Flashcards in Flaccid Dysarthria Exam 1-Dr. Blaesing's Questions Deck (124):
A patient presents with a "flutter: in the check area. What cranial nerve is implicated?
VIIth Facial Nerve
In assessing AMR's, which sound/syllable will mostly likely be affected with VIIth nerve damage?
With bilateral VIIth nerve lesions patients may have difficulty saying bilabials, what is the likely substitution?
Lingual alveolar sounds (using their tongue)
Which nerve innervates the stylopharyngeus muscles?
IXth Glossopharyngeal Nerve
What does the stylopharyngeus muscle do?
Raises pharynx in speech & swallowing
Patient complains of pain going down back of throat. Which cranial nerve is implicated?
Patient presents with hypernasality. Which cranial nerve is implicated?
Xth Vagus-Pharyngeal branch
Which intrinsic laryngeal muscle is the primary pitch changer?
Which nerve innervates the cricothyroid muscle?
Xth Vagus-Superior Laryngeal
Which will have a more significant effect – lesion on the recurrent laryngeal nerve or a lesion above the pharyngeal nerve?
Above the pharyngeal nerve
An axon that originates from a motor neuron on the part of the motor cortex that controls the jaw will descend through the corticobulbar tract to synapse with which cranial nerve?
Vth Trigeminal Nerve-Motor & Sensory Mandibular Branch
The patient presents with tongue atrophy & fasciculations. Upon tongue protrusion, the tongue deviates to the right. Your best estimation is that it is a _______ lesion and that the lesion is on which side?
LMN-lesion on the right
The patient presents with spasticity. Upon tongue protrusion, the tongue deviates to the right. Is the lesion UMN or LMN lesion? The lesion is on which side? Where is the side of weakness?
UMN-Left Side-Right side (where tongue deviates)
The jaw hangs open at rest with little strength to resist closing. Describe lesion.
Cranial Nerve V Trigeminal, Bilateral lesion. But can’t tell if UMN or LMN
The jaw deviates to the right side. With this information can you tell which is the side of weakness? Which is the side of lesion?
You don't really know where the lesion is.
There is a single UMN lesion on the right side that affects the Vth nerve. Will there be a significant effect on speech?
No, because UMN and this is a bilateral nerve. (if LMN, yes)
Are UMN’s part of the CNS?
Are LMN’s part of the PNS?
Are LMN’s part of the Final Common Pathway?
Do LMN’s originate in the cortex?
Do UMN’s (including both DAP and IAP) terminate at the synapses either in the brain stem or spinal cord?
Which subsystems can dysarthria effect?
At which anatomic level (supratentorial, etc.) do cranial nerves III-XII originate?
Which cells form myelin in CNS?
All oligendroglia cells
Name the structures that make up the basal ganglia
a. Globus Paladus
Make up the Striata:
b. Caudate Nucleus
Define UMN and their function
Cell bodies originating in the motor cortex.
Job=tells LMN what to do
Define LMN and their function
Cell bodies originating in the brain stem and spinal cord. Destination=muscle sending message to.
Function=to take the message from UMN and execute it.
The patient presents with tongue atrophy & fasiculations. Upon tongue protrusion, the tongue deviates to the right. Your best estimation is that it is a: (UMN or LMN) lesion and the lesion is on which side (Left or Right)?
How is Dysarthria different than Apraxia?
Apraxia is motor programming and dysarthria is muscle weakness/muscle execution
What sub systems does apraxia effect?
Articulation and prosody
What makes up the motor unit?
Motor neuron and the muscle fiber it innervates
What does the Trigeminal nerve innervate?
a. Mainly tensor veli palatini
b. Mylohyoid for swallowing
What type of innervation is the Trigeminal nerve?
What happens with unilateral vs bilateral damage to the Trigeminal nerve?
Unilateral: deviates to weak side
Bilateral: hangs open at rest or weakness to close
There’s an UMN damage on the left side of the brain with the, which side will the tongue deviate to?
If there’s a LMN lesion on the left side, which side will the tongue deviate to?
Will it always deviate to the side of weakness?
Will it always deviate to the side of lesion?
Describe the innervation of the face
a. Upper face, bilateral
b. Lower jaw is unilateral innervation and contralateral
LMN's are called what?
UMN's are called what?
Paths or tracts
Cranial nerves originate and end where?
Cranial nerves start in the brain stem (previously UMN's with the direct/indirect pathways that synapse in brain stem) at the start of the cranial nerve to the synapse of the muscles they innervate
If lesion ON cranial nerve XII, then must be UMN or LMN?
What are the three branches of the Vagus-Xth nerve?
Superior Laryngeal Branch
Recurrent Laryngeal Branch
The Hypoglossal nerve innervates all of the intrinsic and extrinsic tongue muscles except?
Spinal Nerves effect what sub system?
What effects direct and indirect pathways? (What is the difference between the two?)
One makes stops along the way and one doesn’t. Indirect goes through basal ganglia
T/F Motor movement does not originate in the basal ganglia or cerebellar control circuits.
True (originates in the primary motor cortex but travels through there to coordinate movements)
T/F The Basal Ganglia is in direct contact with LMN.
False; They don’t directly influence the LMN, only the UMN
T/F It takes 2 lesions in the LMN system to significantly affect speech?
False, the LMN are all unilateral in the FCP
T/F An UMN system it takes only 1 lesion to effect speech.
False (except on rare occasions with a single lesion in the brain stem)
What is the primary symptom in flaccid dysarthria?
What are other symptoms of flaccid dysarthria?
Nasal emissions, diminished reflexes, hypotonia
Wasting away of the muscle due to nerve dying
With what type of damage is atrophy associated?
Fasciculations and fibrillations are symptomatic to what system?
Do fasciculations and fibrillations occur immediately after insult?
No, after a few weeks
T/F Flaccid dysarthria is the only dysarthria with the involvement of the PNS.
What is the difference between paralysis and paresis?
Paresis is weakened contractions and paralysis is no movement
What is an outstanding characteristic of MG?
When stressing the system, has rapid fatigue and then after rest, recovers.
What are causes of dysarthria?
Strokes, demyelinating, degenerative diseases, radiation tx
What is the largest nerve?
T/F The Vth-Trigeminal nerve is sensory & motor.
What does unilateral LMN damage to the Vth-Trigeminal nerve look like?
Deviation of jaw to one side and same side as lesion (for LMN damage)
What does unilateral UMN damage to the Vth-Trigeminal nerve look like?
Deviation of jaw to contralateral side of lesion but same side of weakness
What does bilateral damage to the Vth-Trigeminal nerve look like?
Jaw hangs low at rest or is weakened
What sounds will bilateral damage to the Vth-Trigeminal nerve effect? And which sound during AMR's will it likely effect most?
Anything requiring the jaw such as bilabials
T/F Unilateral damage to cranial nerve V greatly effects speech.
False, only if bilateral damage b/c able to compensate
What are some compensations a patient may exhibit with bilateral damage to cranial nerve V?
Patient trying to prop jaw closed or holding it
Bell's Palsy is a viral disease of cranial nerve VII-Facial nerve. Is this typically unilateral or bilateral damage?
What are signs of unilateral damage to cranial nerve VII-Facial?
Drooling, lop sided smile, unwrinkling of the forehead, synkenisis
What are signs of bilateral damage to cranial nerve VII-Facial? And which sound during AMR's does it effect the most?
Don’t see as much asymmetry, not being able to keep food in mouth, cheek flutter due to hypotonia
Describe the innervation to cranial nerve VII.
Bilateral for upper face and unilateral for lower face
Cranial nerve IX innervates what muscle(s)?
T/F Cranial nerve IX is usually damaged on its own.
False, usually nerves IX, X, XI (9-11)
What part of an oral mech exam might we do to identify cranial nerve IX damage?
How do we test for sensory vs. motor issues with cranial nerve IX damage?
If not responding to gag reflex, ask them if they feel it to identify a sensory component. Motor if can feel it and get a response/contraction of the muscle
What is a common complaint of damage to cranial nerve IX?
Pain down back of throat and lower jaw when swallow or stick out tongue
How does damage to cranial nerve IX effect speech?
It doesn't typically
What does the pharyngeal branch of cranial nerve X-Vagus innervate and what is their function?
Muscles of the soft palate. Levator palatini which raises the soft palate to produce intra-oral pressure for plosives and not getting hypernasality. Also innervates palatoglossus to pull palate down and raise tongue up.
If you hear a patient has monotone or low pitch, what muscle & nerve is damaged?
Cricothyroid m.-superiorpharyngeal branch of the Vagus-X
If you have breathiness or problems adducting what nerve is damaged?
The recurrent laryngeal nerve of the Vagus-X
T/F A lesion on the superior laryngeal branch of the vagus will have a more significant effect than a lesion on the pharyngeal branch.
If soft palate is hanging low on one side, what type of lesion is it and to which nerve?
Unilateral lesion of the pharyngeal branch of the Vagus-X
If soft palate is hanging low on both sides, what type of lesion is it and to which nerve?
Bilateral lesion of the pharyngeal branch of the Vagus-X
If there is a bilateral lesion of the pharyngeal branch of the Vagus-X, what symptoms might you see?
Soft palate hanging low, nasal regurgitation, absent gag reflex
If there's a unilateral lesion to the pharyngeal branch of the Vagus-X, will it effect nasality?
If there's a bilateral lesion to the pharyngeal branch of the Vagus-X, will it effect nasality?
Yes; May also have nasal emissions which can be audible or not audible
What’s a procedure we can do to tell if a patient has weakened articulators or problems due to not getting adequate VP closure?
Closing nose to see if it changes the sound. Should be better when pinching nose.
If you have dyplophonia, what does that indicate?
When one vocal fold is paralyized and the other isn’t so getting two frequencies.
If you have dyplophonia, where is the lesion?
Lesion on recurrent laryngeal nerve of the vagus
If patient shows a marked inability to change pitch, what kind of lesion(s) are there?
Bilateral lesion of the superior branch of the vagus-X. (Unilateral just wouldn’t be as prominent)
What can cause damage to the XIth cranial nerve?
Bilateral lesions to the XIth cranial nerve is exhibited by what in a patient? And can effect what subsystems?
Respiration and Phonation
What muscle(s) do cranial nerve XII innervate?
Intrinsic and extrinsic tongue muscles with the exception of the palatoglossus
Where does the tongue deviate to if there's unilateral LMN lesion to XII on the left side?
What do you know if you see a tongue deviating to the right side during an oral mech exam?
We know there is right side weakness and is a unilateral lesion.
Can’t tell UMN or LMN unless see fasciculations, Babinski reflex, etc.
What is exhibited with a bilateral lesion of cranial nerve XII?
Reduced ROM, tongue weakness, no deviation
If see client that complains of getting food squirreld in their mouth, what is that indicative of?
Bilateral lesions to cranial nerve XII
T/F Drooling is a symptom to bilateral damage to cranial nerve XII.
What sounds are affected with bilateral nerve damage to cranial nerve XII? Which one of the AMR's is affected most?
All lingual sounds
"kuh" mostly and also "tuh"
Will there be a resonance problem with bilateral nerve damage to cranial nerve XII?
Yes, if tongue falls too far back in the mouth, can sound hypernasal.
NOT due to VP
What compensation(s) might you see to bilateral nerve damage to cranial nerve XII?
Exaggerated jaw movement
Multiple cranial nerve damage (in any combination of nerves) is called what?
What do symptoms of Bulbar Pulsy look like?
Depends on what nerves are effected
What are names of specific Bulbar Palsy diseases?
MG and ALS
What’s the origin and destination of a LMN.
Brain stem and spinal cord to muscles that they innervate
What is a typical signs of lesions to LMN's?
Fasciculations, atrophy, weakness
What’s the origin and destination of the DAP?
Cortex to brain stem and spinal cord
What are typical signs of lesions to UMN's or DAP?
Weakness, hyporeflexia, babinski sign, decreased muscle tone
What are typical signs of lesions to IAP?
Spasticity, clonus (abrupt muscle mov’t), hyperacticve stretch reflexes, increased muscle tone, decorticate or decerebrate posture (rigidity)
Which tongue muscle is the only tongue muscle to receive contralateral unilateral innervation from cranial nerve XII? What is its function?
Function=tongue protrusion & retraction
Describe the innervation to the remaining tongue muscles besides the genioglossus.
Which pathways communicate directly with the LMN's?
Direct & Indirect Pathways
Soft palate hanging low on one side is indicative of what kind of lesion?
Unilateral lesion to the pharyngeal branch of the Vagus-X
Do lesions affecting the Trigeminal Nerve-V affect speech significantly?
Only if its bilateral
Which fossae and nerves are part of the supratentorial level?
Anterior middle fossae
Cranial nerves I & II
Which fossae and nerves make up the posterior level?
Cranial nerves III-XII
What cranial nerve innervates the tensor veli palatini?
What is synkinesis and which nerve is it associated with?
Abnormal contraction of a muscle
What are some symptoms of damage to cranial nerve XI?
Reduced shoulder elevation & weakened head turn
Is speech generally affected with cranial nerve XI damage?
What are the two subsystems more often affected by damage to cranial nerve X?
Phonation & Resonance