L3 Dysarthria Flashcards
dysarthria
A group of neurological speech disorders that reflects abnormalities in the strength, speed, range, steadiness, tone or accuracy of movements required for breathing, phonatory, resonatory, articulatory or prosodic aspects of speech production” (Duffy, 2013, p.4)
what is dysarthria due to
Due to one or more sensorimotor problem - weakness or paralysis, incoordination, involuntary movements, or excessive, reduced, or variable muscle tone (Duffy, 2013).
prevalence of dysarthria
Considered to be the most commonly acquired primary communication disorder, representing 53% of diagnosed acquired neurogenic communication disorders in clinical practice (Duffy, 2013)
subsytems of speech affected by dysathria
- Prosody -
- Resonance
- Articulation
- Phonation
- Respiration
causes of dyarthria
- congenital
- degenerative diseases
- demyelinating and inflammatory diseases
- infectious diseases
- neoplastic dieases
- other neurological conditions
- toxic/metabolic diseases
types of dysarthria
- flaccid
- spastic
- ataxic
- hypokinetic
- hyperkinetic
- unilateral upper motor neuron
- undetermined
what pathology is flaccid dysarthria associated with
disorders of lower motor neuron system and/or muscle
flaccid dysarthria
- Flaccid means low muscle tone
- Flaccidity and weakness are not the same thing
- LMNs are nerve cells that move from brainstem/spinal cord to the skeletal muscle.
- They are responsible for voluntary movement
- Damage to lower motor neurons (LMNs) leads to flaccidity
location of breakdown in flaccid dysarthria
- Lower motor neurons
- Neuromuscular junction in peripheral nervous system
perceptual speech characteristics in flaccid dysarthria
- Continuous breathiness
- Diplophonia
- Audible inspiration or stridor
- Nasal emission
- Short phrases
- Hypernasality
- Rapid deterioration and recovery with rest
- Imprecise alternating motion rates (AMRs)
distinguishing physical characteristics in flaccid dysarthria
- Weakness
- Flaccidity
- Atrophy
- Fasciculations
- Hypoactive gag reflex
- Facial myokymia
- Synkinesis
- Nasal backflow while swallowing
common causes of flaccid dysathria
- Stroke (brainstem)
- Motor neuron disease
- Myasthenia gravis
- Tumours (brainstem)
- Surgery
- TBI
what pathology is spastic dysarthria associated with
he bilateral disorders of the upper motor neuron system
spastic dysarthria
- Spastic means high tone
- Upper motor neurons are found in the cerebral cortex (CNS) and brainstem.
- They carry information down to activate interneurons and the lower motor neurons
- Damage to the upper motor neurons leads to spasticity
perceptual speech characteristics of spastic dysarthria
- Slow rate
- Strained or harsh voice quality
- Pitch breaks
- Monopitch/monoloudness
- Imprecise articulation
- Slow and irregular Alternating motion rates (AMRs)
distinguishing physical characteristics of spastic dysarthria
- Pathologic oral reflexes (sucking reflex; snout reflex; jaw jerk reflex)
- Lability of affect/emotional lability (pseudobulbar affect)
- Hypertonia
- Hyperactive gag reflex
- Sialorrhea
- Positive Babinski sign (bilateral)
babinski’s sign
a neuropathological cue embedded within the Plantar Reflex of the foot. Elicited by a blunt stimulus to the sole of the foot, the normal adult Plantar Reflex presents as a downward flexion of the toes toward the source of the stimulus
typical causes of spastic dysarthria
- Stroke
- TBI
- Tumour
- Cerebral anoxia
- Viral/bacterial infection
- Motor neuron disease
what pathology is ataxic dysathria associated with
disorders of the cerebellar control circuitdisorders of the cerebellar control circuit
ataxic dysathria
- Ataxic means damage to cerebellar damage
- The cerebellum controls co-ordination
- Damage to the cerebellum leads to incoordination or ataxia
perceptual speech characteristics of ataxic dysarhtria
- Irregular articulatory breakdowns
- Excess and equal stress distorted vowels
- Excessive loudness variation
- Irregular AMRs
- “scanning speech”
distinguishing physical characteristics of ataxic dysathria
- Dysymetric jaw, face, and tongue AMRs
- Head tremor
typical causes of ataxic dysathria
- Cerebellar stroke
- MS
- Friedrichs ataxia
- Toxicity
- TBI
- Tumour
what pathology is associated with hypokinetic dysarthria
disorders of basal ganglia control circuit (eg. parkinsons)
hypokinetic dysarthria
- Damage to basal ganglia
- Reduced movement
perceptual speech characteristics of hypokinetic dysathria
- Monopitch
- Monoloudness
- Reduced loudness/stress
- Breathy voice
- Tendency for rapid or accelerated rate
- Inappropriate silences
- Rapidly repeated phonemes
- Palilalia
- Rapid, “blurred” AMRs
distinguishing physical features of hypokinetic dysarthria
- Masked facial expression
- Tremulous jaw, lips, tongue
- Reduced range of motion on AMR tasks
- Resting tremor
- Rigidity
typical causes of hypokinetic dysarthria
parkinson’s diease
what pathology is associated with hyperkinetic dysarthria
disorders of the basal ganglia control circuit
hyperkinetic dysarthria
- Damage to basal ganglia
- Increased movement
perceptual speech characteristics of hyperkinetic dysarthria
- Prolonged intervals
- Sudden forced inspiration/expiration
- Transient breathiness
- Transient vocal strain or harshness
- Voice stoppages/arrests
- Voice tremor
- Myoclonic vowel prolongation
- Intermittent hypernasality
- Marked deterioration with increased rate
- Inappropriate vocal noises
- Intermittent breathy/aphonic segments
- Distorted vowels
- Excessive loudness variation
- Slow and irregular AMRs
distinguishing physical characteristics of hyperkinetic dysarthria
- Involuntary head, jaw, face, tongue, velar, laryngeal, and respiratory movements
- Relatively sustained deviation of head position
- Multiple motor tics
- Myoclonus of palate, pharynx, larynx, lips, nares, tongue, or respiratory muscles
- Jaw, lip, tongue, pharyngeal, or palatal tremor
- Facial grimacing during speech
typical causes of hyperkinetic dysarthria
- Huntingtons disease
- Syndenham chorea
what pathology is associated with unilteral upper motor neuron dysarthria
unilateral disorders of the upper motor neuron system
unilateral upper motor neuron dysarthria
- Mainly affects muscles of contralateral lower face and tongue
- Sounds similar to spastic but with less strain
perceptual speech characteristics of UMN dysarthria
- Slow rate
- Imprecise articulation
- Irregular articulatory breakdown
- Strained voice quality
- Reduced loudness
- Slow imprecise AMRs
dystinguishing physical characteristics of UMN dysarthrua
- Unilateral lower face weakness
- Unilateral lingual weakness without atrophy/fasciculations
- Pseudobulbar affect
- Nonverbal oral apraxia
- Hemiparesis/hemiplegia
- Unilateral sialorrhea
- Positive Babinski sign (contralateral to lesion)
typical causes of UMN dysathria
- Stroke (91%)
- Brain tumour
- Surgical trauma
mixed dysarthria
various combinations of dysarthria types
undetermined dysarthria
perceptual features are consistent with a dysarthria but do not clearly fit into any of the identified dysarthria types
parkinson’s plus
- What we hypothesise when the medications and treatment that work for Parkinson’s disease dont work
- A major characteristic is an expression of fear as opposed to the typical blank expression present in Parkinson’s patients
impact of dysarthria
- Feeling not so confident
- Withdrawing from conversation
- Avoiding people
- Frustration
- Worry about the future
- Avoiding the phone
- Having to repeat
- Worry about speech in the future
ELMS Model
- etiology
- lesion site
- motor signs
- speech symptoms
etiology
ELMS
understanding of the cause of the dysarthria will tell us how best to treat the patient
lesion site
ELMS
different lesion sites will have different treatment paths
motor signs
ELMS
different characteristics will indicate different nerves being affected
speech symptoms
ELMS
will indicate different types of dysarthria
stages of motor planning
- Linguistic symbolic planning - premotor stage
- Motor planning
- The strategies or general patterns of movement required
- Specified motor goals, specifically the place and manner of articulation
- Motor programming
- Tactics to give the movement particular specifications
- Specify muscle plan, direction of movement, force, range
- Motor execution
- Neuromuscular descending pathways carry instructions where they are coordinated and translated into muscle movements
case history questions
- When did it start
- Sudden v gradual onset
- Course (static, progressive, fluctuating)
- What makes it better/worse (fatigue, anxiety, time of day, medications)
- Features (low volume, excessive loudness..)
- Impact on person? (avoiding phone, hobbies, social occasions..)
- Feedback from family/colleagues
- Compensation to date?
- Other symptoms reported (communication/swallow or other)
- Other medical diagnoses?
- Medications?
- Social support?
