Flaccid Dysarthria Flashcards
1
Q
The __________ branch of the vagus nerve elevates levator palatini closing off VP port and palatoglossus muscle of tongue.
A
Pharyngeal
2
Q
Lesion in ________ cause flaccid dysarthria.
A
LMN system
3
Q
_______ involves all of pathway above the level of the synapse (above brainstem).
A
UMN
4
Q
LMN involves the pathway below the synapse to the _______.
A
muscle fiber.
5
Q
What does the LMN system involve?
A
The pathway below the synapse to the muscle fiber.
6
Q
In the UMN system, fibers never leave the brain stem except for _______ tract.
A
cortico-spinal
7
Q
In the UMN system, you need ___ ___ that take out both bilateral tracts to have severe damage. If just one lesion, something can get through to the LMN system.
A
2 lesions
8
Q
With the LMN system it only takes ___ ___ to wipe out the function because it all comes together in the LMN system.
A
1 lesion
9
Q
Lesions anywehre along the motor unit can result in ______.
A
flaccidity
10
Q
What is the primary unique deficit in flaccidity?
A
Weakness to muscles or flaccidity
11
Q
UMN system damage results in ______ dysarthria
A
spastic
12
Q
Flaccid dysarthria is only dysarthria with _____ involvement.
A
PNS
13
Q
What is the only dysarthria that involves the PNS?
A
flaccid dysarthria
14
Q
What happens when motor units are damaged?
A
Muscle looses its ability to contract. If all of the LMN input is lost to a muscle, paralysis occurs. If there is only partial loss, paresis occurs. WIth paresis, there’s still some input to muscle, but contractions is weakened, therefore weaker muscle movement.
15
Q
When ______ ________ are damaged Muscle looses its ability to contract. If all of the LMN input is lost to a muscle, paralysis occurs. If there is only partial loss, paresis occurs. WIth paresis, there’s still some input to muscle, but contractions is weakened, therefore weaker muscle movement.
A
motor units
16
Q
If all of the LMN input is lost to a muscle, ________ occurs.
A
paralysis
17
Q
If only part of the LMN (nerve impulse) input is lost to a muscle, then ______ occurs.
A
paresis
18
Q
With _______, there’s still some input to muscle, but ____ is weakened, therefore weaker _____ ______.
A
Paresis
muscle contraction
muscle movement
19
Q
What are the defining characteristics of flaccid dysarthria:
A
- Hypotonia & weak reflexes: weak muscles leads to hypotonia (reduced muscle tone). This affects speed, range,/accuracy of muscle movements. Reflexes may be diminished or completely gone. With flaccidity in muscles, muscles don’t contract so you get flabby muscles.
- Atrophy- muscle starts to waste away, loses mass/bulk when nerve fibers are damaged.
- Fasiculations & Fibrillations. Fasiculations don’t occur immediately after insult- (1-3 weeks after nerve supply is gone. They are quick jerky movements in resting muscles.
20
Q
What are fasciculations?
A
quick jerky movements of resting muscle. not visible immediately, usually 1-3 weeks after nerve loss
21
Q
Atrophy and fasiculations are primarily seen in _____ involvement.
A
LMN
22
Q
_______ _______ ___ in all flaccid dysarthria fatigue is a factor.
A
Progressive muscle weakness
23
Q
What are the etiologies of flaccid dysarthria?
A
Neuromuscular junction disease vascular disease infectious processes demyelination disease muscle diseases degenerative disease
24
Q
What is a neruomuscular junction diseas?
A
Myasthenia gravis
25
Chronic disease characterized by rapid weakness of voluntary movement of muscles & improvement with rest.
Myathenia gravis
26
What causes myasthenia gravis?
AcH receptors are destroyed in MG so receptors aren't receptive to Ach, which triggers muscle contraction.
27
What happens when a person with MG lets the muscles rest?
The muscles function more normally
28
Myasthenia gravis occurs in men above ____ and women between ___ and ____.
50
| 20-40
29
What are the characteristics of myasthenia gravis?
dropping eyelids, weak facial muscles, flaccid dysarthria
30
____ test given for myasthenia gravis, injections of ____ give after pt shows signs of fatigue when talking. Pt should show rapid movement. Have patient do stress test.
Tensilon
31
What involves the tensilon test?
give after pt shows signs of fatigue when talking. . Have patient do stress test.Pt should show rapid movement.
32
Vascular disorders:
brain stem stroke that affects cranial nerve nuclei can cause flaccid dysarthria.
33
What are other vascular disorders that may result in flaccid dysarthria besides brain stem stroke?
Wallenberg's lateral medullary syndrome
34
What is a demyelination disease?
Guillian barre
| multiple sclerosis
35
What is affected in demyelination disease?
facial and oropharyngeal muscles are affected first, results in flaccid dysarthria and dysphagia
36
Muscle diseases:
Such as muscular dystrophy, genetic, inherited, and degenerative.
37
What happens in muscle diseases?
muscle fibers degenerate
38
What happens in degenerative diseases?
motor neurons degenerate
39
What is a degenerative disease?
ALS
40
_____ most common motor neuron disease. affects both UMN and LMN system.
ALS
41
What is ALS
ALs is most common motor neuron disease. Affects both UMN and LMN system. results in mixed dysarthria with a flaccid component.
42
ALS results in _______ dysarthria with ________ component.
mixed
| flaccid
43
Antomic anomalities- Arnold Chiari malformation
Congenital, results in distortion of brain stem which may result in impairment of cranial nerves. Often don't see symptoms until adulthood, flaccid dysarthria is one symptom.
44
_____________ Congenital, results in distortion of brain stem which may result in impairment of cranial nerves. Often don't see symptoms until adulthood, flaccid dysarthria is one symptom.
Arnold Chiari malformation
45
ALl symptoms of damage in flaccid dysarthria are due to lesion in the ____ system.
LMN
46
Describe what happens with unilateral LMN lesion of trigeminal nerve?
Jaw deviates to side of weakness or may be easily pushed to one side. May not feel much muscle contraction of masseter when pt bites down.
47
What do patients complain about when they have damage to the trigeminal nerve?
Jaw weakness: drooling, and difficulty chewing
| sensory complaints: decreased sensation from face, cheek, tongue, teeth, palate
48
How do you assess the trigeminal nerve?
Have patient close eyes and touch face
49
How do you assess for effects on speech of trigeminal nerve damage?
- Have patient read or converse, listen to speech
| - DO AMRs-should have more imprecision/slowness for Puh. IF MG present, may be progressive weakness in jaw opening.
50
unilateral damage to the ______ nerve does not affect speech significantly.
trigeminal
51
Does unilateral damage to the Vth nerve have a significant affect in speech?
NO
52
_______ damage of the trigeminal nerve does affect speech.
Bilateral
53
What happens with sensory impairment of the trigeminal nerve?
It may affect articulation due to reduced sensory information regarding movements of articulators
54
Patient with senosry problem may exaggerate ______ _____ to compensate.
articulation movements
55
What nerve is only concerned with motor components for speech?
Facial nerve
56
Facial nerve is only concerned with _____ components of speech.
motor
57
Facial nerve innervates
lip muscles to aid in producing bilabials and labiodentals.
| orbicularis oris and risorious
58
Facial nerve helps to firm cheeck muscles to allow:
build up of intraoral air pressure
59
What does the sensory portion of the facial nerve do?
carries info for taste from anterior 2/3 of tongue
60
_______ is a common condition affecting VII nerve. Results from unilateral VIIth damage. affects upper and lower facial muscles - difficulty opening eyes. Most have full recovery due to viral infection.
Bell's palsy
61
Describe Bell's Palsy.
is a common condition affecting VII nerve. Results from unilateral VIIth damage. affects upper and lower facial muscles - difficulty opening eyes. Most have full recovery due to viral infection
62
What are the symptoms of a unilateral LMN lesion of facial nerve
At rest, affected side sags & is hypotonic
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.
If pt smiles, face will show more movement toward good side.
63
Where is the lesion for the following symptoms: At rest, affected side sags & is hypotonic
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.
If pt smiles, face will show more movement toward good side.
Unilateral LMN of facial nerve
64
Symptoms of bilateral lesions (LMN) of facial nerve include:
- damage isn't so striking because there is facial symmetry
- at rest mouth is lax space between lips more than normal
- pt may not be able to retract lips or puff cheeks
- drooling may occur
- pt may complain of not being able to move lips well in speech and that food spills out of mouth
65
Where is the lesion: -damage isn't so striking because there is facial symmetry
- at rest mouth is lax space between lips more than normal
- pt may not be able to retract lips or puff cheeks
- drooling may occur
- pt may complain of not being able to move lips well in speech and that food spills out of mouth
Bilateral lesion (LMN) of facial nerve
66
Facial nerve damage can result in abnormal movements of face, ________.
synkenesis
67
Synkenesis is:
an abnormal contraction of muscle next to the muscle that is normally moving.
68
To assess for VIIth nerve damage effects on speech:
-use conversation, reading, amrs
-may see flutter in cheek-due to less resistance to intraoral pressure
-may be poor bilabial closure with more imprecions on puh than tuh
may be some slowness, but precision more affected than speed
69
For unilateral damage of facial nerve may be mild distortion of some sound especially _____ and _____.
bilabials
| labiodentals
70
With bilateral damage of facial nerve patient may not be able to make _____ and ____ at all. _____ may also be distorted if pts can round or stretch lips.
bilabial
labiodentals
vowels
71
With _____ weakness, pt may prop up sagging side or assist in movement. May have exaggerated jaw closure to try to make bilabial sounds.
unilateral
72
With unilateral weakness due to damage of facial nerve patient:
may prop up sagging side or assist in movement. May have exaggerated jaw closure to try to make bilabial sounds.
73
With ______ lesions of facial nerve, may be substitution of lingual alveolar sounds for bilabials.
bilateral
74
With bilateral lesions, pt may use substitution of ______ sounds for _______.
lingual alveolar
| bilabials
75
Motor fibers of the glossopharyngeal nerve orginate in
the reticular formation of mesulla
76
Explain glossopharyngeal innervation
Motor fibers originate in the reticular formation of medulla and pass through posterior fossa and into phraynx to innervate the stylopharyngeus muscle (raises pharynx in speech and swallowing).
77
What do sensory fibers of glossophrayngeal nerve do?
Bring info from phraynx & posterior 1/3 of tongue. it is this component that makes us gag. damage here may result in decrease gag reflex.
78
How do you asses glossopharyngeal nerve?
Eliciting gag reflex
-check for symmetry of reflex
reduced gag may implicate either sensory or motor part of nerve
79
The sensory part of the glossophrayngeal nerve is affected if patient reports what?
decreased sensation in the area
80
IX rarely damaged alon, what other nerve is usually damaged?
Vagus (X)
81
Why is the gag reflex not a reliable test of the IXth function?
Some patients experience normal gag reflex after damage of IX.
82
Glossopharyngeal nerve damage may cause
reduced pharyngeal elevation during swallowing due to poor innervation for stylopharyngeus
83
Damage to glossopharyngeal nerve may cause pain patient's ______ going down to back of lower jaw.
throat
84
Damage to _____nerve may cause pain patient's throat going down to back of lower jaw.
glossopharyngeal
85
Can damage to the glossopharyngeal nerve be assessed directly through speech tasks?
No,
86
The vagus nerve exits at
lower level of medulla along with glossopharyngeal and accessory nerves
87
The pharyngeal branch goes to ______ and ______.
pharynx
| palate
88
The superior laryngeal branch goes to _____ and ______.
larynx
| pharynx
89
The recurrent laryngeal branch goes to
upper chest and left branch loops around blood vessels, then travels back up to larynx.
90
Pharyngeal branch innervates muscles of _____ and _____.
pharynx
| soft palate
91
Pharyngeal branch innervates muscles of pharynx except ______.
stylopharyngeus
92
Pharyngeal branch innervates soft palate muscles except _____.
tensor veli palatini
93
Pharyngeal branch results in:
palatal constriction and elevation in speech and swallowing
94
Hypernasality may result if damage occurs in ______
levator palatining which is innervated by the pharyngeal nerve
95
What does the internal part of the superior laryngeal branch do?
brings sensation from larynx and base of tongue
96
What does the external part of the superior laryngeal branch do?
It innervated inferior pharyngeal constrictor nusces & cricothyroid muscle
97
Recurrent laryngeal branch innervates
all intrinsic laryngeal muscles except cricothyroid muscle
98
Sensory fibers from the recurrent laryngeal nerve branch brings
sensory information from vocal fold and larynx
99
Lesions above separation of the 3 branches will affect
all muscles supplied by the specific nerve below the level of lesion.
100
Lesions below pharyngeal branch but still high enough to affect other 2 branches will not affect _____ & _____ muscles, but will cause paralysis or weakness to _____ & other _________.
pharyngeal & palatal
cricothyroid muscle
intrinsic laryngeal muscle
101
Lesions of ____________ but not _________ will affect cricothyroid muscles but not other intrinsic laryngeal muscles.
superior laryngeal branch
| recurrent laryngeal branch
102
What lesions will affect cicothyroid muscles but not other intrinsic laryngeal muscles?
superior laryngeal branch but not reccurent laryngeal branch
103
Lesions affecting only ______ nerve will cause weakness or paralysis of the other intrinsic laryngeal muscles (except cricothyroid ) on the side of lesion.
recurrent laryngeal
104
Lesions affecting only recurrent laryngeal nerve will cause weakness or paralysis of the
other intrinsic laryngeal muscles (except cricothyroid)
105
Unilateral pharyngeal lesions above the origin of the 3 branches of the Xth nerve.
- soft palate hangs lower on side of lesion
- soft palate pulls toward nonparalyzed side in phonation
- gag reflex may be diminished
106
Bilateral pharyngeal lesions above the origin of the 3 branches of the Xth nerve
- soft palate hangs low in pharynx at rest & moves little during phonation
- gag reflex may be diminished or absent
- may be nasal regurgitation in swallowing
107
When pharyngeal branch is affected ______, can be severe hypernasality & marked nasal emission, imprecise pressure consonants due to inability to build up intraoral pressure. may be reduced intensity. May be facial grimacing as they try to hold back air from nares.
bilaterally
108
What happens when pharyngeal branch is affected bilaterally?
severe hypernasality & marked nasal emission, imprecise pressure consonants due to inability to build up intraoral pressure. may be reduced intensity. May be facial grimacing as they try to hold back air from nares.
109
How can you tell if articulation problem is due to general weakness or inability to impound oral pressure
Pinch off nostrils and have patient speak. This allows the pressure tp be maintained & clean listen for weakness in articulators. If it gets better VP port, if it stays the same articulators.
110
Unilateral lesions below ____ branch but above ______ and ______ nerve can produce breathiness, aphonia, reduced loudness, diplophonia, reduced pitch, & pitch break.
pharyngeal
superior laryngeal branch
recurrent laryngeal branch
111
Unilateral lesions below pharyngeal branch but above the superior laryngeal branch and recurrent laryngeal branch can produce
```
breathiness
aphonia
reduced loudness
diplophonia
reduced pitch
pitch break
```
112
Unilateral lesion of superior laryngeal nerve may cause:
mild breathiness or hoarsenes & some problems with pitch changing
113
What causes mild breathiness or hoarseness & some problems with pitch changing?
Unilateral lesion of superior laryngeal nerve
114
Bilateral lesion of superior laryngeal nerve can cause
marked ability to change pitch
115
What can cause marked ability to change pitch?
Bilateral lesion of superior laryngeal nerve
116
Unilateral recurrent laryngeal nerve lesions only causes:
breathy-hoarse voice & decreased loudness
117
What causes breathy-hoarse voice and decreased loudness?
unilateral recurrent laryngeal nerve lesion
118
Bilateral recurrent laryngeal nerve lesions cause
inhalatory stridor but voice may be ok because folds are adducted closed enough to midline. However airway may be compromised.
119
inhalatory stridor but voice may be ok because folds are adducted closed enough to midline. However airway may be compromised.
Bilateral current laryngeal nerve lesions
120
The _____ nerve aids in innervation to uvula, levator palatini (elevates soft palate) and intrinsic laryngeal muscles.
Accessory
121
What does the accessory muscle innervate?
uvula, levator palatini and intrinsic laryngeal muscles
122
What are some non-speech signs of accessory nerve damage?
reduced shoulder elevation on side of lesion, weakened head turn on side opposite of lesion.
123
Bilateral lesion of _____ nerve can cause head drooping with some mild effects on phonation & respiration.
Accessory
124
Where does the hypoglossal originate?
medulla
125
What does the hypoglossal innervate?
intrinsic and extrinsic tongue muscles except for palatoglossus
126
The hypoglossal nerve is essential for what?
tongue movement, chewing & swallowing
127
Damage to hypoglossal often means damage to what other nerves?
glossopharyngeal
| vagus and accessory
128
The hypoglossal can be damaged by
neck surgery or trauma
129
Non-speech signs of unilateral lesions to hypoglossal nerve
- tongue may deviate to weak side & to side of lesion upon tongue protrusion
- will have problems curling tip of tongue on weak side and with pushing tongue to cheek with resistance (on weak side)
130
Tongue may atrophy and have bilateral fasiculations with what type of lesion?
Bilateral LMN of Hypoglossal
131
Tongue may not be able to protrude at all or with limited ROM but will be symmetrical in its excursion
BIlateral LMN of hypoglossal
132
Food may be pocketed in cheek patient may not be able to move food around mouth
bilateral lesion to LMN of hypoglossal
133
Bilateral lesion of hypoglossal pt may complain that
tongue feels heavy and weak and will drool
134
Hypoglossal lesion may lead to following speech signs:
- imprecise articulation with lingual phonemes t, d, l, r, s, s,h,ch
- may have resonance problems due to tongue falling back into pharynx. may sound like hypo or hypernasality but it isn't. it is due to tongue position.
135
HOw do you asses hypoglossal nerve?
look at lingual consonants in connected speech and amrs
| in amrs puh should be okay but kuh will be more affected than tuh, its harder to get the back of the tongue up
136
what is bulbar palsy
it occurs when there are several cranial nerves damaged
137
What are the best distinguising features of flaccid dysarthria?
```
hypernasality
nasal emission
diplophonia
isolated articulatory imprecision
fasiculations
atrophy
audible inspiration (stridor)
```
