Spastic Dysarthria

Question 1

Cause of SD

Answer 1

caused by bilateral damage to both the pyramidal and extrapyramidal neural pathways

Question 2

Upper motor Neuron - pyramidal system

Answer 2

• corticospinal tract
• corticobulbar tract

Question 3

Upper motor Neuron - extrapyramidal system

Answer 3

UMNs = motor fibers in CNS
- motor tract
- to get the signals to the lower neurons

Question 4

Motor neuron - UMN damage

Answer 4

Cause spasticity
- hypertonicity
- hyperreflexia
- unilateral damage > UUMN dysarthria
- bilateral damage > spastic dysarthria

Question 5

Motor neuron - LMN damage

Answer 5

Cause flaccidity
- hypotonicity
- hyperreflexia
- flaccid dysarthria

Question 6

What is spasticity?

Answer 6

UMN damage = spasticity
- a type of hypertonicity
- unregulated reflexive contraction
- some UMN control our reflexes when we don’t want them
- UMNs can override reflexes

Question 7

Neurological basis of SD - Damage UMNs

Answer 7

• motor neurons in CNS
• bilateral damage
• pyramidal and extrapyramidal tracts that serve speech muscles

Question 8

Neurological basis of SD - pyramidal system

Answer 8

• originate in PMC (primary motor cortex)
• synapse with LMNs at brainstem
• direct activation pathway
• corticobulbar tract serves most speech muscles
• bilateral damage = weakness and slowness of speech muscles on both sides

Question 9

Neurological basis of SD - extrapyramidal system

Answer 9

• fibers originate in cortex and brainstem
• make numerous connections
• eventually synapse with LMNs
• indirect activation pathway
• maintains posture, regulate reflexes, monitors muscle tone
• works in parallel with pyramidal system

Question 10

Signs of UMN lesions - SD

Answer 10

bilateral damage to both pyramidal and extrapyramidal and extrapyramidal fibers that innervates speech muscles

Question 11

combination of symptoms

Answer 11

• weakness
• slow movements
• spasticity
• hyperreflexia
• spastic paralysis

Question 12

Etiologies - stroke

Answer 12

• most common cause of SD
• single stroke in brainstem
• or single stroke with or following one in the other hemisphere
• or pre-existing condition on other side
• no such thing as a spastic/UUMN mixed dysarthria

Question 13

Etiologies - TBI

Answer 13

• cortical
• subcortical
• brainstem
• hemorrhages
• hematomas
• herniation - compressed tissues

Question 14

Etiologies - brainstem tumors

Answer 14

compress UMNs or CN nuclei

Question 15

Etiologies - cerebral anoxia

Answer 15

possible widespread damage to both sides

Question 16

Etiologies - viral or bacterial infections

Answer 16

e.g. meningitis
- itis: information

Question 17

Speech characteristics - articulation

Answer 17

imprecise consonants
- incomplete articulatory contacts
- incomplete clusters

vowel distortion

Question 18

Speech characteristics - phonation

Answer 18

harsh voice quality
- fricative through partially open glottis

“strained-strangled”

low pitch
- spasticity of TA muscle

Question 19

Speech characteristics - resonance

Answer 19

hypernasality

Question 20

Speech characteristics - prosody

Answer 20

• monopitch
• monoloudness
• short phrases
• slow speech rate - reduced speed of articulators

Question 21

Additional characteristics

Answer 21

Psudobulbar effect
- “emotionally labile” : very emotional, even with the smallest thing
- UMN damage

Drooling

Positive babinski sign
- bilateral in SD
- spastic on both feet
- sign of upper motor neuron

Question 22

babinski sign

Answer 22

big toe juts out, the other toes faint out

Question 23

Key evaluation tasks

Answer 23

Conversational speech and reading

AMRs
- rhythm can be regular or irregular
- speech is slow and regular

Vowel prolongation
- strength strangled voice

Question 24

Treatment for phonatory deficits

Answer 24

easy onset
- visi-pitch: start out quiet and put more pressure latter

Yawn-sigh
- used to improve pitch, loudness, and quality in hyper funciton
- laryngeal elevation, tongue high and forward, VFs tight, pharynx constrcited
- yawn-sigh is designed to counteract this
– add voice after sigh (mid or low vowels)
– /h/ word

Question 25

Treatment articulation

Answer 25

• intelligibility drills
• phonetic placement
• overarticulation of consonants
• minimal contrast drills > only different from one feature that they have trouble on

Question 26

Treatment for resonance deficits

Answer 26

Behavioral treatment:
- increase loudness: SPL meter; CSL or Visi-Pitch
- exaggerate mouth opening