quiz 4 Flashcards
spastic dysarthria effects which subsystems
any or all
not confined to a single component
SD is predominantly a problem of
- neuromuscular execution
- not planning programming or control
clinical features of SD
excessive muscle tone and weakness (resistance to movement)
direct activiation pathways also known as
pyramidal and extra pyramidal
-form part of the UMN system
direct pathways consist of
corticobulbar and corticospinal tracts
direct pathways are
- bilateral
- facilitatory (impulses sent through them tend to lead to movement which are SKILLED AND DISCRETE MOVEMENTS)
etiologies of SD
- degenerative (ALS, motor neuron disease)
- vascular (stroke, anoxic encephalopathy)
- congenital (CP)
- demylinating (MS)
- undetermined
Spasticity and weakness affect
-speed
-range
-force
of movement
ataxic dyarthria predominantly reflects..
problems with motor CONTROL
ataxic dysarthria can affect which subsystems
and or all
-MOST EVIDENT IN ARTIC AND PROSODY
etiologies of ataxic dysarthria
AND process that damages the cerebellum or cerebellar control circuit
-degenerative, demyelinating, vascular, tumor, traumatic, toxic/metabolic/endocrine, undertermined, multiple, other
clinical features of ataxic dysarthria
- incoordination and reduced muscle tone appear responsible for slowness of movement and inaccuracy in force, range, timing, and direction of speech movements
- people often complain of slurred, drunken speech
- complaints of dysphagia and drooling are infrequent
most distinctive cues of ataxic dysarthria
- irregular articulatory breakdowns
- irregular speech AMRs (alternating motion rates)
- excessive and equal stress
- distorted vowels
- excess loudness variation
hypokinetic dysarthria manifests in which subsystems
any or all
MOST EVIDENT IN VOICE, ARTIC, AND PROSODY
hypoK dysarthria reflects effects of…
- rigidity
- reduced force and range of movement
- slow individual and sometimes repetitive movements of speech
- DECREASED RANGE OF MOVEMENT
hypoK dysarthria results from..
damage to the basal ganglia control circuit pathway
hypoK dysarthria etiologies
-degenerative, vascular, traumatic, infectious, inflammatory, neoplastic, toxic and metabolic diseases
MOST COMMON CAUSE IS PD
(go back and read more about hypoK)
hyperkinetic dysarthria manifests in which subsystems
-any or all
MOST EVIDENT IN PROSODY AND RATE
Hyperkinetic dysarthria results from
- damage to basal ganglia control circuit
- destruction of sub thalamic nucleus causes reduced inhibitory output from BG which results in increased thalamic and subsequent cortical firing
hyperkinesia
abnormal or excessive involuntary movements
hyperkinetic dysarthria deviant speech characteristics
-abnormal rhythmic or irregular and unpredictable, relic or slow involuntary movements
hyper
EXTRA
dyskinesias
abnormal involuntary movements regardless of etiology
orofacial dyskinesias
involuntary orofacial movements that can occur without hyperkinesias elsewhere in the body
myoclonus
involuntary single or repetitive brief lightening-like jerks of a body part
QUICK AND REPETITIVE
-cannot be inhibited willfully
-can be induced by various stimuli or spontaneously
-associated with epilepsy
action myoclonus (AM)
-induced by volitional muscle activity and is less generalized than other forms
palatopharyngolaryngeal myoclonus (PM)
-abrupt, rhythmic, or semi rhythmic uni or bilateral movements of the sort palate, pharyngeal walls and laryngeal muscles
chorea
full limb jerking movements
- non repetitive
- involuntary
- can be response to drugs or during pregnancy
- degenerative (huntington’s chorea)
dystonia
-involuntary abnormal postures resulting from excessive cocontraction of agonist and antagonist muscles
dystonia results from
-abnormailities in the basal ganglia, cerebellum, and dopaminergic system
dystonia reflects impaired inhibition resulting from…
-abnormalities of somatosensory processing and integration
cervical dystonia (spasmodic torticollis)
- segmental dystonia characterized by tonic or clones spasms of the neck muscles especially in sternocleidomastoid and trapezius
- BG disorder
tonic spasm
prolonged or continuous
clonic spasms
repetitive, rapid in onset and brief in duration
most common involuntary movement
tremor
tremor involves..
-rhythmic/periodic movements of a body part
resting tremor
occurs when the body part is in repose (rest)
postural tremor
occurs when the body part is maintained against gravity
action tremor
during movement
terminal tremor
as the body part nears the target
essential tremor
occurs with sustained posture and action and commonly affects the upper limbs, head or voice
- reduced by alcohol
- linked to cerebellar dysfunction
cerebellar tremor
occurs during sustained postures and action and terminally
essential voice tremor
onset is gradual and worsens with fatigue and psychological stress and improve with alcohol intake
-can be isolated or cooccur with head or extremity tremor
most common abnormal movements
chorea, dystonia, athetosis. spasmodic tortocollis, myoclonus, tics and tremor
unilateral upper motor neuron (UUMN) mainifests in which subsystems
-articulation phonation and prosody
any or all
deviant characteristics of UUMN
weakness, sometimes spasticity and incoordination
UUMN label
is ANATOMIC rather than PATHOPHYSIOLOGIC
UMN direct pathway impulses are crutial for
-impulses traveling the direct pathway appear crutial for finely coordinated skilled movements
UMN indirect pathway impulses are crutial for
-regulating reflexes and controlling posture and tone upon which skilled movements are superimprosed
most common cause of UUMN
STROKE
lacunes or lacunar infarcts
occur in brainstem, cortical, or subcortical areas the cerebral hemispheres
- result of occlusion of small penetrating branches of large cerebral arteries
- primarily motor or sensorimotor
most common sites of lacunes
BG, thalamus, internal capsule, brainstem
flaccid dysarthria results from damage to..
one or more cranial or spinal nerves
-reflect problems in the nuclei, axons, or neuromuscular junctions that make up the motor unit of the final common pathway
flaccid manifests in which speech subsystems
respiratory
artic
phonatory
resonatory
primary deviant speech characteristics flaccid
muscle weakness and reduced muscle tone
effect speed range and accuracy of speech movements
how are subtypes of flaccid recognized
-distinct abnormalities attributable to unilateral or bilateral damage to a specific cranial or spinal nerve or a combo
all flaccid dysarthrias are considered to be a problem of..
neuromuscular execution NOT planning programming or control
flaccid-paralysis affects…
reflexive, automatic, and voluntary movements
- weakness hypotonia, diminished reflexes
- atrophy, fasiculations
flaccid-weakness affects
muscles ability to contract is reduced or lost because motor units are inactivated
-results in paralysis or paresis
flaccid-hypotonia or reduced reflexes
- floppiness of muscle tissue and reduced resistance to passive movement
- reduced or absent normal reflexes
-reduced because components of the stretch reflex is activated by the final common pathway
flaccid-atrophy
muscles loose bulk
-always associated with weakness
fasiculations
visible, arrhythmic isolated twiches in resting muscle that result from spontaneous motor unit discharges in response to nerve degeneration or irritation
fibrillations
invisible spontaneous independent contractions of individual muscle fibers that reflect slow repetitive action potentials
can be detected on EMG within about 1-3 wks after a muscle is deprived of motor nerve supply
flaccid-progressive weakness with use
myasthenia gravis
-rapid weakening and recovery with rest are prominent in neuromuscular junctions disease
neuropathy
disease of nerve usually of nonimflmmatory etiology
neuritis
an imflammatory disorder of nerve
peripheral neuropathy
any disorder of nerve in the peripheral nervous system
can affect motor sensory or autonomic fibers
can be demyelinating, axonal or mixed in their effects
pure motor hemiparesis
purely motor stroke involving the face, arm, and leg on one side
clinical features present with UUMN dys
lower facial weakness and hemiparesis
contralateral lingual weakness
drooling and dysphagia
recovery is GOOD
most common deviant speech characteristics UUMN
imprecise arctic, slow rate, slow and irregular AMRs, harsh-strained or harsh -breathy vocal quality, reduced loudness
most common mixed dys
FLACCID-SPASTIC
mixed dys is more common than any other single dys?
YES
Spinal muscle atrophies
affect LMNs only
flaccid
progressive bulbar palsy
associated with flaccid
lmn weakness of cranial nerve mms
PLS
affects UMNs only
bulbar mms affected
without LMN involvement is spastic only
ALS
most common motor neuron disease
UMN and LMN signs
common associated with mixed spastic-flaccid dys
-dysphasia and airways problems pose major threat to life
FA
inherited degenerative disease
spinocerebellar
mixed ataxic-spastic dys
Progressive suprenuclear palsy
neurodegenerative disease multi system
mixed dysarthria occurs in form of various combos of hyperkinetic, spastic, and ataxic
multi system atrophy
sporadic neurodegenerative condition with combos of PD, ataxia, spasticity, and autonomic dysfunction
MSA-P: (PD) hypo kinetic type most often but when seen in combo is seen with spastic or ataxic
MSA-D: (cerebellar) ataxic type most often but when mixed seen with hypo kinetic and spastic
MS
when present, dysarthria may reflect nearly and single type or combo of single types
spastic-ataxic is most common
vascular disorders
combos of spastic, ataxic, and flaccid are common in brainstem strokes
-hyperkinetic resulting from PM myoclonus can occur
corticobasal degeneration
spastic and hypo kinetic types most common
hyperkinetic and ataxic types can occur
toxic-metabolic conditions
commonly a mixed dysarthria
wilson’s disease
hypokinetic, ataxic, spastic cardinal features
hypoxic encephalopathy
presence of at least hypo kinetic and hyperkinetic and ataxic forms
mutism
absence of speech
causes of mutism
maybe organic but non neurologic
- profound congenital hearing loss
- peripheral structural loss
- deliberate
- psychiatric disturbances
neurogenic mutism can result from
severe dysarthria, AOS, aphasia, nonaphasic congitive affective conditions
-post seizures, surgical resection of corpus callosum
anarthria
specchlessness due to severe lossof neuromuscular control of speech
-dysarthria in most severe form
locked in syndrome
when anarthria is accompanied by quadriplegia and total body immobility except for vertical eye movements and blinking
coma
state of unarousable unresponsiveness and absence of sleep/wake on EEG
speech arrest
most commonly associated with parietal seizures speech is halted
palalalia
compulsive repetition of words and phrases, often in context of increasing rate and decreasing loudness
normal voice…then repeated in whisper
associated with hypo kinetic dys
echolalia
motorically normal unsolicited repetition of another’s utterances
limited processing of meaning
