L5: Flaccid Dysarthria Assessment (Part B) and Treatment (Part A) Flashcards
what are the two ways to describe variation in flaccid dysarthria?
focal, multifocal, or generalized
and
unilateral or bilateral
why is it “flaccid dysarthrias” plural?
bc of multiple possibilities - they can have involvement of only a single muscle group or involvement of several subsystems
what are the 6 types of focal flaccid dysarthrias?
facial palsy (VII Facial)
Masticator palsy (V Trigeminal)
Palatopharyngeal palsy (X Vagus)
Laryngeal palsy (flaccid dysphonia, X vagus)
hypoglossal palsy (XII hypoglossal)
respiratory weakness (cervical and thoracic spinal)
palsy
refers to paralysis or paresis (paresis means partial), generally referring to LMN damage (cerebral palsy is an exception to this)
what is the % of facial palsy from duffy 2020
14%
what are the nonspeech features of facial palsy? (focal flaccid dysarthria)
reduced strength of lip closure and drooling
mouth droops and fails to elevate during smile
nasolabial fold flattened
reduced forehead wrinkling
eyebrow lowered and fails to raise
what are the speech features of facial palsy? (focal flaccid dysarthria) …. why does it occur?
imprecise consonants
occurs bc of lip weakness, bilabial and labiodentals may be distorted (may not be distorted in unilateral, but yes in bilateral)
moebius syndrome
rare, non-progressive congenital condition that results from the underdev of facial nerves that control some eye/facial movements
“ventriloquist” = may use compensatory movements bc they cannot move their face to create bilabials, ex. w tongue
bell’s palsy
relatively common condition characterized by the acute onset of isolated upper and lower facial nerve weakness likely related to herpes simplex virus - approx 85% of patients make a full recovery w/i a year
corticosteroids inc likelihood of recovery
what is the % of masticator palsy from duffy 2020
3%
what are the nonspeech features of masticatory palsy? (focal flaccid dysarthria) - unilateral
may only be apparent during jaw testing
may have complaints of probs chewing
atrophy on side of weakness
what are the nonspeech features of masticator palsy? (focal flaccid dysarthria) - bilateral
jaw may sag open
chewing and swallowing impairments
drooling
what are the speech features of masticator palsy? (focal flaccid dysarthria) - unilateral
usually normal (compensation from intact side)
mild bilabial plosive distortions possible
what are the speech features of masticator palsy? (focal flaccid dysarthria) - bilateral
jaw closing weakness or paralysis
distortions in consonants that require lingual palatal contact (s, t, ch, d, k, l etc)
bilabial or labiodental contact
what is the % of palatopharyngeal palsy from duffy 2020
2%
what are the nonspeech features of palatopharyngeal palsy? (focal flaccid dysarthria) - unilateral
weak side of palate hangs lower at rest
deviates to side of strength on elevation
what are the nonspeech features of palatopharyngeal palsy? (focal flaccid dysarthria) - bilateral
palate symmetric but lower than normal
reduced or absent elevation
diminished or absent gag reflex
nasal regurgitation of liquids
what are the speech features of palatopharyngeal palsy? (focal flaccid dysarthria) - unilateral and bi
hypernasality
nasal emission of air
imprecise consonants
what are the speech features of palatopharyngeal palsy? (focal flaccid dysarthria) - unilateral
usually mild or normal
what are the speech features of palatopharyngeal palsy? (focal flaccid dysarthria) - bilateral
hyper nasality and nasal emission can be quite severe
imprecise consonants involving plosives, fricatives, and affricates bc of reduced intraoral pressure
nasal resonance (i.e. nasal formant) may also distort consonant sounds
what is the % of laryngeal palsy (flaccid dysphonia) from duffy 2020
57%
what are the nonspeech features of laryngeal palsy? (focal flaccid dysarthria) - unilateral
one vocal fold remains stationary and slightly abducted or makes very weak movements towards the midline
weak or incomplete contact bw folds
reduced cough and aspiration problems
what are the nonspeech features of laryngeal palsy? (focal flaccid dysarthria) - bilateral
both vocal folds remain stationary, slightly abducted (paralysis) or make very weak contact
in paralysis the restricted airway opening requires surgical intervention (tracheotomy or artyneoid surgery)
what will you especially hear in those with bilateral laryngeal palsy? (focal flaccid dysarthria)
audible inspirations (inhalatory stridor, vibration on inhalation signal)
what are the speech features of laryngeal palsy? (focal flaccid dysarthria) (both bi and unilateral)
breathy voice
short phrases
reduced loudness
monopitch and monoloudness
diplophonia
harsh voice (bc of jitter/shimmer)
what is the % of hypoglossal palsy from duffy 2020
24%
what are the nonspeech features of hypoglossal palsy? (focal flaccid dysarthria) (both bi and unilateral)
loss of tongue strength and atrophy
swallowing probs
what are the nonspeech features of hypoglossal palsy? (focal flaccid dysarthria) - unilateral
deviation to side of weakness on protrusion
what are the nonspeech features of hypoglossal palsy? (focal flaccid dysarthria) - bilateral
reduced range of movements if severe
what are the speech features of hypoglossal palsy? (focal flaccid dysarthria) - (uni and bilateral)
imprecise consonants
linguo-palatal consonants can be sig impaired (s, z, sh, t, d, k, g, ch, etc)
what is the % of respiratory weakness (cervical and thoracic) from duffy 2020
2%
what are the nonspeech features of resp weakness (spinal cervical and thoracic)? (focal flaccid dysarthria)
frequent shallow inspirations
shortness of breath and reduced vital capacity
postural or clavicular movements during inhalation
blueness of lips or finger nails
what are the speech features of resp weakness (spinal cervical and thoracic)? (focal flaccid dysarthria)
short phrases
reduced loudness
what are the 4 most distinctive features of flaccid dysarthria?
hypernasality
breathiness
nasal emission
audible inspiration
