midterm Flashcards

1
Q

in what parts of speech are ataxic dysarthria characteristics most evident

A

articulation and prosody

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2
Q

what are the reasons for the characteristics

A

incoordination and reduced muscle tone

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3
Q

identification of ataxic dysarthria can help localize the lesions to….

A

cerebellum or cerebral control circuit

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4
Q

ataxic dysarthria predominantly reflects problems of…

A

motor control

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5
Q

what are purkinje cells

A

inhibitory and sole output neurons of cerebellar cortex

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6
Q

what level of the motor system does the cerebellum infuence? motor or sensory

A

sensory

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7
Q

what are the roles in speech

A
  • reciprocal connections with cerebral cortex
  • auditory and proprioceptive feedback from speech muscles, tendons, and joints
  • reciprocal connections with brainstem component of indirect activation pathway
  • cooperation with the basal ganglia control circuit through loops among the thalamus, cortex, and indirect motor system
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8
Q

what is the function of the cerebellum

A
  • helps time components of movement
  • scales the size of muscle actions
  • coordinates sequences of muscle contraction for skilled motor behavior
  • monitors the adequacy of movement outcomes based on feedback from muscles, tendons and jints, and auditory feedback in speech.
  • makes modifications that smooth the timing and coordination of movement
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9
Q

which part of the cerebellum is used for preparation of speech via the thalamus, SMA, motor cortex, and insula

A

Anterior-superior

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10
Q

which part of the cerebellum is used for speech execution

A

inferior portions

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11
Q

ataxic dysarthria is associated with what part of the cerebellum

A

bilateral cerebellar hemisphere, paravermal, dentate nucleus

*especially assoicated with damage to paramedian regions of superior cerebellar hemispheres

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12
Q

is ataxic dysarthria associated with bilateral or unilateral lesions

A

bilateral

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13
Q

where else can lesions be to cause ataxic dysarthria

A

superior cerebellar peduncle or along the frontopontocerebellar pathways

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14
Q

where are cerebellar lesions when they are focal

A

lateral hemispheres and posteromedial or paravermal

unilateral lesions causing ataxic dysarthria are often on the right

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15
Q

what is the direct activation pathway

A

pyramidal tracts, form part of the UMN. Their activity stimulates the LMN. Includes the corticospinal and corticobulbar tracts. Innervate muscles contralateral from lesion

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16
Q

What is the indirect pathway

A
  • extrapyramidal.
  • synapses occur between corex and brainstem via basal ganglia, cerebellum, reticular formation, vestibular nuclei or red nucleus.
  • Regulate reflexes and maintain posture, tone.
  • primarily inhibitory
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17
Q

what are common clinical signs of cerebellar lesions

A

broad stance and gait

  • truncal instability
  • steps irregularly placed
  • legs overlifted
  • no difference in standing with feet together and eyes open or closed
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18
Q

what is the romberg test

A

stand with feet together. Test steadiness with eyes open and closed

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19
Q

What is titubation

A

rhythmic tremor of body or head that can occur with cerebellar disease
*usually in trunk (rocking) or head (forward back, side to side, or rotary)

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20
Q

What is nystagmus

A

abnormal eye movements (rapid back and forth)

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21
Q

What is ocuardysmetria

A

small rapid eye movements as eyes attempt to fix on a target or to correct for inaccurate fixation

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22
Q

what is pendulousness

A
  • extremity allowed to swing freely in pendular manner has *greater number of oscillations before resting. Function of hypotonia.
  • may also include impaired check and excessive rebound
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23
Q

what is dysmetria

A
  • common sign of cereballar disease

* characterized by overshooting or undershooting target by abnormalities in speed, making the movements look jerky

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24
Q

what is dysdiadochokinesis

A
  • errors in timing and speed of components of a movement
  • manifestation of decomposition of movement (dyssynergia)
  • results in poor coordination
  • tested by alternating alternate movements such as knee pat test
  • poor performance is characterized by abnormalities in rate, rhythm, amplitude, and precision
25
what is ataxia
product of dysmetria, dysdiadochokinesis, and decomposition of movement
26
what is decomposition of movement
errors in the timing and speed of components of a movement
27
what is intention or kinetic tremor
tremor that is apparent during movement | obvious as a target is approximated (terminal tremor)
28
what are other signs with cerebellar disease
* mild facial weakness, lower face * occurs frequently with focal cerebellar lesions * cognitive disturbances
29
what is cerebellar cognitive affective disorder
affective, cognitive, and language deficits in people with cerebellar disease
30
what are common etiologies of ataxic dysarthria
* degenerative disease * demylinating disease * vascular disorders * neoplastic disorders * trauma * toxic or metabolic conditions
31
what are hereditary ataxias
autosomal recessive X linked. Largely confined to cerebellum when they also affect spinal cord (spinocerebellar when they affect inferior olive and pontine nuclei(olivopontocerebellar)
32
What is Friedreich's ataxia
degenerative disorder begins before age 20 limb gait ataxia, dysarthria, absent muscle stretch reflexes in lower limbs, sensory loss, signs of corticospinal tract involvement may have LMN weakness
33
what is ataxia telangiectasia
geneticdisorder | truncal or appendicular ataxia, choreoathetosis, dystonia, sensory loss, and distal muscle atrophy
34
what are primary episodic ataxias
intermittent, brief attacks of ataxia often dysarthria and sometimes other neurologic signs can be induced by exercise or startle can be managed pharmacologically
35
what is olivopontocerebellar atrophy
degeneration of the pontine, arcuate, and olivary nuclei
36
what demylinating diseases are associated with ataxic dysarthria
MS paroxysimal ataxic dysarthria PAD: brief episodes of ataxic dysarthria in otherwise normal individual. Overbreathing may evoke the paroxysms Miller Fisher syndrome
37
what is Miller Fisher syndrome
subtype of Gullain-Barre | autoimmune acute neuropathy characterized by opthalmoplegia, arefelexia, and ataxia
38
what vascular disorders are associated with ataxic dysarthria
aneurysms AVM stroke occurs at posterior inferior cerebellar artery PICA, anterior inferior cerebellar artery AICA, at pons, superior cerebellar artery in midbrain,
39
which artery lesions more common with ataxic dysarthria
superior cerebellar artery lesions
40
what is Von Hippel Lindau disease
inherited condition that produces tumors in cerebellum. medulla, and spinal cord
41
which tumors are the most risk for ataxic dysarthria
midline tumors which can displace portions of the cerebellum
42
what are paraneoplastic disorders
autoimmune conditions associated with cancer
43
what type of trauma causes damage to cerebellum
anoxia secondary to TBI | rotational injuries associated with TBI
44
what is punch drunk encephalopathy
damage by repeated boxing blows to the head
45
what toxic conditions can lead to ataxic dysarthria
acute or chronic alcohol abuse creates abnormal stance and gait neurotoxic levels of drugs such as the anticonvulsant Dilantin, Tegretol, Depakote, and Mysoline cerebellar dysfunction can develop with severe malnutrition and vitamin deficiencies
46
what are other causes of ataxic dysarthria
hypothyroidism normal pressure hydrocephalus viral, bacterial, and other infectious processes heat stroke lack of proprioceptive input which leads to sensory ataxia
47
what is normal pressure hydrocephalus
enlarged ventricles even when CSF pressure is maintained
48
what is the most frequent cause of ataxic dysarthria
degenerative diseases most frequent
49
what are patient complaints in ataxic dysarthria
slurred speech inability to coordinate their breathing with speaking bike cheek or tongue while talking or eating unexpectedly stumble over words
50
what are nonspeech oral mech findings with ataxic dysarthria
nonspeech AMRs of jaw, lips, and tongue may be irregular
51
what are clinical speech findings with ataxic dyssarthria
irregular speech AMRs are a distinguishing characteristic | associated impaired coordination or control of movement (sequenced movements give distinctive character)
52
which are the most useful tasks to distinguish ataxic dysarthria characteristics
conversational speech, reading, and speech AMRs | repetition of multisyllabic words
53
what are the clusters of deviant demenisions of ataxic dysarthria
* articulator inaccuracy, represented by imprecise consonants, irregular articulatory breakdowns, and vowel distortions * prosodic excess, composed of excess and equal stress, prolonged phonemes, prolonged intervals, and slow rate * phonatory-prosodic insufficiency, composed of harshness, monopitch, and monoloudness
54
what is scanning
isochronous syllable durations that seems to reflect a prolongation of short vocalic elements
55
what is telescoping
inconsistent breakdown of articulation in which a syllable or series of syllables are unpredictably run together, giving speech a transient accelerated character
56
what are physiologic respiratory findings for ataxic dysarthria
*incoordination between timing of onset of exhalation and phonation, leading to air wastage *paradoxical movements or abrupt changes in movements of rib cage and abdomen *irregularities in chest wall movements during sustained vowels and syllable repetition *tendency to initiate utterances at lower than normal lung volume levels abnormalities reflect poor coordination of speech breathing and phonatory
57
what are acoustic findings for articulation, rate, and prosody in ataxic dysarthria
*slow rate including longer syllable and sentence durations, longer formnt transitions, lengthened consonants clusters and vowel nuclei in syllable and wordslonger VOT
58
what are explanations for slow rate in ataxic dysarthria speakers
* hypotonia which delays generation of muscle force and reduced rate of muscle contraction * cerebellar damage that interferes with feedforward motor commands and leads to heavier reliance on cerebral ortex motor control * reliance on auditory feedback * abnormalities in rhythm on speech AMR tasks