Flaccid Flashcards
flaccid dysarthria is cased by damage to what
lower motor neurons
lower motor neurons include what
cranial nerves and spinal nerves
flaccid characteristics
- slow labored articulation
- marked degrees of hyper nasal resonance
- hoarse-breathy phonation
last and only “road” neural impulses from upper motor neurons travel to reach muscles
final common pathway
the six pairs of cranial nerves that play a role in speech production
- trigeminal
- facial
- glossopharyngeal
- vagus, accessory
- hypoglossal
specific causes of damage to your lower motor neurons
- physical trauma
- brainstem stroke
- myasthenia gravis
- Guillain-Barre syndrome
- polio
flaccid dysarthria is caused by anything that …
disrupts the flow of motor impulses along cranial or spinal nerves that innervate muscles of speech production
what nerve is one of the most important nerves of respiration (and motor speech production) that come out of C3, C4, and C5
phrenic nerve
damage to the phrenic nerve can cause
- paralyzed diaphragm
- decreased loudness
- shortened, breathy, or strained vocal quality
physical trauma can include
- surgical trauma
- head and neck injury
a brainstem stroke is also known as a
cerebrovascular accident (CVA)
damage from a CVA depends on what
the amount of lower motor neurons that are lost and don’t receive blood flow from that stroke
what does Myasthenia Gravis affect
the neuromuscular junction
symptoms of Myasthenia Gravis
- rapid fatigue of muscular contractions over a short time with recovery after rest
- hyper nasality
- decreased loudness
- breathy voice quality
- decreased articulatory precision
how would you assess Myasthenia Gravis
with a stress tess
what is a stress test
counting from 1 to 100 or to read a lengthy paragraph
Guillain-Barre Syndrome results in
demyelination (depletion of the myelin sheath on the neuron)
Guillain-Barre frequently occurs when?
after certain kinds of infections and immunizations
symptoms of Guillian-Barre
- flaccid dysarthria
- dysphagia
recovery of Gillian-barre syndrome
- high recovery rate, lasting weeks or months
- 5% die in acute stages
polio is what
an infectious viral disease that attacks cell bodies of lower motor neurons
what does polio most frequently affect
cervical and thoracic spinal nerves
polio causes
- labored inhalation during speech
- shortened speech phrases
- speaking on residual air
- decreased loudness
Can polio also affect spinal nerves?
yes
Others causes of flaccid dysarthria
- tumors
(growing in or near the brainstem) - muscular dystrophy
(progressive degeneration of muscle tissue) - progressive bulbar palsy
(often only present in LMN but can he in the UMN as well)
Main word or flaccid characteristic
weaknesses
resonance in flaccid
- hypernasality (most noticeable voice quality error)
- nasal emission
- weak pressure consonants
- shortened phrases
articulation in flaccid dysarthria
- imprecise consonant production
damage to the trigeminal nerve affects articulation in that
they would have difficulty in elevating the jaw sufficiently to bring articulators into contact with each other
intervention for problems with jaw movement
use your hand to elevate the jaw or use a jaw sling
phonation in flaccid dysarthria
phonatory incompetence (incomplete adducting of the vocal folds during phonation)
incomplete adduction of the vocal folds during phonation results in
- breathy voice quality or whisper
- weak or paralyzed adductor and abductor muscles
what is the strongest confirmatory sign of flaccid dysarthria
hypernasality and phonatory incompetence
respiration in flaccid dysarthria
weakened respiration (decreased inhalation of impaired control of exhalation) may be present
respiration symptoms in flaccid dysarthria
- reduced loudness
- shortened phrase length
- strained vocal quality if speaking on residual air to prolong phrase length
- monoloudness *
- monopitch *
- may inhale frequently (affects prosody)
prosody in flaccid dysarthria
weakened laryngeal muscles that are unable to make many fine vocal-fold adjustments necessary for normal pitch and loudness variations
prosodic symptoms
- monopitch
- monoloudness
is prosody a definite diagnostic marker for flaccid dysarthria?
nope!
key evaluation tasks for flaccid
- conversational speech and reading
- alternate motion rate (AMR)
- prolonged vowel
- speech stress test
what is the primary task for evaluating flaccid
conversational speech and reading
conversational speech and reading can evoke errors of what
- resonance (hypernasality)
- articulation (imprecise consonants)
- respiration (shortened phrase length)
- prosody (mono pitch, mono loudness)
what will AMR highlight in flaccid dysarthria
a slow rate of phoneme production (showing the weak articulation movement)
what will a prolonged vowel evoke in flaccid
- helpful in seeing the breathy voice quality heard in phonatory incompetence
- useful in observing respiratory weakness
why is a speech stress test necessary in flaccid
for myasthenia gravis (to show the tired)
the traditional approach to treating motor speech disorders is to
- use assessment data to identify deficits
- begin working with patients use appropriate treatment goals
- increase complexity of tasks as patients improve
- work toward generalization of improvements
Rosenbek made 6 additional recommendations
- help pts recognize differences in their speech
- help pts have a willingness to change their speech for the better
- work closely with pts when setting goals for treatment
- insist that pts are talking therapeutically in their sessions even in small talk
- ensure pts are learning to list, evaluate, and self-correct their speech
- progressively add cognitive-linguistic load to treatment tasks to ensure pts are working toward generalization
treatment for flaccid are presented according to what
which cranial nerve or combination of nerves are damaged
respiration treatment for flalccid
- correct posture
- compensatory prosthetic devices
- speaking immediately on exhalation
- cueing for complete inhalation
phonation treatment for flaccid
- pushing and pulling procedures
- holding breath
- hard glottal attack
- head turning
- sideways pressure on the larynx
articulation treatment for flaccid
traditional articulation drills
resonance treatment for flaccid
- velar strength-training procedure
- modification of speech
- reduced rate
- more open-position mouth during speech
- increase loudness
