Lecture 12: Clinical Speech Syndromes of the Motor System Flashcards
name of the category of motor speech syndromes characterized by abnormalities in strength, speed, range, steadiness, tone, or accuracy of movements required for control of respiratory, phonatory, resonator, articulatory, and prosodic aspects of speech production
dysarthria
name of the category of motor speech syndromes whose central or PNS abnormalities most often reflect weakness, spasticity, incoordination, involuntary movements, slowness of speech, or excessive, reduced, or variable muscle tone
dysarthria
UMN lesions : UUMN dysarthria and spastic dysarthria :: LMN lesions : ___ dysarthria
*note: UUMN (unilateral upper motor motor neuron)
flaccid
name of the type of lesions responsible for both hypokinetic and hyperkinetic dysarthria
basal ganglia lesions
name of the type of lesions responsible for ataxic dysarthria
cerebellar and cerebellar pathway lesions
true or false: mixed lesions lead to mixed dysarthrias
true
name of the type of dysarthria characterized by the following symptoms:
very mild, relative mildness of speech impairment, usually due to stroke, imprecise articulation (harshness, reduced loudness, hyper nasality, slow rate of speech)
UUMN (unilateral upper motor neuron) dysarthria
re: UUMN dysarthria
where do these lesions occur?
unilateral upper motor neuron dysarthria; lesions in:
cerebral hemisphere (usually motor cortex), descending white matter pathways, internal capsule, brainstem
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
unilateral lower facial weakness, unilateral tongue weakness
UUMN (unilateral upper motor neuron) dysarthria
name of the type of dysarthria characterized by the following symptoms:
strained-harsh voice quality, monopitch, monoloudness, slow rate of speech (slow AMRs)
spastic dysarthria
name of the measurement of rate, rhythm, precision, and range of motion of rapid movements of the lips, jaw, and tongue; patient is asked to breathe and repeat: /p p p/ /t t t/ and /k k k/
alternate motion rate (AMR)
what is the AMR for normal adults?
5 - 6 syllables per second
name of the type of lesions responsible for spastic dysarthria
central nervous system lesions and lesions affecting the upper motor neuron pathways
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
slow rate of orofacial movements, reduced range of motion, hyperactive gag reflex, pseudo bulbar effect, pathologic laughter and crying, drooling, dysphagia
spastic dysarthria
name of the type of dysarthria whose symptoms vary depending on the location of LMN damage, potentially affecting: respiration, phonation, resonance, and articulation
flaccid dysarthria
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
bilateral trigeminal weakness (reduced jaw movements, weakened closure, articulatory contacts between the tongue, lips, and teeth)
CN V
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
imprecise articulation of sounds requiring facial movements, paresis or bilateral weakness resulting in distortion of sounds, prevented production of bilabials and labiodentals if paralysis occurs bilaterally
CN VII
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
voice and resonance changes
CN X
*note: occurs because this cranial nerve innervates both the muscles of the larynx and soft palate
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
vocal cord paralysis, hoarseness, breathiness, diplophonia
CN X
*note: diplophonia is when two pitches are perceived rather than one because the two vocal cords are vibrating at different rates
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
vocal breathiness and / or inhalators stridor
CN X
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
restricted control of vocal pitch
CN X
true or false: unilateral lesions of the superior laryngeal nerve produce significant dysphonia
false; they do not produce significant dysphonia
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
nasality, audible nasal emission, significant weakness of sounds requiring intramural pressure
CN X
damage to which cranial nerve results in the following flaccid dysarthria symptoms:
articulatory tongue imprecisions (weakness, atrophy, and fasciculations)
CN XII
*note: unilateral hypoglossal lesions : mild articulatory imprecision :: bilateral lesions : severe articulatory imprecisions
lesions in which areas often lead to flaccid dysarthria?
cell bodies, axons, or neuromuscular junction of the LMNs, CN V, VII, X, XII, cervical and thoracic spinal nerves
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
damage expressed as weakness and loss of muscle tone, oral reflexes reduced or absent, atrophy of affected muscles, fasciculations
flaccid dysarthria
name of the type of dysarthria characterized by the following speech symptoms:
“drunken” speech, slow speech rate, unsteady vowel prolongations, slow and irregular AMRs
ataxic dysarthria
lesions in which areas often lead to ataxic dysarthria?
cerebellum or cerebellar control circuits / pathways
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
normal size, strength, symmetry, and reflexes; slow, irregular jaw, face, and tongue movements during non-speech AMR tasks
ataxic dysarthria
name of the type of dysarthria characterized by the following speech symptoms:
accelerated speech, hypophonia, arctic errors due to reduced range of motion, rapid (and “blurred”) speech AMRs
hypokinetic dysarthria
lesions in which areas often lead to hypokinetic dysarthria?
basal ganglia control circuit (when diseased); frequent in persons with Parkinson’s disease
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
expressionless face even during social interaction; tremors in the jaw, face, or tongue at rest; reduced range of motion of the jaw, face, and tongue during speech AMRs
hypokinetic dysarthria
the following are two subtypes of which kind of dysarthria?
- quick or slow, rhythmic or arrhythmic, involuntary movements that interrupt, distort, or slow speech movements
- affect respiration, phonation, resonance, and articulation - often, prominent affects on prosody
hyperkinetic dysarthria
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
rhythmic, quavering waxing, and waning vocal character; possibly abrupt voice arrests and slowed speech rates
tremor
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
quick, unsustained, and unpredictable movements where abnormal speech characteristics depend on the structures (jaw, face, tongue, palate, larynx, respiratory system) affected
chorea
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
quick, involuntary adductor or abductor movements; voice arrests with strained quality or transient breathiness; hyper nasality and nasal emissions; irregular articulatory breakdowns; prosodic abnormalities; irregular AMRs
chorea
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
slow and sustained speech movements; slow, adventitious movements of lips, tongue, or jaw; can be confined to muscles for speed hand swallowing and triggered only by the act of speaking
dystonia
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
__ductor spasmodic dysphonia : waxing / waning strained-harsh voice quality :: __ductor spasmodic dysphonia: breathy / aphonic segments of speech
layngeal dystonia;
[fill-ins] ad, ab
name of the kind of hyperkinetic dysarthria characterized by the following speech symptoms:
hypernasality, significantly impaired articulation, abnormalities of prosody
dystonia
lesions in which area often lead to hypokinetic dysarthria?
basal ganglia control circuits
name of the type of dysarthria characterized by the following non-speech oral mechanism findings:
normal size, strength, and symmetry; no hyper or hyporeflexia; involuntary movements only observed during the oral motor exam
hyperkinetic dysarthria
name of the category of motor speech syndromes characterized by disorders in motor planning
apraxia
a disorder of learned movement
apraxia
true or false: apraxia is caused by paralysis, weakness, or incoordination and is accounted for by sensory loss, comprehension deficits, or inattention to commands
false;
“disorder of learned movement, NOT caused by paralysis, weakness, or incoordination and CANNOT be accounted for by sensory loss, comprehension deficits, or inattention to commands”
name of the kind of apraxia characterized by the following speech symptoms:
difficulty carrying out volitional, oral non-speech movements (not due to weakness, incoordination, sensory, or cognitive-linguistis impairment)
oral apraxia; also called nonverbal oral apraxia (NVOA)
name of the kind of apraxia characterized by the following speech symptoms:
imprecise / distorted articulation (SODA); slow speech rate; prolonged consonants and vowels; syllabic production of speech
apraxia of speech (AOS)
lesions in which areas often lead to apraxia of speech (AOS)?
middle cerebral artery, posterior portions of the frontal lobe (Broca’s area), parietal lobe, sometimes basal ganglia
*note: rarely seen in isolation; usually paired with aphasia and / or a unilateral UMN dysarthria
___ is a function of the dominant hemisphere, and apraxia of speech is associated with left (___) hemisphere damage
praxis, dominant
name of the type of apraxia characterized by the following non-speech oral mechanism findings:
right lower facial and tongue weakness due to involvement of the nearby corticobulbar pathway; co-occurance of nonverbal oral apraxia (but may also occur independently)
apraxia of speech (AOS)
given that a patient has basal ganglia lesions, they will likely have a ___
hypokinetic : little excitation :: hyperkinetic : excess excitation
dysarthria
UUMN (unilateral upper motor neuron) dysarthria is often ___ with lesions in the ___
mild; internal capsule
