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Motor Speech Disorders > Types of Dysarthria > Flashcards

Types of Dysarthria Flashcards

1
Q

Key characteristic of Flaccid dysarthria

A

Weakness

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2
Q

Lower motor neuron damage (in cranial nerves or spinal nerves) causes what type of dysarthria

A

Flaccid

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3
Q

What is the final common pathway?

A

It refers to the final pair of nerves that a neural impulse travels through from the upper motor neurons before it reaches the muscles

This is affected in flaccid dysarthria

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4
Q

Damage to part of the Peripheral nervous system will cause…

A

Flaccid dysarthria

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5
Q

What main three speech systems are affected in flaccid

A

Weak resonance muscles

Weak phonation muscles

Weak articulation muscles

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6
Q

What are 6 conditions/ characteristics associated with flaccid

A
  1. Muscle paralysis or weakness
  2. Hypotonicity
  3. Muscle atrophy
  4. Hypoactive reflexes
  5. Diplophonia
  6. Inhalatory stridor
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7
Q

Thinking of the three main speech systems affected, what are main characteristics of flaccid dysarthria symptoms

A

-Reduced VP closure causing marked degrees of hypernasality
-Weak VF vibration and increased amounts of air escaping, causing harsh voice quality
-Reduced articulatory contact, causing slow and labored speech

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8
Q

What is the cause of damage that results in flaccid dysarthria

A

Any disorder disrupting the flow of neural impulses along the lower motor neurons that innervate muscles of respiration, phonation, resonance, articulation, or prosody

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9
Q

What are 5 common causes that result in flaccid

A
  1. Physical trauma
  2. Brainstem stroke
  3. Myasthenia Gravis
  4. Guillain-Barre Syndrome
  5. Polio
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10
Q

What additional, less common causes can result in flaccid

A
  1. Tumors in or near brainstem
  2. Muscular dystrophy due to muscle tissue dying
  3. Progressive bulbar palsy
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11
Q

What dysarthria is associated with hypoactive oral reflexes & what does that mean?

A

Flaccid
Diminished or absent oral reflexes (i.e., absent gag reflex)

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12
Q

What is hypotonicity

A

Reduced muscle tone

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13
Q

Identify the types of physical trauma categories

A

Surgical injury- accidentally cutting cranial nerve, especially during: Carotid endarectomy, cardiac surgery, removal of head or neck tumors, & dental surgery

or

Head and neck injury (i.e., fall, blow to head, motor vehicle injury)

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14
Q

What is another word for a brainstem stroke?

A

Cerebrovascular accident (CVA)

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15
Q

What is a brainstem stroke

A

interruption of blood flow to the brain as an artery breaks or is blocked

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16
Q

Can a single brainstem stroke cause damage to more than one cranial nerve?

A

Yes, a single brainstem stroke can damage 1+ nerves, with degree of impairment depending on the number of LMN’s lost

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17
Q

What is myasthenia gravis

A

A chronic autoimmune disorder affecting the neuromuscular junction/involuntary movements, especially of the upper structures, due to antibodies blocking or damaging the muscle tissue

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18
Q

Symptoms of myasthenia gravis

A

-rapid fatigue of muscular contraction over short time, with recovery after rest
-hypernasality
-decreased loudness
-breathy voice quality
-decreased articulatory precision

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19
Q

How could you assess for myasthenia gravis

A

Stress test (take a deep breath and count to 100 as rapidly, steady as you can)

reading a lengthy paragraph

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20
Q

How is myasthenia gravis treated?

A

Temporarily treated with injection of Tensilon (edrophonium chloride)

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21
Q

What is guillain barre syndrome

A

Demyelization, which often occurs after certain types of injections and immunizations

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22
Q

What are 2 symptoms of Guillain barre syndrome

A

Flaccid dysarthria
Dysphagia

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23
Q

What is the typical recovery of Guillain Barre syndrome?

A

High recovery rate, lasting weeks or months

5% die in acute stages

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24
Q

What is polio

A

Infectious, viral disease that attacks cell bodies of lower motor neurons
Commonly affects the cervical and thoracic spinal nerves
Can also affect cranial nerves

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25
Q

Symptoms of polio

A

Labored inhalation during speech
Shortened speech phrases
Speaking on residual air (due to low air capacity)
Decreased loudness

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26
Q

Progressive Bulbar Palsy can affect…

A

Upper and Lower motor neurons

It more often affects lower motor neurons- causing flaccid dysarthria
But can also affect both, upper and lower motor neurons causing mixed dysarthria

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27
Q

What symptoms are the strongest confirmatory sign of flaccid?

A

Phonatory incompetence and hypernasality

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28
Q

List the 9 major symptoms often seen in flaccid

A
  1. hypernasality
  2. imprecise consonants
  3. continuous breathiness
  4. monopitch
  5. nasal emission
  6. audible inspiration
  7. harsh quality
  8. short phrases
  9. monoloudness
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29
Q

harsh voice quality is defined as….

A

Breathiness +hoarseness

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30
Q

How is the respiratory system affected in Flaccid dysarthria

A

Often not impaired, but if it is will see:
-Impaired control of inhalations and exhalations during speech
-Reduced loudness
-Shortened phrase length
-Strained voice quality if speaking on residual air to prolong phrase length
-Monopitch
-Monoloudness
-Frequent inhalations during speech, which negatively affect prosody

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31
Q

In flaccid dysarthria, impairment to the cervical and thoracic spinal nerves is responsible for what kind of damage?

A

Damage to the diaphragm and intercostal muscles
Resulting in respiration damage

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32
Q

How is the phonation system affected in flaccid dysarthria

A

-Incomplete VF adduction, phonatory incompetence
-Breathy voice quality, whisper-like

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33
Q

How is the resonance system affected in flaccid dysarthria

A

-Hypernasality (most noticable)
-Shortened phrases due to nasal emission
-Weak pressure consonants

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34
Q

How is the articulation system affected in flaccid dysarthria

A

-Imprecise consonant production
-Reduced articulatory contact due to insufficient elevation of jaw

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35
Q

How is prosody affected in flaccid dysarthriaa

A

-Monopitch
-Monoloudness

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36
Q

In flaccid, damaged laryngeal muscles adversely affect the ability to make fine VF adjustments for…

A

Normal pitch and loudness variations
So, prosody is adversely affected

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37
Q

Where is the damage in the brain with spastic dysarthria

A

Bilateral upper motor neurons in cranial nerves or spinal nerves, affecting the left and right pyramidal and extrapyramidal system tracts

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38
Q

If the pyramidal and extrapyramidal system (desending motor) tracts are damaged on both sides, what is the result?

A

Spastic dysarthria

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39
Q

Explain descending motor tracts

A

Neural pathways carrying motor impulses from the cortex to the brainstem and spinal cord OR from the brainstem to the nuclei area

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40
Q

The pyramidal system is responsible for…

A

Transmitting neural impulses for discrete skilled movements (i.e., speech) down to the Lower motor neurons, which then sends the impulse to the muscles

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41
Q

The extrapyramidal system is responsible for…

A

Transmitting signals to maintain posture, regulate reflexes, monitor muscle tone, and probably some voluntary movements of the speech mechanism

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42
Q

What Key Characteristic is associated with spastic dysarthria

A

Stiffness and some weakness

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43
Q

When one descending motor system (either pyramidal or extrapyramidal) is damaged, what is the affect on the other

A

When one system is damages, the other system will almost always be damaged

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44
Q

If the pyramidal system is damaged, what is the result on speech

A

Weak, slow skilled movements
Mainly of the lips and tongue

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45
Q

If the extrapyramidal system is damaged, what is the effect on speech

A

Weakness, increased muscle tone (stiffness), and abnormal reflexes (mainly of the laryngeal and possibly velum muscles)

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46
Q

Which main speech systems are affected in Spastic dysarthria

A

Stiff, sluggish moving Phonation muscles

Stiff, sluggish moving prosody muscles

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47
Q

What are additional characteristics seen in spastic dysarthria

A

-Pseudobulbar affect (motor-emotion)
-Drooling (very prominent)
-Spastic paralysis or paresis of the muscles
-Hyperflexia (hyperactive jaw-jerk)
-Little to no muscle atrophy
-Presence of pathological reflexes (sucking reflexes)

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48
Q

What is the possible causes of spastic dysarthria

A
  1. Stroke
  2. Degenerative diseases
  3. Traumatic head injury
  4. Viral or bacterial infection of the brain/cerebral tissues
  5. Brainstem tumor
  6. Less common cause: cerebral anoxia
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49
Q

What is cerebral anoxia

A

Lack of oxygen in the blood within the brain

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50
Q

What main two degenerative diseases are causes of spastic dysarthria

A

-Amyotrophic lateral sclerosis (ALS)
-Multiple Sclerosis (MS)

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51
Q

What is amyotrophic lateral sclerosis

A

A terminal, degenerative, progressive neurological disease of unknown cause
With a life expectancy of 22 months from time of onset

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52
Q

When amyotrophic lateral sclerosis has mainly upper motor neuron involvement, what is the result?

A

Spastic dysarthria

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53
Q

When amyotrophic lateral sclerosis eventually affects upper motor neurons and lateral motor neurons, what is the result?

A

Mixed dysarthria (flaccid-spastic dysarthria)

54
Q

What is multiple sclerosis?

A

Suspected immunological disorder resulting in inflammation or complete detruction of myelin sheath covering the axons

This is Demyelinization

55
Q

A stroke results in spastic dysarthria ONLY when….

A
  1. there are two or more cerebral strokes that occur in certain combinations in each hemisphere
    OR
  2. One brainstem stroke occurs affecting bilateral upper motor neurons
56
Q

Keeping in mind the two speech systems mainly affected in spastic dysarthria, what are the main systems

A

-Incomplete VF closure and hyperadducted VF closure resulting in harsh quality
-monopitch, monoloudness, and short phrases

57
Q

How is respiration affected in spastic dysarthria

A

Often doesnt play a great role, but it could have abnormal respiration movements if impaired
-Reduced inhalation and exhalation
-Uncoordinated breathing patterns
-Reduced vital capacity

58
Q

How is the phonatory system affected in spastic dysarthria

A

Increased muscle tone of the larynx, causing still and sluggish laryngeal muscles
-harsh (breathy + hoarse) quality due to air leakage
-strained strangled quality due to hyperadducted VFs
-Low pitch due to reduced cricoarytenoid rocking to vary pitch

59
Q

How is the resonance system affected in spastic dysarthria

A

Reduced range of motion in velar muscles, causing incomplete VP closure
-Moderate to mild hypernasality (not as bad as seen in flaccid) WITHOUT nasal emission

60
Q

How is the articulatory system afffected in spastic dysarthria

A

Articulators range of motion is reduced, reduced contact, and reduced tongue movement (less advanvement and height)

-Imprecise consonant production
-Vowel distortions

61
Q

In spastic dysarthria, what are the three main reasons for imprecise consonant production

A

-Abnormally short voice onset time for voiceless consonants
-Incomplete articulatory contact
-Incomplete consonant clusters

62
Q

How is prosody affected in spastic dysarthria

A

Prosodic impairment is related to articulatory aspects (tight laryngeal muscles, reducing speed and range of motion)

-Monoloudness due to increased muscle tone
-monopitch due to inability to relax and vary pitch
-short phrased due to reduced range of motion and speech
-Slow rate of speech

63
Q

Where does the damage occur in unilateral upper motor neuron dysarthria?

A

Upper motor neuron lesion on one side of the brain, which is supplying impulses to spinal and cranial nerves involved in speech production

64
Q

What is the key characteristic of unilateral upper motor neuron dysarthria

A

Weakness or paralysis of the lower face on the OPPOSITE side of the lesion

65
Q

Why is unilateral upper motor neuron dysarthria typically less severe than bilateral damage?

A

The cranial nerves innervate most of the speech muscles bilaterally, so if damage occurs they are still receiving impulses from the opposite side
This means the Velum, Pharynx, and Larynx will not be affected structurally

66
Q

Muscles of the _____ are primarily affected in unilateral upper motor neuron dysarthria. Why?

A

Lower face & tongue are primarily affected because they primarily ONLY receive unilateral upper motor neuron innervation

67
Q

Unilateral upper motor neuron dysarthria is primarily a disorder of….

A

Articualtion, with weakness in lip and tongue muscles

68
Q

If Left hemisphere damage results in unilateral upper motor neuron dysarthria, what condition/s could co-occur?

A

Aphasia
Apraxia

69
Q

If Right hemisphere damage is the result of unilateral upper motor neuron dysarthria, what condition/s could co-occur?

A

Cognitive deficit
Visual deficit

70
Q

In unilateral upper motor neuron dysarthria, what causes the UMN damage?

A

Any condition causing focal damage to the upper motor neurons on the right or left hemisphere

71
Q

What is the most common condition causing unilateral UMN dysarthria?

A

Stroke
Frontal stroke is the leading cause

72
Q

A stroke that occurs within which four areas could result in unilateral upper motor neuron dysarthria

A

Cortical areas
Subcortical areas
Brainstem
Internal capsule

73
Q

List the 3 common causes of unilateral UMN dysarthria

A
  • Stroke
    -Brain tumor causing focal lesion
    -Traumatic brain injury
74
Q

Most TBI’s result in diffuse lesions, but a focal lesion could occur through…

A

Shot to the head
Projectile motion of object to head

75
Q

How is the respiratory system affected in unilateral UMN dysarthria?

A

It is rarely impaired because of the wide distribution of innervation of intercostal muscles and diaphragm being innervated bilaterally

76
Q

How is the phonation system affected in Unilateral UMN dysarthria?

A

Often it is not impaired
If it is, harsh voice quality

77
Q

When may you see phonation deficits in unilateral UMN dysarthria?

A
  • Mild VF weakness or spasticity
  • Previous lesion presenting with new lesion
  • Dysphonia (partial loss of voice)
  • General medical condition, not attributed to UMN damage
78
Q

How is resonance affected in unilateral UMN dysarthria

A

Mild hypernasality

79
Q

How is the articulation system affected in unilateral UMN dysarthria

A

Damage causes weakness, reduced range of motion, and decreased fine motor control of the tongue

-Imprecise consonant production
-Irregular articulatory breakdowns
-Slow, irregular, and imprecise AMR

80
Q

How is the prosody system affected in unilateral UMN dysarthria

A

Rarely impaired, but if it is: slightly slow rate of speech

81
Q

Lesion site seen in Ataxic dysarthria?

A

cerebellum and/or cerebral control circuits (cerebellum neural pathways that connect the cerebellum to other parts of the nervous system)

82
Q

Function of the cerebellum

A

regulates muscle tone, maintains balance, and coordinates skilled motor movements by coordinating timing and force of muscle contraction while processing sensory information all over the body and integrating information to execute movements

83
Q

How does the cerebellum communicate with the CNS?

A

Through the cerebellar peduncles (3 bundles of neural tracts)

84
Q

List each of the 3 cerebellar peduncles, briefly what is the function of each

A

Superior cerebellar peduncle- transmits commands to cortex
Middle cerebellar peduncle- transmits planned movements
Inferior cerebellar peduncle- transmits sensory information

85
Q

Explain cerebellar control circuits

A

Neurons that course through three cerebellar pathways and synapse with true UMN within extrapyramidal system or interneurons in the brainstem or spinal cord
NOT synapsing with LMN

86
Q

What is the key characteristic of Ataxic Dysarthria

A

(In coordination or lack or order
Disturbed speed, range, and directions of movements/fine motor control)

87
Q

Which main speech mechanisms are affected in Ataxic?

A

Articulation
Prosody

88
Q

Keeping in mind the main characteristics affected in Ataxic, what are main features seen

A

-Unsteady and slurred speech, imprecise consonants
-Equal and excess stress, prolonged phonemes, prolonged pause intervals

89
Q

Conditions that can co-occur with Ataxic dysarthria

A

Limb ataxia
Balance problems
Visual deficits

90
Q

Cause of damage in Ataxic Dysarthria

A

Degenerative diseases: -Autosomal dominant cerebellar ataxia of late onset
-Idiopathic sporadic late-onset cerebellar ataxia
-Friedreich’s ataxia (cerebellar ataxia)
-Olivopontocerebellar degeneration
Stroke
Toxic conditions
Metabolic conditions
Traumatic head injury
Tumors

Other causes:
Viral infections invading cerebellum
Infections (syphilis, trichinosis)
Bacterial abscesses

91
Q

How is the respiration system affected in Ataxic

A

Paradoxical movements leading to reduced air supply
Can cause: increased speech rate, decreased loudness, harsh quality

92
Q

How is the phonation system affected in Ataxic

A

Harsh voice quality
Tremulous phonation

93
Q

How is the resonance system affected in Ataxic

A

Mild hypernasality
Intermittent hyponasality

94
Q

How is the articulation system affected in Ataxic

A

Imprecise consonant production
Distorted vowels
Irregular articulatory breakdowns
Jerky speech

95
Q

How is the prosodic system affected in Ataxic

A

Scanning speech
Equal and excess stress
Prolonged phonemes
Prolonged pause intervals
Monopitch
Monoloudness
Inappropriate silences
Short rushes of speech

96
Q

Lesion site within basal ganglia or basal ganglia control circuit (extrapyramidal system) can result in?

A

Hypokinetic dysarthria
Hyperkinetic dysarthria

97
Q

What is hypokinetic

A

Reduced movement

98
Q

What causes in damage resulting in hypokinetic dysarthria

A

Reduction of dopamine (inhibitor) within nigra striatum, causing increased levels of acetycholine (excitatory)

99
Q

Hypokinetic dysarthria is the only dysarthria that has….

A

Increased rate as a symptoms
Mainly one causative factor: Parkinsonism

100
Q

What are the main speech systems affected in Hypokinetic

A

Phonation
Prosody
Articulation

101
Q

What are additional characteristics you may see in hypokinetic

A

Fasciculations
Oral Tics

102
Q

What is the key characteristic of hypokinetic dysarthria

A

Rigidity
Reduced ROM
Slow, but occasionally fast and repetitive movement

103
Q

Causes of Hypokinetic

A

Parkinsonism- idiopathic parkinsons, neuroleptic-induced, and postencephalitic
Traumatic head injury
Toxic metal poisoning
Stroke

104
Q

How is respiration affected in hypokinetic

A

often not affected, but can be:
Faster breathing rates
Reduced range of respiratory muscles
Shallow breath
Short breath cycles

105
Q

How is phonation affected in hypokinetic

A

Harsh quality
Breathy quality
Aphonia
Low pitch

106
Q

What is the least system affected in hyponasality

A

Resonance
You may have mild hypernasality

107
Q

How is articulation affected in Hypokinetic

A

Imprecise consonants
Repeated phonemes
Palilalia

108
Q

What is palilalia

A

Compulsive, increasingly rapid repetitions of word or phrase

109
Q

How is prosody affected in hypokinetic

A

Monopitch
Reduced stress
Monoloudness
Inappropriate silences
Short rushes of speech (stop and go quality)

110
Q

What is the key characteristic of hyperkinetic

A

Involuntary (increased) movement

111
Q

What is the main speech system affected in hyperkinetic

A

Prosody and rate

112
Q

Causes of hyperkinetic

A

Chorea
Myoclonus
Tic Disorder
Essential Tremor
Dystonia

113
Q

What are 4 disorders where dystonia is present?

A

Spasmodic dysphonia
Spasmodic torticollis
Drug induced dystonia
Meige syndrome

114
Q

What is chorea?

A

Random, involuntary movements of limbs, trunk, head, and neck

Will look like dance-like movements
Unpredictable, purposeless, jerky/abrupt movements appearing smooth and coordinated

115
Q

How is respiration affected in chorea-hyperkinetic

A

Rapid, unexpected inhalations and exhalations

116
Q

How is phonation impaired in chorea-hyperkinetic

A

Harsh quality
Excess loudness variations
Strained and strangled voice
Intermittent breathiness
Voice stoppages

117
Q

How is resonance affected in chorea-hyperkinetic

A

Hypernasality

118
Q

How is the articulation system affected in chorea-hyperkinetic

A

Imprecise consonant productions
Distorted vowels
Prolonged phonemes

119
Q

How is prosody affected in chorea-hyperkinetic

A

Prolonged intervals between syllables and words
Variable speech rate
Monopitch
Monoloudness
Inappropriate silences

120
Q

Explain myoclonus

A

Involuntary and brief contractions of whole, part, or groups of muslces simultaneously

121
Q

Explain tic disorder

A

Rapid movement that can be controlled voluntarily for a time, but performed frequently due to compulsive desire to perform movement

122
Q

What types of tics are there?

A

Motor tics- facial twitches, rapid blinks, grimaces, shoulder shrugging, squatting, hopping, hand gestures, etc.
Voice tics- throat clearing, grunting, barking, palilalia, shorting

123
Q

How does stress affect tics

A

Stress can increase the frequency of tics
Tics can also evolve over time

124
Q

What is essential tremor

A

Idiopathic, benign hyperkinetic movement disorder causing movements most often affecting the hands, arms, or head occurring during actions
Disappearing when at rest

125
Q

What is the most common hyperkinetic movement disorder

A

Essential tremor

126
Q

Explain dystonia

A

Hyperkinetic movement disorder of muscle tone, causing involuntary and prolonged muscle contractions interfering with normal movement or posture

127
Q

Contractions during dystonia are characterized as…

A

Waxing and waning quality
Appearing and disappearing

128
Q

How is respiration affected in dystonia-hyperkinetic

A

Not very impacted

129
Q

How is phonation affected in dystonia-hyperkinetic

A

Harsh quality
Strained and strangled
Excess loudness variations

130
Q

How is resonance affected in dystonia-hyperkinetic

A

Not very impacted

131
Q

How is articulation affected in dystonia-hyperkinetic

A

Imprecise consonants
Distorted vowels
Irregular articulatory breakdowns
Prolonged phonemes

132
Q

How is prosody affected in dystonia-hyperkinetic

A

Monopitch
Monoloudness
Inappropriate silences
Short phrases

Motor Speech Disorders (7 decks)

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