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Motor Speech Exam 2 > Spastic Dysarthria > Flashcards

Spastic Dysarthria Flashcards

1
Q

Spastic Dysarthria (SD) is caused by damage to..

A

The direct and indirect activation pathways of the CNS.

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2
Q

T/F: Frequently, there is only direct activation or indirect activation pathway damage because these tracts intermingle.

A

FALSE: RARELY there is only direct activation or indirect activation pathway damage because these tracts intermingle.

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3
Q

T/F: Bilateral lesions have a more severe effect than unilateral lesions.

A

True

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4
Q

Why don’t unilateral lesions have as severe effect as bil lesions?

A

Because something is getting through on the side not affected (there is usually bilateral innervation)

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5
Q

Spastic Dys can be seen in which subsystems?

A

Respiratory
Phonatory
Resonatory
Articulatory

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6
Q

Spastic Dys may also be referred to as:

A

Pseudobulbar palsy

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7
Q

What are some effects spasticity has on the body?

A

Slows movement

Decreases ROM and force

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8
Q

T/F: Spasticity is not enough muscle tone meaning uncontracted muscles.

A

FALSE: Spasticity is TOO MUCH muscle tone meaning CONTRACTED muscles.

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9
Q

Spasticity is a result of the__

A

Hyperactivity of the stretch reflex.

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10
Q

T/F: In spasticity, you have increased muscle tone.

A

TRUE

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11
Q

List the defining characteristics of spasticity.

A
  • weakness
  • slow movements
  • reduced ROM
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12
Q

In spasticity, why is there slow movement?

A

Because of the increased resistance to movement.

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13
Q

Lesions of the UMN system cause:

A
  • Weakness
  • Loss of skilled movements
  • Decreased tone
  • Hypertonia
  • Babinski reflex
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14
Q

How would you elicit the babinski reflex?

A

Stroke the bottom of the foot and if the toes fan out with the large toe extending=positive

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15
Q

Is the babinksi reflex abnormal in both adults and babies?

A

No. only abnormal in adults.

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16
Q

T/F
UMN lesion: at first, signs are of reduced muscle tone and weakness, but as it progresses, signs change to increased muscle tone and spasticity.

A

True.

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17
Q 
T/F
UMN lesion (damage to direct pathway): ability to produce fine, skilled, movements, like those in speech, is not affected.
A

FALSE: ability to produce fine, skilled, movements, like those in speech, IS AFFECTED OR COMPLETELY LOST.

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18
Q

Abnormal reflex seen w/ UMN damage:

Sucking (list how to elicit it & what the abnormal reflex is)

A

Elicit: (on both sides) stroke the tongue blade across the upper lip, starting at the side and move to the middle.

Abnormal response: pursing of lips.

In very exaggerated reflexes: the mouth may turn toward the tongue blade to result in a rooting reflex.

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19
Q

Abnormal reflex seen with UMN damage: Snout (explain)

A

Elicit: use tongue blade or finger to tap or push backward on tip of nose or philtrum (part between nose and upper lip)

Abnormal response: Bottom lip pulls up

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20
Q

Abnormal reflex seen with UMN damage: Jaw jerk reflex (explain)

A

Elicit: have lips open and parted. Place a tongue blade or finger on the chin and tap with the other finger.

Abnormal response: quick closing of the jaw.

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21
Q

Direct Activation Pathway (DAP) is also known as the ____. Why?

A

Pyramidal system because it passes through the pyramidal structures.

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22
Q

The DAP sends messages to __?

A

DAP sends messages to the LMN or FCP to tell them what to do.

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23
Q

T/F: The DAP is part of the LMN system.

A

FALSE: it is part of the UMN system.

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24
Q

DAP is made up of two tracts..

A

Corticobulbar

Corticospinal

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25
Q

T/F: DAP is bilateral.

A

TRUE: It has one nerve originating in each cerebral hemisphere; left and right.

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26
Q

DAP is called “direct” because..

A

it leads directly to the cranial nerve nuclei in the brainstem and spinal nerve nuclei in the spinal cord.

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27
Q

T/F: The direct pathway mainly arises (60%) in motor cortex.

28
Q

The DAP is called ____ because it leads to movement. It is responsible for skilled, discrete, quick movements.

A

Facilitory

29
Q

The Indirect Activation Pathway (IAP) is aka..

A

Extrapyramidal

30
Q

Why is the IAP indirect?

A

Because it has many synapses along its path from the cerebrum to the brain stem and spinal cord.

31
Q

Where does the IAP originate?

A

In the cortex of each hemisphere

32
Q

Where does the IAP make connections?

A

In the:

(1) basal ganglia
(2) cerebellum
(3) reticular formation
(4) vestibular nuclei
(5) red nucleus

33
Q

The IAP is essential for regulating ___?

A

Skilled movements

34
Q

The IAP helps maintain tone- which is important for?

A

Important for sustained postures required to support movements of the direct activation system.

35
Q

Damage to the IAP primarily affects the___?

A

inhibitory role of motor control

36
Q

Damage to the IAP results in __ and __.

Which demonstrated by..?

A

(1) Increased m. tone
(2) Hyperactive reflexes

Demonstrated by a spasticity that causes the legs to resist bending and the arms to resist straightening.

37
Q

Spastic Dysarthria etiology..

A

Can be causes by anything that affects the direct or indirect pathway.

Can include:

  • degenerative
  • inflammatory
  • toxic
  • metabolic
  • traumatic
  • vascular diseases
38
Q

T/F: Typically, vascular diseases have more flaccid dysarthrias than other kind of dysarthrias.

A

False: Typically, vascular diseases have more SPASTIC dysarthrias than other kind of dysarthrias.

39
Q

Vascular disorders: Infarcts of which arteries (in the cerebrum) can cause spastic dysarthria?

A

Infarcts of:

(1) Interior carotid artery &
(2) Middle cerebral artery &
(3) Posterior cerebral artery

*Lesion must be bilateral to cause SD because these arteries are far apart (one in each hemisphere) so damage to one doesn’t affect the other.

40
Q

In the brainstem, can a single lesion or single brainstem stroke cause damage to both pathways? Why or why not?

A

You may get damage to both pathways by a single lesion or single brainstem stroke because the left and right pathways are closer together in the brainstem.

41
Q

T/F: A single cerebral hemisphere stroke can usually cause spastic dysarthria, but a single brainstem stroke cannot cause spastic dys.

A

FALSE:

  • A single cerebral hemisphere stroke usually CANNOT cause SD.
  • A single brainstem stroke CAN cause SD.
42
Q

Lacunar infarcts are caused by …. and can lead to ….

A
  • Very tiny holes in the cortex from strokes.

- Can lead to dementia or damage to brain

43
Q

Lacunar state is a term used for…

A

Term used for pts w/ many lacunar infarcts who have dementia, usually spastic dys, dysphagia, and incontinence.

44
Q

A term given to pts with multiple infarct dementia occurring over years and months.

A

Binswanger’s subcortical encephalopathy

45
Q

Pts with Binswanger’s subcortical encephalopathy may also have…?

A

Spastic Dysarthria

46
Q

Characteristic that can help differentiate Binswanger’s subcortical encephalopathy from other dementias.

A

Dysarthria

47
Q

Inflammatory disease that can cause Spastic Dys.

A

Leukoencephalitis- inflammation of white matter of brain.

48
Q

Spastic dysarthria can be seen with which degenerative dz?

A

Primary lateral sclerosis (PLS)

49
Q

In PLS, there are only signs of UMN or LMN damage?

A

UMN damage

50
Q

Primary lateral sclerosis (PLS)

A
  • A type of motor neuron dz

- ALS is a subcategory of PLS

51
Q

T/F: ALS has spastic dys.

A

FALSE: ALS has mixed flaccid-spastic dysarthria

52
Q

Spastic Dys-patient complaints..

A
  • Slow or effortful speech
  • They feel as if theres some physical resistance to their speaking
  • Fatigue(w/ speech deterioration)
  • Feel their speech is nasal
  • Difficulty swallowing
  • Drooling
  • Pseudobulbar affect
53
Q

In what other dysarthria (besides Spastic) does the pt complain of slow/effortful speech?

A

Some Hyperkinetic Dys

54
Q

A pt with Flaccid Dys will not complain of fatigue unless they have __?

A 
Myasthenia Gravis (MG) 
-deterioration is more rapid in MG
55
Q

Is this more common in spastic or flaccid: pt feels that their speech is nasal.

A

More common in spastic.

56
Q

T/F: pt complaints of difficulty swallowing and drooling are more commonly heard in spastic dys than any other dys.

57
Q

Define: pseudobulbar affect. It is usually seen in which type of dys?

A
  • Difficulty controlling emotions, esp laughing and crying.
  • Emotional lability
  • Pathological laughing and crying
  • Due to DECREASED INHIBITION
  • Seen in Spastic mixed
58
Q

T/F: Dysphagia is often seen along with nasal regurgitation.

59
Q

Nonspeech Clinical Findings in SD:

T/F: Drooling is seen due to poor control of secretions.

60
Q

List some nonspeech clinical findings in SD.

A
  • Drooling (due to poor control of secretions)
  • Face may be held in fixed posture-smiling or pouting. May be excessive facial emotional expressions.
  • Emotional lability-cry or laugh for no reason.
  • Jaw strength may be normal, face may be weak bilaterally, tongue may have reduced ROM/weakness when strength testing. Palate symmetrical but slow to move.
  • Gag reflex may be hyperactive.Cough may be weak.
  • Pathological oral reflexes.
61
Q

How would you assess SD?

A
  • Conversational speech
  • Reading
  • AMRs
  • Vowel prolongation
62
Q

Does it help to assess individual cranial nerve effects? Why or why not?

A

-No because damage is in the CNS which results in impaired movement patterns.

63
Q

Does SD affect all speech movements?

A 
Yes. 
Affected:
-jaw movement
-tongue movement
-soft palate movement
64
Q

Prominent speech characteristics of SD?

A
  • Strained-strangled voice quality, harshness, low pitch, reduced pitch and loudness variability
  • Hypernasality- due to slowness of palate
  • Imprecise articulation- mvments are restricted
  • Slow rate- slow but regular AMRs
65
Q

Does SD have a severe effect on intelligibility?

A

Yes, because all speech movements are affected.

66
Q

Why would a pt with SD have hypernasality?

A

Due to the slowness of the palate.

67
Q

T/F: When assessing a pt with SD, look for patterns of symptoms, not just one symptom.

Motor Speech Exam 2 (3 decks)

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