Chapter 15

Question 1

What is differential dx?

Answer 1

The process of narrowing possibilities and reaching conclusions about the nature of a deficit.

Question 2

What are two reasons that may interfere with making a definitive diagnosis?

Answer 2

1) noncooperative client

2) equivocal/uncertain findings

Question 3

What are some etiologies of MSD (10)

Answer 3

1) Vascular
2) Degenerative (ALS,PD)
3) TBI
4) Surgical Trauma
5) Toxic and metabolic conditions
6) Infections and metabolic conditions (rare)

Question 4

What kind of stroke is the most common cause for dysarthria?

Answer 4

Hemorrhagic.

Question 5

What kind of the dysarthria most commonly occurs w/ closed head injuries (TBI) ?

Answer 5

Spastic.

Question 6

T/F In an open head injury (TBI), flaccid dysarthria is likely to occur.

Answer 6

False; it is more common for it to cause the CNS dysarthrias (spastic, UUMN, & ataxic)

Question 7

If there is a skull fracture or neck trauma, which dysarthria is likely to occur?

Answer 7

Flaccid.

Question 8

T/F Surgeries involved w/ ENT, chest/cardiac areas are only associated with flaccid dysarthria.

Answer 8

True.

Question 9

The only dysarthria that does not occur from surgical trauma is ______________.

Answer 9

Hypokinetic.

Question 10

Which two dysarthrias are associated with toxic conditions?

Answer 10

Ataxic and hyperkinetic.

Question 11

Guillian barre is what kind of d/o and what kind of dysarthria does it typically cause?

Answer 11

demylenating dz, typically causes flaccid dysarthria.

Question 12

Which demylenating dz is usually associated w/ ataxic dysarthria?

Answer 12

Multiple Sclerosis (MS).

Question 13

What is Arnold Chiari? Which dysarthria is typically associated with it?

Answer 13

An anatomic malformation of the brain. Flaccid Dysarthria.

Question 14

Neuromotor junction d/o typically cause which kind of dysarthria?

Answer 14

Flaccid.

Question 15

What are the confirmatory signs for flaccid dysarthria?

Answer 15

Fasciculations, atrophy, hypoactive gag reflex, hypotonia, MAYBE nasal regurgitation.

Question 16

What are the confirmatory signs for spastic dysarthria?

Answer 16

Pathological oral reflexes, hyperactive gag reflex, dysphagia, drooling, psuedobulbar affect.

Question 17

What are the confirmatory signs for ataxic dysarthria?

Answer 17

Dysmetria for non-speech jaw, face, tongue.

Question 18

What are the confirmatory signs for hypokinetic dysarthria?

Answer 18

orofacial tremors, masked facies

Question 19

What are the confirmatory signs for hyperkinetic dysarthria?

Answer 19

Abnormal or unwanted mvmts at rest and in speech

Question 20

What are the confirmatory signs for UUMN?

Answer 20

Unilateral facial and tongue weakness (w/o atrophy).

Question 21

Which two subsystems of speech are affected in flaccid dysarthria?

Answer 21

Resonatory and phonatory abnormalities.

Question 22

What are the main VOICE characteristic seen in flaccid dysarthria and which CN is damaged?

Answer 22

Breathiness, diplophonia, short phrases, inspiratory stridor.

CNX (VAGUS)

Question 23

What are the 3 main speech characteristics in spastic dysarthria?

Answer 23

Slow rate combined with slow, but regular AMRs.

Strained voice.

Question 24

What are the speech characteristics in ataxic dysarthria?

Answer 24

Irregular artic. breakdowns, irregular AMRs, dysprosody.

Question 25

What are the speech characteristics for hypokinetic dysarthria?

Answer 25

Rapid, blurred speech and AMRs, palilalia.

Question 26

What are the speech charcteristics for hyperkinetic dysarthria?

Answer 26

unwanted speech movements.

Question 27

What are the speech characteristics of UUMN?

Answer 27

Mild & transient duration. (may be confused w/ ataxic due to irregular breakdowns and mild irregular AMRs). -rarely hypernasal, sometimes strained.

Question 28

Apraxia = damage to which areas of the brain ?

Answer 28

LH (typically); supratentorial.

Question 29

Dysarthria = damage to which areas of the brain ?

Answer 29

Supratentorial, posterior fossa, spinal or peripheral lesions.

Question 30

Which vascular systems are typically affected in apraxia?

Answer 30

Carotid.

Question 31

Which vascular systems are typically affected in dysarthria?

Answer 31

May be any, not only carotid.

Question 32

Which type of dysarthria is most commonly confused with Apraxia (AOS) ?

Answer 32

UUMN.

Question 33

How can you differentiate b/w dysarthria & apraxia?

Answer 33

1) oral mech exam indicates neuromuscular problem for dysarthria and NOT for apraxia. 2) In dysarthria, all subsystems are affected. In apraxia, articulation and prosody are mainly affected. 3) AOS is more often linked to Aphasia than dysarthria. 4) Distortions in apraxia are predictable and in dysarthria they are not. 5) Apraxia speakers grope.

Question 34

How can you differentiate dysarthria and aphasia?

Answer 34

1) Oral mech = normal for aphasia and not normal for dysarthria (muscle problems). 2) Dysarthria do not have LANGUAGE problems, aphasia pt's DO.

Question 35

What is anarthria?

Answer 35

Lack of speech.

Question 36

T/F Anarthria is typically is present with limb motor deficit.

Answer 36

False; usually occurs without it.

Question 37

What other abnormalities are present in a pt with anarthria that can help w/ dx?

Answer 37

Dysphagia and oromotor abnormalities.

Question 38

What are other characteristic found in anarthria?

Answer 38

Restricted artic ROM, reduced loudness, strained, goaning quality. TYPICALLY have oromotor deficits.

Question 39

T/F Mute apraxic pt's usually try to speak and show frustration when they can't.

Answer 39

True.

Question 40

T/F Mute apraxic pt's typically show an abnormal oral mech exam.

Answer 40

False; they may show normal oral mech structures.

Question 41

What is one difference b/w mutism present in aphasia vs. mutism present in apraxia?

Answer 41

Pt's w/ mutism present in aphasia typically have problems following directions.

Question 42

What are three reasons a pt can have a neurogenic mutism?

Answer 42

1) due to aphasia 2) due to apraxia 3) due to cognitive-affective disturbances = not enough stimulationof brain; may be severely delayed if they do start to speak.