L16: Mixed Dysarthrias Flashcards
mixed dysarthrias are
disorder of multiple motor systems
a combo of 2 or more of the types of dysarthria
virtually any combo of 2 or more of the single D types possible
about ___% of motor speech disorders are mixed Ds
_____ dysarthria is the most common component of the mixed Ds (____ %)
25%
spastic dysarthria - 60-80%
ALS was the cause of mixed dysarthria is ____ % of mixed cases at the mayo clinic
64%
ALS is a
a rapidly progressing neurological disease effecting the upper and lower motor neurons
describe the stats surrounding ALS
affects about 5 per 100,000
average age of onset 56 years (80% between 40 and 70yrs)
male : female ratio is 2:1
median length of survival is 3 years after onset
70-80% die within 5 years, 10-20% may survive beyond 10 years
cause of death is ALS is
usually related to respiratory failure or infection (often linked to swallowing/aspiration problems)
ALS may affect ____ or ____ motor neurons initially, ____ in about 22% pts initially, poorer prognosis for ____ pts
spinal or bulbar
bulbar
bulbar pts
cause of ALS?
unknown cause, genetic predisposition, environmental agent, exposure to specific metal or minerals, slow virus, etc.
95% of patients have no family history of ALS
a rare hereditary form of ALS exists, linked to mutation of the SOD1 gene and can be treated with Qalsody (slows symptom progression)
major symp of ALS is
weakness
both upper and lower motor symptoms in ALS…
may be present and the relative prominence of flaccid or spastic symptoms may change over time
spastic symptoms may evolve to become mostly flaccid
flaccid symptoms may predominate in the latter stages because the spastic symptoms cannot be expressed through the LMNs
UMN ALS =
weakness, spasticity, slowness, hyperreflexia
LMN ALS =
weakness, muscle atrophy, fasciculations, reduced reflexes
how do they diagnose ALS?
MRI to rule out other spinal cord disorders
EMG fibrillations/fasciculations in 2 or more separate body parts
Presence of UMN and LMN symptoms
Progression of symptom severity and functional impairment
describe the speech characteristics of those with ALS
speech will be involved in most patients
one study of 100 ALS pts indicated that 75% of patients could not speak at the time of death
features of spastic and flaccid dysarthria present to varying degrees across patients
features may evolve quite dramatically over time
what did Kent et al find when examining the intelligibility of ALS speech?
these were the most common errors:
stop/nasal –> hypernasality (palatal)
glottal/null (hat/at) –> harsh/hoarse voice quality
voiced/voiceless –> harsh voice/laryngeal control
stop/affricate –> imprecise lingual consonants
s/s–> imprecise lingual consonants
what dimensions have the greatest impact on the intelligbility of ALS speech?
hyper nasality
imprecise consonants
harsh voice
what are the 6 + one extra most distinctive features of mixed D: ALS speech?
imprecise consonants
(very) slow rate
short phrases
distorted vowels
hoarse (wet) voice
bizarreness
+ vocal flutter?
