Mixed Dysarthria Flashcards
What is Mixed Dysarthria?
Any dysarthria where one or more systems are affected, creating combined effects of one or more subtypes
Flaccid and spastic, Spastic and ataxic, etc.
Typically due to multiple lesion sites or one diffuse lesion
More common than singular dysarthria types
Important for differential diagnosis
You can have combinations of any of them except ONE pairing= Spastic and Unilateral
Because both are UMN. They cannot coexist together
Amyotrophic Lateral Sclerosis
Initially has the symptoms of the area attacked first
- Spinal nerves - weakness in arms and legs, hypotonia, atrophy, hyporeflexia
- Cranial nerves - flaccid dysarthria, dysphagia, reduced gag, weakness, lingual fasciculations
- Corticospinal - weakness and spasticity, hyperreflexia, muscle cramps
- Corticobulbar - spastic dysarthria, hyperactive gag, slow movements, dysphagia, pseudobulbar affect
Dysarthria most often mixed flaccid-spastic
ALS Speech Characteristics
Imprecise consonants
Hypernasality
Harshness
Slow rate
Monopitch
Short phrases
Distorted vowels
Vocal flutter
Friedreich’s Ataxia
Inherited, progressive disorder causing neuron degeneration in the cerebellum, brainstem and spinal cord
Fatal - usually a result of heart failure or coma
Prominent speech characteristics
- Harshness, breathiness, strained strangled voice quality
- Audible inspiration
- Monopitch, pitch breaks, fluctuating pitch, inappropriate pitch level
Most often associated with ataxic-spastic Dysarthria
Predominately ataxic throughout the progression
Progressive Supranuclear Palsy
Rare progressive disease causing degeneration of neurons in the brainstem, basal ganglia and cerebellum
Frequently mistaken for PD
Fatal in several years (6-7 years)
Most obvious: gradual restriction of voluntary eye
movements – especially downward gaze
Dysarthria & dysphagia are often early & prominent signs
Various combinations of hypokinetic, spastic, and ataxic types
Most mistaken for parkinsons
Faster progression
Unresponsive to dopamine
Spreads from basal ganglia to cerebellum
Gaze palsy- difficulty moving eyes in the downward direction
Supranuclear Palsy vs Parkinsons Speech Characteristics
Supranuclear
Monopitch
Hoarseness
Nasal emissions
Excess & equal stress
Hypernasality
Imprecise articulation
Slow rate
Parkinson’s
Vocal flutter/tremor
Reduced loudness
Reduced stress
Breathiness
Rapid rate
Mutiple System Atrophy
Shy-Drager Syndrome (MSA – A)
- Degenerative affecting the brainstem, basal ganglia, and autonomic NS
- Blood pressure regulation, bowel and bladder dysfunction; reduced respiration
- Parkinson-like symptoms (bradykinesia, rigidity) but without tremor
1/3rd have laryngeal stridor – associated with excessive snoring and sleep apnea - Most common dysarthrias: spastic-ataxic-hypokinetic and hypokinetic-ataxic and ataxic-spastic dysarthria
Other MSA Subtypes
MSA –P
Parkinsonism features predominate, faster progression, doesn’t respond to Levadopa
Hypokinetic with spastic or ataxic or both
MSA –C
Predominant cerebellar involvement
Ataxic with spastic or hypokinetic or both
Ataxic overrides hypokinetic over time
Corticobasal Degeneration
Uncommon neurodegenerative disease
Asymmetrical cortical (frontal & parietal lobes) and bilateral basal ganglia involvement
Primary Progressive Aphasia (PPA) co-occurs frequently
Apraxia of speech may be present
Single or Mixed dysarthria types are common
Hypokinetic, spastic, and ataxic types
Relatively rare
Hypokinetic component is prominent
Predominantly becomes cognitive in nature
Frontal lobe degeneration
As this spreads across frontal lobes and basal ganglia goes from hypo to spastic/ataxic stage
Multiple Sclerosis
Most common of the demyelinating diseases
Appears around 30; women more than men
Etiology is unknown but some evidence that it is an autoimmune disease triggered by environmental & genetic interactions
Due to destruction of the myelin sheaths and death of oligodendrocytes (cells that produce myelin)
Demyelination can occur in the brainstem, cerebellum, cerebral hemispheres, and spinal cord (almost anywhere in the
Multiple Sclerosis, continued
Common complaints
- Vision difficulties (double vision, color perception, decreased acuity and impaired central vision
- Chronic feeling of tiredness and weakness in the limbs
- Gait disturbance
- Sensory disturbances (numbness, burning, itching, tingling)
Dysarthria present in 25% to 50%
- Spastic-ataxic most common mixed dysarthria
Traumatic Brain Injury
Dysarthria occurs in about one third of TBI population
Can vary significantly in severity
May or may not be accompanied by language and other cognitive disorders
Mixed dysarthria most common & any type can be present
Due to diffuse nature of the injury
Congruent with motor deficits present – weakness, spasticity, rigidity, dystonia, tremor
MIXED CHART
—->
What to look for
- Which systems have the salient part for each dysarthria
HYPO
= Rushes of speech
- Look at that in articulation
