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Motor Speech Exam 2 > Flaccid Dysarthria > Flashcards

Flaccid Dysarthria Flashcards

1
Q

Upper Motor Neurons

A
  • descending motor fibers in the CNS
    ** synapse with motor neurons in PNS
  • UMNs = motor fibers in CNS
  • Tract and nerves are the same
    ** nerves are in PNS
    ** tracts are in CNS
  • everything that we try to do is from the cortex
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2
Q

Lower Motor Neurons

A

Motor fibers in the PNS
- cranial nerves: most head & neck muscles
- spinal nerves: trunk & limb muscles

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3
Q

Cranial nerve nuclei

A
  • points at which cranial nerves attach to brainstem
  • cell bodies of LMNs
  • synapse with UMNs
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4
Q

Movement chain

A

UMN > CNN > LMN > muscles

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5
Q

Neurological basis

A
  1. Damage LMNs: motor neurons in PNS
    - Final common pathway (aka. LMN)
    - nerves never cross
  2. Flaccidity of affected muscles - can cause weakness
    - are not synonymous
  3. Hypotonia: low tone; con’t contrast and lose tone
  4. Hyporeflexia: lose reflexes
  5. Atrophy: loss of muscle bulk and mass
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6
Q

what is flaccidity?

A

a pathophysiological state of the muscle, which can cause weakness

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7
Q

What is weakness?

A

a functional outcome

less ability to contract and to perform “work”
- push or pull against an object
- but spastic or rigid muscles can also be “weak,” like PD

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8
Q

Etiologies - physical trauma

A
  • surgeries
  • TBI
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9
Q

Etiologies - brainstem stroke

A

near cranial nerve nuclei

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10
Q

Etiologies - myasthenia gravis

A
  • it affects neuromuscular junction
  • symptom: rapid fatigue of muscle contractions
  • recover after a rest
  • antibodies damage acetylcholine receptors
  • acetylcholine
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11
Q

Etiologies - tumors

A
  • grow near the brainstem
  • occur along CN
  • isn’t always in the brain itself
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12
Q

Etiologies - Moebius Syndrome

A
  • CN Vll absence or underdevelopment
  • Other CNs can also be involved (VI)
  • Swallowing issues
  • Open mouth posture
  • Surgery: the “smile operation” - help the drooping side of the lip to come up
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13
Q

Etiologies - Bell’s Palsy

A
  • CN VII; facial m, weakness
  • Viruses, environmental conditions, immune diseases, diabetes, high BP
  • less ability to close eye
  • audiology issue > stapedius muscle
  • about 70-75% recover normal facial function
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14
Q

Speech characteristics - resonance

A
  • hypernasality
  • nasal emissions
  • weak pressure components
  • shortened phrases
  • CN (pharyngeal branch) - also, possible IX and XI
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15
Q

Speech characteristics - articulation

A
  • imprecise consonants
  • mild to unintelligible
    CNs V, VII, XII
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16
Q

Speech characteristics - phonation

A
  • breathiness (continuous)
  • monochrome
  • monoloudness
  • inhalatory stridor
  • harsh quality
  • CN X:
    ** external superior laryngeal n.
    ** recurrent laryngeal
17
Q

Speech characteristics - respiration

A
  • reduced loudness
  • mono pitch
  • monoloudness
  • harsh voice quality
  • shortened phrase length
  • spinal nerves
18
Q

Speech characteristics - prosody

A
  • monopitch
  • monoloudness
19
Q

key evaluation tasks

A
  1. conversational speech & reading
  2. AMRs - alternating motion rate
    a. pay attention to both rate and rhythm
    b. flaccid: slow but regular
  3. vowel prolongation - if vagus is affected
20
Q

Treatment - Damage to CN VII (facial)

A

Lip Muscle Strengthening - needs resistance
- button & string: put button in the mouth, right in front of the teeth
- lip puckering
- smile: hold it up by the gravity for 10 seconds
- lip rounding: pressing in with tongue depressor
- lip press: use finger to try to open the lips
- resistance to movement exercises: use evaluation tasks for ideas
- use resistance, like when you work out : tongue depressor, your finger to hold for 5 seconds against resistance for 5 times

21
Q

Treatment - Damage to CN X: Resonance Deficits

A

Modification of speech:
- increase loudness: SPL meter, CSL or Visi-Pitch
- reduce speech rate
- exaggerate mouth opening - start with VC shape

22
Q

Important note for treatment

A

biofeedback is only successful if patient is anatomically and physiologically capable of achieving adequate VP closure

23
Q

Prosthodontist

A
  • prosthetic devices to replace or improve appearance of teeth and orofacial structures
  • makes and fits devices to assist with feeding and VP closure (palatal lifts, speech bulbs, obturators)
24
Q

Prosthetic treatments: palatal lift - adequate patients

A
  • severe hypernasality
  • no deteriorating medical condition
  • adequate dentition
  • no hyperactive gag reflex or spasticity
  • motivation to use/care for prosthetic
  • ability to see prosthodontist & SLP
25
Q

Recommendations for prosthetic treatment

A
  • If prosthesis is insufficient > follow-up fiber optics > possible incomplete rest leak > possibly a pharyngeal flap
  • superiorly-based
    1. cut flap of tissue, side-bottom-side
    2. keep it attached to the top
  • inferiorly-based
    1. cut top side, keep it attach inferiorly
  • depends on the preference of the surgeon
26
Q

Good candidates for therapy

A

Associated with oral-motor dysfunction
- trial therapy before surgical decision
- prosthetic management

Surgery has been done, but patients need to learn to use “new structure”
- same with a prosthesis
- train proper articulatory placement and oral airflow
- reduction therapy
- possible with palatal lift
- might work better with speech bulb

27
Q

Techniques for hypernasality

A

Tactile-Kinesthetic Training
- have client raise/lower velum during vowels
- use tongue blade to raise velum
- may be a candidate for a palatal lift

Lower back of tongue
- use yawn (think yawn)
- produce vowels and anterior consonants
- VC > “up”

28
Q

Techniques for nasal emission

A

Visual feedback
- see scape (Pro ed)
- air paddle

Cul-de-Sac technique
- occlude nares (or nose clip)
- during production of pressure consonants
- “feel” air pressure in mouth
- direct airflow from mouth

29
Q

Treatment - Damage to CN X: phonatory deficits

A

Pushing/pulling:
- effortful closure
- holding breath
- falsetto /i/

HGA - high glottal attack
- after vowels, adding in voiced consonants

30
Q

Treatment - Damage to CN X: prosodic deficits

A

Pitch range exercises:
- Visi-Pitch
- Use scale or glide

Intonation profiles
- written sentences
- Visi-pitch: have clients copy the clinician’s curve

Lexical stress drills
- example: record - record
- N vs. V
- activities: words, sentences, sentences with both words

Sentence stress drills
- example: may won the contest
- don’t say “no” before the sentence

31
Q

Minimal contrast drills

A
  • one word has that feature, the other word does not
  • you don’t just change the sound; you change one feature
  • P, M, V, cluster, etc
  • example for cluster: top - stop
  • example for nasals: bop - mop
32
Q

Treatment for respiratory weaknesses in FD

A
  • cueing for complete inhalation
  • speak immediately on exhalation
  • start with vowel in isolation
  • add final consonants or a word

Motor Speech Exam 2 (5 decks)

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