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Neurogenic Dysphonias Flashcards

1
Q

Neurogenic Dysphonias

A

Any dysphonia which occurs as a result of an impairment in the innervation, function, or motor planning aspects of the muscles involved in phonation, and resonance/articulation resulting in a change in voice production

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2
Q

Motor Speech Disorders

A

Disorders of speech resulting from neurologic impairment affecting the motor programming or neuromuscular execution of speech
Dysarthria, Apraxia

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3
Q

Dysarthrias

A

Group of MSD resulting from disturbances in muscular control over the speech mechanism
Due to damage of the central or peripheral nervous system
Results from paralysis, paresis, or incoordination of the speech musculature

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4
Q

Vocal fold paralysis

A

When one or both vocal folds are unable to move either towards or away from midline
Etiology: damage to CN X
90% due to LMN lesions

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5
Q

Vocal fold paralysis characteristics

A

Flaccid dysphonias due to a reduction in muscle tone resulting from a loss of motor supply to the muscle

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6
Q

Bilateral vocal fold paralysis

A

Usually result of lesions high in trunk of vagus nerve or at the nuclei of origin in the medulla
Etiology: tumors, carcinoma, trauma

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7
Q

Adductor vocal fold paralysis

A

Neither vocal fold is capable of moving toward the midline
Phonation = impossible
At risk for aspiration

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8
Q

Abductor vocal fold paralysis

A

Vocal folds remain at midline

Serious respiratory problems

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9
Q

Unilateral vocal fold paralysis

A

Most common cause = disruption of recurrent laryngeal nerve on one side
Etiology: damage or trauma to the RLN
Laryngeal adductor muscles cannot adduct the vocal folds
Paralyzed vocal fold remains fixed in paramedian position during both inspiration and expiration

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10
Q

Unilateral vocal fold paralysis Characteristics

A 
Dysphonic or aphonic
Breathy, hoarse
Phonation time reduced
Reduced or monoloud
Diplophonia, pitch breaks
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11
Q

Myasthenia Gravis

A

Autoimmune disease in which the neuromuscular junction becomes impaired as the patient uses that particular muscle or muscle group resulting in extreme muscle fatigue
Muscles innervated by head and neck are very vulnerable to this disease
Possible difficulty swallowing
Results in flaccid dysarthria/dysphonia
Etiology: damage to the receptors at the neuromuscular junction, prevents the normal transfer of impulse from the nerve in the particular muscle

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12
Q

Myasthenia Gravis Characteristics

A

Typically normal voice changes to weak, breathy, barely audible voice; after a few minutes of rest voice is restored

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13
Q

Guillain-Barre

A

Focal demyelination of spinal and cranial nerves
Flaccid dysarthria/dysphonia
Possible dysphagia
Etiology: unknown cause but frequently preceded by a viral infection
Affects extremities as well as facial, oro-pharyngeal and occular muscles

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14
Q

Spastic Dysphonia

A

Muscular hypertonia: significantly increased muscle tone wherein the limb cannot be moved passively or volitionally with ease
UMN dysphonia
Spasticity of the laryngeal muscles
Etiology: small bilateral lesions that occur just above the nucleus of CN X
Frequently co-occurs with spastic dysarthria

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15
Q

Ataxic Dysphonia

A

Lesion in cerebellum

Loss of regulatory movements

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16
Q

Spastic Dysphonia Characteristics

A

Strained, strangled, harsh vocal quality, low pitch, monopitch, reduced/variable loudness, possible hypernasality

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17
Q

Ataxic Dysphonia Characteristics

A

Normal vocal quality, hoarse/harsh vocal quality, low pitch or monopitch, monoloudness, inappropriate/imprecise prosody, excessive loudness, vocal tremor

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18
Q

Dysphonias related to Extrapyramidal System

A

Depletion/functional reduction of Acetylcholine or dopamine on the activities of the basal ganglia
Imbalance of the two neurotransmitters causes movement disorders with related dysarthrias/dysphonias

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19
Q

Hypokinetic Dysarthria

A

Extrapyramidal movement disorder due to a depletion of dopamine in the striatum, secondary to a slow degeneration of the substantia nigra (PD)

20
Q

Hypokinetic Dysarthria Characteristics

A

Breathy, harsh vocal quality, reduced loudness, monoloudness, monopitch, reduced stress
Imprecise articulation, intermittent rushes of speech

21
Q

Hyperkinetic Dysarthria

A

Movement disorders in which the speech muscles are quick, jerky, and irregular
3 Types: Quick, Slow, Tremor

22
Q

Chorea

A

Disease of the basal ganglia
Purposeless, irregular, fleeting, involuntary movements of the limbs and facial muscles
Etiology: lesions that damage the striate nucleus of the basal ganglion

23
Q

Chorea Characteristics

A

Harsh, strained-strangled, intermittent breathiness, limited pitch range, limited loudness range, intermittent variability, inappropriate and imprecise stress patterns

24
Q

Myoclonus

A

Movement disorder that results in a hyperkinetic dysarthria characterized by episodic moments of abnormal speech production due to short rhythmic movements of the laryngeal and supraglottic musculature
Etiology: lesions in the pathways connecting the red nucleus, the olivary bodies of the cerebellum

25
Q

Myoclonus Characteristics

A

Voice arrest during vowel prolongation and singing
Usually go unnoticed during connected speech
Short, rhythmic contractions throughout the speech system
Voiced/voiceless segments may be altered

26
Q

Tourette’s syndrome

A

Episodic periods of uncontrolled, abnormal speech production due to rapid, tic-like movements and involuntary vocalizations

27
Q

Tourette’s syndrome characteristics

A

Tics, dysfluency, throat clearing, coprolalia, echolalia

28
Q

Athetosis

A

Involuntary, unpatterned, arrhythmic wriggling and writhing movements of the head, neck, torso, and extremities
May interfere with all voluntary body movements
Etiology: congenital (CP), or acquired (neuronal degenerative disases, encephalitis, etc.)

29
Q

Athetosis characteristics

A

Hoarse, breathy, monopitch, monoloudness of dramatic variations in loudness levels, inappropriate and imprecise stress patterns
Irregular movements of the face, cheek, lips, mandible, and tongue

30
Q

Dystonia

A

Movement disorder characterized by slow involuntary movements and severe postural deformities resulting from fixed muscle contractions
Etiology: damage to the extrapyramidal system

31
Q

Dystonia characteristics

A

Intermittent, harsh, strained-strangled, breathy, limited pitch and loudness ranges, inappropriate variations in loudness, inappropriate and imprecise stress, forced inspiration and expiration
Irregular movements of the lips, mandible, tongue
Neuromuscular and dysarthric symptoms

32
Q

“Quick” hyperkinetic

A

Chorea, Huntington’s Disease, Myoclonus, Tourette’s syndrome

33
Q

“Slow” hyperkinetic

A

Athetosis, drug-induced dyskinesia, dystonia

34
Q

3 types of hyperkinetic

A

1) Quick
2) Slow
3) Tremor

35
Q

Essential tremor

A

Finely oscillating tremor found in individuals without any other conditions
Etiology: idiopathic or an involuntary, benign hereditary laryngeal tremor

36
Q

Essential tremor characteristics

A

Quivering, intonation, voice arrests
Lip, mandibular, soft palate or tongue tremor may be present
Increased variation in intensity and frequency

37
Q

Amyotrophic Lateral Sclerosis

A

Progressive degenerative debilitating disease of the anterior horns, cranial nerve motor nuclei, and the corticobulbar and corticospinal tracts results in mixed flaccid-spastic dysarthria
Onset of disease: usually middle-late age
Etiology: unknown

38
Q

ALS Perceptual charactertistics

A

Harsh, breathy, monopitch, monoloudness, hypernasality, strained-strangled

39
Q

ALS Acoustic characteristics

A

Increased note in stop gaps in stop consonants and vowel durations
Changes in fundamental frequency, jitter, shimmer, intensity and HNR seem to be most affected

40
Q

Multiple Sclerosis

A

Demyelinating disease characterized by deposits of plaque anywhere in the CNS
Symptoms may be mild initially with long period of remission or latency in between episodes
Results in a mixed dysarthria
Etiology: unknown, assumed to be an autoimmune disorder

41
Q

Multiple Sclerosis Characteristics

A

harsh vocal quality, reduced pitch and impaired loudness control, hypernasality
Poor respiration and poor sustained phonation

42
Q

Multiple Sclerosis: Associated symptoms

A

Articulation errors
Neuromuscular coordination for respiration; decreased vital capacity
Nystagmus

43
Q

Mixed Dysarthria types

A

1) Amyotrophic Lateral Sclerosis
2) Multiple Sclerosis
3) Wilson’s Disease

44
Q

Wilson’s Disease

A

Progressive lenticular degeneration which results in a mixed ataxic-hypokinetic-spastic dysarthria
Etiology: inadequate processing of dietary copper due to a rate, inherited autosomal recessive disorder

45
Q

Wilson’s Disease Characteristics

A

Harsh vocal quality, low pitch, reduced range of pitch and loudness
Motor speech symptoms: difficulty noted in the face, lips, mandible, and velopharyngeal movement
Neuromuscular symptoms

46
Q

Apraxia of Speech

A

Disorder of motor speech planning

Etiology: lesion that separates Broca’s area from the motor association area that deals with motor planning

47
Q

Apraxia of Speech Characteristics

A

Intermittent aphonia, voicing errors

Associated symptoms: changes in motor programming for articulation, pauses or hesitations in conversational speech

Voice (7 decks)

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