Spastic Dysarthria Flashcards
1
Q
What causes spastic dysarthria?
A
Damage to the direct and indirect activation pathways of the CNS.
2
Q
Damage to the direct and indirect activation pathways of the CNS causes ___________.
A
spastic dysarthria
3
Q
True or False. There is mainly damage to either the direct activation or indirect activation pathway.
A
False, because these pathways intermingle.
4
Q
What kind of lesions are involved with spastic dysarthria?
UMN or LMN
A
UMN lesions
5
Q
What kind of lesions are usually required to have significant dysarthria?
A
bilateral
6
Q
Why do unilateral lesions don’t have a severe affect?
A
An impulse can get through on the side not affected, because there is usually bilateral innervation.
7
Q
What is another name for spastic dysarthria?
A
Pseudobulbar palsy
8
Q
Pseudobulbar palsy can also be called ________.
A
spastic dysarthria
9
Q
Spastic dysarthria can be seen in what subsystems?
A
Respiratory, phonatory, resonatory, and articulatory.
10
Q
How is spasticity reflected?
A
In weakness and muscles that are hard to move-Flaccid muscles are not hard to move.
11
Q
What does spasticity do to movement?
A
It slows movement and decreases ROM and force.
12
Q
Spasticity is too much ________ ________ meaning ______ muscles.
A
muscle tone
contracted
13
Q
What happens when there is too much muscle tone, contracted muscles?
A
spasticity
14
Q
Spasticity itself is a result of the hyperactivity of the ____ ____.
A
stretch reflex
15
Q
What results from hyperactivity of the stretch reflex?
A
spasticity
16
Q
In spasticity you have ______ muscle tone.
A
increased
17
Q
What is the primary characteristic of spastic dysarthria?
A
Spasticity
18
Q
What are other characteristics of spastic dysarthria besides spasticity?
A
weakness, slow movements, reduced ROM
19
Q
Why is there slow movement in spastic dysarthria?
A
There is slow movement because of the increased resistance to movement.
20
Q
What do lesions to the upper motor neuron system cause?
A
- weakness
- loss of skilled movements
- decreased tone
- hypertonia
- babinski reflex
- reflexes at first may be reduced (hypo-reflexia) but then become hyper (hyper-reflexia)
21
Q
Lesion of the UMN can cause loss of skilled movements. What does this entail?
A
With damage to the direct pathway you are unable to produce fine, skilled movements, like those in speech. Can be affected or completely lost.
22
Q
What happens when there is decreased tone due to a lesion of UMN?
A
At first, the signs are of reduced muscle tone and weakness but as it progresses the signs change to increased muscle tone and spasticity.
23
Q
How is the babinski reflex affected by a lesion to the UMN system?
A
A positive babinski reflex is sign of UMN/direct pathway damage. To elicit this you stroke the bottom of the foot and the toes fan out with the large toe extending. This is an abnormal response in adults, but is normal in babies.
24
Q
What does a positive babinski reflex indidcate?
A
it is a sign of UMN/direct pathway damage.
25
How do you elicit the babinski reflex?
To elicit this you stroke the bottom of the foot and the toes fan out with the large toe extending. This is an abnormal response in adults, but is normal in babies
26
What are other abnormal reflexes seen with UMN damage?
- sucking
- snout
- jaw jerk reflex
27
How do you elicit the sucking reflex?
Stroke the tongue blade across the upper lip starting at teh side and move to the middle - do on both sides.
28
How can one tell if the sucking reflex is abnormal?
- When there is pursing of lips, normally nothing happens.
| - In very exaggerated reflexes, the mouth turn toward teh tongue blade to result in a rooting reflex.
29
How do you elicit the snout reflex?
If you use tongue blade or finger to tap or push backward on tip of nose or philtrum (part between nose and upper lip) you see the bottom lip pull up.
30
How do you elicit jaw jerk reflex?
Have lips open and parted. Place a tongue blade or finger on the chin and tap with the other finger.
31
What is an abnormal response of jaw jerk reflex?
Quick closing of the jaw.
32
What is the direct activation pathway?
Direct pathway is also known as the pyramidal system because it passed through the pyramidal structures. The direct pathway is part of the UMN system. it sends messages to the LMN or FCP to tell them what to do.
33
What are the two tracts of the direct activation pathway?
Corticobulbar and corticospinal
34
Corticobulbar goes to the _________ nerves and corticospinal goes to the _______ nerves
cranial
| spinal
35
Is the direct activation pathway unilateral or bilateral?
bilateral, it has one nerve originating in each cerebral hemisphere, left and right.
36
why is the direct activation pathway called direct?
it leads directly to the cranial nerve nuclei in the brainstem and spinal nerve nuclei in the spinal cord.
37
___________ leads directly to the cranial nerve nuclei in the brainstem and spinal nerve nuclei in the spinal cord.
Direct activation pathway
38
Most cranial nerves innervating speech muscles have _______ input meaning that innervation comes from ______.
bilateral
| both sides
39
Why is it important to have bilateral innervation for cranial nerves?
It helps protect the function of those muscles so that even if there is even damage in one side you have bilateral innervation which reduces the impact of damage.
40
What happens when you only have contralateral innervation and there is damage to the left side?
The right side will show strong affect
41
If you have innervation from both hemispheres, even if the left side is damaged the ______ side can still send innervation.
right
42
What happens if you have innervation from both hemispheres and one side is damaged?
The side that is not damaged sends innervation
43
Where does the direct pathway mainly arise?
Motor cortex
44
The indirect activation pathway is also called _________.
extrapyramidal
45
Why is the indirect activation pathway called indirect?
It has many synapses along its path from the cerebrum to the brain stem and spinal cord.
46
Where does the indirect activation pathway originate?
cortex of each cerebral hemisphere
47
Where does the indirect activation pathway make connections?
- basal ganglia
- cerebellum
- reticular formation
- vestibular nuclei and red nucleus
48
Why is the indirect activation pathway essential?
regulating skilled movements
49
Indirect activation pathway helps maintain _________
tone
50
Why is it important to maintain tone?
It helps sustain postures required to support movements of direct activation system
51
Damage to the indirect pathway primarily affects the ______ role of motor control.
inhibitory
52
What is primarily affected when there is damage to the indirect pathway?
inhibitory role of motor control
53
What happens when there is damage to the indirect pathway affecting the inhibitory role of motor control?
There is increased muscle tone and hyperactive reflexes. It is demonstrated by a spasticity that causes the legs to resist bending and the arms to resist straightening.
54
Why don't we understand spastic dysarthria as well as flaccid dysarthria?
complexity of the CNS
55
Typically ______ diseases have more spastic dysarthrias than other kind of dysarthrias.
vascular
56
Spastic dysarthria can be caused by anything that affects the ________ or ________ __________.
direct
| indirect pathway
57
What else can cause spastic dysarthria?
- damage to direct or indirect pathway
- degenerative
- inflammatory
- toxic
- metabolic
- traumatic
- vascular
58
What disease typically cause more spastic dysarthrias than other kind of dysarthrias?
vascular
59
A single ________ stroke can cause spastic dysarthria, but a single ________ ________ stroke usually cannot.
brain stem
| cerebral hemisphere
60
Can a single cerebral hemisphere stroke cause spastic dysarthria?
No
61
Can a single brain stem stroke cause spastic dysarthria?
Yes
62
Infarcts in what arteries can cause spastic dysarthria?
internal carotid artery
| middle and posterior cerebral arteries
63
In order to have spastic dysarthria you must have _____ lesions.
bilateral lesions
| one in each hemisphere
64
In the brain stem where the left and right pathways are closer together, you may get damage to ____ _____ by a single lesion or single brain stem stroke.
both pathways
65
Why can you get damage to both pathways by a single lesion or single brain stem stroke?
The left and right pathways are closer together in the brain stem.
66
________ infarcts are caused by very tiny holes in the cortex from strokes.
Lacunar
67
What causes lacunar infarcts?
very tiny holes in the cortex from strokes
68
What can lacunar infarcts lead to?
dementia or damage to the brain.
69
Dementia or damage to the brain may be caused by what type of infarcts?
lacunar
70
Lacunar infarcts are ______ strokes, the patient may not even know they are having a stroke.
mini
71
What is lacunar state?
term for patients with many lacunar infarcts who have dementia, usually spastic dysarthria, dysphagia, & incontinence.
72
________ ________ is a term for patients with many ______ infarcts who have dementia, usually spastic dysarthria, dysphagia, & incontinence.
Lacunar state
| lacunar
73
What is Binswanger's subcortical encephalopathy?
A term given to patients with multiple infarct dementia occurring over years and months. They may have spastic dysarthria. Dysarthria is a differentiating characteristic and can help differentiate this disease from other dementias that don't have dysarthria.
74
_________ ______ ______ is a A term given to patients with multiple infarct dementia occurring over years and months. They may have spastic dysarthria. Dysarthria is a differentiating characteristic and can help differentiate this disease from other dementias that don't have dysarthria.
Binswanger's subcortical encephalopath
75
Name an inflammatory disease
Leukoencephalitis
76
What is leukoencephalitis?
inflammation of white matter of brain. can cause spastic dysarthria.
77
__________ is inflammation of white matter of brain. can cause spastic dysarthria.
leukoencephalitis
78
Name a degenerative disease that causese spastic dysarthria
Primary lateral sclerosis (PLS)
79
inflammation of white matter of brain. can cause spastic dysarthria.
leukoencephalitis
80
Prmary lateral sclerosis is a type of ______ ______ disease that causes spastic dysarthria.
motor neuron
81
ALS is a subcategory of __________
PLS (primary lateral sclerosis)
82
In PLS (Primary lateral sclerosis) there are only signs of _____ damage, ALS has both UMN and LMN damage.
UMN
83
What differentiates ALS from purely PLS?
PLS has spastic dysarthria, ALS has mixed flaccid-spastic dysarthria resulting from both UMN and LMN damage.
84
What are the patient complaints of spastic dysarthria?
-slow or effortfull speech-they feel as if there some physical resistance to their speaking.
-Fatigue- with accompanying speech deterioration.
speech is nasal-more common in spastic
-difficulty swallowing
-drooling
-difficulty controlling emotions
85
There is fatigue in both spastic and flaccid dysarthria but in myasthenia gravis deterioration is more _______.
rapid
86
What is the pseudobulbar affect (usually seen with spastic dysarthira, and not other dysarthrias).
Difficulty controlling their emotions, especially laughing and crying.
87
The pseudobulbar affect can also be referred to as ______ _____ or _________ laughing and crying.
emotional liability
| pathological
88
What causes the pseudobulbar affect?
decreased inhibition
89
Nonspeech Clinical finding for spastic dysarthria: dysphagia often seen along with ______ ________.
nasal regurgitation
90
Nonspeech Clinical finding for spastic dysarthria: Why is drooling seen?
poor control of secretions
91
Nonspeech Clinical finding for spastic dysarthria: What happens to the face?
Face may be held in a fixed posture, either smiling or pouting. May be excessive facial emotional expressions.
92
Nonspeech Clinical finding for spastic dysarthria: What happens with emotional liability?
Cry or laugh inappropriately or for no reason. May not be able to control it once started. May switch from laughing to crying. This may not match their inner emotional state.
93
Nonspeech Clinical finding for spastic dysarthria: Jaw strength may be ________, face may be _______ bilaterally, tongue may have ______ _____ and show ______ when doing strength testing. Palate is _______ but slow to move.
```
normal
weak
reduced ROM
weakness
symmetric
```
94
Nonspeech Clinical finding for spastic dysarthria: Gag reflex may be _______. Cough may be _____.
hyperactive
| weak
95
Nonspeech Clinical finding for spastic dysarthria: Pathological _______ _______.
oral reflexes
96
What are the nonspeech clinical findings:
- dysphagia often seen along with nasal regurgitation
- drooling is seen due to poor control of secretions
- face may be held in a fixed posture, either smiling or pouting. may be excessive facial emotional expressions.
- emotional liability
- gag reflex may be hyperactive
- cough may be weak
- pathological oral reflexes
- jaw strength may be normal
- face may be weak bilaterally
- tongue may have reduced ROM and show weakness when doing strength testing
- palate is symmetric but slow to move
97
You can assess spastic dysarthria with _____ speech, _______, _____ and _______ prolongation.
conversational
reading
AMRs
vowel
98
Why will it not help to assess individual cranial nerve effects in spastic dysarthria?
Because it is CNS damage and results in impaired movement patterns.
99
What speech movements are generally affected with spastic dysarthria?
all: jaw, tongue, soft palate movement etx
100
Spastic dysarthria has a ______ affect on ________.
severe
| intelligibility
101
Spastic dysarthria are better with ____ because they don't have to think about it.
reading
102
What are prominent speech characteristics of spastic dysarthria?
- strained-strangled voice quality, harshness, low pitch, reduced pitch and loudness variability.
- hypernasaslity due to slowness of palate
- imprecise articulation-movements are restricted
- slow rate-slow but regular AMRs
103
Look for _____ of symptoms, not just ______ _____.
patterns
| one symptom
104
Look at page 133 table 5-5
Go over patient cases 5.1 and 5.2
