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motor speech exam 1 > Flaccid dysarthria > Flashcards

Flaccid dysarthria Flashcards

0
Q

Which upper motor neurons leave the brain stem?

A

The ones for the cortico-spinal tract.

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1
Q

Where do lesions resulting in flaccid dysarthria occur?

A

Lesions in the lower motor neuron system.

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2
Q

What is the primary deficit in flaccid dysarthria?

A

Weakness and flaccidity (which can happen in any muscle)

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3
Q

What kind of dysarthria results from upper motor neuron damage?

A

Spastic dysarthria, for which weakness isn’t the defining character. Although some weakness may occur.

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4
Q

Which is the only dysarthria resulting from LMN damage?

Describe the damage that could occur with LMN damage.

A

Flaccid dysarthria.

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5
Q

State difference between paralysis and paresis.

A

Paralysis: all innervation is lost
Paresis: only partial loss of innervation

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6
Q

List the defining characteristics of flaccid dysarthria. And what do those characteristics affect?

A

Hypotonia, weak reflexes. These affect speed, range/accuracy of movement. Reflexes may be diminished or gone. Flabby muscles due to lack of contraction.
Atrophy: nerve is dying basically, so loss of muscles
Fasciculation & fibrillation: fasciculations take a while to form after the nerve is gone. Quick jerky movements in resting muscles. Fasciculations are visible while fibrillations need to be counted using EMG

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7
Q

What determines the characteristics of damage in flaccid dysarthria?

A

Where the damage occurs on the motor unit.

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8
Q

Progressive recovery only occurs with which type of damage?

A

Neuromuscular junction disease. Most common is myasthenia gravis.

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9
Q

What are the different etiologies for flaccid dysarthria?

A

Neuromuscular junction disease, vascular disorders, infectious processes, demyelinating diseases, muscle disease, degenerative, anatomic anomalies, radiation, traumatic (surgical & nonsurgical)

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10
Q

What are three branches of the Trigeminal nerve? What do they innervate?

A

Sensory ophthalmic (upper face) sensory maxillary (midface) and sensorimotor mandibular branch (jaw, tensor tympani, tensor veli palatini)

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11
Q

Where does the trigeminal originate?

A

At the level of the pons.

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12
Q

Describe the functions of the 5th nerve.

A

Provides sensory information from the jaw, mouth, face and tongue. Provides motor input to the muscles of mastication/jaw, tensor tympani, tensor veli palatini.

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13
Q

True or false: the trigeminal nerve is usually damaged on its own without other cranial nerve damage co-occurring.

A

False: damage to the trigeminal indicates other cranial nerves are damaged too.

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14
Q

Describe signs of damage to trigeminal nerve, in LMN lesions depending on which type of lesion.

A

Unilateral LMN lesions result in jaw deviation to one side, the weaker side. Patient may not feel much masseter contraction when biting down.
Bilateral: jaw drops. Patient may not be able to open/close; there will be limited ROM. Patient may not be able to resist the movement if examiner pushes the jaw up for closure.

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15
Q

What are some patient complaints related to Vth nerve damage?

A

Jaw weakness, chewing, drooling.

Decreased sensation in jaw, lips, mouth, tongue, teeth, cheek, palate.

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16
Q

How can one assess for effects on speech with trigeminal nerve damage?

A

Have them close eyes & touch face (assessing sensory input).
Have them read or converse; listen to their speech.
Do AMR’s.

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17
Q

What does AMR stand for and what are some things you would expect to see?

A

AMR-alternate motion rates.

Expect to see imprecision in bilabials. If MG is present, may be progressive weakness in jaw opening.

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18
Q

Which damage affects speech more significantly in fifth nerve damage?

A

Bilateral damage, may result in slower speech rate, artic problems. Unilateral does not have a significant impact.

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19
Q

What are some compensatory mechanisms the patient might use in the case of 5th nerve damage?

A

They might hold their jaw closed to compensate. They may exaggerate artic movements.

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20
Q

What does the facial nerve innervate that is significant for speech?

A

The lips muscles (in production of bilabials & labiodentals). Also helps firm the cheek muscles to allow intraoral air pressure to buildup.

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21
Q

What sensory info does the facial nerve carry?

A

Anterior 2/3 of the tongue (for taste)

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22
Q

What is Bell’s Palsy?

A

Results from unilateral 7th nerve damage. Affects upper and lower facial muscles. Most people recover fully as it is often caused by a viral infection.

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23
Q

Name diagnostic indicators of Bell’s Palsy.

A

The patient may have difficulty opening their eyes. Eyes might be hypotonic and have side sags. Forehead may be unwrinkled, eyebrow drooped, unblinking eyes, tip of nose and corner of mouth may be tip toward affected side. Patient will show more movement toward the good side, if they smile.

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24
Q

Describe bilateral damage to the facial nerve.

A

Due to symmetry, damage isn’t as striking. There may be more space between the lips than usual. Patient may not be able to retract their lips, puff out their cheeks, and may drool. May complain that they can’t move their lips during speech and food might spill out of the mouth.

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25
Q

What is synkinesis?

A

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

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26
Q

How would you assess for 7th nerve damage?

A

Use conversation, AMR’s, stress testing and reading.
You may see flutter in cheek due to less resistance to intraoral pressure.
Poor bilabial closure with imprecision on “puh”
Stress testing for Myasthenia Gravis
.

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27
Q

What could unilateral damage to facial nerve cause?

A

Mild distortion of some bilabial & labiodental sounds. Visible symptoms may be more apparent than speech symptoms. Vowels aren’t usually affected.

28
Q

What do the obicularis oris and risorious muscles do?

A

Innervated by the 7th nerve, OO moves lips. Risorious spreads lips.

29
Q

Bilateral damage to the facial nerve would result in what characteristics?

A

Patient may not be able to produce bilabial and labiodentals at all. Vowels may be distorted if patient can’t round or spread lips.

30
Q

What is patient compensation for unilateral damage to the facial nerve?

A

Patient may prop up sagging side or assist in movement. May have exaggerated jaw closure to try to make bilabial sounds.

31
Q

Describe patient compensation for bilateral damage to facial nerve.

A

May use substitution of lingual alveolar sounds for bilabials. t for p.

32
Q

Where do the motor fibers for the glossopharyngeal originate?

A

They originate in the reticular formation of the medulla, passing through the posterior fossa, into the pharynx.

33
Q

What does the tenth nerve innervate?

A

Stylopharyngeus, which elevates the pharynx in speech & swallowing.

34
Q

What do sensory fibers of the glossopharyngeal nerve receive?

A

Information from the pharynx and tongue. Damage may lead to decrease gag reflex due to lower sensation. If 9th nerve is damaged, the vagus is probably damaged as well.

35
Q

How would you assess glossopharyngeal damage?

A

Elicit a gag reflex. Check for symmetry. A reduced gag reflex may imply damage to sensory or motor part of the nerve. If the patient reports decreased sensation, then the sensory part is affected.

36
Q

True or false: the gag reflex is an excellent test for assessing damage to the glossopharyngeal nerve.

A

False: patient may have normal or increases gag reflex as well. Some people don’t have a gag reflex to begin with. In this case, it’s important to ask the patient their premorbid gagging history.

37
Q

How would damage to the glossopharyngeal nerve affect swallowing?

A

Due to poor innervation to the stylopharyngeus, elevation of the pharynx during swallowing may decrease. Patient may also experience pain, going down to back of lower jaw. Can be assessed by swallowing or sticking the tongue out.

38
Q

What are some speech tasks used to assess glossopharyngeal damage?

A

There are none.

39
Q

Where does the vagus nerve exit the skull?

A

At the lower level of the medulla.

40
Q

What are the three branches of the vagus nerve?

A

Pharyngeal (pharynx & palate)
Superior laryngeal branch (intrinsic laryngeal muscles)
Recurrent laryngeal branch (more larynx muscles. Goes through upper chest and loops around blood vessels, before coming back to the larynx)

41
Q

Damage to the pharyngeal branch can result in?

A

Palatal construction, hypernasality due to poor VP closure.

42
Q

What does the internal superior laryngeal branch do?

A

Brings in sensation from larynx and base of tongue.

43
Q

What does the external superior laryngeal branch do?

A

The external part innervates inferior pharyngeal constrictor muscles & cricothyroid.

44
Q

What does the recurrent laryngeal nerve innervate?

A

Intrinsic laryngeal muscles. Sensory fibers being in info from vocal folds and larynx.

45
Q

Describe the relationship between place of lesion and muscle impairments.

A

Lesions above separation of the 3 branches will affect all speech muscles supplied by the specific nerve below it.

46
Q

True or False: Lesions below the pharyngeal branch always affect the other two branches.

A

False: lesions below the pharyngeal branch but high enough above the other two branches, will not affect the palatal & pharyngeal muscles, but will cause paralysis or weakness to cricothyroid and other intrinsic laryngeal muscles.

47
Q

What do lesions of the superior branch but not recurrent branch affect?

A

Affect cricothyroid but not other intrinsic laryngeal muscles.

48
Q

What do lesions affect only the recurrent laryngeal branch do?

A

They affect the intrinsic laryngeal muscles on the inside of the lesion with the exception of the cricothyroid. There will be weakness or paralysis.

49
Q

Describe unilateral pharyngeal lesions above the origin of the 3 branches of the vagus nerve.

A

Soft palate hangs lower on side of lesion; soft palate pulls towards non paralyzed side during phonation; gag reflex may be diminished.

50
Q

Describe bilateral pharyngeal lesions above the origin of the 3 branches.

A

Soft palate hangs low in pharynx at rest and moves a little during phonation; gag reflex may be diminished or absent; may be nasal regurgitation in swallowing.

51
Q

What speech characteristics does damage to the vagus nerve affect?

A

Phonation, resonance, articulation and prosody. But most affected are phonation and resonance.

52
Q

What happens when there is a unilateral lesion to the pharyngeal branch of the vagus nerve?

A

Little or no hypernasality but there may be nasal emission during pressure consonants.

53
Q

What happens when the pharyngeal branch is affected bilaterally?

A

There can be severe hypernasality and marked nasal emissions. Imprecise pressure consonants due to inability to build up intraoral pressure. Intensity may be reduced.
May have facial grimacing due to holding air back.

54
Q

Articulation can be a problem due to general weakness or inability to build enough intraoral air pressure. Explain how to find out.

A

Pinch off the nostrils and ask patient to speak. This allows pressure to be maintained and SLP can listen for weakness in articulators.

55
Q

Unilateral lesions below pharyngeal branch but above superior and recurrent laryngeal branch can cause what?

A

Breathiness, aphonia, reduced pitch, Diplophonia, and pitch breaks.

56
Q

Unilateral lesions in superior laryngeal nerve can cause _______

A

Mild breathiness or hoarseness and problems in pitch.

57
Q

Bilateral lesions in superior laryngeal nerve can cause_____?

A

Marked ability to change pitch.

58
Q

What is Diplophonia

A

Each vocal food vibrates at a different frequency, causing the person to have two pitches when phonating

59
Q

Difference in unilateral and bilateral recurrent laryngeal nerve?

A

Unilateral: may only cause breathy-hoarse voice and decreased loudness.
Bilateral: may cause inhaltory strider but voice may be okay because VF are closed enough to midline. However, airway may be compromised.

60
Q

What does the accessory nerve aid in innervating?

A

Levator veli palatini; uvula; intrinsic laryngeal muscles.

61
Q

What can happen from damage to the accessory nerve?

A

Effect on speech is negligible.

62
Q

What can cause damage to Accessory Nerve?

A

Neck surgery and things affecting the vagus nerve

63
Q

What are some nonspeech signs of damage to Accesory nerve?

A

Reduced shoulder elevation, weakened head turning. Bilateral lesions can cause eye drooping with effects on phonation and respiration

64
Q

Where does the hypoglossal originate,

A

Medulla

65
Q

Which muscle does the hypoglossal not innervate?

A

Palatoglossus

66
Q

What are speech signs of damage to the hypoglossal nerve?

A

Imprecise articulation, problems with lingual phonemes; maybe some resonance problems.
May sound like hypo/hyper nasality but it’s a tongue problem.

67
Q

How would you assess damage to the hypoglossal?

A

You could ask the patient to produce lingual consonants in AMR and connected speech. “Kuh” may be affected because its harder to get tongue up. May have exaggerated jaw movement

68
Q

What is a condition where multiple cranial nerves are damaged?

A

Bulbar’s Palsy. This can occurs from everyyy thing we just talked about

motor speech exam 1 (2 decks)

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