Types of Dysarthria Flashcards by Mary Beth Shumpert

Flaccid Dysarthria results from a lesion to the

Lower motor neuron

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T or F. Flaccid dysarthria is only associated with progressive processes.

F. Flaccid dysarthria is associated with progressive AND nonprogressive processes

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weakness, loss of tone in the effected muscle, and impairment of individual muscles rather than the movement best describes

flaccid dysarthria

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List Clinical Characteristics of Flaccid Dysarthria

weakness of oral musculature, hypotonia, atrophy, fasiculations, progressive weakness with use

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myasthenia gravis is what type of dysarthria?

flaccid dysarthria

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Etiologies associated with flaccid dysarthria include

any process that damages the motor unit: degenerative (ALS), infection (meningitis, Bell’s Palsy), toxic (botulism), neoplastic (tumor), traumatic (surgery, TBI), vascular (CVA), other (XRT=radiation), cranial nerve damage

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T or F. Flaccid Dysarthria can result from isolated cranial nerve damage or multiple cranial nerve damage.

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Name the dysarthria that is characterized by the following clusters of deviant speech:
phonatory incompetence (breathy voice, audible inspiration, short phrases)
resonatory incompetence (hypernasality, nasal, emission, imprecise consonants, short phrases)
phonatory-prosodic insufficiency (harsh voice, mono pitch &amp; loudness)

flaccid dysarthria

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may be manifest in any/all systems of speech, combined weakness & spasticity leading to slow movement and reduced range & force

spastic dysarthria

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Spastic dysarthria is the result of

bilateral upper motor neuron damage (or unilateral brainstem lesion above synapse)

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Confirmatory signs of spastic dysarthria are

+ babinski, suck, snout, and jaw reflexes

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Patient complaints of spastic dysarthria

slow effortful speech, speaking against resistance, fatigue, nasal speech, need to speak slowly to be understood, dysphagia, difficulty controlling emotions

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Clinical findings of Spastic Dysarthria

dysphagia, drooling, flattened nasolabial fold, pathologic laughing/crying, + reflexes, slow BUT regular AMRs, harsh vocal quality during ‘ah’

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Name the dysarthria that is characterized by the following clusters of deviant speech:
prosodic excess (excess and equal stress, slow rate), articulatory-resonatory incompetence (imprecise consonants, distorted vowels, hypernasality), prosodic insufficiency (monpitch and loudness, reduced stress, short phrases), phonatory stenosis (low pitch harshness, strained-vocal quality)

Spastic dysarthria

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Confirmatory signs of Ataxic Dysarthria

difficulty standing & walking, broad based gait, titubation (staggering), nystagmus (quick movements of eyes), dysmetria (overshoot or undershoot intended position)

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Salient features of Ataxic Dysarthria

irregular AMRs, normal oral motor exam, drunken sounding speech

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Name the dysarthria that is characterized by the following clusters of deviant speech: articulatory inaccuracy (imprecise consonants, irregular articulatory breakdowns, distorted vowels), prosodic excess (excess and equal stress, prolonged phonemes, prolonged intervals, slow rate), phonatory-prosodic insufficiency (harshness, monopitch & loudness)

ataxic dysarthria

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Dysarthria as a result of a lesion in the basal ganglia control circuit resulting in lack of dopamine

hypokinetic dysarthria

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the only dysarthria associated with fast rate

hypokinetic dysarthria

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Parkinson’s disease is associated with what kind of dysarthria

hypokinetic dysarthria

Confirmatory signs of hypokinetic dysarthria

resting tremor, rigidity, bradykinesia (slow initiation and speed of movements), postural abnormalities, mask like face

Salient features of hypokinetic dysarthria

infrequent swallowing, drooling, tremor of jaw/lips at rest, AMRs slow to initiat then increase in rate, rushes of speech, limited range of movement of articulators, excessive muscle tone

Name the dysarthria that is characterized by the following clusters of deviant speech: prosodic insuffiency (monopitch, monoloudness, reduced stress, short phrases, variable rate, short rushes of speech, imprecise consonants)

hypokinetic dysarthria

disease of the basal ganglia control circuit, speech characteristics are the result of abnormal, rhythmic or irregular rapid of slow INVOLUNTARY movements, perceptually distinguishable & visually distinguishable

hyperkinetic dysarthria

Possible movement patterns secondary to basal ganglia damage are called

dyskinesia (involuntary muscles movements)

types of dyskinesia

myoclonus (spamodic jerky contraction of groups of muscles) tics (habitual spasmodic contration of muscles) chorea( jerky involuntary movements) ballism (twisting, shaking, jerking motions) dystonia (abnormal muscle tone resulting in muscular spasm and abnormal posture) spasm (sudden involuntary muscular contration or convulsive movement)

disease processes associated with hyperkinetic dysarthria

degenerative disease (huntington's chorea), toxic-metabolic conditions (tardive dyskinesia), vascular (not common, but possible--infarct of BG), neoplasm (tumor of BG or thalamus), infectious processes (sydenham's chorea), other (Tourette's syndrome, chorea gravidarum)

Sydenham's chorea is rar and seen in what age population

children

Chorea gravidarum is only seen in what population

pregnant women

Characteristics of chorea

oral motoar exam wnl, occassional drooling, dysphagia, motor unsteadiness

patient complaints of chorea

effortful speech, inability to get speech out, involuntary orofacial movements, chewing/swallowing problems

Speech characteristics of chorea

imprecise consonants, prolonged intervals, variable rate, monopitch, harsh vocal quality, inappropriate silence, distorted vowels, excess loudness variation

Name the dysarthria that is characterized by the following clusters of deviant speech: prosodic excess (prolonged intervals & phonmemes, inappropriate silences, excess & equal stress), prosodic insufficiency (monopitch & loudness, reduced stress, short phrases)

hyperkinetic (chorea)

oral motor exam often normal, drooling, chewing & swallowing difficulties, difficulty with attempts to maintain orofacial posture, facial grimacing, slower movements than chorea, and sensory tricks to inhibit movement are characteristic of

dystonia (hyperkinetic dysarthria)

Patients with dystonia complain of

effortful speech, involuntary orofacial movements, tricks temporarily improve speech, chewing/swallowing problems, food sticking in throat

Speech characteristics of dystonia are

voice stoppages, strainged-harsh vocal quality, excess loudness variations, hypernasality, irregular breakdown of consonants, variable rate, slow/irregular AMRs

What kind of dysarthria isgenerally mild and temporary, primarily effects articulation, often co-occurs with aphasia, apraxia, & cognitive disorders

unilateral upper motor neuron | dysarthria

UUMN is manifested as weakness/incoordination of the ____side

contralateral

What is a common site for a lesion that causes UUMN?

internal capsule

hemiplegia, impairment of fine motor skills, Babinski on affected side, hyporeflexia, central facial weakness, & lingual weakness are signs of...

direct motor system lesions of | unilateral upper motor neuron

increased muscle tone, spasticity, clonus (muscle spasm involving repeated, rhythmic, contractions), hyperactive stretch reflexes, central facial weakness during emotional expression are signs of

indirect damage of unilateral upper motor neuron

Etiologies associated with UUMN dysarthria are

tumor, trauma, CVA (most common)

Speech characteristics of UUMN are

imprecise artic, irregular articulatory breakdowns, slow AMRs, strained harsh vocal quality, mildly slowed rate, possible reduced loudness, possible hypernasality

Patient Complaints of UUMN

thick tongue, heavy lower face, difficulty with pronunciation, mild dysphagia, improvment daily, usually pt aware of speech difficulty

Approximately 35% of all dysathrias (very common), any combo of 2 or more, often difficult to tease out

Mixed Dysarthria

Common degenerative disease associated with etiologies of mixed dysarthria

ALS, MS, Friedreich's ataxia, PSP, Shy-Drager syndrome, Olivopontocerebellar atrophy

Other etiologies of mixed dysarthria (other than degenerative disease)

toxic metobolic condition (Wilson's disease), Vascular disorders (multiple infarcts), trauma (diffuse lesions associated w/ TBI), Tumor (generally brainstem), Infectious disease (AIDS)

Common Types of Mixed Dysarthrias

``` Flaccid-Spastic 42% Ataxic-spastic 23% Hypokinetic spastic 7% Ataxic flaccid spastic 6% Hyper-hypo 3% other 19% ```