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Motor Speech > Unilateral UMN > Flashcards

Unilateral UMN Flashcards

1
Q

Is unilateral one sided?

A

YES

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2
Q

What is Unilateral UMN one sided or two sided?

A

One sided

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3
Q

What pathways are affected?

A

Direct Pathways and Indirect Pathways

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4
Q

Unilateral UMN Info

A

Only subtype of dysarthria determined by anatomy NOT physiologic changes (defined by its damaged location)

Often temporary with spontaneous recovery- due to onset of brain swelling from other areas damaged

Co-occurs with aphasia (brocas) and/or apraxia of speech in dominant hemisphere

Co-occurs with aprosodia or cognitive deficits in non-dominant hemisphere

Can be the only or most obvious sign of neurologic disease, especially stroke

Resolves without treatment

Brain injury and strokes cause this

Facial drop is one characteristic of UMN.

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5
Q

Characteristics of Unilateral

A

Direct Activation Pathway Damage
- Weakness
- Hemiplegia
- Unilateral lower face and tongue weakness
- Abnormal Reflexes - Babinski sign and/or Hoffman’s sign

Indirect Activation Pathway Damage
- Increased muscle tone
- Clonus
- Hyperreflexia

Only going to see unilateral LOWER face weakness

Only see cheek and lip

Its CONTRALATERAL presentation
Abnormal reflexes

Hoffman- flick of the finger next to the pointer, pointer and thumb will slowly look like they are coming together (see video)

Babinski- toes point up instead of away/curl

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6
Q

Non-Speech Clinical Findings

A

Contralateral lower facial weakness
- Weakness at rest & during movement

Contralateral lingual weakness

Jaw usually normal

Velopharyngeal function usually normal

Minority may have contralateral vocal fold weakness

High likelihood of dysphagia

Left side tongue will make right side tongue weak- tongue will go right

Opposite of flaccid

Bilateral stuff is
persevered

Will have a lot of dysphagia

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7
Q

Speech Effects of Unilateral

A

For CN V, IX, X and VII (upper face)
- UMNs bilaterally innervate LMNs of the jaw, velum, pharynx, and larynx

-Damage results in more mild effects on speech involving these structures

For CN VII (lower face), XII
- UMNs contralaterally innervate LMNs for tongue and lower face

  • More pronounced changes to speech when affected
  • Only get contralateral information
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8
Q

Speech Characteristics of Unilateral

A

Consonant imprecision- due to articulatory impairment with tongue. Disruptions with sensory feedback. Slow articulation such as AMRs/SMRs.

Irregular articulatory breakdowns

Slow, imprecise AMRs

Dysphonia – harshness, breathiness, strain

Slow rate

Monopitch

Monoloudness

Mild Hypernasality

Dysphonia can go anywhere- Inward= more harshness and strained

Very rarely there is hypernasality

90% of what you would see is articulatory- A red flag
Localized slow weak movement

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9
Q

Stroke

A

Over 90% of UUMN dysarthrias

Frontal lobe near motor strip

Lacunar strokes
- Internal capsule
- Thalamus

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10
Q

Lesion Location Breakdown

A

Frontal Lobe (41%)
- Frontal Lobe, cortical and subcortical (27%)
- Frontal Lobe, cortical only (7%)
- Frontal Lobe, subcortical only (7%)

Internal Capsule (34%) (white matter pathway going to thalamus)
- Internal Capsule only (34%)
- Internal capsule adjacent (11%)

Frontal lobe and Internal Capsule (7%)

Brainstem (4%)- eye movement disruptions

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10
Q

Other causes

A

TBI- 90+%

Tumor resection

Multiple Sclerosis

All resulting in unilateral damage generally in and around motor strip or white matter connected to the motor strip

90+% of TBI

Signs Early on in MS

You will see good muscle tone in Unilateral

NO fasciculations will be seen

Face drooping on the right, means damage on the left (and vice versa)

Looks flaccid and spastic

Facial weakness is going to be a hallmark in distinguishing

Forehead is bilateral, the cheek is contralateral

Velum is bilateral, larynx is bilateral

Jaw is bilateral for chewing

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11
Q

UNILATERAL UMN CHART

A

——>

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12
Q

UNILATER UMN

A
  • One sided weakness in THE LOWER FACE
  • Location:
    (where the damage is)
    Motor cortex, corticobulbar tract, corticospinal, thalamus damage, internal capsule (all the corticobulbar and corticospinal stuff running down from motor cortex and out as it exits the brain).
  • Results in CONTRALATERAL WEAKNESS & INCOORDINATION
  • The reason lower face and tongue only get information form the contralateral motor cortex

BILATERAL COMMANDS
- Upper face
- Jaw
- Velum
- Larynx
- Diaphragm

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13
Q

ARTICULATION

A
  • Slow AMRs and SMRs
  • Imprecision
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14
Q

PHONATION

A
  • Mild breathiness
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15
Q

RESONANCE

A
  • Mild hypernasality
16
Q

RESPIRATION

A
  • Usually fine because of the backup system
17
Q

NEUROANTOMY

A
  • Motor Cortex, etc

Motor Speech (9 decks)

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