Unilateral Upper motor neuron Flashcards
In order to have a significant dysarthria in the UMN system you need ______ damage.
bilateral
You can have dysarthria with ______ UMN damage, but it is generally a mild dysarthria.
unilateral
_______ dysarthria is a little studied but very common problem. It may be the most commonly occurring dysarthria,
UUMN
What may be the most commonly occurring dysarthria?
UUMN
UUMN usually occurs with _____ & _____ when the lesion occurs in the left hemisphere.
aphasia
apraxia
When the lesion is in the right hemisphere UUMN may co-occur with _____ and other _____ deficits (not related to dysarthria).
cognitive
speech
UUMN dysarthria tends to be _____ and ______ duration (this and its being masked by the other concomitant problems are why not much attention has been given it).
mild
short
WHy is UUMN not given much attention?
It tends to be mild and short in duration. It is also being masked by other concomitant problems.
What causes UUMN?
stroke
WHy do lesions causing UUMN damage doesn’t show on neurological scans?
they are too small
________ dysarthria may be so the person’s most apparent symptoms of neurologic problems so it can be important for diagnosis reasons
UUMN
UUMN primarily affects ______, _____ and ______
articulation
phonation
prosody
Speech problems in UUMN are due mainly to ______ of face and tongue.
weakness
What are the speech problems of UUMN due to?
weakness of face and tongue. There may also be some spasticity and in coordination.
The UMN system includes what two pathways?
Direct and indirect, it is bilateral, one half starts in the left hemisphere and the other half in the right hemisphere.
WHat are the two tracts from the direct pathway?
corticobulbar and corticospinal
Corticobulbar goes to ______ nerves and corticopsinal to _____ nerves.
cranial
spinal
Most of the innervation in the tracts of the direct and indirect pathway is to the __________ side.
contralateral
What is the path of hte fibers from the corticobulbar and corticospinal tracts?
It starts at the cortex and then descends via corona radiate then go into the internal capsule near the level of the basal ganglia and thalamus.
What happens to the tracts of the direct and indirect pathway after they go into the internal capsule near the level of the basal ganglia and thalamus?
Descends to the brain stem. THe corticobulbar fibers cross to the opposite side just before they get to the level of the cranial nerve they are going to innervate.
Corticospinal fibers cross over or decussate in the _____ of the ____. T
pyramids
medulla
The nerve impulses from the corticobulbar and corticospinal provide innervation for what?
finely coordinated, skilled movements.
The indirect pathway has the same _____ and the same ________ destinations. It crosses over in the same general area s the direct activation pathway, but not through the _____.
origin
contralateral
pyramids
Why is it called indirect pathway?
IT makes synaptic connections with several other structures, such as basal ganglia, cerebellum, reticular formation and other brain stem nuclei.
Why is the indirect pathway important?
It regulated reflexes and controls posture and tone upon which skilled movements must be superimposed.
The bulbar speech muscles have mostly what type innervation?
bilateral
The ______ speech muscles have mostly bilateral innervation except for what?
lower part of the face and part of tongue.
The bulbar speech muscles have mostly bilateral innervation except for the lower part of hte face and part of tongue. These areas have primarily ______ innervation so that one lesion can cause more damage.
contralateral
The ____, and the part of the ____ that goes to upper face,___ and ___ have more bilateral innervation, to protect vegetative functions of _____ and _______.
Vth, ViII X IX respiration feeding
What does the term central facial weakness refers to?
weakness caused by central nervous system damage not peripheral nervous system damage. It involved the lower part of the face.
It is called “central” facial weakness to differentiate it from what?. It involves the lower part of the face.
lesions due to cranial nerve VII damage
There may also be contralateral (unilateral) lingual weakness which may be called what?
central lingual weakness
In UUMN lesions there is usually a combination of what?
direct and indirect pathway lesions.
Typically _____ and ______ are seen in the limbs that are affected from UUMN lesions. A ______ reflex is seen on the side of the body affected.
weakness
spasticity
babinski
How do the symptoms of central facial weakness change over time?
Initially weakness, hyporeflexia, and hypotonia are seen in limbs - this changes to spasticity, hyperactive reflexes as time goes by.
What does decerebrate posturing mean in UUMN lesion?
Assuming a stiff, rigid posture - It occurs primarily when the cerebrum is removed.
What is the etiology of UUMN ?
Anything that damges the UMN system unilaterally. Degenerative, inflammatory and toxic metabolic diseases usually produce more than unilateral damage so don’t usually cause UUMN. Some trauma and tumors can cause unilateral damage.
What is the most common cause of UUMN dysarthria?
stroke
Types of strokes that are involved in UUMN damage:
-Left carotid or left middle cerebral artery blockages
-Right carotid or right middle cerebral artery blockages
Unilateral strokes in the posterior cerebral basilar and anterior cerebral arteries
Lacunar infarcts
What happens in a left carotid or left middle cerebral artery blockages?
Lead to aphasia and apraxia of speech as well as UUMN damage.
What happens in a right carotid or right middle cerebral artery blockages?
Lead to neglect and cognitive problems
What happens in unilateral strokes in the posterior cerebral basilar and anterior cerebral arteries?
cause UUMN damage
What happens in lacunar infarcts?
small strokes that leave little holes/cavities
What is the most common cause of UUMN dysarthria when dysarthria is the only sign of a stroke?
Lacunar infarcts
____ ____ cause UUMN damage in structures like the basal ganglia.
Lacunar infarcts
Lacunar infarcts don’t usually lead to ______. ____ or _____ deficits are the most common problems in addition to ________.
aphasia
motor
sensorimotor
dysarthria
Site of lesions for patients seen by Duffy?
stroke was the cause of UUMN 92% of the time
What was the conclusion from the patients seen by Duffy?
Could be more left than right lesions were referred to Duffy because of aphasia and speech problems, so this may not reflect a true picture. But enough evidence is available to know that UUMN dysarthria can result from lesions in both left and right hemispheres.
Most of UUMN dysarthria is reported to be _______ or _____ to _______. However, there are some cases reported for ____ to ______ UUMN dysarthria.
mild
mild -moderate
moderate-severe
UUMN dysarthria is usually ________. However, UUMN dysarthria can _____ in some cases.
transient
persist
If the patient has persistent severe dysarthria after a presumes unilateral stroke, suspicions should be raised about the possibility of lesions where?
on the other side of the brain
What do patients with UUMN dysarthria complain about?
- patient is usually aware of problem
- c/o thick tongue or thick, slurred speech
- speech deteriorates with fatigue (not as sharply as MG)
- words don’t come our right - difficulty with pronunciation
- drooling or mild dysphagia
- heavy feeling on affected side of face
- chewing & swallowing difficulty, especially soon after onset
- occasionally some have inappropriate crying and laughing
Non-speech clinical findings of patients with UUMN dysarthria:
- often have hemiplegia or hemiparesis
- may have sensory deficits
What are the oral mechanism findings that you see in patients with UUMN dysarthria?
- unilateral lower facial weakness (central weakness) in both rest and movement
- unilateral tongue weakness - usually occurs with facial weakness
- jaw usually demonstrates normal strength but some contralateral jaw weakness may occasionally be seen.
- VP function is usually OK but some unilateral palatal weakness may occur
- dysphagia may occur
Unilateral lower facial weakness (central weakness) in both rest and movement - presence of this is a good indicator of what?
dysarthria for stroke patients
Presence of tongue weakness is good indicator of presence of what?
UUMN dysarthria and dysphagia with stroke patients.
Tongue weakness detected best by deviation to _____ side upon protrusion.
weak
What are speech findings of patients with UUMN dysarthria?
- Imprecise consonants
- mildly slow AMRs
- irregular articulatory breakdowns
- Irregular AMRs (usually mild)
- hoarseness/harshness
- hypernasality is rare but occasionally occurs
- may sound similar to spastic dysarthria due to damage to indirect activation pathway
- reduced loudness
- slow rate
- intelligibility usually only mildly affected
- therapy often not needed due to recovery
What is the most common deviant characteristic of UUMN dysarthria?
imprecise consonants
What is the second most prominent deviant feature of UUMN dysarthria?
Mildly slow AMRs
Why do irregular AMRs occur in UUMN dysarthria?
Not sure because this occurs as it is symptomatic of cerebellar problems. Could be due to damage to cerebellocortical fibers intermingling with UMN fibers.
Why does UUMN dysarthria sound like spastic dysarthria?
may sound similar to spastic dysarthria due to damage to indirect activation pathway
What are the distinctive characteristics of UUMN dysarthria?
There are no single clear distinguishing features
Need to look for a cluster or group of characteristics
Cluster or group of characteristics that would distinguish UUMN dysarthria:
- Unilateral central face & tongue weakness
- primarily results from strokes
- mild to moderate articulation problems
- mild irregular articulatory breakdowns
- slow rate-slow & irregular AMRs
- strained, hoarse voice quality
- reduced loudness
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