FLACCID DYSARTHRIA Flashcards
(22 cards)
Flaccid Dysarthria
- Caused by injury or disease of one or more cranial or spinal nerves involved in speech, to the muscles involved in speech, or to the junction between them
- Reflect problems in the nuclei, axons, or neuromuscular junctions that make up the motor units of the Final Common Pathways (FCP).
- May be manifest in any or all of the respiratory, phonatory, resonatory, and articulatory components of speech.
- Muscle weakness and reduced muscle tone in one or more groups of muscles
- Decrease in the speed, range and accuracy of speech movements.
- These are problems of EXECUTION not planning or programming.
ONE WORD for Flaccid
WEAKNESS
RESPIRATION
- Decreased/reduced loudness
- Short phrase length
PHONATION (voicing/utterance)
- Monopitch
- Breathiness (rapid/shallow breathing)
- Hoarseness
- Diplophonia (two different pitches/2 voices at different rates, different frequencies)
- Aphonia (without voice/complete loss of voice)
- Reduced pitch and loudness range
RESONANCE (refers to the way airflow for speech is shaped as it passes through the pharynx (throat), oral (mouth) and nasal (nose) cavities)
- Hypernasality
- Nasal emission (air that escapes out of nose)
- Weak pressure on consonants (air coming out of nose limits air pressure build up in mouth)
ARTICULATION
- Imprecise alternating motion rates (sharpness of sound)
- Imprecise consonants
- Decreased precision and rate on “puh” (CN 7: Facial) but not “tuh” or “kuh” (CN 12: Hypoglossal)
- Distortion of bilabial and labiodental consonants
- May exaggerate jaw movement because of weak lip
PROSODY (variation in pitch, loudness, and duration)
- Decreased pitch range
- Slow rate
NON-SPEECH (Oral Mech)
- Atrophy (loss of physical muscle volume)
NON SPEECH- CN V: TRIGEMINAL
- Difficulty resisting lateral pressure on jaw (unilateral)
- Jaw hangs open at rest (bilateral)
- Difficulty with chewing or drooling is sometimes reported
NON SPEECH- CN VII: FACIAL
- Infections can trigger Bell’s Palsy,
- Drooping eyebrow and unwrinkled forehead on affected side,
- Ipsilateral (located on same side of body) does not blink or close
- Lip may droop and not seal during eating (biting lip) (Unilateral)
- Reduced Blink/face movement
NON SPEECH- CN IX: GLOSSOPHARYNGEAL (sensory part of back of tongue)
- Faucial pillars
- Asymmetric gag reflex if damage is unilateral
- Pain in the upper pharynx
- Decreased pharyngeal elevation during swallow
NON SPEECH- CN X: Vagus (Oral) (vocal folds and velum)
- Pharyngeal branch- velar movement and upper throat
Unilateral
- Velum will hang lower on the side of the lesion and pulls toward the strong side during swallow and phonation
- Decreased gag reflex on the impaired side
Bilateral
- Velum hangs low and does not elevate during swallow or phonation
- Absent or near-absent gag reflex
- Nasal regurgitation during swallow
NON SPEECH CN X: VAGUS (Larynx)
Superior laryngeal- changes pitch
Recurrent laryngeal- opens and closes vf’s (comes down neck and goes up to your heart) gets cut when doing heart surgery and one of the vf’s is paralyzed.
Unilateral
- Decreased reflexive and volitional cough strength
- Increased chance of penetration and aspiration during swallow
- Visible reduction of movement on side of lesion during endoscopy
Bilateral
- Respiratory stridor during inhalation if vocal folds are paralyzed adducted
- Cough sharpness severely reduced or absent
- Significant risk of aspiration if vocal folds are paralyzed abducted
NON SPEECH- CN XII: HYPOGLOSSAL
Unilateral
- Atrophy and fasciculations on the side of damage
- Tongue deviates to the weak side on protrusion
Bilateral
- Atrophy and fasciculation on both sides of the tongue
- Limited movement of tongue laterally and on protrusion
- Saliva accumulation and decreased bolus control during eating
NEUROANATOMY
- Trigeminal CN V (5)
- Facial CN VII (7)
- Glossopharyngeal CN IX (9)
- Vagus CN X (10)
- Hypoglossal CN XII (12)
(FINAL COMMON PATHWAY)
** Lower motor neurons originate in the brainstem at the cranial nerve nuclei (cell body) and terminate at the neuromuscular junction
CLINICAL CHARACTERISTICS
- Hypotonia (low muscle tone)
- Hyporeflexia (absent or decreased reflexes)
- Weakness
- Atrophy
- Fasciculations
- Progressive weakness
**With rest or certain medications, the person will recover strength very quickly
Summary of Common Characteristics
- Hypernasality
- Nasal emission
- Imprecise consonants
- Breathiness
- Dysphonia
- Decreased pitch range
- Decreased loudness
ETIOLOGIES
- Degenerative Disease
- Physical Trauma
- Surgery
- Head/neck injury - Brainstem stroke
- Head and Neck Cancer
- Guillain-Barre Syndrome
- Myasthenia Gravis
- Multiple Sclerosis
- ALS
- Traumatic Injury
(HGMMAT)
Treatments
Is the cause progressive?
- Work on maintenance and compensation
Respiratory system treatments
- Postural adjustment and monitoring
-Working on maximum loudness and/or vowel duration
- Working on monitoring inhalation/exhalation rates and phrase lengths and adjusting them
Articulation treatments
- Strength training (e.g., oral-motor exercises) are frequently used, but their efficacy when used alone is limited at best
- Using a bite-block during therapy to force tongue movement and limit jaw compensation
- Make them talk, focusing on the appropriate voice/place/manner, overarticulation, rate modification
Voice treatments
- Adjust voice onset via effortful closure, easy onset, etc. as necessary
Dysarthria
Is the impaired production of speech due to disturbances in the muscular control of the speech mechanism
- Can include impaired articulation, resonance, phonation, and respiration
Apraxia
Is a deficit in the ability to smoothly sequence the speech-producing movements of the tongue, lips, jaw, etc.
- Primarily affects articulation and prosody
Flaccid Dysarthria
- Caused by injury or disease of one or more cranial or spinal nerves involved in speech, to the muscles involved in speech, or to the junction between them
- Reflect problems in the nuclei, axons, or neuromuscular junctions that make up the motor units of the Final Common Pathways (FCP).
- May be manifest in any or all of the
respiratory
phonatory
resonatory
articulatory components of speech. - Muscle weakness and reduced muscle tone in one or more groups of muscles
- Decrease in the speed, range and accuracy of speech movements.
- These are problems of EXECUTION not planning or programming.
