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Motor Speech Exam 2 > Spastic Dysarthria > Flashcards

Spastic Dysarthria Flashcards

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1
Q

Spastic Dysarthria (SD) is caused by damage to..

A

The direct and indirect activation pathways of the CNS.

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2
Q

T/F: Frequently, there is only direct activation or indirect activation pathway damage because these tracts intermingle.

A

FALSE: RARELY there is only direct activation or indirect activation pathway damage because these tracts intermingle.

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3
Q

T/F: Bilateral lesions have a more severe effect than unilateral lesions.

A

True

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4
Q

Why don’t unilateral lesions have as severe effect as bil lesions?

A

Because something is getting through on the side not affected (there is usually bilateral innervation)

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5
Q

Spastic Dys can be seen in which subsystems?

A

Respiratory
Phonatory
Resonatory
Articulatory

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6
Q

Spastic Dys may also be referred to as:

A

Pseudobulbar palsy

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7
Q

What are some effects spasticity has on the body?

A

Slows movement

Decreases ROM and force

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8
Q

T/F: Spasticity is not enough muscle tone meaning uncontracted muscles.

A

FALSE: Spasticity is TOO MUCH muscle tone meaning CONTRACTED muscles.

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9
Q

Spasticity is a result of the__

A

Hyperactivity of the stretch reflex.

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10
Q

T/F: In spasticity, you have increased muscle tone.

A

TRUE

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11
Q

List the defining characteristics of spasticity.

A
  • weakness
  • slow movements
  • reduced ROM
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12
Q

In spasticity, why is there slow movement?

A

Because of the increased resistance to movement.

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13
Q

Lesions of the UMN system cause:

A
  • Weakness
  • Loss of skilled movements
  • Decreased tone
  • Hypertonia
  • Babinski reflex
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14
Q

How would you elicit the babinski reflex?

A

Stroke the bottom of the foot and if the toes fan out with the large toe extending=positive

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15
Q

Is the babinksi reflex abnormal in both adults and babies?

A

No. only abnormal in adults.

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16
Q

T/F
UMN lesion: at first, signs are of reduced muscle tone and weakness, but as it progresses, signs change to increased muscle tone and spasticity.

A

True.

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17
Q 
T/F
UMN lesion (damage to direct pathway): ability to produce fine, skilled, movements, like those in speech, is not affected.
A

FALSE: ability to produce fine, skilled, movements, like those in speech, IS AFFECTED OR COMPLETELY LOST.

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18
Q

Abnormal reflex seen w/ UMN damage:

Sucking (list how to elicit it & what the abnormal reflex is)

A

Elicit: (on both sides) stroke the tongue blade across the upper lip, starting at the side and move to the middle.

Abnormal response: pursing of lips.

In very exaggerated reflexes: the mouth may turn toward the tongue blade to result in a rooting reflex.

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19
Q

Abnormal reflex seen with UMN damage: Snout (explain)

A

Elicit: use tongue blade or finger to tap or push backward on tip of nose or philtrum (part between nose and upper lip)

Abnormal response: Bottom lip pulls up

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20
Q

Abnormal reflex seen with UMN damage: Jaw jerk reflex (explain)

A

Elicit: have lips open and parted. Place a tongue blade or finger on the chin and tap with the other finger.

Abnormal response: quick closing of the jaw.

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21
Q

Direct Activation Pathway (DAP) is also known as the ____. Why?

A

Pyramidal system because it passes through the pyramidal structures.

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22
Q

The DAP sends messages to __?

A

DAP sends messages to the LMN or FCP to tell them what to do.

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23
Q

T/F: The DAP is part of the LMN system.

A

FALSE: it is part of the UMN system.

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24
Q

DAP is made up of two tracts..

A

Corticobulbar

Corticospinal

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25
T/F: DAP is bilateral.
TRUE: It has one nerve originating in each cerebral hemisphere; left and right.
26
DAP is called "direct" because..
it leads directly to the cranial nerve nuclei in the brainstem and spinal nerve nuclei in the spinal cord.
27
T/F: The direct pathway mainly arises (60%) in motor cortex.
True
28
The DAP is called ____ because it leads to movement. It is responsible for skilled, discrete, quick movements.
Facilitory
29
The Indirect Activation Pathway (IAP) is aka..
Extrapyramidal
30
Why is the IAP indirect?
Because it has many synapses along its path from the cerebrum to the brain stem and spinal cord.
31
Where does the IAP originate?
In the cortex of each hemisphere
32
Where does the IAP make connections?
In the: (1) basal ganglia (2) cerebellum (3) reticular formation (4) vestibular nuclei (5) red nucleus
33
The IAP is essential for regulating ___?
Skilled movements
34
The IAP helps maintain tone- which is important for?
Important for sustained postures required to support movements of the direct activation system.
35
Damage to the IAP primarily affects the___?
inhibitory role of motor control
36
Damage to the IAP results in __ and __. | Which demonstrated by..?
(1) Increased m. tone (2) Hyperactive reflexes Demonstrated by a spasticity that causes the legs to resist bending and the arms to resist straightening.
37
Spastic Dysarthria etiology..
Can be causes by anything that affects the direct or indirect pathway. Can include: - degenerative - inflammatory - toxic - metabolic - traumatic - vascular diseases
38
T/F: Typically, vascular diseases have more flaccid dysarthrias than other kind of dysarthrias.
False: Typically, vascular diseases have more SPASTIC dysarthrias than other kind of dysarthrias.
39
Vascular disorders: Infarcts of which arteries (in the cerebrum) can cause spastic dysarthria?
Infarcts of: (1) Interior carotid artery & (2) Middle cerebral artery & (3) Posterior cerebral artery *Lesion must be bilateral to cause SD because these arteries are far apart (one in each hemisphere) so damage to one doesn't affect the other.
40
In the brainstem, can a single lesion or single brainstem stroke cause damage to both pathways? Why or why not?
You may get damage to both pathways by a single lesion or single brainstem stroke because the left and right pathways are closer together in the brainstem.
41
T/F: A single cerebral hemisphere stroke can usually cause spastic dysarthria, but a single brainstem stroke cannot cause spastic dys.
FALSE: - A single cerebral hemisphere stroke usually CANNOT cause SD. - A single brainstem stroke CAN cause SD.
42
Lacunar infarcts are caused by .... and can lead to ....
- Very tiny holes in the cortex from strokes. | - Can lead to dementia or damage to brain
43
Lacunar state is a term used for...
Term used for pts w/ many lacunar infarcts who have dementia, usually spastic dys, dysphagia, and incontinence.
44
A term given to pts with multiple infarct dementia occurring over years and months.
Binswanger's subcortical encephalopathy
45
Pts with Binswanger's subcortical encephalopathy may also have...?
Spastic Dysarthria
46
Characteristic that can help differentiate Binswanger's subcortical encephalopathy from other dementias.
Dysarthria
47
Inflammatory disease that can cause Spastic Dys.
Leukoencephalitis- inflammation of white matter of brain.
48
Spastic dysarthria can be seen with which degenerative dz?
Primary lateral sclerosis (PLS)
49
In PLS, there are only signs of UMN or LMN damage?
UMN damage
50
Primary lateral sclerosis (PLS)
- A type of motor neuron dz | - ALS is a subcategory of PLS
51
T/F: ALS has spastic dys.
FALSE: ALS has mixed flaccid-spastic dysarthria
52
Spastic Dys-patient complaints..
- Slow or effortful speech - They feel as if theres some physical resistance to their speaking - Fatigue(w/ speech deterioration) - Feel their speech is nasal - Difficulty swallowing - Drooling - Pseudobulbar affect
53
In what other dysarthria (besides Spastic) does the pt complain of slow/effortful speech?
Some Hyperkinetic Dys
54
A pt with Flaccid Dys will not complain of fatigue unless they have __?
``` Myasthenia Gravis (MG) -deterioration is more rapid in MG ```
55
Is this more common in spastic or flaccid: pt feels that their speech is nasal.
More common in spastic.
56
T/F: pt complaints of difficulty swallowing and drooling are more commonly heard in spastic dys than any other dys.
TRUE
57
Define: pseudobulbar affect. It is usually seen in which type of dys?
- Difficulty controlling emotions, esp laughing and crying. - Emotional lability - Pathological laughing and crying - Due to DECREASED INHIBITION - Seen in Spastic mixed
58
T/F: Dysphagia is often seen along with nasal regurgitation.
TRUE
59
Nonspeech Clinical Findings in SD: | T/F: Drooling is seen due to poor control of secretions.
TRUE
60
List some nonspeech clinical findings in SD.
- Drooling (due to poor control of secretions) - Face may be held in fixed posture-smiling or pouting. May be excessive facial emotional expressions. - Emotional lability-cry or laugh for no reason. - Jaw strength may be normal, face may be weak bilaterally, tongue may have reduced ROM/weakness when strength testing. Palate symmetrical but slow to move. - Gag reflex may be hyperactive.Cough may be weak. - Pathological oral reflexes.
61
How would you assess SD?
- Conversational speech - Reading - AMRs - Vowel prolongation
62
Does it help to assess individual cranial nerve effects? Why or why not?
-No because damage is in the CNS which results in impaired movement patterns.
63
Does SD affect all speech movements?
``` Yes. Affected: -jaw movement -tongue movement -soft palate movement ```
64
Prominent speech characteristics of SD?
- Strained-strangled voice quality, harshness, low pitch, reduced pitch and loudness variability - Hypernasality- due to slowness of palate - Imprecise articulation- mvments are restricted - Slow rate- slow but regular AMRs
65
Does SD have a severe effect on intelligibility?
Yes, because all speech movements are affected.
66
Why would a pt with SD have hypernasality?
Due to the slowness of the palate.
67
T/F: When assessing a pt with SD, look for patterns of symptoms, not just one symptom.
TRUE

Motor Speech Exam 2 (3 decks)

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