Spastic Dysarthria Flashcards
Spastic Dysarthria: Overview
Caused by bilateral damage to activation pathways of the CNS.
Can manifest in any or all of the components of speech production, but is rarely confined to only a single component.
Is a problem of neuromuscular execution.
Spastic Dysarthria: Characteristics
Characteristics reflect the combined effects of weakness and spasticity in a manner that slows movement and reduces range and force.
Clinical features reflect the effects of excessive muscle tone (hypertonicity) and weakness on speech.
Can exhibit clonus
Major abnormalities that affect movement in spastic paralysis:
- Spasticity
- Weakness
- Reduced ROM
- Slowness of movement
Clonus
A repetitive reflex contraction that occurs when a muscle is kept under tension
Etiologies
Any process that damages the activation pathways bilaterally can cause spastic dysarthria.
Can include:
- Degenerative
- Vascular
- Congenital
- Trauma
- Inflammatory
- Toxic/Metabolic Diseases
Vascular Disorders
Strokes in the following arteries can lead to spastic dysarthria:
- Internal carotid
- MCA
- PCA
- ACA (sometimes)
Lesions are needed in both hemispheres to produce the bilateral damage associated with spastic dysarthria.
Some spastic dysarthria patients have had multiple infarcts
Binswanger’s Disease
A term sometimes applied to patients with vascular dementia.
The bilateral lesions associated with BD can affect the UMN pathways and sometimes lead to spastic dysarthria and dysphagia.
Moyamoya Disease
A chronic, progressive vascular disease most frequently affecting children and young adults.
Can cause stroke and intracranial hemorrhage that can lead to S&L deficits, including spastic dysarthria.
Degenerative Diseases
When spastic dysarthria is the primary manifestation of neurodegenerative disease, the disorder is sometimes referred to as Progressive Pseudobulbar Palsy.
Spastic dysarthria can emerge in people with neurodegenerative apashia and apraxia of speech.
Primary Lateral Sclerosis (PLS)
Subcategory of motor neuron disease (degenerative) that often begins around age 50-60.
Can present with spastic dysarthria with or without dysphagia, and dysarthria is eventually present in many cases.
Cerebral Palsy
A congenital disorder that is very often associated with spastic dysarthria, which can be severe.
Leukoencephalitis
An inflammatory demyelinating disease that affects the white matter of the brain or spinal cord.
The bilateral and multifocal effects can affect UMN pathways and cause spastic or mixed dysarthrias.
Patient Perceptions and Complaints
- Speech is slow or effortful
- Fatigue when speaking
- Must speak more slowly to be understood, but also admit they can’t speak any faster.
- Swallowing complaints often in the oral and pharyngeal phases.
- Drooling (more than any other dysarthria type)
- Gagging when brushing teeth
- Difficulty controlling emotions (more than any other dysarthria type)
Non-Speech Oral Mech
- Dysphagia is common and can be severe
- Face may be weak bilaterally; range of lips may be decreased.
- Face may be in a fixed, subtle smiling posture.
- Tongue is fully symmetric but ROM may be reduced.
- Slow and reduced ROM in AMRs
- Symmetric but slow palate
Speech
Conversational speech, reading, AMRs, and vowel prolongation are most useful tasks.
Spastic dysarthria is associated with impaired movement patterns rather than weakness of individual muscles
Speech: Distinguishing Features
Strained-harsh VQ Monopitch Monoloudness Slow speech rate Slow and regular AMRs