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Voice Disorders > Neurogenic voice disorders > Flashcards

Neurogenic voice disorders Flashcards

1
Q

What structures of the central nervous system control the larynx?

A
  • motor cortex
  • primary motor strip
  • mid-brain
  • brain stem
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2
Q

What is the function of Broca’s area?

A

Voice response (pre-planning)

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3
Q

What is the function of the insula?

A

Motor planning for voice

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4
Q

What is the function of the precentral gyrus?

A

voice production

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5
Q

What is the function of the basal ganglia/thalamus?

A

sensory info for vocalizing (motor)

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6
Q

What is the function of the temporal lobes (Heschyl’s gyrus)?

A

audition

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7
Q

Name the different structures important for speech/language and their function

A
  1. Broca’s area - voice response (pre-planning)
  2. Insula - Motor planning for voice
  3. precentral gyrus - voice production
  4. basal ganglia/thalamus - sensory info for vocalizing (motor)
  5. Temporal lobes (Heschyl’s gyrus) - audition
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8
Q

Peripheral nervous system includes what nerves?

A

cranial nerves

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9
Q

What are the cranial nerves important for phonation/voice?

A
  • glossopharyngeal (CN IX)
  • -Vagus (X)
  • Spinal accessory (XI)
  • Hypoglossal (XII)
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10
Q

what is the function of the glossopharyngeal nerve?

A

innervates stylopharyngeus muscle for motor movement. (elevates larynx)

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11
Q

What is the function of the vagus nerve?

A
  • superior laryngeal nerve (above vocal folds)

- recurrent laryngeal nerve: sensory and motor to larynx, motor to thorax

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12
Q

What is the function of the spinal accessory nerve (XI)?

A

innervates
neck accessory muscles
levator veli palatini
uvula

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13
Q

What is the function of the hypoglossal (XII) nerve?

A

innervates tongue muscles to help depress/elevate larynx

innervates neck strap muscles

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14
Q

What are the branches of the vagus nerve?

A

superior laryngeal nerve

recurrent laryngeal nerve

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15
Q

What does the superior laryngeal nerve innervate?

A

sensory: (internal branch) mucous membrane supraglottal larynx
Motor: (external branch) innervates cricothyroid muscle

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16
Q

What muscles does the recurrent laryngeall nerve innervate?

A

Motor:

  • thyroarytenoid muscle of vocal folds
  • posterior cricoarytenoid muscle (abductor)
  • lateral cricoarytenoid muscle (adductor)
  • transverse arytenoids (adduction)
  • oblique arytenoids (adductors)
  • all other laryngeal muscles
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17
Q

The recurrent laryngeal nerve innervates _____ side.

A

same

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18
Q

Right recurrent laryngeal nerve innervates which vocal fold?

A

right vocal fold

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19
Q

Left recurrent laryngeal nerve innervates which vocal fold?

A

left vocal fold

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20
Q

What causes vocal fold paralysis?

A

damage to the recurrent laryngeal nerve

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21
Q

What is the pathway of the right recurrent laryngeal nerve?

A

Right recurrent laryngeal nerve loops behind right carotid and right subclavian arteries

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22
Q

What is the pathway of the left recurrent laryngeal nerve?

A

The left recurrent laryngeal nerve loops around aortic arch

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23
Q

Look at vagus nerve pathway and describe the pathway of the left and right recurrent laryngeal branches

A

right recurrent laryngeal nerve: female: loops behind the subclavian and common carotid arteries
left recurrent laryngeal nerve: male loops around aortic arch

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24
Q

What are the neurogenic etiologies?

A
  • congenital
  • lesions/tumor/disease
  • trauma
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25
Q

What is a neurogenic congenital disorder?

A

Hungtington’s (genetic disposition)

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26
Q

A neurogenic lesion/tumor/disease can cause what?

A

dysarthria
stroke
cancer

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27
Q

What would be neurogenic trauma?

A

TBI

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28
Q

Name disorders caused by lesions in lower motor neuron ?

A
  • Vocal fold paralysis
  • Myasthenia gravis
  • Guillaine-Barre
  • Flaccid dysarthria
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29
Q

Flaccidity means:

A

weakness
reduced muscle contraction
reduced range of motion

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30
Q

Describe laryngeal function of flaccid dysarthria?

A
  • weak vocal folds
  • fibrillations
  • atrophy
  • fasciculations
  • low tone (hypotonic)
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31
Q

What is the number one sign of flaccid dysarthria?

A

hypernasality

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32
Q

What are the voice qualities of flaccid dysarthria?

A
  • Phonatory incompetence: breathy voice, audible inspiration and short phrases
  • Resonatory incompetence: hypernasality, nasal emission, imprecise consonants, short phrases
  • Phonatory - Prosodic insufficiency: harsh voice, monpitch, monoloudness
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33
Q

Vocal fold paralysis is due to what?

A

Unilateral lesion to the recurrent laryngeal nerve

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34
Q

The majority cases resulting in unilateral vocal fold paralysis are of what type?

A

Adductor type: paralyzed vocal fold cannot adduct or help with closing the glottal space.

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35
Q

Speech pathologist often see what kind of lower motor neuron disorder?

A

Vocal fold paralysis

36
Q

What do you need to check for with a patient who has vocal fold paralysis?

A

Make sure they don’t have swallowing problems since vocal fold can’t come mid-line to help close glottis.

37
Q

What factors into the highly variable presentation of unilateral vocal fold paralysis?

A
  • location of paralyzed fold relative to the non-paralyzed fold.
  • compensatory strategies to help close off the glottal space
38
Q

What is the voice quality of vocal fold paralysis?-

A

breathiness

hoarseness

39
Q

Surgery-knit scratched can damage what?

A

recurrent laryngeal nerve

40
Q

What causes myasthenia gravis?

A

Reductions in the peripheral nervous system neurotransmitter, acetylcholine, via an autoimmune mechanism, resulting in severe decline in a muscle’s ability to contract.

41
Q

What are the symptoms of myasthenia gravis?

A
  • sound prolongations means muscle weakness increases
  • dysphonia, weak and breathy
  • inspiratory stridor
  • reduced vocal loudness
  • monotone voice
  • hypernasality
  • hoarseness
  • tremor
42
Q

What happens in Guillian Barre?

A

Voice problems result in speech issues.
Body attacks itself: nerve to muscle transmission is not happening
-Cerebral spinal fluid diagnosis
-slurring words (Bell’s palsy)

43
Q

What causes spastic dysarthria?

A

Bilateral damge to the upper motor neuron system

44
Q

What are the voice qualities of a patient with spastic dysarthria?

A
  • spasticity
  • hypernasality
  • straing/strangle
  • short phonation time
  • monopitch/monoloudness
  • harshness
45
Q

Never sit ______ a patient with spastic dysarthria.

A

across

46
Q

What is the laryngeal function of patients with spastic dysarthria?

A
  • hypertonicity: excessive muscle tone
  • reduced range of motion
  • hyperactive reflexes
  • vocal fold spasms
47
Q

Name neurogenic disorders with upper motor neuron involvement.

A
  • spastic dysarthria
  • hypokinetic/hyperkinetic dysarthira
  • mixed dysarthria
  • ataxic dysarthria
48
Q

What causes hypokinetic dysarthria?

A

Damage to the basal ganglia control circuit (UMN involvement)

  • There is a loss of dopamine which is produced in basal ganglia
  • muscle starts to lose nerve muscle transmission
49
Q

What are the voice qualities of patients with hypokinetic dysarthria?

A
  • reduced vocal intensity
  • breathy voice quality
  • inability to vary vocal pitch
  • reduced phonation duration
  • reduced intelligibility
  • tremor in the voice
50
Q

What is the laryngeal function of a patient with hypokinetic dysarthria?

A
  • rigidity
  • bradykenisia
  • limited ROM
  • resting tremor
51
Q

The muscles in ______ disease can be trained as opposed to the muscles with an _____ disorder.

A

Parkinson’s

ALS

52
Q

What disease is associated with hypokinetic dysarthria?

A

Parkinson’s disease

53
Q

______ of vocal folds happens in Parkinson’s disorder because muscle atrophies, can’t keep tone

A

bowing

54
Q

Why does bowing of vocal folds occur in Parkinson’s disease?

A

Because muscle atrophies, can’t keep tone

55
Q

What happens with bowing of the vocal folds in parkinson’s disorder?

A
  • There is a gap between vocal folds

- Prevents vocal folds from closing completely and from vibrating normally.

56
Q

Parkinson’s disease affects what systems?

A

Phonatory and respiratory

57
Q

What are the symptoms of Parkinson’s disease?

A
  • affects posture
  • reduced loudness/reduced intensity
  • short phonation time
  • laryngeal tremor
  • breathy
58
Q

What causes hyperkinetic dysarthria?

A

Any damage to the basal ganglia control circuit or portions of the cerebellar control circuit

59
Q

What are other disorders associated with hyperkinetic dysarthria?

A
  • neurogenic: spasmodic dysphonia
  • essential tremor
  • (Chorea) Huntington’s disease
60
Q

What is spasmodic dysphonia?

A

Neurogenic voice disorder caused by irregular and uncontrollable spasms within muscles controlling the opening and closing the vocal folds.

61
Q

What are the symptoms of hyperkinetic dysarthria

A
  • uncontrolled movements
  • strain/strangle
  • excess loudness
  • pitch control
62
Q

What causes ataxic dysarthria?

A

Damage to the cerebellum or cerebellar control circuit (UMN involvement)

63
Q

A person with ataxic dysarthria has ____ speech hence sounds

______.

A

slurred

drunk

64
Q

What are the symptoms of ataxic dysarthria?

A
  • prosodic slowdown
  • resonance changes
  • inarticulation “intoxicated”
65
Q

What happens to the vocal folds in ataxic dysarthria?

A

There is in-coordination of vocal folds, not moving symmetrically.

66
Q

What is usually the cause of death for patients with Parkinson’s Disease?

A

Aspiration/pneumonia because vocal folds stop coming together when they swallow. Liquids water get into lungs causing bacteria to grow.

67
Q

Parkinson’s is a _____ _____ disease.

A

progressive degenerative

68
Q

_______ disease can recover.

A

Parkinson’s

69
Q

_____ doesn’t recover.

A

ALS

70
Q

Why does a patient with ALS does not recover?

A

Weakness of respiratory muscles, failure to breathe

71
Q

Akinesias are present in what type of dysarthria?

A

Hypokinetic dysarthria

72
Q

What is the origin of spasmodic dysphonia?

A

-UMN neurogenic

73
Q

What is the origin of muscle tension dysphonia/functional dysphonia?

A

Functional

74
Q

If you can laugh or yawn there is no muscle tension which means ______ ________.

A

normal voicing

75
Q

What is the most common mixed dysarthria?

A

Spastic-flaccid

76
Q

What causes multiple sclerosis?

A

Myelin sheath degeneration

77
Q

What diseases can have mixed dysarthria?

A

ALS
Multiple sclerosis
TBI

78
Q

What causes ALS?

A

Damage to the UMN and LMN: it attacks the neurons responsible for voluntary muscle contraction.

79
Q

What are the voice characteristics for a patient with ALS?-

A
  • weak voice
  • hoarseness
  • roughness
  • strained voice
  • hypernasality
  • decreased speech intelligibility
  • slow rate of speech
80
Q

What happens to the vocal folds in ALS?

A

Incomplete vocal fold closure

81
Q

What kind of dysarthria results of ALS?

A

Mixed dysarthria
flaccid-spastic
-spastic-flaccid

82
Q

What are the voice qualities of MS?

A
  • abnormally long pauses between words or individual syllables of words
  • hypernasal
  • difficulty raising the vocal loudness due to the inability to generate sufficient expiratory muscle force
  • weak phonation, harshness
  • disturbances of respiratory cycle
83
Q

What are the visual features of multiple sclerosis?

A
  • reduced vocal fold closure

- weakened laryngeal muscles

84
Q

What voice qualities result from a TBI?

A

hoarseness

inspiratory and expiratory stridor

85
Q

What type of dysarthrias are associated with MS?

A

Ataxic

Mixed

Voice Disorders (6 decks)

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