Flaccid Dysarthria

Question 1

Lesions in the LMN system causes which type of dysarthria?

Answer 1

Flaccid Dysarthria.

Question 2

Lesions in the UMN system causes which type of dysarthria?

Answer 2

Spastic Dysarthria.

Question 3

The primary unique deficit in Flaccid Dysarthria is _________.

Answer 3

Weakness to the muscles.

Question 4

What can be a result of the palate being flaccid aka too weak to close?

Answer 4

Hypernasality can occur.

Question 5

What is the difference b/w paralysis and paresis?

Answer 5

Paralysis= all the LMN input to muscle is gone.
Paresis= partial loss of nerve impulse. Very little input aka weaker muscle mvmt.

Question 6

T/F Weakness is only seen in Flaccid Dysarthria.

Answer 6

False; atrophy & fasiculations are only seen in Flaccid dysarthria.

Question 7

What is hypotonia?

Answer 7

Reduced muscle tone.

Question 8

What happens when a muscle atrophies?

Answer 8

The muscle starts to waste away, thus it loses its bulk/mass.

Question 9

What happens to reflexes in Flaccid Dysarthria?

Answer 9

They are weakened/ slowed down. They are not as accurate or they can be completely gone.

Question 10

What are fasiculations and what is the difference b/w fasiculations and fibrillations?

Answer 10

Fasiculations are quick jerky mvmts of the resting muscle. Fasiculations are visible and fibrillations are not.

Question 11

What is Myasthenia Gravis (MG)?

Answer 11

A neuromuscular junction dz where the muscles fatigue quickly with use. Gets better when the muscles rest.

Question 12

Explain what is happening neurologically in MG?

Answer 12

Ach RECEPTORS are affected, not the actual Ach. They do not respond to Ach, thus weakness occurs.

Question 13

What are some characteristics of MG?

Answer 13

Drooping eyelids, weak facial muscles, flaccid dysarthria.

Question 14

How do you test for MG?

Answer 14

Count to 100. Give Tensilon. Pt should show rapid improvement after this injection.

Question 15

What are the common age groups for MG?

Answer 15

Men= after 50; Women=20-40

Question 16

Which kind of stroke can result in Flaccid Dysarthria?

Answer 16

Brainstem stroke that affects CN nuclei.

Question 17

What kind of d/o Wallenberg’s Lateral Medullary Syndrome? Which type of dysarthria can result from it?

Answer 17

Vascular; Flaccid.

Question 18

What is an example of an infectious/ viral dz which can affect LMN cell bodies?

Answer 18

Polio.

Question 19

What are the 8 etiologies of Flaccid dysarthria? Give an example of each.

Answer 19

1) Neuromuscular Junction dz - Myasthenia Gravis (MG)
2) Demylenating dz- Guillian Barre
3) Degenerative dz- aka motor neuron dz =ALS
4) Muscle dz- muscular dystrophy
5) Infectious Processes- Polio
6) Vascular d/o= Wallenberg or brainstem stroke.
7) Radiation treatment
8) Anatomic Anomalies

Question 20

Which is the most common motor neuron dz that affects both UMN and LMN? Which dysarthria does this d/o typically result in?

Answer 20

ALS. It results in mixed dysarthria with flaccid component.

Question 21

T/F All symptoms of damage in Flaccid dysarthria are due to lesions in the UMN system.

Answer 21

False. Lesions are in the LMN system.

Question 22

What are the three branches of the Trigeminal Nerve (V)?

Answer 22

1) Sensory ophthalmic branch
2) Sensory maxillary branch
3) M&S mandibular branch

Question 23

T/F The Trigeminal Nerve (V) is rarely damaged on it’s own.

Answer 23

True.

Question 24

Unilateral LMN damage to the Trigeminal nerve (V) will cause the jaw to_____________.

Answer 24

Deviate to the side of weakness, can be easily pushed.

Question 25

Bilateral LMN damage to the Trigeminal nerve (V) will cause the jaw to _______________.

Answer 25

Hang open at rest.

Question 26

T/F Unilateral damage to the Trigeminal nerve (V) will significantly impact speech.

Answer 26

False.

Question 27

How do you assess a pt that may have a LMN lesion in CN V?

Answer 27

Have pt read or converse, do AMRs, will be slow/imprecise for "puh"

Question 28

T/F The facial nerve (VII) is only concerned with motor components for speech.

Answer 28

True.

Question 29

Which sounds are produced with the lip muscles innervated by the facial nerve (VII)?

Answer 29

bilabials & labiodentals.

Question 30

Bell's Palsy is the result of damage to which nerve? What kind of lesion (uni or bi)?

Answer 30

Facial Nerve (VII); unilateral.

Question 31

T/F Bell's Palsy only affects the upper facial muscles.

Answer 31

False; Both upper and lower facial muscles.

Question 32

Which nerve is important and aids the muscles that are responsible for building intraoral pressure (cheeks)?

Answer 32

Facial Nerve (VII).

Question 33

What is the sensory portion of the Facial Nerve (VII) responsible for?

Answer 33

Taste in the anterior 2/3 of the tongue.

Question 34

What are the symptoms of Bell's Palsy?

Answer 34

Forehead may be unwrinkled , eyebrow drooped, eye open and unblinking, tip of nose & corner of mouth may be drawn toward affected side. Drooling may occur. Pt smile may be crooked.

Question 35

What is synkinesis?

Answer 35

Abnormal contraction of a muscle next to the muscle that is normally moving.

Question 36

How do you assess for the Facial Nerve (VII)?

Answer 36

Stress testing, convo reading, AMRs. | Look for bilabial closure, precision more affected that speed. Vowels are not usually affected.

Question 37

What does LMN bilateral lesion in the Facial Nerve (VII) cause?

Answer 37

Facial symmetry, not as striking. Pt may not be able to retract lips or puff up cheeks (bilabials and labiodentals may not be produced). Drooling may occur. Pt complains of not being able to move lips well for speech and for eating. Synkinesis may appear.

Question 38

Why would you see a flutter in cheeks for pts with damage to the Facial Nerve (VII)?

Answer 38

Because they have less resistance to intraoral pressure.

Question 39

With unilateral lesions to the LMN of the Facial Nerve (VII), what will the pt exhibit?

Answer 39

Weakness on one side and to compensate they will exaggerate their mvmt of the lips. They may have poor production of the /p/.

Question 40

With bilateral lesions to the LMN of the Facial Nerve (VII), what will the pt exhibit?

Answer 40

The pt may substitute linguadentals for bilabials. ex: /t/ for /p/

Question 41

T/F The Glossopharyngeal Nerve (IX) is rarely damaged on it's own.

Answer 41

True.

Question 42

How would you assess CN IX (Glossopharyngeal)?

Answer 42

Check for gag reflex (not always reliable), check for symmetry of the reflex, check for reduced reflex, decreased sensation in the area.

Question 43

If hypernasality is occurring, what CN is likely damaged?

Answer 43

Pharyngeal Branch of the Vagus Nerve.

Question 44

What is the function of the palatoglossus muscle? Which CN innervates it?

Answer 44

Contraction can either depress soft palate or pull sides of tongue up and back. The Pharyngeal Branch of the Vagus Nerve (X) innervates it.

Question 45

If there are pitch problems occurring in a pt, which CN is likely damaged? Be specific.

Answer 45

Vagus nerve (X)- superior laryngeal branch- external branch.