Neurogenic Dysphonias

Question 1

Neurogenic Dysphonias

Answer 1

Any dysphonia which occurs as a result of an impairment in the innervation, function, or motor planning aspects of the muscles involved in phonation, and resonance/articulation resulting in a change in voice production

Question 2

Motor Speech Disorders

Answer 2

Disorders of speech resulting from neurologic impairment affecting the motor programming or neuromuscular execution of speech
Dysarthria, Apraxia

Question 3

Dysarthrias

Answer 3

Group of MSD resulting from disturbances in muscular control over the speech mechanism
Due to damage of the central or peripheral nervous system
Results from paralysis, paresis, or incoordination of the speech musculature

Question 4

Vocal fold paralysis

Answer 4

When one or both vocal folds are unable to move either towards or away from midline
Etiology: damage to CN X
90% due to LMN lesions

Question 5

Vocal fold paralysis characteristics

Answer 5

Flaccid dysphonias due to a reduction in muscle tone resulting from a loss of motor supply to the muscle

Question 6

Bilateral vocal fold paralysis

Answer 6

Usually result of lesions high in trunk of vagus nerve or at the nuclei of origin in the medulla
Etiology: tumors, carcinoma, trauma

Question 7

Adductor vocal fold paralysis

Answer 7

Neither vocal fold is capable of moving toward the midline
Phonation = impossible
At risk for aspiration

Question 8

Abductor vocal fold paralysis

Answer 8

Vocal folds remain at midline

Serious respiratory problems

Question 9

Unilateral vocal fold paralysis

Answer 9

Most common cause = disruption of recurrent laryngeal nerve on one side
Etiology: damage or trauma to the RLN
Laryngeal adductor muscles cannot adduct the vocal folds
Paralyzed vocal fold remains fixed in paramedian position during both inspiration and expiration

Question 10

Unilateral vocal fold paralysis Characteristics

Answer 10

Dysphonic or aphonic
Breathy, hoarse
Phonation time reduced
Reduced or monoloud
Diplophonia, pitch breaks

Question 11

Myasthenia Gravis

Answer 11

Autoimmune disease in which the neuromuscular junction becomes impaired as the patient uses that particular muscle or muscle group resulting in extreme muscle fatigue
Muscles innervated by head and neck are very vulnerable to this disease
Possible difficulty swallowing
Results in flaccid dysarthria/dysphonia
Etiology: damage to the receptors at the neuromuscular junction, prevents the normal transfer of impulse from the nerve in the particular muscle

Question 12

Myasthenia Gravis Characteristics

Answer 12

Typically normal voice changes to weak, breathy, barely audible voice; after a few minutes of rest voice is restored

Question 13

Guillain-Barre

Answer 13

Focal demyelination of spinal and cranial nerves
Flaccid dysarthria/dysphonia
Possible dysphagia
Etiology: unknown cause but frequently preceded by a viral infection
Affects extremities as well as facial, oro-pharyngeal and occular muscles

Question 14

Spastic Dysphonia

Answer 14

Muscular hypertonia: significantly increased muscle tone wherein the limb cannot be moved passively or volitionally with ease
UMN dysphonia
Spasticity of the laryngeal muscles
Etiology: small bilateral lesions that occur just above the nucleus of CN X
Frequently co-occurs with spastic dysarthria

Question 15

Ataxic Dysphonia

Answer 15

Lesion in cerebellum

Loss of regulatory movements

Question 16

Spastic Dysphonia Characteristics

Answer 16

Strained, strangled, harsh vocal quality, low pitch, monopitch, reduced/variable loudness, possible hypernasality

Question 17

Ataxic Dysphonia Characteristics

Answer 17

Normal vocal quality, hoarse/harsh vocal quality, low pitch or monopitch, monoloudness, inappropriate/imprecise prosody, excessive loudness, vocal tremor

Question 18

Dysphonias related to Extrapyramidal System

Answer 18

Depletion/functional reduction of Acetylcholine or dopamine on the activities of the basal ganglia
Imbalance of the two neurotransmitters causes movement disorders with related dysarthrias/dysphonias

Question 19

Hypokinetic Dysarthria

Answer 19

Extrapyramidal movement disorder due to a depletion of dopamine in the striatum, secondary to a slow degeneration of the substantia nigra (PD)

Question 20

Hypokinetic Dysarthria Characteristics

Answer 20

Breathy, harsh vocal quality, reduced loudness, monoloudness, monopitch, reduced stress
Imprecise articulation, intermittent rushes of speech

Question 21

Hyperkinetic Dysarthria

Answer 21

Movement disorders in which the speech muscles are quick, jerky, and irregular
3 Types: Quick, Slow, Tremor

Question 22

Chorea

Answer 22

Disease of the basal ganglia
Purposeless, irregular, fleeting, involuntary movements of the limbs and facial muscles
Etiology: lesions that damage the striate nucleus of the basal ganglion

Question 23

Chorea Characteristics

Answer 23

Harsh, strained-strangled, intermittent breathiness, limited pitch range, limited loudness range, intermittent variability, inappropriate and imprecise stress patterns

Question 24

Myoclonus

Answer 24

Movement disorder that results in a hyperkinetic dysarthria characterized by episodic moments of abnormal speech production due to short rhythmic movements of the laryngeal and supraglottic musculature
Etiology: lesions in the pathways connecting the red nucleus, the olivary bodies of the cerebellum

Question 25

Myoclonus Characteristics

Answer 25

Voice arrest during vowel prolongation and singing Usually go unnoticed during connected speech Short, rhythmic contractions throughout the speech system Voiced/voiceless segments may be altered

Question 26

Tourette's syndrome

Answer 26

Episodic periods of uncontrolled, abnormal speech production due to rapid, tic-like movements and involuntary vocalizations

Question 27

Tourette's syndrome characteristics

Answer 27

Tics, dysfluency, throat clearing, coprolalia, echolalia

Question 28

Athetosis

Answer 28

Involuntary, unpatterned, arrhythmic wriggling and writhing movements of the head, neck, torso, and extremities May interfere with all voluntary body movements Etiology: congenital (CP), or acquired (neuronal degenerative disases, encephalitis, etc.)

Question 29

Athetosis characteristics

Answer 29

Hoarse, breathy, monopitch, monoloudness of dramatic variations in loudness levels, inappropriate and imprecise stress patterns Irregular movements of the face, cheek, lips, mandible, and tongue

Question 30

Dystonia

Answer 30

Movement disorder characterized by slow involuntary movements and severe postural deformities resulting from fixed muscle contractions Etiology: damage to the extrapyramidal system

Question 31

Dystonia characteristics

Answer 31

Intermittent, harsh, strained-strangled, breathy, limited pitch and loudness ranges, inappropriate variations in loudness, inappropriate and imprecise stress, forced inspiration and expiration Irregular movements of the lips, mandible, tongue Neuromuscular and dysarthric symptoms

Question 32

"Quick" hyperkinetic

Answer 32

Chorea, Huntington's Disease, Myoclonus, Tourette's syndrome

Question 33

"Slow" hyperkinetic

Answer 33

Athetosis, drug-induced dyskinesia, dystonia

Question 34

3 types of hyperkinetic

Answer 34

1) Quick 2) Slow 3) Tremor

Question 35

Essential tremor

Answer 35

Finely oscillating tremor found in individuals without any other conditions Etiology: idiopathic or an involuntary, benign hereditary laryngeal tremor

Question 36

Essential tremor characteristics

Answer 36

Quivering, intonation, voice arrests Lip, mandibular, soft palate or tongue tremor may be present Increased variation in intensity and frequency

Question 37

Amyotrophic Lateral Sclerosis

Answer 37

Progressive degenerative debilitating disease of the anterior horns, cranial nerve motor nuclei, and the corticobulbar and corticospinal tracts results in mixed flaccid-spastic dysarthria Onset of disease: usually middle-late age Etiology: unknown

Question 38

ALS Perceptual charactertistics

Answer 38

Harsh, breathy, monopitch, monoloudness, hypernasality, strained-strangled

Question 39

ALS Acoustic characteristics

Answer 39

Increased note in stop gaps in stop consonants and vowel durations Changes in fundamental frequency, jitter, shimmer, intensity and HNR seem to be most affected

Question 40

Multiple Sclerosis

Answer 40

Demyelinating disease characterized by deposits of plaque anywhere in the CNS Symptoms may be mild initially with long period of remission or latency in between episodes Results in a mixed dysarthria Etiology: unknown, assumed to be an autoimmune disorder

Question 41

Multiple Sclerosis Characteristics

Answer 41

harsh vocal quality, reduced pitch and impaired loudness control, hypernasality Poor respiration and poor sustained phonation

Question 42

Multiple Sclerosis: Associated symptoms

Answer 42

Articulation errors Neuromuscular coordination for respiration; decreased vital capacity Nystagmus

Question 43

Mixed Dysarthria types

Answer 43

1) Amyotrophic Lateral Sclerosis 2) Multiple Sclerosis 3) Wilson's Disease

Question 44

Wilson's Disease

Answer 44

Progressive lenticular degeneration which results in a mixed ataxic-hypokinetic-spastic dysarthria Etiology: inadequate processing of dietary copper due to a rate, inherited autosomal recessive disorder

Question 45

Wilson's Disease Characteristics

Answer 45

Harsh vocal quality, low pitch, reduced range of pitch and loudness Motor speech symptoms: difficulty noted in the face, lips, mandible, and velopharyngeal movement Neuromuscular symptoms

Question 46

Apraxia of Speech

Answer 46

Disorder of motor speech planning | Etiology: lesion that separates Broca's area from the motor association area that deals with motor planning

Question 47

Apraxia of Speech Characteristics

Answer 47

Intermittent aphonia, voicing errors | Associated symptoms: changes in motor programming for articulation, pauses or hesitations in conversational speech