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Motor Speech Disorders > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Spastic dysarthria

A
  • combined effects of weakness and spasticity
  • problem of neuromuscular execution
  • combined with spastic paralysis
  • pseudobulbar palsy
  • 7% of MSDs
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2
Q

Neurobasis of spastic dysarthria

A

Damage to pyramidal at first (weakness) , then extrapyramidal systems starts to show (hyperreflexia, spasticity in velar muscles)

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3
Q

Specific damage to pyramidal system

A

Loss of fine movement, weakness, absent abdominal reflexes

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4
Q

Specific Extrapyramidal damage symptoms

A
  • increased muscle tone
  • spasticity
  • clonus
  • decorticate posture
  • hyperactive stretch reflex
  • babinski sign
  • hyperactive gag reflex
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5
Q

Confirmatory signs of spastic dysarthria

A

Spasticity, weakness, pseudobulbar affect, pathological reflexes, hyperactive stretch reflex, clonus

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6
Q

Speech subsystems affected

A

Manifests in any or all of respiratory, phonatory, resonatory, prosodic and articulatory components of speech

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7
Q

Spastic dysarthria rate, range, force, tone

A

Rate: slow
Range: reduced
Force: recused
Tone: excessive

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8
Q

Perceptual characteristics

A

Low pitch, slow rate, strained-strangled voice quality

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9
Q

Spastic dysarthria locus and primary deficit

A

Locus: upper motor neuron
Deficit: spasticity

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10
Q

Articulation symptoms with spastic dysarthria

A

Imprecise consonant production, vowel distortion

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11
Q

Phonation symptoms with spastic dysarthria

A

Harsh vocal quality, strained-strangled voice, low pitch

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12
Q

Resonance symptoms with spastic dysarthria

A

Hypernasality without nasal emission

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13
Q

Prosody symptoms with spastic dysarthria

A

Mono loudness, mono pitch, short phrases, slow rate of speech

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14
Q

Patient complaints with spastic dysarthria

A 
Slow, effort full speech
Fatigue with speaking
Swallowing complaints
Hypernasality
Hyperactive gag reflex
Drooling
Pseudobulbar affect
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15
Q

Assessment task findings for spastic dysarthria

A

Slow speech AMRs, mono loudness/pitch in conversational speech, vowel prolongation

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16
Q

Etiology of spastic dysarthria

A

Anything that damages upper motor neuron system bilaterally, degenerative diseases being most common

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17
Q

Other etiologies of spastic dysarthria

A

Stroke, TBI, brainstem tumor, cerebral anoxia, viral or bacterial infection

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18
Q

Phonation deficit treatments for spastic dysarthria

A
  • head and neck relaxation

- easy onsets

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19
Q

Articulation deficit treatments for spastic dysarthria

A

Tongue and lip stretching, intelligibility drills, phonetic placement, exaggerating consonants, minimal contrasts

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20
Q

Prosody deficit treatments for spastic dysarthria

A

Pitch range exercises, intonation profiles, contrastive stress drills, chunking utterances into syntactic units

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21
Q

Resonance deficit treatments for spastic dysarthria

A

Surgical and prosthetic treatment, increase loudness, mirror for visual feedback

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22
Q

Neurological basis of UUMN

A

Often think of UUMN dysarthria as specifically damage to lower face/tongue but some bilaterally innervated speech structures also show effects

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23
Q

Clinical characteristics/confirmatory signs of UUMN

A

Hemiparesis/plegia
Unilateral central face weakness
Unilateral central tongue weakness

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24
Q

Speech subsystems affected by UUMN

A

Mainly articulation, because of weakness

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25
Q

Neuromuscular bases/salient features UUMN

A

None defined, but can assume possible weakness, increased muscle tone, and incoordination

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26
Q

Patient perceptions/complaints UUMN

A

Typically aware of difficulty with speech
When severe, patients are distressed over their unintelligibility
Speech deteriorates under stress and fatigue
Drooling on affected side of face
Chewing and swallowing problems

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27
Q

Perceptual features of UUMN

A

Imprecise consonants, slow AMRs, harsh vocal quality, imprecise or irregular AMRs, slow rate, irregular articulatory breakdowns, mild Hypernasality, reduced loudness, strained voice, excess and equal stress

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28
Q

Articulation deficits by UUMN

A 
Weakness and reduced range of motion
Decreased fine motor control of tongue and lips
Imprecise consonant production
Articulatory breakdowns
Slow AMRs
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29
Q

Phonation deficits of UUMN

A

Mild to moderate harsh vocal quality
Possibly reduced vocal loudness
Harsh vocal quality means function of larynx is compromised

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30
Q

Resonance deficits in UUMN

A

Hypernasality

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31
Q

Prosody and respiration deficits in UUMN

A

Prosody: slight slower rate of speech
Respiration: not typical

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32
Q

Assessment tasks for UUMN

A

Medical records
Conversation or reading
Prolonged vowel
AMR task

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33
Q

Treatment for UUMN

A

Intelligibility drills
Phonetic placement
Exaggerating consonants
Minimal contrast drills

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34
Q

Locus of ataxic dysarthria

A

Cerebellar control circuit

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35
Q

Primary deficit of ataxic dysarthria

A

Incoordination

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36
Q

Ataxic dysarthria dysarthria

A

Incoordination and reduced muscle tone result in slowness and inaccuracy in the timing, and direction of speech movements

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37
Q

Cerebellar circuit

A

Superior peduncle: sends information out
Middle peduncle: movements
Inferior peduncle: sensory information

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38
Q

Confirmatory signs of ataxic dysarthria

A 
Generalized ataxia
Nystagmus - jerky eye movements
Dysmetria
Dysdiadochokinesis
Terminal tremor
39
Q

Direction, rhythm, and tone of movements for ataxic dysarthria (salient features)

A

Direction: inaccurate
Rhythm: irregular
Tone: reduced

40
Q

Most severe perceptual characteristics for ataxic dysarthria

A 
Excess and equal stress
Irregular articulatory breakdown
Distorted vowels
Prolonged phonemes
Excess loudness variations
41
Q

Which speech subsystems are most affected by ataxic dysarthria

A

Articulation and prosody

42
Q

Articulation symptoms with ataxic dysarthria

A

Imprecise consonant production
Distorted vowels
Irregular articulatory breakdowns

43
Q

Prosody symptoms with ataxic dysarthria

A 
Excess and equal stress
Prolonged phonemes
Slow rate
Mono pitch
Monoloudness
Excess/explosive loudness
44
Q

Resonance symptoms with ataxic dysarthria

A

Some brief periods of hyponasality

45
Q

Respiration symptoms with ataxic dysarthria

A 
Paradoxical movements (opposite inhale/exhale movements)
Exaggerated movements
46
Q

Phonation symptoms with ataxic dysarthria

A

Harsh vocal quality

Voice tremor

47
Q

Patient complaints with ataxic dysarthria

A 
Slurred, drunk speech
Difficulty coordinating breathing and speaking
Bite cheek/tongue while eating/talking
Stumble over words
May fatigue
48
Q

Good assessments for diagnosing ataxic dysarthria

A

Speech AMRs
Reading, conversational speech, repeating sentences
(Vowel prolongation is not as useful)

49
Q

Etiology of ataxic dysarthria

A

Primarily degenerative followed by idiopathic

50
Q

Traditional articulation treatments for ataxic dysarthria

A

Intelligibility drills
Minimal contrast drills
Phonetic placement
Exaggerating consonants

51
Q

Respiratory treatments for ataxic dysarthria

A

Slow and controlled exhalation
Cueing for complete inhalation
Stop phonation early
Teach patient amount of syllables for each breath

52
Q

Prosodic treatments for ataxic dysarthria

A

Intonation profiles
Contrastive stress
Chunking utterances into syntactic units
Pitch range exercises

53
Q

Prosodic treatments for ataxic dysarthria (rate control)

A

Metronome
Finger/hand tapping
Cued reading material

54
Q

Hypokinetic dysarthria locus and primary deficit

A

Locus: basal ganglia

Primary deficit: rigidity and decreased range of motion

55
Q

Hypokinetic dysarthria symptoms

A

Rigidity, reduced force/range of movement, slow individual movements, occasional fast repetitive movements

56
Q

Why is hypokinetic dysarthria unique?

A
  • increased range of motion

- vast majority of cases share same etiology

57
Q

Dopamine vs acetylcholine

A

Dopamine: inhibitory NT
Acetylcholine: excitatory NT

58
Q

Basal ganglia damage will impair:

A

Goal directed activities
Postural adjustment during skilled movements
Adjusting movements to environment
Learning, selection, and initiation of movements
Sensorimotor integration

59
Q

Confirmatory signs of hypokinetic dysarthria

A 
Tremor: static or resting
Rigidity
Loss of postural reflexes (difficulties sitting to standing)
Bradykinesia
Akinesia: lack of delay in movement
Micrographia in writing
Festinations: shuffling of steps
60
Q

Patient perceptions of hypokinetic dysarthria

A

Quiet voice, can’t be heard, talk fast, no emotional tone, stutter, drooling, swallowing problems, stiff upper lip

61
Q

Most pronounced speech subsystems affected

A

Voice, articulation, prosody

62
Q

Prosody symptoms in hypokinetic dysarthria

A

Inappropriate silences due to akinesia
Reduced stress
Increased speech rate
Short rushes of speech/variable rate

63
Q

Articulation symptoms of hypokinetic dysarthria

A

Imprecise consonants
Repeated phonemes
Palilia: increasingly rapid repetition of words

64
Q

Phonation symptoms of hypokinetic dysarthria

A

Harsh or breathy, low pitch, brief periods of aphonia, tremor

65
Q

Respiration symptoms of hypokinetic dysarthria

A

Faster breathing rate, shallow breath support, reduced range of motion

66
Q

Salient features of hypokinetic dysarthria

A 
Individual movements: slow
Repetitive movements: fast
Range of individual movements: reduced
Range of repetitive movements: very reduced
Force: reduced
Tone: excessive
67
Q

Most severe perceptual characteristics for hypokinetic dysarthria

A

Mono pitch, reduced stress, inappropriate silences, short rushes of speech, breathy quality, variable rate, increased rate in segments, increase of rate overall, repeated phonemes

68
Q

Etiology of hypokinetic dysarthria

A

Anything that reduces dopamine to striatum

69
Q

Pharmacological treatment of hypokinetic dysarthria

A

L-dopa, anticholinegics

70
Q

Surgical treatment for hypokinetic dysarthria

A

Ablation: thalamus purposefully lesion end

Deep brain stimulation

71
Q

Behavioral treatment for hypokinetic dysarthria

A

Rate reduction, stretching, traditional articulation techniques, phonatory techniques, respiratory techniques, prosodic techniques

72
Q

Pros of delayed auditory feedback for hypokinetic dysarthria

A

Little trading, great improvements, better movements,

73
Q

Cons of delayed auditory feedback for hypokinetic dysarthria

A

May not help in conversation, may not improve intelligibility

74
Q

Lee Silverman voice treatment

A

One vocal target with multiple repetitions

75
Q

Hyperkinetic dysarthria locus and primary deficit

A

Locus: basal ganglia control circuit

Primary deficit: involuntary movements

76
Q

Hyperkinetic dysarthria symptoms

A

Characterized by abnormal, unpredictable, involuntary movements

77
Q

Neurobasis of hyperkinetic dysarthria

A

Disease of basal ganglia control circuit resulting from pathways failure to inhibit cortical motor discharges

78
Q

Confirmatory signs of hyperkinetic dysarthria

A

Abnormal involuntary movements, extra movements, dyskinesia

79
Q

Chorea

A

Rapid, involuntary, random, purposeless movements of body parts

80
Q

Huntington’s disease

A

Gradual degeneration of neurons in basal ganglia and cerebral cortex

81
Q

Types of involuntary movements for hyperkinetic dysarthria

A

Myoclonus: involuntary jerks/contractions of body part
Tics
Ballism: gross, abrupt contractions of muscles of extremities resulting in flailing

82
Q

Essential tremor

A

Tremor of arms, hands, voice box, jaw, head, and neck with movement

83
Q

Essential voice tremor

A

20% of patients with essential tremor, heard during vowel movement

84
Q

Dystonia

A

Sustained, slow involuntary contractions of muscles in one or more body parts

85
Q

Patient complaints for hyperkinetic dysarthria

A

Slow, slurred speech

Shaky voice

86
Q

Most severe perceptual characteristics for hyperkinetic dysarthria

A

Prolonged intervals, variable rates, inappropriate silences, excess loudness variations, prolonged phonemes, voice stoppages, breathiness

87
Q

Which speech subsystem is most affected by hyperkinetic dysarthria chorea

A

Prosody

88
Q

Which speech subsystem is most affected by hyperkinetic dysarthria dystonia

A

Articulation

89
Q

Assessment task findings for hyperkinetic dysarthria

A

Vowel prolongation, AMRs highlight irregular articulatory breakdowns and speech rate variations, conversational speech/reading aloud,

90
Q

Mixed dysarthria neurological breakdown

A

Neurological damage extends into two or more parts of motor system

91
Q

Most common mixed dysarthria

A

Flaccid-spastic

Ataxic-spastic

92
Q

Speech affected by mixed dysarthria

A

Profound difficultly with intelligibility, cognitive deficits,

93
Q

Etiology of mixed dysarthria

A

Largely degenerative, multiple sclerosis, ALS, freidrichs ataxia, Wilson’s disease

Motor Speech Disorders (1 decks)

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