Ataxic Dysarthria

Question 1

What is Ataxic Dysarthria?

Answer 1

Distinct MSD produced by damage to the cerebellar control circuit.

Results in decreased coordination in the movement of the speech mechanism

Likely to affect all speech systems, but most easily perceived in articulation and prosody

** A decrease in coordination of movements

Question 2

Where is the Cerebellum located specifically and has what?

Answer 2

Inferior to the occipital lobe and posterior to the brainstem
- Three cerebellar peduncle connections
- Four anatomic areas

Question 3

What is the Cerebellum responsible for?

Answer 3

Responsible for balance, movement coordination and movement scaling

Question 4

Each cerebellar hemisphere contributes to the control of voluntary movement on the..

Answer 4

IPSILATERAL SIDE
- Contain deep cerebellar nuclei for processing

Question 5

What does the Vermis do in the Cerebellum?

Answer 5

Vermis assists with coordination of gait and posture, keeps center of balance

Question 6

The motor cortex in the Cerebellum is what?

Answer 6

CONTRALATERAL

Question 7

Flocculus and nodule (Flocculonodular lobe) assist with coordination of information from..

Answer 7

Vestibular system
- Influence eye movement
- Coordinate axial muscles for balance

Question 8

What are the 3 Cerebellar Peduncles?

Answer 8

Inferior peduncle

Middle peduncle

Superior peduncle

Question 9

What is the function of the Inferior Peduncle?

Answer 9

Receives sensory information about body position

Can provide emergency reflexive information to body

Question 10

What is the function of the Middle Peduncle?

Answer 10

Takes input from cortex (e.g., motor plan) into cerebellum

Smooths and refines movements

Main output channel to superior CNS
Completes corticocerebellar control circuit

Question 11

What word is Ataxic Dysarthria?

Answer 11

INCOORDINATION

Question 12

Ataxic Dysarthria Info

Answer 12

Difficulty with motor EXECUTION resulting in impairments in control of the timing, force or coordination of movement

Any sign of weakness is due to miscalculation of the amount of force required
- These are NOT issues with final common pathway/flaccidity

Reduced range of motion is due to miscalculation of distance needed to move
- These are NOT issues with stopping/starting movements like basal ganglia

Question 13

What are the Physical Clinical Characteristics?

Answer 13

Broad-based gait
- Difficulty with balance and center of gravity

Titubation
-Rocking/nodding of the head

Nystagmus
- Issues with cranial nerve VIII and floccular lobe in cerebellum

Dysmetria- the inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated movements.

** You can’t complete movements from point to point. For example, it may be very difficult to grab an object with your fingers. You may underreach or overreach for the object you’re trying to grasp

Hypotonia without muscle atrophy

Question 14

What are the Non-Speech Oral Characteristics?

Answer 14

Typically normal size, strength and symmetry of musculature

Normal gag reflex with no abnormal reflexes

Difficulty with coordinated, repetitive movements
- a.k.a. Dysdiadochokinesis (DDks)
- AMRs/SMRs, Tongue side-to-side, or Smile-pucker-smile of lips

Question 15

What are the Common Speech Characteristics?

Answer 15

Irregular speech AMRs are a hallmark of ataxic dysarthria

Articulatory inaccuracy
- Imprecise consonants
- Irregular articulatory breakdowns
- Distorted vowels

Prosodic Excess
- Equal and excess stress – can be compensatory
- Prolonged phonemes and intervals between them creating slower rate

Phonatory/Respiratory
- Uncontrolled variations in pitch or loudness

AMRs and SMRs best way to look a diagnosis for ataxic dysarthria

Question 16

Additional Speech Characteristics

Answer 16

Telescoping– Inconsistent breakdown of articulation in which a syllable or series of syllables are unpredictably run together

Voice tremor (around 3 Hz)

Intermittent mild hyponasality and hypernasality – due to timing errors between muscles of velum and rest of speech mechanism

Question 17

What are the etiologies?

Answer 17

Friedreich’s ataxia

Hereditary Spinocerebellar Ataxias (SCAs)

Multiple Sclerosis affecting the cerebellar control circuits

Miller-Fisher syndrome

Cerebellar Stroke

Neoplasms

Traumatic brain injury

Toxicity

Normal Pressure Hydrocephalus

Infections

Question 18

Friedreich’s ataxia

Answer 18

Progressive & hereditary (autosomal recessive)

Begins in early 20s, with a prevalance of ~2 per 100,000

Gait disturbance, dexterity impairments, dysarthria, visual disorders

Lifespan of around 20 years post-diagnosis

Question 19

Hereditary Spinocerebellar Ataxias (SCAs)

Answer 19

Multiple subtypes, total prevalence ~ 4 per 100,000

Onset ranges across the lifespan

Question 20

Miller-Fisher syndrome

Answer 20

Rare subtype of Guillain-Barre that shows signs of ataxia

Attacks the cerebellum

Same viral onset, autoimmune disease

Question 21

Cerebellar Stroke

Answer 21

Superior cerebellar artery, Posterior-inferior cerebellar artery or Anterior-inferior cerebellar artery

Question 22

Neoplasms

Answer 22

Cerebellar tumors may also put pressure on brainstem or cranial nerves as they exit

16% of metastatic brain tumors develop in the cerebellum

Question 23

Toxicity

Answer 23

Alcohol abuse/poisoning

Lead or mercury poisoning

Excessive levels of certain prescription drugs, including some anticonvulsants

Question 24

Normal Pressure Hydrocephalus

Answer 24

Enlarging of the ventricles from excess cerebrospinal fluid

Associated with TBI, hemorrhages, meningitis

Triad of progressive symptoms
- Gait disturbance
- Impaired cognitive function
- Urinary incontinence

Question 25

Infections

Answer 25

Lyme Disease

Prion diseases
- Creutzfeld-Jakob Disease
- BSE (Mad Cow)

Question 26

Treatment Notes

Answer 26

Strength training is not supported by evidence

Surgery and prosthetics are generally not used

Minimal evidence for pharmacological support

Behavioral treatments are the standard

** USE AMR’s TO TEST ATAXIA

Question 27

Treatment Options

Answer 27

Rate reduction

Contrastive stress tasks

Phonetic placement

Minimal pairs

Intelligibility drills

Question 28

ATAXIC CHART

Answer 28

—->

Question 29

ATAXIC = TELESCOPING

Answer 29

• Sudden jerk movement (unintentional)

Question 30

RESPIRATION

Answer 30

• Uncontrolled variations in loudness
• Explosive loudness

Question 31

PHONATION

Answer 31

• Uncontrolled variations in pitch or loudness

Question 32

RESONANCE (refers to the way airflow for speech is shaped as it passes through the pharynx (throat), oral (mouth) and nasal (nose) cavities)

Answer 32

• Intermittent mild hypernasality due to timing errors between muscles of the velum and rest of speech mechanism

Question 33

ARTICULATION

Answer 33

• Articulatory imprecision
• Imprecise consonant
• Irregular articulatory breakdowns
• Distorted vowels

Question 34

PRODOSY (pitch, loudness, duration of voice)

Answer 34

• Prosodic excess (big changes in loudness and pitch)
• Equal and excess stress- can be compensatory (scanning)
• Prolonged phonemes and intervals between them creating slower rate

Question 35

NON SPEECH

Answer 35

• No atrophy or fasciculations
• NO MUSCLE TIGHTNESS
• NORMAL gag reflex with no abnormal reflexes
• Difficulty with coordinated repetitive movements aka AMRS/SMRs (tongue side to side, or smile pucker smile of lips)

Question 36

NEUROANATOMY

Answer 36

• Control circuits (CEREBELLUM)