spastic dysarthria Flashcards
what is spastic dysarthria caused by?
damage to the direct and indirect activation pathways on the CNS
T or F. There is rearely only direct activation or indirect activation pathway damage bc these tracts intermingle
True
T or F. bilateral lesions are usually required to have significant dysarthria
True
T or F. unilateral lesions don’t have as severe affect because something is getting through on the side not affected.
True
what is another name for spastic dysarthria?
pseudobulbar palsy
What subsystems does spastic dysarthria affect?
respiratory, phonatory, resonatory, and articulatory
may affect prosody
what is the primary characteristic of spastic dysarthria?
spasticity
what are the symptoms of spastic dysarthria?
spasticity
weakness
slow movements
reduced ROM
there is slow movement bc of the increased resistance to movement.
lesions of the UMN cause:
weakness
loss of skilled movements: with damage to the direct pathway you find the ability to produce fine, skilled movements, like those in spch, is affected or lost.
decreased tone: at first, the signs are of reduced muscle tone and weakness but as it progresses the signs change to increased muscle tone
hypertonia:
babinski reflex: a pos babinski reflex is a sign of UMN/direct pathway damage, (stroke the bottom of the foot and the toes fan out with the large toe extending. This is an abnormal reflex in adults but normal in babies.)
what are the abnormal reflexes seen with UMN damage: (3)
- sucking: stroke the tongue blade across the upper lip starting at the side and move to the middle.-do on both sides. Abnormal reflex is when there is pursing of lips. Normally nothing happens. in very exaggerated reflexes, the mouth may turn toward the tongue blade to result in a rooting reflex.
- snout: if you use tongue balde or finger to tap or push backward on tip of nose or phitrum you see the bottom lip pull up
- Jaw jerk reflex: have lips open and parted. place a tongue blade or finger on the chin and tap with other finger. Abnormal response is the quick closing of the jaw.
what does spacticity do to movements?
it slows movement and decreases ROM and force
What does it mean when your muscles are spastic?
too much muscle tone meaning the contracted muslces (spasticity is the result of the hyperactivity of the stretch reflex. increased muscle tone)
What is the direct pathway also known as?
The pyramidal system
The direct pathway is part of what system the UMN or LMN?
UMN
Is the direct activation pathway bilateral or unilateral?
bilateral
The UMN/ Direct pathway sends messages to the?
LMN/FCP (final common pathway)
What are the two parts of the UMN/ Direct activation pathway?
Corticobulbar and corticospinal
Corticobulbar goes to what pathway?
The cranial nerves
Corticospinal goes to what pathway?
the spinal nerves
What is the direct activation pathway called “direct”
it is direct bc it leads directly to the cranial nerve nuclei in the brainstem and the spinal nerve nuclei in the spinal cord
Are most cranial nerves that innervate muscles for speech bilaterally innervated or are most unilaterally innervated?
bilaterally
Why are most of the cranial nerves that innervate speech muscles bilateral?
this bilateral input functions as protection bc it takes two lesions to really affect the muscles
-it reduces the impact of damage
What two muscles are unilaterally innervated?
the genioglossus that is innervated by the hypoglossal
-the bottom portion of the face (Facial nerve)
Why is the direct pathway called facilitory?
bc it leads to movement (it is responsible for skilled, discrete, quick movements)
What kind of movements is the DAP responsible for
skilled, discrete, quick movements
What is another name for the indirect activation pathway?
Extrapyramidal system
Why is the iap called indrect?
it is called indirect bc it has many synapses along the way from its path from the cerebrum to the brain stem and the spinal
Where does the iap originate from?
it originates in the motor cortex of each cerebral hemisphere
The indirect activation pathway makes connections with?
the basal ganglia, cerebellum, reticular formation, vestibular nuclei and the red nucelus
the iap is essential for regulating of what kind of movements?
regulates skilled movements
The IAP helps maintain?
tone
What is tone important for?
tone is important for sustained postures required to support movements of direct activation system
T or F damage to the indirect pathway primarily affects the inhibitory role of motor control.
True
What does damage to the indirect pathway primarily affect?
The inhibitory role of motor control
Since damage to the IAP affects the inhibitory role of motor control what will you see?
increased muscle tone and hyperactive reflexes.
What can cause spastic dysarthria (etiologies)
can be caused by anything that affects the direct/ indirect pathway -degenerative, inflammatory toxic metabolic traumatic vascular dz
What is the most common cause of spastic dysarthria?
vascualr dz
Vascular disorders are?
infarcts of interior carotid artery and middle and posterior cerebral arteries -must have bilateral lesion bc these arteries are far apart (one in each hemisphere so damage doesnt affect the other) However in the brain stem where L a R pathways are closer together you may get damage to both pathways by a single lesion.
Does a single lesion in the cerebral hemisphere usually cause spastic dysarthria?
No, it usually does not the tracts are far apart (1 in each hem.) so it takes to lesion.
Does a single lesion in the brainstem cause spastic dys?
Yes because the tracts are so close together in the brainstem damage to one normally means damage to both tracts
What are lacunar infarcts
they are caused by very tiny holes in the cortex from strokes (mini strokes)
what can lacunar infarcts lead to?
they can lead to dementia or damage to the brain
T or F when a ptnt is having a lacunar infarct stroke do they may not even know they are having one.
True because they are mini strokes
what is the term for ptnts with many lacunar infarcts that have dementia, usually spastic dys, dysphagia and incontenence?
lacunar state
What is binswanger’s subcortical encephalopathy?
is a term given to patients with multiple infarct dementia occurring over years and mos. They may have spastic dys. (dys can be a differentiating characteristics btwn the types of dementias that have dys and the ones that don’t)
What is a type of inflammatory dz that can cause spastic dys?
leukoencephalitis
what is leukoencephalitis?
it is the inflammation of the white matter in the brain
What is the degenerative dz that can cause spastic dysarthria?
Primary lateral sclerosis (PLS)
what is primary lateral sclerosis?
a degenerative dz it is a motor neuron dz
ALS is a subcategory of PLS but in PLS there are only signs of UMN damage not LMN
What type of dys does ALS result in?
Flaccid spastic
What does the ptnt compain of in spastic dys?
slow or effortful speech, fatigue, ptnt feels their spch is nasaly, difficulty swallowing, drooling, difficulty controlling emotions
what is the pseudobulbar affect?
difficulty controlling emotions especially laughing and crying
What types of dys is pseudolbulbar affect in?
spastic but can be in mixed if spastic component
What is another term for pseudobulbar affect?
emotional lability
What are nonspeech clinical findings of spastic dys?
dysphagia along with nasal regurgitation
drooling,
face may be held in a fixed posture, either smiling or pouting (excessive facial emotional expressions)
emotional lability seen
jaw strenght may be normal, face may be weak bilaterally, tongue may have reduced ROM and show weakness when doing strength testing
gag reflex may be hyperactive
pathological oral reflexes: jaw jerk, snout, suck
How would you want to assess spastic dys?
conversational speech, reading AMR’s and vowel prolongation
What are some speech characteristics of spastic dys?
strained-strangled voice qality
hoarsness
low pitch reduced pitch and loudness variability
hypernasality-due to slowness of palate
imprecise articulation-mevements are restricted
slow rate (regular but slow AMR’s)
What can the speech characteristics be traced to? ex: why is their hypernasality etc..
spasticity, slowness of movemnet, reduced ROM, and to the lesser degree-weakness.
