Flashcards in Exam 2-Dr. Blaesing Deck (43):
Damage to what results in Spastic Dysarthria
Direct and Indirect pathways of the CNS
T or F: Rarely is there only direct activation or indirect activation pathway damage.
True because these tracts intermingle
Is Spastic Dysarthria UMN or LMN damage?
Are the typically uni or bilateral damage in Spastic Dysarthria?
Which causes more UMN damage? Uni or bilateral damage?
What subsystems does Spastic Dysarthria effect?
What does spasticity look like/characteristics?
#1 Spasticity-muscles hard to move
weakness, slow movements, reduced ROM
What causes spasticity?
Too much muscle tone meaning contracted muscles (Spasticity itself is a result of the hyperactivity of the stretch reflex)
Lesions of UMN damage cause what?
Loss of Skilled Movements
How do you elicit the Babinski Reflex?
Stroke the bottom of the foot and the toes fan out with the large toe extending. This is an abnormal response in adults, but is normal in babies.
Tor F: In spastic dysarthria reflexes at first may be reduced (hypo-reflexia) but then become hyper (hyper-reflexia).
What is Clonus?
Repetitive contractions when muscle is under tension. Seen sometimes in jaw.
What abnormal reflexes are seen in UMN damage?
Babinksi Reflex in Adults
Jaw Jerk Reflex
What is the sucking reflex, and how do you elicit it?
Stroke the tongue blade across the upper lip starting at the side and move to the middle – do on both sides. Abnormal reflex is when there is pursing of lips.
What is the snouting reflex, and how do you elicit it?
If you use tongue blade or finger to tap or push backward on tip of nose or philtrum (part between nose and upper lip) you see the bottom lip pull up.
What is the jaw jerk reflex, and how do you elecit it?
Have lips open and parted. Place a tongue blade or finger on the chin and tap with the other finger. Abnormal response is quick closing of the jaw.
What is the Direct Activation Pathway also called?
What are the parts of the Direct Activation Pathway?
1. Corticobulbar Tract goes to the cranial nerves
2. Corticospinal Tract goes to spinal nerves.
T or F: The Direct Activation Pathway is unilateral.
T or F: Most cranial nerves innervating speech muscles have bilateral input.
Why is the Direct Activation Pathway called facilitory?
Because it leads to movement. It is responsible for skilled, discrete, quick movements.
What is the Indirect Activation Pathway indirect also called and why is it indirect?
It is indirect because it has many synapses along its path from the cerebrum to the brain stem and spinal cord.
Where does the Indirect Activation Pathway make connections?
Basal ganglia, cerebellum, reticular formation, vestibular nuclei, and red nucleus
What is the Indirect Activation Pathway essential for and what else does it do?
Regulating skilled movements
It helps maintain tone – which is important for sustained postures required to support movements of direct activation system.
What does damage to the Indirect Activation Pathway primarily affect?
Inhibitory role of motor control
(increase muscle tone, hyperactive reflexes, spasticity)
What is the etiology of Spastic Dysarthia?
Anything that affects the Direct or Indirect pathway.
Degenerative, inflammatory, toxic, metabolic, traumatic and vascular diseases.
What are Vascular Disorders in spastic dysarthria?
Infarcts of internal carotid artery and middle and posterior cerebral arteries. Usually bilateral lesions in each hemisphere unless brainstem-unilateral.
What are lacunar infarcts and what do they lead to?
Very tiny holes in the cortex from strokes. Can lead to dementia or damage to brain.
What is a lacunar state?
Term for patients with many lacunar infarcts who have dementia, usually spastic dysarthria, dysphagia, & incontinence.
What is Binswanger’s Subcortical Encephalopathy?
A term given to patients with multiple infarct dementia occurring over years and months.
What type of disease is Leukoencephalitis and what is it?
inflammation of white matter of brain
What type of disease is Primary Lateral Sclerosis (PLS) and what is it?
A type of motor neuron disease
What is a subcategory of PLS?
Amyotrophic lateral sclerosis (ALS)
What are the differences in PLS vs ALS?
PLS there are only signs of UMN damage and has spastic dysarthria.
ALS has mixed flaccid-spastic dysarthria resulting from both UMN and LMN damage.
What are patient complaints of spastic dysarthria?
Slow or effortful speech
Patient feels nasal speech
Difficulty controlling emotions
What is difficulty controlling emotions called and what is it due to?
Emotional lability or pathological laughing and crying due to increase inhibition.
What dysarthrias is Pseudobulbar Affect seen in?
Usually only Spastic Dysarthria (or Spastic-Mixed)
What are non-speech findings of Spastic Dysarthria?
Dysphagia often with nasal regurgitation
Face in a fixed posture
Emotional lability (PSA)
Hyperactive gag reflex
Pathological oral reflexes
Face may be weak bilaterally
Tongue ROM and weakness during strength testing
Palate symmetric but slow to move
How do you assess for spastic dysarthria?
AMR's-slow rate but regular
Imprecise articulation-movements restricted
All speech movements affected
What is Ataxic Dysarthria a problem with?
T or F: In Ataxic Dysarthria, it is worthless to work on oral motor strengthening exercises.
What type of dysfunction is Ataxic Dysarthia?
Cerebellar Control Circuit Dysfunction