through spastic dysarthria

Question 1

motor speech disorder

Answer 1

affects motor control of speech neurologically (not musculoskeletal): dysarthria and apraxia

Question 2

dysarthria

Answer 2

abnormalities in parameters of speech mechanism (respiratory, laryngeal, nasal, oral tract, articulators)–execution, movement disorder

Question 3

apraxia

Answer 3

planning/programming impairment

Question 4

dysarthria types (Mayo clinic)

Answer 4

flaccid + spastic (brainstem: F: brainstem MN or nerves to muscles; S:fiber tracts between cortex and MN); ataxic (cerebellum); hypokinetic, hyperkinetic (basal ganglia); mixed (Duffy adds unilateral UMN)

Question 5

gold standard of dysarthria classification

Answer 5

DAB perceptual (clustering)

Question 6

cortical areas for planning and programming speech

Answer 6

primary motor cortex, lateral premotor cortex, supplementary motor cortex, Broca’s, parietal lobe of dom. hemisphere, right hem.

Question 7

control/monitoring circuits for speech

Answer 7

cerebellum (coordination, tone, sequencing, motor learning, adjustment) and basal ganglia (posture, tone, inhibitory, coordination, planning/executing/refining/regulating movement)

Question 8

direct activation pathways (pyramidal)

Answer 8

corticospinal, corticobulbar (support skilled movement; alpha MN)

Question 9

indirect activation pathways (extrapyramidal)

Answer 9

corticoreticular (reflex, posture, tone, subsconscious, facilitate pyramidal; support skilled movement, gamma MN)

Question 10

peripheral pathways

Answer 10

final common pathway: LMN of cranial and spinal nerves (damage leads to weakness, paralysis, fasciculations, fibrillations)

Question 11

motor end plate

Answer 11

specialized post-synaptic area in neuromuscular junction of PNS important for activating muscle

Question 12

bundles of axons travel together in ___ and ___

Answer 12

tracts (CNS–synapse with other neurons); nerves (PNS–nerves transmitting to muscles or from sensory organs)

Question 13

cell body, axon, synapse diseases associated with dysarthria

Answer 13

ALS; MS/Guillain Barre; myasthenia gravis

Question 14

cortical motor areas

Answer 14

prim. motor cortex; supp. motor area; premotor area; Broca’s; left insula; right insula

Question 15

cortical sensory areas

Answer 15

prim. sensory, visual, auditory cortices

Question 16

cerebellar damage

Answer 16

hypotonia, intention tremor, dysmetria, decomposition of movement, ataxia

Question 17

basal ganglia damage

Answer 17

hypokinesia (Parkinson’s), muscle rigidity, resting tremor, bradykinesia

Question 18

important cranial and (spinal) nerves for speech

Answer 18

V, VII, X, XII + IX/XI with X, (respiration)

Question 19

UMN contralateral vs. bilateral

Answer 19

corticospinal; corticobulbar (esp. head and neck); EXCEPTIONS: CN VII–upper face receives bilateral corticobulbar/UMN input and lower face receives contralateral UMN; CN XII–receives mostly contralateral corticobulbar

Question 20

UMN and LMN damage

Answer 20

spasticity, weakness, hyper-reflexia; hypotonicity, atrophy, hyporeflexia, weakness (voluntary and automatic), fasciculations

Question 21

direct pathway damage

Answer 21

weakness and loss of skilled movement, hyporeflexia, Babinski, decreased muscle tone

Question 22

indirect pathway damage

Answer 22

spasticity, clonus, hyperactive stretch reflexes, increased muscle tone

Question 23

unilateral UMN vs. LMN damage

Answer 23

UMN: spastic paresis of contralateral genioglossus=reduced ROM, no fasciculations, tongue deviates to opposite side of lesion; LMN: flaccid paresis or low muscle tone with atrophy, reduced ROM, fasciculations, tongue deviates to side of lesion

Question 24

MSD eval consists of

Answer 24

background/hx; oral mech/DDK/nonverbal oral apraxia/AOS; resp.-laryng. integrity; articulation; auditory-perceptual characteristics and intelligibility

Question 25

AMR vs. SMR

Answer 25

repetition of single syllable (alternating motion rate) vs. syllable sequence (sequential motion rate); both should be 5-7x/sec. for adults

Question 26

Can you use DDK rate (syll./sec.) to make inferences about speed or regularity of tongue movement for speech?

Answer 26

No

Question 27

low tech manometer used to

Answer 27

assess breath support (cup with straw)

Question 28

vowel prolongation (normal)

Answer 28

about 8 seconds

Question 29

things to look for in articulation

Answer 29

precision, rate and rhythm, coordination, intelligibility (perceptual), instrumental

Question 30

cognitive linguistic load in assessing speech from low cog. ling. load to high

Answer 30

non-speech--monologue--conversation

Question 31

intelligibility vs. comprehensibility

Answer 31

degree to which listener understands acoustic signal (fx impairment: adequate for communication?); intelligibility PLUS other contributing contextual information (disability: impact on daily life)

Question 32

ways to test intelligibility

Answer 32

interval scaling/percent estimates; PCC (children); transcription; Direct Magnitude Estimation (weird scale thing--more for research, requires modulus, more for global severity measures, better with groups), Visual Analog Scale, published tests

Question 33

considerations for instrumental testing

Answer 33

sensitivity to dysarthria, relevance to fx comm., measure reflective of movement characteristics, feasibility of application and interpretation

Question 34

key perceptual components

Answer 34

pitch, loudness, voice quality, respiration, prosody, articulation, overall impressions

Question 35

Have instrumental studies validated a straightforward relationship between phys. deficits and preceptual labels?

Answer 35

No

Question 36

flaccid dysarthria lesion and clinical presentations

Answer 36

LMN damage (motor unit of fcp, brainstem to spinal cord and muscles): cell body, cranial nerves, axons, neuromuscular juncture, muscle fiber; hypotonia, weakness/paralysis/atrophy, fasciculations, no reflexes, drooping/drooling in oral mech.

Question 37

flaccid dysarthria perceptual

Answer 37

phonatory incompetence (breathy, short inhalations, stridor), resonatory incompetence (hypernasal, nasal emission), phonatory-prosodic insufficiency (monopitch, monoloud), imprecise consonants; add'l from sheet: harsh voice, audible inspiration, slow rate, short phrases

Question 38

flaccid dysarthria acoustics

Answer 38

greater VOT variability (resp. incompetence), reduced formant transitions

Question 39

flaccid dysarthria etiologies

Answer 39

progressive bulbar palsy, polio, Guillain-Barre, Bell's palsy, muscular dystrophy, trauma, tumor, brainstem stroke, myasthenia gravis

Question 40

spastic dysarthria lesion and clinical presentations

Answer 40

bilateral UMN damage (MN in cerebral cortex, axons, up to but not including LMN synapse); hypertonia (spasticity), pathologic reflexes, no fasciculations

Question 41

spastic dysarthria pyramidal vs. extrapyramidal damage

Answer 41

fine, skilled movements, hypotonia, weakness (more distal), hyporeflexia, Babinski present; increased tone, spasticity, clonus, hyperactive reflexes

Question 42

spastic dysarthria perceptual

Answer 42

prosodic excess (slow rate, reduced stress, effortful), artic.-resonatory incompetence, prosodic insufficiency (monopitch, monoloud), phonatory stenosis (strained-strangled); add'l from sheet: abnormal pitch, pitch breaks, breathy, harsh, hypernasal, short phrases, excess and equal stress, distorted vowels, imprecise consonants

Question 43

spastic dysarthria acoustics

Answer 43

shorter VOT, slow speaking rate

Question 44

spastic dysarthria etiologies

Answer 44

stroke (if bilateral), primary lateral sclerosis, TBI, tumor, cerebral palsy, multiple sclerosis (autoimmune, myelin damage/demyelination)

Question 45

corticospinal tract crosses at the

Answer 45

medulla

Question 46

flaccid dysarthria disease example

Answer 46

myasthenia gravis: autoimmune, more women (and younger) than men

Question 47

spastic dysarthria disease example

Answer 47

cerebral palsy, multiple sclerosis (autoimmune, demyelinating, more women than men)