Dysarthrias - Diff Dx

Question 1

Dysarthria

Answer 1

a speech disorder resulting from weakness, paralysis, or incoordination of the muscles of the speech mechanism

Question 2

Motor Speech Disorder

Answer 2

• disorders of speech resulting from neurological impairment affecting the motor programming or neuromuscular execution of speech (Duffy, 1995, p.5)
• includes dysarthria & apraxia of speech

Question 3

Flaccid dysarthria - Neural basis?

Answer 3

Final common pathway (spinal & cranial nerves) (aka LMN)

Question 4

Spastic dysarthria- Neural basis?

Answer 4

Bilateral direct & indirect activation pathways (pyramidal and extrapyramidal systems) (aka UMN)

Question 5

Ataxic dysarthria - Neural basis?

Answer 5

Cerebellum

Question 6

Hypokinetic dysarthria - Neural basis?

Answer 6

Basal Ganglia

Question 7

Hyperkinetic dysarthria - Neural basis?

Answer 7

Basal Ganglia

Question 8

Mixed Dysarthria - Neural basis

Answer 8

?

Question 9

Flaccid Dysarthria - Physiology?

Answer 9

Weakness

Question 10

Spastic Dysarthria - Physiology?

Answer 10

Spasticity

Question 11

Ataxic Dysarthria - Physiology?

Answer 11

Incoordination

Question 12

Hypokinetic Dysarthria - Physiology?

Answer 12

Rigidity, Reduced ROM

Question 13

Hyperkinetic Dysarthria - Physiology?

Answer 13

involuntary movements

Question 14

Mixed dysarthria - Physiology?

Answer 14

?

Question 15

Unilateral UMN - neural basis & physiology?

Answer 15

Neural basis: unilateral UMN

Physiology - Weakness & possibly incoordination

Question 16

Often ______ ______ are the 1st sign of a neurological disease

Answer 16

speech symptoms

Question 17

Identification of speech symptoms can assist w/ medical dx and care (T/F)

Answer 17

True

Question 18

Flaccid dysarthria - Symptoms

Answer 18

Can vary widely depending on what cranial nerves are involved. Unlike most dysarthria types, this dysarthria sometimes reflects involvement of only a single muscle group (e.g., tongue) or speech subsystem (e.g., phonatory).

Question 19

Flaccid dysarthria - clinical characteristics?

Answer 19

• Weakness
• Hypotonia & Reduced Reflexes
• Muscle Atrophy
• Fasciculations & fibrillations
• Progressive weakness with use, when damage is at the neuromuscular junction as in Myasthenia Gravis (Rapid weakening w/ use and Recovery with rest)

Question 20

Flaccid dysarthria - General oral motor exam would look like?

Answer 20

Expect to see

• Weakness & Reduced ROM for articulators
• Jaw deviates to weak side when opening (unilateral mandibular lesions)
• Tongue deviates to weak side when protruded
• Drooling

Question 21

Flaccid dysarthria - Articulation?

Answer 21

imprecise articulation

Question 22

Flaccid dysarthria - Resonance?

Answer 22

• Hypernasality

- Nasal Emission

Question 23

Flaccid dysarthria - Prosody?

Answer 23

• Short Phrases

- Monoloudness & mono pitch

Question 24

Flaccid dysarthria - Phonation?

Answer 24

• Breathy voice

- Audible inspiration

Question 25

Flaccid dysarthria - Commonly associated neurological diagnoses?

Answer 25

- Brainstem stroke (could lead to locked-in syndrome) - Gullain - Barre Syndrome (GB) - Mysathenia Gravis (MG) - Muscular Dystrophy (MD) (Duchenne, Myotonic)

Question 26

Flaccid dysarthria - Trigeminal Sensory Neuropathy

Answer 26

* Viral etiology is common, but also associated w/ diabetes, sarcoidosis, and connective tissue disease. * Facial numbness is occasionally a presenting symptom of Multiple Sclerosis (MS).

Question 27

Flaccid dysarthria - Trigeminal Nerve (V) lesions - Nonspeech oral mech exam - - In cases of bilateral weakness what would be pt complaints & what would you expect to see?

Answer 27

can include chewing difficulty, drooling, and recognition that the jaw is difficult to close or move

Question 28

Flaccid dysarthria - Trigeminal Nerve (V) lesions - Nonspeech oral mech exam - - if sensory branches are affected, what would be pt complaints & what would you expect to see?

Answer 28

pt may complain of decreased face, cheek, tongue, teeth, or palate sensation. (Assess during OME by having pt close eyes and indicate when light touch or pressure is applied to the affected area)

Question 29

Flaccid dysarthria - Trigeminal Nerve (V) lesions - Nonspeech oral mech exam - - In pts with unilateral mandibular branch lesions, what would be pt complaints & what would you expect to see?

Answer 29

- jaw will deviate to weak side when opened - partly opened jaw may be pushed easily to the weak side by the examiner - degree of master or temporals contraction felt on palpation when the pt bites down may be decreased on the weak side