Quiz Flashcards
Flaccid dysarthria overall definition
Perceptually distinct group of motor speech disorders caused by injury or disease of one or more cranial or spinal nerves
Flaccid dysarthrias may manifest in _____, _____, or _____ parts of speech
Respiratory, resonatory, articulatory
Flaccid dysarthria affects the _____, ______, and ______ of speech movements
rate, range, accuracy
All subtypes of flaccid dysarthria share a lesion somewhere between ____ and ____
brainstem or spinal cord and muscles of speech
Spastic dysarthria definition
Perceptually distinct group of motor speech disorders that are produce by damage to the direct and indirect activation pathways of the CNS
Spastic dysarthria may manifest in the ____, ____, ____, or ____ parts of speech
Respiratory, phonatory, resonatory, and articulatory
Spastic dysarthria accounts for ___% of all dysarthrias and ____% of all MSDs
7.3, 6.8
General features of spastic dysarthrias reflect the effects of __________
Excessive muscle tone
Spastic dysarthria is primarily a problem of ______, as opposed to planning, programming , or control
Neuromuscular execution
The direct activation pathways are primarily ____, meaning impulses through them tend to lead to ____ and ____ movement
facilitatory, skilled, discrete
________ accounts for 60% of the etiology of cases of spastic dysarthria
Degenerative neurological disease such as ALS or PLS(Primary lateral sclerosis)
General etiology spastic dysarthria
Any process that damages the direct and indirect pathways bilaterally can case spastic dysarthria (degenerative disease, vascular, congenital, traumatic, inflammatory, toxic, and metabolic diseases).
Vascular etiologies of spastic dysarthria can include
nonhemorrhagic stroke, hemorrhagic stroke, anoxic or hypoxic encephelopathy
Congenital etiologies of spastic dysarthria can include
Cerebral palsy
Demyelinating disease etiologies of spastic dysarthria can include
Multiple sclerosis
______ seems to account for most deviant speech characteristics in spastic dysarthria
Effects of spasticity and weakness on speed, range, and force of movement
Clinical signs accompanying spastic dysarthria can include
Weakness, loss of skilled movements, spasticity, hyperactive reflexes, pathologic reflexes
Salient effects of UMN lesions on speech movements in spastic dysarthria include
Spasticity, weakness, reduced range of movement, slowness of movement
Other comorbid conditions in spastic dysarthria can be
Dysphagia, pseudo bulbar effect
Major clusters of speech characteristics in spastic dysarthria include
Prosodic excess, articulatory-resonatory incompetence, prosodic insufficiency, phonatory stenosis
Most distinctive clues to the presence of spastic dysarthria are
Strained-harsh voice quality, reduced pitch and loudness variability, slow speech rate, and slow and regular AMRs
Spastic dysarthria has a correlation with _____ disease
Cerebellar
Ataxic dysarthria general definition
Perceptually distinct motor speech disorder associated with damage to the left cerebellar control circuit (problems with motor control)
Ataxic dysarthria may manifest in the ____, _____, ____, and _____ components of speech
respiratory, phonatory, resonatory, articulatory
Ataxic dysarthria most evident in ___ and ___ aspects of speech
Articulation and prosody
General etiology of ataxic dysarthria
Any process that damages the cerebellum or cerebellar control circuit such as degenerative, demyelinating, vascular, neoplastic, inflammatory/infectious, endocrine, structural, traumatic, immune mediated, toxic, and metabolic diseases
_____ is the most common etiology in ataxic dysarthria
Degenerative disease
Degenerative etiologies of ataxic dysarthria can include
Cerebellar degeneration, NOS, unspecified etiology, spinocerebellar ataxia, multiple system atrophy, hereditary,
Unspecified etiologies in ataxic dysarthria can include
Cerebellar disease, NOS, indeterminate cerebellar lesion
Vascular etiologies of ataxic dysarthria can include
Stroke (cerebellar or brainstem), AVM, anoxia
Demyelnating etiologies in ataxic dysarthria include
Multiple sclerosis, chronic inflammatory, demyelinating polyradiculopathy
Tumor etiologies of ataxic dysarthria can include
Cerebellar or brainstem tumor, paraneoplastic cerebellar degeneration
Traumatic etiologies of ataxic dysarthria
Postoperative (tumor, AVM, deep brain stimulatory)
Toxic/metobolic etiologies of ataxic dyarthria can include
Hypothyroidism, lithium toxicity
Other etiologies of ataxic dysarthria are
Episodic ataxia, cerebral palsy, autoimmune disease, NOS, pervasive developmental disorder
Ataxic dysarthria results from damage to the ______ or most frequently damage to the ___ or ___
Cerebellar control circuit, lateral hemispheres, paravernal areas or vermis
Ataxic dysarthria is most perceptible in the ___ and ___ aspects of speech
Articulation and prosody
___ and ___ appear responsible for slowness of movement and inaccuracy in force, range, timing, and direction of speech movements in ataxic dysarthria
Inaccuracy and reduced muscle tone
Cerebellar lesions can be identified by
Neuroimaging studies
Aside from degenerative disease, ___, ____, and ___ are other common etiologies of ataxic dysarthria
Demyelinating, vascular, undetermined
People with ataxic dysarthria often complain of ____ and ____
Slurred speech, “drunken” quality to their speech
Most distinctive clues to the presence of ataxic dysarthria include
Irregular articulatory breakdowns, irregular speech AMRs, Excessive and equal stress, distorted vowels, excess loudness variation
Acoustic and physiologic studies of ataxic dysarthria have corroborated perceptual characteristics such as
Slowness of movement, problems with timing
Diagnosis of ataxic dysarthria and correlation with cerebellar function can _______
Aid localization and diagnosis of neurologic disease
Hypokinetic dysarthria general definition
Perceptually distinct motor speech disorder associated with the basal ganglia control circuit
Hypokinetic dysarthria may manifest in the ____, _____, ____, or ______ aspects of speech
Respiratory, phonatory, resonatory, articulatory
Hypokinetic dysarthria may be most evident in the ____, ____, or ____ aspects of speech
voice, articulation, prosody
______ is a significant contributor to hypo kinetic dysarthria
Decreased range of movement
General etiology of hypo kinetic dysarthria
Any process that interferes with the basal ganglia control circuit (Degenerative, vascular, traumatic, infectious, inflammatory, neoplastic, toxic, metabolic diseases)
____ is the most frequent cause of hypo kinetic dysarthria
Parkinson’s Disease
Degenerative disease accounts for ___% of etiologies of hypokinetic dysarthria
87%
Possible degenerative etiologies of hypokinetic dysarthria (87%)
PD, Parkinsonism, multiple system atrophy, progressive supranuclear palsy, Lewy body disease, corticobasal degeneration, frontotemporal dementia, parkinsonism + ALS
Possible vascular etiologies of hypokinetic dysarthria (4%)
Nonhemorrhagic stroke, vascular parkinsonism; hypoxia
Multiple possible causes of hypokinetic dysarthria (3%)
PD+stroke, corticobasal degeneration + normal pressure hydrocephalus; degenerative CNS disease + right cerebral hemorrhage; lymphoma + strokes; neurofibromatosis + seizures
Traumatic etiologies of hypokinetic dysarthria (2%)
Deep brain stimulation for PD; tumor resection, postoperative
Undetermined etiologies of hypokinetic dysarthria (2%)
Basal ganglia disorder, undetermined; CNS disease, undetermined
Infectious disease etiologies of hypokinetic dysarthria (1%)
Encephalitis
Other etiologies of hypokinetic dysarthria (1%)
Stiff person syndrome
What is Differential Diagnosis?
narrowing diagnostic possibilities and reaching conclusions about the nature of a deficit; requires application of knowledge and clinical skill to a specific population
- diagnosis should be related to suspected or known neurologic diagnosis or lesion localization
- multiple diagnoses are possible
- normal speech is a possible diagnosis
Differential Diagnosis of Dysarthrias
can be difficult because there is overlap in the characteristics of dysarthrias
- dysarthrias differ in their anatomic and vascular localizations, etiologic distributions, oral mechanism findings, and speech characteristics
Distinguishing AOS from dysarthrias
depends on recognizing deviant speech characteristics commonly associated with AOS that are uncommon in dysarthrias
Name elements associated with vascular parkinsonism
Gait difficulty, postural instability, dementia, corticospinal signs, pseudo bulbar effects, pathologic reflexes
Deviant speech characteristics in hypokinetic dysarthria include
the effects of rigidity, reduced force, and range of movement and slow individual and sometimes fast repetitive movements
Parkinson’s disease is …
a degenerative condition associated with a depletion of dopamine in the striatum of the basal ganglia
Symptoms of Parksinon’s are often managed by…
Medications that restore the balance between dopamine and other neurotransmitters in the basal ganglia
Name elements associated with vascular parkinsonism
Gait difficulty, postural instability, dementia, corticospinal signs, pseudo bulbar effects, pathologic
Drugs that can cause parkinsonism
Neuroeleptic and illicit drugs, drugs that interfere with the brain’s ability to store dopamine
Distinguishing between aprosodia and certain dysarthrias
rely on certain speech characteristics and the clinical setting in which they occur.
Common complaints of patients or significant others with hypokinetic dysarthria
Voice is weak or quiet, Rate is too rapid, deterioration with fatigue toward the end of a parkinsonian medication cycle , drooling and swallowing, facial masking and general reduction in the visible range of articulator movement during speech
Acquired Psychogenic and Related Disorders: Schizophrenia
Schizophrenia: usually begins in adolescence or early adulthood
- delusions, hallucinations, disorganized/catatonic behavior affecting flattening and disorganized speech
- specific conditions that can lead to schizophrenia include closed head injury, encephalitis, temporal lobe epilepsy, Huntington’s chorea, Wilson’s disease and demyelinating disease
Psychogenic Nonorganic Speech Disorders (PNSDs)
Voice disorders represent the largest category of PNSDs
- characterized by aphonia, hoarseness or strained dysphonia
Stuttering-like disfluencies are the next largest category of PNSDs
Articulation, prosodic deficits, infantile speech and mutism can also reflect psychogenic disorders
Hyperkinetic dysarthria may manifest in the ___, ___, ___, or ___ aspects of speech
Respiratory, phonatory, resonatory, articulatory
Acquired Psychogenic and Related Disorders: Depression
An affective disorder of mood
- primary depression can exist without any nonaffective psychiatric disorder or any serious organic disorder
- secondary depression is associated with a preexisting organic or psychiatric illness
Acquired Psychogenic and Related Disorders: Mania
Near emotional mirror image of depression
- excited mood, euphoria, low frustration tolerance, elevated self-esteem, poor judgement, disorganization, paranoia, little need for sleep, high energy
Hyperkinetic dysarthria can be caused by any process that damages the circuitry associated with ____
Hyperkinesias
Common etiologies of hyperkinetic dysarthria include
Toxic-metabolic, degenerative, infectious, vascular, traumatic, neoplastic, and inflammatory disease
What is dementia pugilistic and what is its relation to dysarthria
Repeated head trauma as occurs in boxers damages substantia nigra over time and may lead to parkinsonism- hypokinetic dysarthria
Other Neurogenic Speech Disturbances: Aphasia
a disturbance of language that can alter the characteristic of speech
- grammatical and syntactic deficits, word retrieval deficits and phonologic errors alter the rate, fluency and prosodic flow of verbal expression
Drugs that can cause parkinsonism
Neuroeleptic and illicit drugs, drugs that interfere with the brain’s ability to store dopamine
Toxins that can cause parkinsonism include
Chronic exposure to heavy metals, chemicals such as carbon disulfide, cyanide, methanol, temporary parkinsonism can occur during alcohol withdrawal
Common complaints of patients or significant others with hypokinetic dysarthria
Voice is weak or quiet, Rate is too rapid, deterioration with fatigue toward the end of a parkinsonian medication cycle , drooling and swallowing, facial masking and general reduction in the visible range of articulator movement during speech
Speech characteristics in hypokinetic dysarthria
Flat attenuated fused and sometimes accelerated speech pattern, mono pitch, mono loudness, reduced stress, short phrases, variable rate, short rushes of speech and imprecise articulation, inappropriate silences, breathy dysphonia, reduced loudness, and increased rate of speech
Hyperkinetic dysarthria general definition
Perceptually distinct motor speech disorder with basal ganglia control circuit pathway
Hyperkinetic dysarthria may manifest in the ___, ___, ___, or ___ aspects of speech
Respiratory, phonatory, resonatory, articulatory
Basal ganglia control circuit includes the
Basal ganglia, thalamus, cerebral cortex
Destruction of the sub thalamic nucleus causes ….
reduced inhibitory output from the basal ganglia, resulting in increased thalamic and subsequent cortical firing- uninhibited abnormal movements are “released” through the motor cortex to the corticospinal and coritcobulbar pathways
Hyperkinetic dysarthria can be caused by any process that damages the circuitry associated with ____
Hyperkinesias
Common etiologies of hyperkinetic dysarthria include
Toxic-metabolic, degenerative, infectious, vascular, traumatic, neoplastic, and inflammatory disease
Hyperkinesia definition
Abnormal or excessive involuntary movements
Other Neurogenic Speech Disturbances: Neurogenic Stuttering
Characterized by various patterns of dysfluency that may occur with or without accompanying aphasia, AOS or dysarthria
Other Neurogenic Speech Disturbances: Palilalia
compulsive repetition of words and phrases, often in a context of increasing rate and decreasing loudness
- bilateral basal ganglia pathology
- frequently associated with hypokinetic dysarthria
Other Neurogenic Speech Disturbances: Echolalia
motorically normal, unsolicited repetition of another’s utterances
- repetition can be rote or modified in a way that suggests linguistic processing
Other Neurogenic Speech Disturbances: Aphasia
a disturbance of language that can alter the characteristic of speech
- grammatical and syntactic deficits, word retrieval deficits and phonologic errors alter the rate, fluency and prosodic flow of verbal expression
Other Neurogenic Speech Disturbances: Aprosodia
a disturbance that has been associated with right hemisphere dysfunction although it can be associated with various site lesions, MSDs, and cognitive and affective deficits
Other Neurogenic Speech Disturbances
Can alter speech in ways that are not attributable to commonly described dysarthrias or AOS
- other alterations in speech can be due to cognitive, affective or linguistic disturbances
What is Neurogenic Mutism?
The absence of speech
- can reflect psychiatric disturbances
- can be organic but nonneurologic (profound congenital hearing loss, peripheral structural loss/laryngectomy)
- can be caused by congenital or acquired neurologic diseases that affect the PNS or CNS anywhere from the brain stem to the cortex
How can neurogenic mutism occur?
Neurogenic mutism can result from severe dysarthria, AOS, aphasia or nonaphasic cognitive affective conditions
- can occur post seizures or after surgical re-sectioning of the corpus callosum
What is Anarthria?
speechlessness due to severe loss of neuromuscular control over speech
- most severe form of dysarthria
- neuromotor system does not permit speech
- patients do not speak because they cannot speak
- most commonly results from bilateral or diffuse neurologic damage
- when a single vascular event causes anarthria, its locus is usually in the brainstem
What is Locked-In Syndrome?
anarthria accompanied by quadriplegia and total body immobility except for vertical eye movements and blinking
- individual is conscious and sufficiently intact cognitively
(individuals w/ ALS and AAC devices)
- caused by occlusion of the basilar artery, which affects the ventral aspect of the pons
What is coma?
a state of unarousable unresponsiveness and absence of sleep/wake cycles on EEG in response to an injury that suppresses or damages neuronal networks that permit consciousness
- voluntary behavior is absent, eyes remain closed and there is no evidence of purposeful movement or localizing responses
- any observable actions are reflexive
What is speech arrest?
associated with partial seizures
speech in progress at onset of seizure is halted, consciousness is maintained
commonly occurs with frontal lobe seizures
Neurogenic mutism that arises from acquired neurologic disease can be due to…
- Severe dysarthria (anarthria)
- AOS
- Aphasia
- various nonaphasic cognitive and affectiveconditions
Mutism in the acute period following the onset of aphasia or associated with AOS…
is not unusual, but does not usually persist
Apraxia of Speech (AOS)
A neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosaically normal speech
AOS accounts for….
6.9% of all motor speech disorders
AOS can occur…
- in the absence of physiologic disturbances associated with the dysarthrias and in the absence of disturbance in any component of language
- with other motor and sensory signs of left hemisphere damage
- as the only evidence of neuropathy
The MSP is….
Motor Speech Programmer
- motor planning/programming component of motor speech control
- organizes the motor commands that ultimately result in the production of temporarily ordered syllables, word and phrases at particular rates and patterns of stress and rhythm
- relies heavily on the left hemisphere’s capacity to prepare for speaking and to drive the acquisition and execution of learned motor speech programs
Broca’s area roles in MSP
- candidate region for contributing to the specification of speech movements base don input from the language network and sensory modalities
- storehouse and processor for previously acquired, highly practiced speech routines and their serial organization and guidance
- often identified as lesion site in people with AOS
Supplementary Motor Area roles in MSP
- may be important to nonmotoric speech planning and sequence learning
- involved in the initiation and control of speech production
- tied to cognitive and emotional processes that drive or motivate action
connects with the primary motor cortex and Broca’s area, the basal ganglia and limbic system
Parietal areas (somatosensory cortex + supramarginal gyrus)
- important in integrating sensory info for skilled movements and their sequencing for lengthy utterances
- transferring that information into plans and targets for action
- matching feedback during speech with internal representation of utterance
What other areas have a role in motor control and MSP activities?
Basal ganglia and cerebellum
What can cause AOS?
Any process that compromises dominant hemisphere functions for MSP can cause AOS
- Stroke is the most common cause of AOS
- tumors or trauma can also cause AOS
- occasionally it is a sign of a degenerative CNS disease
The clinical characteristics of AOS are NOT attributable to…
the physiologic disturbances that explain the dysarthrias or the language processing disturbances that explain aphasia
AOS is a result of abnormality in the ___ hemisphere
Left
AOS is often a secondary diagnosis when ____ is the primary communication disorder
Aphasia
People with AOS can also have…
nonverbal oral apraxia (NOVA) and/or limb apraxia, but the three conditions can also occur independently
When AOS occurs in association with dysarthria, it most often occurs with…
UUMN dysarthria or spastic dysarthria
Deviant speech characteristics associated with AOS:
- distorted sound substitutions and additions
- decreased phonemic accuracy with increased rate
- attempts to correct articulatory errors that cross phonemic boundaries
- groping for articulatory postures
- greater difficulty on volitional than automatic speech acts
- greater difficulty on sequential motor rates and multi-syllabic word tasks than alternate motion rates and single syllable tasks
People with AOS may have:
- a limited phonetic repertoire
- little difference between voluntary and automatic speech utterances
- a highly consistent pattern of perceived speech errors
How can AOS be distinguished from errors of aphasia?
AOS = articulatory distortions, reduced rate and various prosodic abnormalities help distinguish AOS from aphasic phonologic errors
Hyperkinesia definition
Normal or excessive involuntary movements
Dyskinesia definition
Abnormal involuntary movements regardless of etiology
What is tardive dyskinesia
Common side effect of antipsychotic drugs - stereotyped and repetitive lip smacking, pursing, puffing and retraction, tongue protrusion or opening closing, or lateral jaw movements
What is Akathisia?
Inner sense of motor restlessness which can be manifested by overt motor restlessness (weight shifting, pacing) to relieve the sensation
What is myoclonus?
Involuntary single or repetitive brief lighting-like jerks of a body part
In myoclonus, jerks can be ____ or ______ and cannot be inhibited willfully
rhythmic, nonrhythmic
How is myoclonus induced?
Can occur spontaneously or be induced by visual, tactile, or auditory stimuli or sometimes by voluntary movements
Myoclonus can occur in the following conditions
- Dementing illnesses (Creutzfeldt Jacob disease, Lewy body dementia, progressive myoclonic ataxia)
- Uncommon syndromes such as opsoclonus-myoclonus syndrome
- Post-anoxic and metabolic encephalopathies
- TBI
How is action myoclonus induced?
Volitional muscle activity
Most common etiology of action myoclonus is
Anoxic encephalopathy - principle damage to the globes pallidus, hippocampus, deep folia in the cerebellum, deep layer of the cerebral cortex
Action myoclonus is a product of….
Unrestrained synchronous or repetitive firing of thalamocortical neurons in the ventrolateral thalamus - the main relay nucleus from the cerebellum to the cortex
