Flaccid Dysarthria Flashcards
What are speech characteristics of flaccid dysarthria?
monopitch; monoloudness; audible inspiration; nasal emission; imprecise consonant production; breathiness; hypernasality; harsh voice; short phrases
What causes flaccid dysarthriaS?
LMN damage
What are LMNs?
motor neurons that send information from the UMN to the muscles; they originate in the brain stem and spinal cord
What are the main clinical characteristics of LMN damage?
hypotonia; weakness of movements; diminished reflexes
What is the most common etiology of flaccid dysarthrias?
Degenerative diseases (e.g., ALS, MS)
What are causes of motor neuron disorders that affect the cell body?
stroke; tumor; degenerative disease; viral infection (poliomyelitis)
Which degenerative disease affects the spinal lower motor neurons?
progressive (spinal) muscular atrophy
Which degenerative disease affects the cranial lower motor neurons?
progressive bulbar palsy
Which degenerative disease affects both UMNs and LMNs?
ALS (Amylotropic Lateral Sclerosis)
What are the symptoms of a nerve cell body disorder?
fasciculations, atrophy, weakness, reduced or lost reflexes, reduced muscle tone
What is a peripheral nerve disorder?
disorder affecting the axons and myelin of the peripheral nerve
What are causes of a peripheral nerve disorder?
nutritional issues (e.g., alcoholism and vitamin deficiency); carcinomas; trauma; immunologic diseases (e.g., HIV, lyme, and leprosy); genetic disease; metabolic diseases (e.g., diabetes and hypothyroidism) ; toxins (e.g., lead and mercury) ; drugs (nitrous oxide)
What are clinical symptoms of a peripheral nerve disorder?
sensory loss and no fasciculations
What are clinical symptoms of a muscle disorder?
weakness, atrophy, and myotonia (cannot relax a muscle after contracting it)
What type of disorder is myasthenia gravis?
a neuromuscular junction disorder that affects postsynaptic processes
What is a neuromuscular junction disorder?
a disorder that affects pre or post-synaptic processes
What are causes of a neuromuscular junction disorder?
autoimmune disorders and toxins
An autoimmune disorder that disrupts presynaptic processes and causes NMJ disorder is
Eaton-Lambert disease
A toxin that affects presynaptic processes and causes NMJ disorder is
botulinum
A toxin that affects postsynaptic processes and causes NMJ disorder is
snake venom
What is myasthenia gravis?
an autoimmune disorder which destroys Ach receptors; thus muscles contract less because they do not have enough receptors for Ach to bind to
What are clinical symptoms of myastenia gravis?
No atrophy; no fasciculations; facial weakness; no loss of reflexes; droopy eyelid; more than one longitudinal fissure down the tongue
What are muscle disorders characterized as?
diseases of muscle tissue that are chronic and worsen over time
What can focal flaccid dysarthria result in?
facial palsy, masticator palsy, palatopharyngeal palsy, laryngeal palsy - flaccid dysphonia, Hypoglossal palsy; respiratory weakness
The temporal branch of the facial nerve innervates which muscles?
frontalis, orbicularis oculi, and corrugator supercili
The zygomatic branch of the facial nerve innervates which muscle?
orbicularis oris
The cervical branch of the facial nerve innervates which muscle?
platysma
The marginal mandibular branch of the facial nerve innervates which muscles?
mentalis, levator labii inferioris, depressor angular oris
The buccal branch of the facial nerve innervates which muscles?
levator labii superioris alaquae nasi; levator labii superioris; levator angular oris; zygomatic major and minor, risorius; depressor angular oris; depressor labii inferioris
What are the most distinctive speech features of flaccid dysarthria?
hypernasality, breathiness, nasal emission, audible inspiration
What are other speech features of flaccid dysarthria?
imprecise consonants, monopitch, monoloudness, harsh voice, and short phrases
What are symptoms of hypoglossal palsy?
tongue gets weaker and atrophy occurs; swallowing issues; imprecise consonants, particularly lingual-palatal sounds
What are symptoms of unilateral damage associated with hypoglossal palsy?
tongue deviates to the weak side when it protrudes
What are symptoms of bilateral damage associated with hypoglossal palsy?
tongue moves much less
What are speech symptoms of laryngeal palsy?
breathy phonation, shorter phrases, longer pauses, whispy tone of voice, slow rate of speech, reduced loudness, prosody issues
What are symptoms of unilateral damage associated with laryngeal palsy?
one VF does not move as much towards the midline or does not move at all; reduced coughing and aspiration issues
What are nonspeech symptoms of facial palsy?
eyebrows lower and fail to rise, drooling, less strength when closing lips, flat nasolabial fold, reduced forehead wrinkling; mouth droops and does not rise when smiling
What are nonspeech symptoms of unilateral masticator palsy?
may complain of issues chewing; may only see symptoms during jaw testing
What are nonspeech symptoms of bilateral masticator palsy?
jaw may sag open; drooling; chewing and swallowing issues
What are nonspeech features of unilateral palatopharyngeal palsy?
weak side of palate hangs lower at rest; moves to the stronger side when soft palate is raised
What are nonspeech features of bilateral palatopharyngeal palsy?
liquids come out the nose; palate is lower but symmetrical; absent or diminished gag reflex; less elevation or no elevation at all
What branch of the vagus nerve is damaged in laryngeal palsy?
recurrent laryngeal branch
What branch of the vagus nerve is damaged in palatopharyngeal palsy?
pharyngeal branch
What are symptoms of bilateral laryngeal palsy?
both vocal folds do not move or may weak contact; this restricts the airway and requires a tracheostomy
What four parts of the LMN could be effected and cause flaccid dysarthria or LMN damage?
nerve cell body, peripheral nerve, neuromuscular junction, and the muscle
What branches innervate orbicularis oculi?
temporal and zygomatic branches
What is the function of the orbicularis oculi?
closes your eyes when you blink or squink
What branches innervate the corrugator supercilli?
temporal branch
What is the function of the corrugator supercili?
draws eyebrows together
What is the function of the frontalis belly of the epicraneus?
muscle of the scalp that raises eyebrows and wrinkles forehead
What is the function of the occipitalis belly of the epicraneus?
fixes aponeurosis and pulls scalp posteriorly
What branch of the facial nerve innervates the frontalis belly?
temporal branch
What branch of the facial nerve innervates the occipitalis belly?
posterior auricular branch
The problem with flaccid dysarthria is ______
neuromuscular execution
