spastic dysarthria

Question 1

what is spastic dysarthria caused by?

Answer 1

damage to the direct and indirect activation pathways on the CNS

Question 2

T or F. There is rearely only direct activation or indirect activation pathway damage bc these tracts intermingle

Answer 2

True

Question 3

T or F. bilateral lesions are usually required to have significant dysarthria

Answer 3

True

Question 4

T or F. unilateral lesions don’t have as severe affect because something is getting through on the side not affected.

Answer 4

True

Question 5

what is another name for spastic dysarthria?

Answer 5

pseudobulbar palsy

Question 6

What subsystems does spastic dysarthria affect?

Answer 6

respiratory, phonatory, resonatory, and articulatory

may affect prosody

Question 7

what is the primary characteristic of spastic dysarthria?

Answer 7

spasticity

Question 8

what are the symptoms of spastic dysarthria?

Answer 8

spasticity
weakness
slow movements
reduced ROM

there is slow movement bc of the increased resistance to movement.

Question 9

lesions of the UMN cause:

Answer 9

weakness
loss of skilled movements: with damage to the direct pathway you find the ability to produce fine, skilled movements, like those in spch, is affected or lost.
decreased tone: at first, the signs are of reduced muscle tone and weakness but as it progresses the signs change to increased muscle tone
hypertonia:
babinski reflex: a pos babinski reflex is a sign of UMN/direct pathway damage, (stroke the bottom of the foot and the toes fan out with the large toe extending. This is an abnormal reflex in adults but normal in babies.)

Question 10

what are the abnormal reflexes seen with UMN damage: (3)

Answer 10

• sucking: 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. Normally nothing happens. in very exaggerated reflexes, the mouth may turn toward the tongue blade to result in a rooting reflex.
• snout: if you use tongue balde or finger to tap or push backward on tip of nose or phitrum you see the bottom lip pull up
• Jaw jerk reflex: have lips open and parted. place a tongue blade or finger on the chin and tap with other finger. Abnormal response is the quick closing of the jaw.

Question 11

what does spacticity do to movements?

Answer 11

it slows movement and decreases ROM and force

Question 12

What does it mean when your muscles are spastic?

Answer 12

too much muscle tone meaning the contracted muslces (spasticity is the result of the hyperactivity of the stretch reflex. increased muscle tone)

Question 13

What is the direct pathway also known as?

Answer 13

The pyramidal system

Question 14

The direct pathway is part of what system the UMN or LMN?

Answer 14

UMN

Question 15

Is the direct activation pathway bilateral or unilateral?

Answer 15

bilateral

Question 16

The UMN/ Direct pathway sends messages to the?

Answer 16

LMN/FCP (final common pathway)

Question 17

What are the two parts of the UMN/ Direct activation pathway?

Answer 17

Corticobulbar and corticospinal

Question 18

Corticobulbar goes to what pathway?

Answer 18

The cranial nerves

Question 19

Corticospinal goes to what pathway?

Answer 19

the spinal nerves

Question 20

What is the direct activation pathway called “direct”

Answer 20

it is direct bc it leads directly to the cranial nerve nuclei in the brainstem and the spinal nerve nuclei in the spinal cord

Question 21

Are most cranial nerves that innervate muscles for speech bilaterally innervated or are most unilaterally innervated?

Answer 21

bilaterally

Question 22

Why are most of the cranial nerves that innervate speech muscles bilateral?

Answer 22

this bilateral input functions as protection bc it takes two lesions to really affect the muscles
-it reduces the impact of damage

Question 23

What two muscles are unilaterally innervated?

Answer 23

the genioglossus that is innervated by the hypoglossal

-the bottom portion of the face (Facial nerve)

Question 24

Why is the direct pathway called facilitory?

Answer 24

bc it leads to movement (it is responsible for skilled, discrete, quick movements)

Question 25

What kind of movements is the DAP responsible for

Answer 25

skilled, discrete, quick movements

Question 26

What is another name for the indirect activation pathway?

Answer 26

Extrapyramidal system

Question 27

Why is the iap called indrect?

Answer 27

it is called indirect bc it has many synapses along the way from its path from the cerebrum to the brain stem and the spinal

Question 28

Where does the iap originate from?

Answer 28

it originates in the motor cortex of each cerebral hemisphere

Question 29

The indirect activation pathway makes connections with?

Answer 29

the basal ganglia, cerebellum, reticular formation, vestibular nuclei and the red nucelus

Question 30

the iap is essential for regulating of what kind of movements?

Answer 30

regulates skilled movements

Question 31

The IAP helps maintain?

Answer 31

tone

Question 32

What is tone important for?

Answer 32

tone is important for sustained postures required to support movements of direct activation system

Question 33

T or F damage to the indirect pathway primarily affects the inhibitory role of motor control.

Answer 33

True

Question 34

What does damage to the indirect pathway primarily affect?

Answer 34

The inhibitory role of motor control

Question 35

Since damage to the IAP affects the inhibitory role of motor control what will you see?

Answer 35

increased muscle tone and hyperactive reflexes.

Question 36

What can cause spastic dysarthria (etiologies)

Answer 36

``` can be caused by anything that affects the direct/ indirect pathway -degenerative, inflammatory toxic metabolic traumatic vascular dz ```

Question 37

What is the most common cause of spastic dysarthria?

Answer 37

vascualr dz

Question 38

Vascular disorders are?

Answer 38

infarcts of interior carotid artery and middle and posterior cerebral arteries -must have bilateral lesion bc these arteries are far apart (one in each hemisphere so damage doesnt affect the other) However in the brain stem where L a R pathways are closer together you may get damage to both pathways by a single lesion.

Question 39

Does a single lesion in the cerebral hemisphere usually cause spastic dysarthria?

Answer 39

No, it usually does not the tracts are far apart (1 in each hem.) so it takes to lesion.

Question 40

Does a single lesion in the brainstem cause spastic dys?

Answer 40

Yes because the tracts are so close together in the brainstem damage to one normally means damage to both tracts

Question 41

What are lacunar infarcts

Answer 41

they are caused by very tiny holes in the cortex from strokes (mini strokes)

Question 42

what can lacunar infarcts lead to?

Answer 42

they can lead to dementia or damage to the brain

Question 43

T or F when a ptnt is having a lacunar infarct stroke do they may not even know they are having one.

Answer 43

True because they are mini strokes

Question 44

what is the term for ptnts with many lacunar infarcts that have dementia, usually spastic dys, dysphagia and incontenence?

Answer 44

lacunar state

Question 45

What is binswanger's subcortical encephalopathy?

Answer 45

is a term given to patients with multiple infarct dementia occurring over years and mos. They may have spastic dys. (dys can be a differentiating characteristics btwn the types of dementias that have dys and the ones that don't)

Question 46

What is a type of inflammatory dz that can cause spastic dys?

Answer 46

leukoencephalitis

Question 47

what is leukoencephalitis?

Answer 47

it is the inflammation of the white matter in the brain

Question 48

What is the degenerative dz that can cause spastic dysarthria?

Answer 48

Primary lateral sclerosis (PLS)

Question 49

what is primary lateral sclerosis?

Answer 49

a degenerative dz it is a motor neuron dz | ALS is a subcategory of PLS but in PLS there are only signs of UMN damage not LMN

Question 50

What type of dys does ALS result in?

Answer 50

Flaccid spastic

Question 51

What does the ptnt compain of in spastic dys?

Answer 51

slow or effortful speech, fatigue, ptnt feels their spch is nasaly, difficulty swallowing, drooling, difficulty controlling emotions

Question 52

what is the pseudobulbar affect?

Answer 52

difficulty controlling emotions especially laughing and crying

Question 53

What types of dys is pseudolbulbar affect in?

Answer 53

spastic but can be in mixed if spastic component

Question 54

What is another term for pseudobulbar affect?

Answer 54

emotional lability

Question 55

What are nonspeech clinical findings of spastic dys?

Answer 55

dysphagia along with nasal regurgitation drooling, face may be held in a fixed posture, either smiling or pouting (excessive facial emotional expressions) emotional lability seen jaw strenght may be normal, face may be weak bilaterally, tongue may have reduced ROM and show weakness when doing strength testing gag reflex may be hyperactive pathological oral reflexes: jaw jerk, snout, suck

Question 56

How would you want to assess spastic dys?

Answer 56

conversational speech, reading AMR's and vowel prolongation

Question 57

What are some speech characteristics of spastic dys?

Answer 57

strained-strangled voice qality hoarsness low pitch reduced pitch and loudness variability hypernasality-due to slowness of palate imprecise articulation-mevements are restricted slow rate (regular but slow AMR's)

Question 58

What can the speech characteristics be traced to? ex: why is their hypernasality etc..

Answer 58

spasticity, slowness of movemnet, reduced ROM, and to the lesser degree-weakness.