Flashcards in Mixed Dysarthria Deck (46):
1
Mixed dysarthrias are common because...
the damage that causes dysarthia often affects more than one area or system.
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T/F
Mixed dysarthria is a combination of just 2 disarthrias
False
Can be 2 OR MORE (typically no more than 3 types)
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How is the mixed dysarthria named?
The component that dominates is the first name given, such as flaccid-spastic
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Why is it important to determine the types of mixed dysarthrias, the components,
because it may help rule out or confirm neurological diagnoses
e.g. flaccid-spastic usually = ALS
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What is the most common type of dysarthria?
Mixed (Figure 1-3 shows it to be the most frequently occurring dysarthria)
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Etiologies:
• Commonly caused by more than one event, i.e. multiple strokes, combination of neurological or degenerative diseases such as PD and stroke, chorea and stroke.
• Often seen in degenerative diseases (e.g. ALS)
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ALS is usually...
flaccid-spastic
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Types of mixed dysarthrias and percentages in Duffy’s practice:
• Flaccid-spastic – 42%
• Hyperkinetic-hypokinetic – 35%
• Ataxic-spastic – 23%
• Other mixes – 19%
• Hypokinetic-spastic - 7%
• Ataxic-flaccid-spastic – 6%
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Which is the most common type of mixed dysarthria?
Flaccid-spastic (42%)
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Which is the least common type of mixed dysarthria?
Ataxic-flaccid-spastic (6%)
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ETIOLOGIES: Specific diseases associated with mixed dysarthrias (6):
1. Degenerative diseases
2. Toxic - metabolic conditions
3. Vascular disorders
4. Trauma
5. Tumor
6. Infections and autoimmune diseases
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Degenerative diseases and mixed dysarthria:
These often affect several parts of the motor system thus produce mixed dysarthrias
This is the most common etiology of mixed dysarthrias.
e.g. Motor neuron disease - primarily affects upper or lower motor neurons or both.
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Most common type of motor neuron degenerative disease that causes mixed dysarthria:
Amyotrophic lateral sclerosis (ALS)
- Has both UMN and LMN involvement
- Commonly has mixed spastic-flaccid or flaccid-spastic components
- ALS occurs in 1% to 5 % per 100,000
- More men affected than women. 5% is familial
- Onset for most is between 40 to 70 years
- Often hard to diagnose - Diagnosis confirmed by EMG findings of weakness
- Nearly always fatal. Most die between 1 and 5 years after diagnosis. Some few live more than 12 years
- Death usually due to respiratory failure – but person can be put on ventilator.
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Onset of ALS between ages ___ to __ years old
40-70
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Patients with ALS usually die between __ and __ years after diagnosis
1-5
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Death with ALS is usually due to:
respiratory failure
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2 types of ALS:
Bulbar or spinal
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Patients with bulbar ALS initially have troubles with (2):
speech and swallowing problems very early on
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Patients with spinal ALS initially have troubles with (1):
problems with limbs first
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Motor neuron degenerative disease that causes mixed dysarthria (4):
1. ALS
2. Primary lateral sclerosis (PLS)
3. Spinal muscle atrophies
4. Progressive Bulbar Palsy
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Primary lateral sclerosis (PLS) (a motor neuron degenerative disease) and mixed dysarthria:
– affects UMN only
– may be hard to distinguish from ALS
- It typically produces spastic dysarthria but is hard to differentiate from ALS
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Spinal muscle atrophies (a motor neuron degenerative disease) and mixed dysarthria:
– affects LMN only
– progressive limb wasting and weakness
– may have some cranial nerve weakness as well
- It is a motor neuron disease but typically produces only flaccid dysarthria, not mixed
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Progressive Bulbar Palsy (a motor neuron degenerative disease) and mixed dysarthria:
– primarily has LMN weakness of cranial nerve muscles. - Dysarthria and dysphagia predominate
- Similar to ALS without limb involvement
- It is usually associated with flaccid dysarthria, not mixed.
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Multiple Sclerosis and mixed dysarthria:
– it is a demyelinating disease
– the myelination is attacked but the axon itself is not
- Cause is unknown – may be related to autoimmune cause triggered by environmental and genetic interactions
- Diagnosis is difficult – MRI often used for diagnosis.
- Patient often exhibits problems with vision and other sensory difficulties and some cognitive deficits.
- Dysphagia is not common.
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ALS affects more (men or women)
men
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MS affects more (men or women)
women
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What is the most common CNS disease affecting young and middle age adults?
MS
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Age of onset for MS
onset between 20 to 40 years of age
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Courses of disease for MS (4):
1. Benign – only few episodes, then remission
2. Relapsing-remitting – comes and goes
3. Remitting-progressing - comes and goes but progressively gets worse
4. Progressive – no remission
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Type of mixed dysarthria with MS:
Most common type of mixed dysarthria is ataxic-spastic but any combination can occur
The type of dysarthria is more unpredictable than with other diseases
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Frederich's Ataxia and mixed dysarthria:
- Is associated with cerebellar dysfunction but can also be associated with mixed spastic/ataxic dysarthria
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Progressive Supranuclear Palsy and mixed dysarthria:
- neurodegenerative disease associated with multisystem involvement
- May be confused with PD because it has similar symptoms such as bradykinesia
- Dysphagia and dysarthria are common and are evidenced early on in the disease
- Mixed dysarthrias seen in this disease are combinations of hypokinetic, spastic and ataxic
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Multiple Systems Atrophy and mixed dysarthria:
- similar to PSP and PD - but doesn't respond well to L-Dopa
- Shy Drager Syndrome falls under this category of diseases
- Types of mixed dysarthrias include hypokinetic, hyperkinetic, ataxic and spastic depending on the underlying pathologies
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Shy-Drager syndrome (type of Multiplle Systems Atrophy) and mixed dysarthrai:
- progressive neurologic disease
– unknown etiology
- First signs are usually blood pressure problems when standing, incontinence and decreased respiration and impotence
- May also have problems with gait, dysarthria and dysphagia
- Most common types of dysarthria associated with SDS are hypokinetic, ataxic, spastic and flaccid
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What characteristics distinguish ALS from the others (2)?
1. Wet/gurgle voice
2. Vocal Flutter
36
Corticobasal degeneration and mixed dysarthria:
- It is rare and involved impairment of cortex and basal ganglia
- presents most often with spastic-hypokinetic dysarthria, but can have ataxic and hyperkinetic components.
(Primary progressive aphasia is sometimes put under this category.)
37
Degenerative diseases that cause mixed dysarthria (6):
1. Motor Neuron Diseases (ALS, PLS, Spinal Muscle atrophies, Progressive Bulbar Palsy)
2. Multiple Sclerosis
3. Frederich's Ataxia
4. Progressive Supranuclear Palsy
5. Multiple Systems Atrophy
e.g. Shy-Drager syndrome
6. Corticobasal degeneration
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Toxic - metabolic conditions that cause mixed dysarthria (2):
* Effects tend to be diffuse and damage can impair several components, thus resulting in a mixed dysarthria.
1.Wilson's disease
2. Hypoxic encephalopathy
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Wilson's disease (a toxic - metabolic condition that causes mixed dysarthria):
-It is a metabolic disorder leading to too much copper in brain, eyes and liver
- It can be fatal
- It often demonstrates brown rings around cornea of the eyes
- Dysarthria is a predominant symptom - and typically involves two or more of these: hypokinetic, ataxic, and spastic
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Hypoxic encephalopathy (a toxic - metabolic condition that causes mixed dysarthria):
- Due to lack of oxygen to brain because of heart and lung problems
- With loss of oxygen, brain damage occurs
- Mixed dysarthrias often occur involving hypokinetic, hyperkinetic and ataxic dysarthrias
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Vascular disorders and mixed dysarthria:
- Multiple strokes often affect multiple systems and produce mixed dysarthrias of any combination
- If strokes affect brainstem, dysarthria may include flaccid, spastic and ataxic due to close proximity of pyramidal and extrapyramidal fibers
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Trauma and mixed dysarthria:
- TBI can produce any combination of dysarthrias
- Mixed dysarthia is more common with TBI than single dysarthrias due to the diffuse injuries associated with TBI
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Tumors and mixed dysarthrias:
- Can affect various components of neurological system and produce various mixed dysarthrias
44
Infections and autoimmune diseases and mixed dysarthria:
- AIDS is a good example and can produce various mixed dysarthrias
- The type of dysarthias depend on the condition that is presenting with AIDs as various conditions can result
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SPEECH PATHOLOGY and ALS
• Dysarthria is often the first sign.
• The majority are unintelligble by the time death occurs.
• Most need AAC intervention within approximately 3 years of diagnosis and use them about 2 years before death.
• Dysarthria may not be mixed throughout the entire disease.
• Dysarthria has components of both flaccid and spastic when it is mixed and either of those can predominate.
• Symptoms of each of those types can occur, i.e. with spasticity - pathological reflexes and pseudobulbar effect can occur; with flaccidity - fasiculations and atrophy can occur.
• Intelligibility can be severely affected due to hypernasality, reduced ability to build up intraoral air pressure and weakness of tongue.
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