quiz 2 - flaccid dysarthria

Question 1

differential dx of the dysarthrias

Answer 1

• diff dx is ability to distinguish among all types of dysarthria
• each type of dysarthria has different auditory perceptual characteristics that can be distinguished clinically
• current practice: determine most salient speech characteristic, along with chart review, for dx

Question 2

purpose of differential dx of dysarthria

Answer 2

• plan treatment appropriately
• corroborate or establish medical diagnosis
• relate motor speech diagnoses to neurological localization

Question 3

characteristics of flaccid dysarthria

Answer 3

• impact is due damage of LMN, final common pathway, where nerves stimulate muscle
• LMN damage –> flaccidity
• muscle weakness in all contexts: voluntary movement, postural maintenance, muscle tone
• damage to brainstem, coma, swallowing problems, arousal problems, hypothesize flaccid dysarthria

Question 4

possible etiologies of flaccid dysarthria

Answer 4

• traumatic (surgery/injury)
• degenerative (ALS, progressive bulbar palsy)
• muscle disease (muscular dystrophies)
• inflammatory
• neuromuscular junction disease (myasthenia gravis, botulism)
• vascular diseases (brainstem stroke)
• demyelinating disease (Gullain-Barre syndrome)
• infections (poliomyelitis)
• neoplastic (tumors, especially skull base)

Question 5

speech characteristics of flaccid dysarthria

Answer 5

• completely dependent upon where in LMN/final common pathway the lesion is

Question 6

basic functions of alpha and gamma motor neurons

Answer 6

• alpha motor neuron: efferent, stimulates muscle contraction at motor end plate
• gamma motor neuron: afferent, sends information back to make adjustments
• alpha-gamma co-activation: same motor commands are delivered to both alpha and gamma motor neurons, regulating muscle tone during both rest and movement

Question 7

gamma motor neurons

Answer 7

• two types: dynamic and static
• dynamic responsible for reaction to rapid, ongoing changes in voluntary movement
• static adjust tonic level of activity, postural and/or muscle tone
• muscle spindles are buried inside muscle fibers and send information about muscle stretch to take up slack in the middle

Question 8

Rosenbek’s framework for motor learning

Answer 8

• focuses on components of client-centered tx to facilitate generalization
• feels motor speech disorders should be called cognitive motor disorders, because cognitive load affects motor speech even when cognition is normal
  1. recognizing differences
  2. willingness to change
  3. setting goals
  4. flipping the switch
  5. learning to listen, evaluate, and self-correct
  6. add cognitive-linguistic load

Question 9

1. recognizing differences

Answer 9

• determine client level of awareness
• communicative effectiveness survey

Question 10

2. willingness to change

Answer 10

• stages of readiness are: precontemplation, contemplation, preparation, action, ultimate goal (generalization)

Question 11

3. setting goals

Answer 11

• mutual goal setting, that will evolve as client improves

Question 12

4. flipping the switch

Answer 12

• therapeutic talking - talking purposefully and using strategies at all times
• initiate this right away in therapy

Question 13

5. learning to listen, evaluate, and self-correct

Answer 13

• need this to facilitate generalization
• client learns to judge correctness before clinician offers opinion
• 3-point scale is most efficient

Question 14

6. add cognitive load

Answer 14

• speech adequacy will decline in situations with higher cognitive demand even when cognition is normal
• increase load