Motor Exam 2

Question 1

In UUMN dysarthria, the clinician might observe the following during an oral mechanism exam:

Answer 1

lower facial weakness and hemiparesis
drooling
contralateral lingual weakness

Question 2

Individuals who are diagnosed with Multiple Sclerosis often have ________ dysarthria

Answer 2

ataxic

Question 3

The three essential procedural components when assessing an individual for dysarthria are

Answer 3

review medical history, identify salient features, identify confirmatory signs

Question 4

A weak or quiet voice, rapid rate of speech, difficulty initiating speech, drooling, and swallowing complaints are common with ______ dysarthria

Answer 4

hypokinetic

Question 5

Flaccid dysarthria characterized by tongue weakness is due to damage to which cranial nerve?

Answer 5

XII

Question 6

A 57 year old man was seen for evaluation. He had residual symptoms from a stroke 3 years earlier. The neurologist reported the patient had a “pure motor hemiparesis, almost like a capsular infarct.” The speech evaluation revealed mild lower left face and tongue weakness. The patient’s speech revealed mildly imprecise articulation and imprecise AMRs. Phonation and resonance were normal. What type of dysarthria does this patient have?

Answer 6

UUMN

Question 7

Where does hypokinetic dysarthria localize to?

Answer 7

basal ganglia control circuit

Question 8

What is the specific neuromuscular basis (or main problem) associated with spastic dysarthria?

Answer 8

spasticity

Question 9

Where does spastic dysarthria localize to?

Answer 9

Bilateral UMNs

Question 10

____ palsy occurs when several cranial nerves are affected.

Answer 10

Bulbar

Question 11

What is the most common main/broad etiologic category of unilateral UMN dysarthria?

Answer 11

vascular/stroke

Question 12

A patient who has problems that localize to the extrapyramidal system will have which type(s) of dysarthria?

Answer 12

hypokinetic

hyperkinetic

Question 13

Deviant speech characteristics of hyperkinetic dysarthrias can be manifest in which levels of speech?

Answer 13

respiratory, phonatory, resonatory, and articulatory

Question 14

A 72 year old man is referred to you for a speech evaluation by his neurologist. His medical history includes a left-side brainstem stroke 6 months ago, with no previous strokes. The are of his stroke suggests impairment of cranial nerves IX, X, and XI on the left. What type of dysarthria would you suspect?

Answer 14

flaccid

Question 15

Perceptual attributes that are consistent with laryngeal muscle weakness and hypotonia are a result of lesions to which branch of the vagus nerve?

Answer 15

superior laryngeal and recurrent laryngeal

Question 16

Phonatory and resonatory incompetence are commonly encountered distinguishing features of what type of dysarthria?

Answer 16

flaccid

Question 17

Clinical characteristic of cerebellar lesions and ataxia include:

Answer 17

hypotonia

titubation

Question 18

Hallmark speech characteristics of hypokinetic dysarthria include:

Answer 18

accelerated speech
monopitch
inappropriate silences

Question 19

Reduced respiratory support for speech, reduced loudness, pitch variability, and reduced phrase length can be caused by lesions to?

Answer 19

spinal respiratory nerves

Question 20

Where does flaccid dysarthria localize to?

Answer 20

LMNs

Question 21

A 68 year old man presented with a 5 year history of difficulty getting into and out of chairs, stiffness during walking, and difficulty turning in bed. He had voice and handwriting difficulty. He presented with neck rigidity and diminished arm swing. Facial expression was masked. He reported he was uncertain if “words would come out.” His spouse reported he was quieter and slower in the evening or following extended periods of speaking. His jaw, lips and tongue were mildly tremulous during sustained postures. Infrequent rapid repetitions, prolongations of initial phonemes, nasal emission (but did not sound hypernasal) were observed during the speech evaluation. Speech AMRs were normal and prolonged “ah” was breathy-hoarse. What type of dysarthria did this gentlemen have?

Answer 21

hypokinetic

Question 22

A 73 year old woman presented with a 10 year history of voice difficulty that was present upon awakening one day. The problem progressed for a while by the patient had been stable for several years. Neurologic evaluation identified a head tremor, postural upper extremity tremor, and “spastic speech.” The speech evaluation noted her speech was characterized by a tremor that consistently interrupted her voice and slowed her speech rate. Prolonged “ah” contained consistent, somewhat irregular, and strained voice interruptions were noted. Tremor fluctuations were not apparent during prolongation of voiceless fricatives. What type of dysarthria did this patient have?

Answer 22

hyperkinetic

Question 23

Slurred speech and “drunken” sounding speech is one of the hallmark complaints of individuals with which type of dysarthria?

Answer 23

ataxic

Question 24

What is the specific neuromuscular basis (or main problem) associated with hyperkinetic dysarthria?

Answer 24

involuntary movements

Question 25

A 63 year old female was hospitalized for evaluation and treatment of cardiovascular problems. Three weeks before admission, she suddenly developed speech and gait difficulty. She had no difficulties with language, chewing, or swallowing. A CT scan of the head identified a 2-cm area of low attenuation in the right cerebellar hemisphere consistent with a stroke. The speech pathologist was consulted. Speech-language evaluation results noted: normal oral mechanism exam; speech difficulties included irregular articulatory breakdowns, irregular speech AMRs, and unsteady vowel prolongation. The SLP reported intelligibility was normal. With what motor speech disorder would you diagnose her?

Answer 25

Ataxic

Question 26

Movement disorders associated with hyperkinetic dysarthria are:

Answer 26

dystonia
chorea
tremor
tics

ALL?

Question 27

The dysarthria types differ in:

Answer 27

oral mechanism findings
anatomic and vascular localization
speech characteristics
etiologic distributions

Question 28

Monopitch, monoloudness, reduced stress, and short phrases are speech characteristics that can be attributed to which cluster of deviant dimensions?

Answer 28

prosodic insufficiency

Question 29

What is the specific neuromuscular basis associated with hypokinetic dysarthria?

Answer 29

rigidity and reduced range of movement

Question 30

Spasticity, weakness, reduced range of movement, slowness of movement are salient effects of what type of lesions?

Answer 30

UMN

Question 31

The two most common known causes of motor unit lesions that cause flaccid dysarthria are

Answer 31

surgical trauma

degenerative disease

Question 32

What is the specific neuromuscular basis associated with flaccid dysarthria?

Answer 32

weakness

Question 33

The most distinctive clues of spastic dysarthria include:

Answer 33

slow speech rate
strained-harsh voice quality
slow and regular AMRs
reduced pitch and loudness variability

Question 34

What is the specific neuromuscular basis associated with ataxic dysarthria?

Answer 34

incoordination

Question 35

A 54 year old woman has been referred to you for a speech evaluation by her neurologist. She has had worsening of her speech difficulties over the last 6 months. She has been diagnosed with cerebellar degeneration. She is currently working as a marketing manager for Nabisco foods. Which speech symptom would most likely be present?

Answer 35

irregular articulatory breakdowns

Question 36

Where does ataxic dysarthria localize to?

Answer 36

cerebellar control circuit

Question 37

Where does unilateral UMN dysarthria localize to?

Answer 37

Unilateral UMN system

Question 38

What is the specific neuromuscular basis associated with unilateral UMN dysarthria?

Answer 38

UMN weakness and possibly incoordination or spasticity

Question 39

Where does hyperkinetic dysarthria primarily localize to?

Answer 39

basal ganglia control circuit

Question 40

One of the most deviant speech characteristics of unilateral UMN dysarthria is

Answer 40

Imprecise articulation

Question 41

A 67 year old female was referred to you for a speech evaluation from her neurologist. She recently had an anoxic episode during a hysterectomy surgery causing widespread cortical damage. She complains of difficulty eating and swallowing, drooling, and difficulty speaking. During the oral mechanism exam, you note slow alternating motion rates, reduced range of motion of the jaw and tongue, and presence of jaw jerk reflex. Her speech rate is slow. She presents with a strained strangled voice and imprecise articulation. With what motor speech disorder would you diagnose her?

Answer 41

spastic

Question 42

Individuals with ______ dysarthria may complain of chewing and swallowing problems, effortful speech, involuntary orofacial movements, and “tricks” that improve speech temporarily.

Answer 42

hyperkinetic

Question 43

______ is a nonspecific term that indicates inflammation of the spinal cord

Answer 43

Myelitis

Question 44

Movement between the thumb and forefinger is called ______

Answer 44

pill-rolling

Question 45

Parkinson’s disease is a degenerative condition associated with a depletion of ________ in the striatum of the basal ganglia.

Answer 45

dopamine