Flaccid Dysarthria Flashcards

Question

What is the CN X- Speech changes in the Recurrent Laryngeal Branch?

Answer 1

Dysphonia (Hoarseness, Breathiness, Diplophonia Stridor, Aphonia)

Answer 2

Reduced pitch range

Answer 3

Begins in medulla from a number of roots that combine after exiting the brainstem **Controls all the muscles of the tongue except palatoglossus (CN X)** Often damaged along with CN IX- Glossopharyngeal, CN X- Vagus, and/or CN XI- Spinal Accessory.

Answer 4

**Unilateral** - Atrophy and fasciculations on the side of damage - Tongue deviates to the weak side on protrusion **Bilateral** - Atrophy and fasciculation on both sides of the tongue - Limited movement of tongue laterally and on protrusion - Saliva accumulation and decreased bolus control during eating

Answer 5

Decreased speed and articulatory precision of lingual consonants and vowels Can be compensated for by excessive jaw movement Cul-de-sac resonance effects ** Cul-de-sac resonance—occurs when sound resonates in a cavity (oral, nasal, or pharyngeal) but is “trapped” and cannot exit because of an obstruction.

Answer 6

Phrenic Nerve (C3-5) innervates the diaphragm Other cervical and thoracic nerves for accessory muscles Damage can result in rapid, shallow breathing Respiratory weakness alone leading to flaccid dysarthria is rare, but it happens - Decreased loudness - Short phrase length

Answer 7

Hypernasality Nasal emission Imprecise consonants Breathiness Dysphonia (hoarsness) Decreased pitch range Decreased loudness ** Nasal air emission (air that escapes out of nose) can be heard during production of certain consonants (such as /p/, /t/, /k/, /s/, /sh/, and /ch/). When there is nasal emission, the consonants become weak or omitted. ** When there is nasal emission, the consonants become weak or omitted. In addition, the child may use abnormal speech sounds (such as a hard "uh" instead of the consonant sound /g/) because of the lack of air pressure in the mouth. Hypernasality is due to an abnormal opening between the nose and the mouth during speech.

Answer 8

Degenerative Disease Physical Trauma - Surgery - Head/neck injury Brainstem stroke Head and Neck Cancer Guillian-Barre Syndrome Myasthenia Gravis Multiple Sclerosis Amyotrophic Lateral Sclerosis Tramatic Injury

Answer 9

Autoimmune disease of the peripheral nervous system Onset often follows viral infection Progressive, but quick (2-3 weeks to reach significant weakness) Recovery period is long (30% have residual weakness after 3 years) **A condition in which the immune system attacks the Peripheral nerves causing weakness and numbness in the limbs.

Answer 10

Autoimmune disease of the neuromuscular junction **Rapidly increasing weakness with use, recovery with rest** May sound normal at first, but after counting to 100, significant dysarthria

Answer 11

Progressive, autoimmune demyelinating disease of the brain and spinal cord Can affect any and all sensory and motor functions May show mixed dysarthria symptoms (flaccid, spastic, and/or ataxic) - Flaccid first, or alone, is incredibly rare (~1.5% of cases)

Answer 12

Progressive disorder of voluntary muscles Depending on course of progression, may show flaccid and/or spastic dysarthria symptoms

Answer 13

Damage primarily to brainstem and cranial nerves Additional damage to other areas of cerebrum and control circuits present differently

Answer 14

Is the cause progressive? Work on maintenance and compensation **Respiratory system treatments** - Postural adjustment and monitoring - Working on maximum loudness and/or vowel duration - Working on monitoring inhalation/exhalation rates and phrase lengths and adjusting them **Articulation treatments** - Strength training (e.g., oral-motor exercises) are frequently used, but their efficacy when used alone is limited at best - Using a bite-block during therapy to force tongue movement and limit jaw compensation - Make them talk, focusing on the appropriate voice/place/manner, overarticulation, rate modification **Voice treatments** - Adjust voice onset via effortful closure, easy onset, etc. as necessary

Answer 15

Goal is counteracting weakness and strengthening muscles again - BUT if the nerves aren’t firing, treatments will do nothing! Prosthetics (e.g., palatal lift for hypernasality) Amplifiers to compensate for reduced loudness Surgical intervention - Thyroplasty or injection for vocal fold paralysis