1
Q
What is Flaccid Dysarthria also known as?
A
Bulbar Palsy
2
Q
Describe Flaccid Dysarthria
A
- muscle weakness/reduced tone
- negative impact to speed, range, and accuracy of movement
- hypernasal
- nasal emission
- audible inhalation
- speaks in short phrases
- hypotonia
- asymmetry
- fasciculations
3
Q
Describe Spastic Dysarthria
A
- slow movement, reduced range, face
- all areas of speech are affected
- spasticity and weakness
- initially flaccid, then spastic
- pathological reflexes
- pseudobulbar affect—Emotional lability
4
Q
Describe Ataxic Dysarthria
A
- irregular articulatory breakdowns (inconsistent)
- Irregular AMR’s
- Excess and Equal stress
- distorted vowels
- “drunken speech”
- poorly coordinate movement pattern
- scanning or staccato pattern of speech
- ataxic gait
- freidrich’s ataxia
5
Q
Describe Hypokinetic Dysarthria
A
- decreased range of motion (ROM)
- associated with basal ganglia pathology (PARKINSONS)
- affects aspects of motor control (preparation, maintenance, switching of motor programs)
- increased rate of speech with reduced intelligibility
- monopitch and monoloudness
- palilalia
6
Q
Describe Hyperkinetic Dysarthria
A
- Basal ganglia control circuit or indirect activation pathways
- primarily affects prosody
- abnormal, rhythmic, or irregular, unpredictable, rapid or slow involuntary movements
- chewing/swallowing issue common
- voice feels shaky, tight, closed off
- excessive involuntary movements that may interfere with speech production
7
Q
Describe Mixed Dysarthrias
A
- speech characteristics are a combo of those found in single dysarthrias
- prominence of dysarthria type that is most evident can change over time
- caused from neurological damage to two ro more parts of the motor system (combined events, 2+diseases)
- ex: brainstem stroke, ALS (bilateral damage to both direct and indirect pathways)
- TBI-Cerbral and cranial nerve damage (ataxic flaccid dysarthria)
8
Q
What are some concomitant disorders that may influence/impact therapy?
A
- depression
- schizophrenia
- conversion disorder
- Somatization Disorder
Volitional disorders (factitious disorders & malingering)
9
Q
Describe depression
A
- more common in confluent aphasia than global or fluent aphasia (awareness)
- common in parkinson’s, epilepsy, Alzheimers, MS, and Huntington’s
- TBI,stroke, more often with lesions of L than R
10
Q
Describe Schizophrenia
A
- delusions, hallucinations, disorganized or catatonic behaviors, affective flattening, disorganized speech.
- social isolation/withdrawal
- peculiar behavior (talking to oneself)
- conditions leading to schizophrenic behavior: closed head injury (CHI), Wilson’s Disease, Demyelinating Disease
11
Q
Describe conversion disorder
A
- Physical symptoms without demonstrable organic causes but that suggest a medical or neurologic cause and for which there is at least circumstantial evidence of a link between symptoms and psychological factors or conflicts.
- in other words: it is a condition in which you show psychological stress in physical ways, it’s a health problem that starts as a mental or emotional crisis–a scary or stressful incident of some kind–and converts to a physical problem.
- actual loss of volitional muscle control or sensation that is not consciously motivated
12
Q
Describe Somatization disorder
A
- chronic illness characterized by recurrent, multiple physical complaints, and a belief that one is ill
- numerous dramatic complaint involving multiple organs
- insists on and receive multiple tests/treatment, and fail to be reassured when told there is no evidence of an organic disease
13
Q
Describe factitious disorders
A
- feign physical or psychological symptoms but do so for uncontrolled/unconscious psychological reasons that lead them to seek out the role of a sick person
- loners with personality disorders often with a history of abuse, trauma, and deprivation
- Munchausen’s Syndrome–pathological lying
14
Q
Describe Malingering
A
- deliberate, vountary feigning of physical or psychological symptoms for consciously motivated purposes (e.g., avoid work, for financial gain, to evade prosecution)
- may stage events (e.g., getting hit by a car) alter medical tests, take advantage of natural event, etc..
- not a mental disorder
15
Q
What is Apraxia of Speech?
A
-apraxia results from an impaired ability to generate the motor programs for speech movements, rather than from the disordered transmission of controlling messages to the speech musculature. Apraxia is a planning/programming problem, not a movement problem like dysarthria
16
Q
What is dysarthria?
A
the muscles of the mouth, face and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury.
17
Q
Describe signs/symptoms of Apraxia
A
- errors are inconsistent and unpredictable
- different errors occur in spontaneous speech versus repetition
- patient’s spontaneous speech contains fewer errors than does his/her speech in repetition tasks
- there are islands of clear speech; when producing over-learned material or material that has become automatic, the patient will speak clearly
- substitutions are the most common type of error, with others normally being approximations of the targeted phoneme
- anticipation of errors causes dysfluent speech
- groping, trial and error types of articulatory movements
18
Q
Describe s/s of dysarthria
A
- errors are consistent and predictable
- errors are mainly distortions and omissions
- slurred speech
- speaking softly or barely able to whisper
- slow rate of speech
- hoarseness
- breathiness
- changes in vocal quality
19
Q
See table of etiologies/types of dysarthrias & systems of speech affected
A
in study guide
20
Q
Cranial Nerve I
A
- olfactory
- sensory
- function: smell
- symptom: lack of smell
21
Q
Cranial Nerve II
A
- Optic
- sensory
- function: vision: controls central and peripheral vision, superior and inferior fields
- Symptom: vision problems. Patient may not be able to read printed material
22
Q
Cranial Nerve III
A
- Oculomotor
- both (sensory and motor)
- function: eye movement: pupil constriction
- Symptom: ptosis
23
Q
Cranial Nerve IV
A
- Trochlear
- both (S&M)
- Eye movement: acts as pulley to move eyes down toward tip of nose
24
Q
Cranial Nerve V
A
Trigeminal
both (S&M)
Function: Jaw movement; face, mouth, jaw (and scalp) sensation. Innervates forehead, cheek and jaw.
Symptom: Lack of sensation when stroked. Weak motor strength of jaw (temporal and Masseter muscles)
25
Cranial Nerve VI
Abducens
Both (S&M)
Function: Eye movement from side to side
Symptoms: twitching or nystagmus
26
Cranial Nerve VII
Facial
Both (S&M)
Function: Facial movement, hyoid elevation, stapedius reflex, salivation, lacrimation, taste (facial symmetry)
Symptoms: asymmetry of the face, inability to wrinkle forehead, close eyes, smile, pucker lips, show teeth, puff out cheeks. Nasolabiofold flat when patient smiles.
27
Cranial Nerve VIII
Vestibulocochlear
Sensory
Function: Hearing and Balance
Symptoms: Impaired hearing
28
Cranial Nerve IX
Glossopharyngeal
Both (S&M)
Function: Pharyngeal movement, pharynx and tongue sensation, taste for posterior 1/3 of tongue, SWALLOW
Symptom: lack of taste sensation on back of tongue, inability to swallow secretions. Uvula not in the midline and palate does not rise while the patient says "ahhhh"
29
Cranial Nerve X
Vagus
Both (S&M)
Function: sensation of pharynx and visceral organs. Speech, swallowing, pharyngeal, palatal, and laryngeal movement
Symptom: assessed w/ CN IX..
30
Cranial Nerve XI
Accessory
both (S&M)
Function: shoulder and neck movement
Symptom: Trapezius muscle is weak if pt. cannot raise his shoulders against your hands. Sternocleidomastoid muscle is weak if pt. cannot turn his head against your hand.
31
Cranial Nerve XII
Hypoglossal
Both (S&M)
Function: Tongue Movement
Symptom: When pt. sticks out tongue and it is not in the midline. weakness in strength and mobility of tongue for protrusion, elevation, and lateralization
32
Describe primary clinical manifestations from most severe to least severe
1. coma
2. vegetative state
3. minimally conscious state
4. akinetic mutism
33
Describe a coma
- state of unarousable unresponsiveness and absence of sleep/wake cycles
- voluntary behavior is absent
- eyes remain closed
- no evidence of purposeful movement or localizing responses--any observable response in reflexive
- Etiologies: TBI & vascular disorders, diffuse bilateral cerebral damage, brianstem injury, or both. disruption of th reticular activating System (RAS)--crucial role in arousal and consciousness
34
Describe vegetative state
- a condition of wakeful awareness
- individuals don't exhibit purposeful behavior and don't interact meaningfully with the environment
- sleep/wake cycles remain relatively preserved
- vegetative,non-cognitive functions are still present
- generally don't visually track or respond to normal external stimulation
- motor responses (e.g., flexion withdrawal, nonspecific patterned movements, groaning) may be elicited by harmful or noxious stimuli
- muteness is consistent with a severely reduced level of arousal and cognition
35
What are etiologies of a vegetative state?
- often follows an initial period of coma when caused by a TBI
- Can occur proceeding severe TBI, anoxia, drug toxicity, Wernicke's encephalopathy, Alzheimer's and anencephaly
36
What is a minimally conscious state?
- occurs more commonly than does a vegetative state.
- those affected show a degree of awareness and responsiveness
- May visually track moving stimuli, reach for objects and hold them
- may follow simple commands and respond to yes-no questions
- may smile or cry in response to emotional topics, but not to neutral stimuli
- usually bed bound, incontinent (lacking in restraint or control) and require tube feeding
- may not be entirely mute and may occasionally produce intelligible words
37
Describe akinetic mutism
- pathology in the anterior or medial (internal) options of the frontal lobes may lead to abulia, or diminished motivation
- when abulia is severe, it can result in akinetic mutism (AM)
38
What is akinetic mutism often characterized by?
- lack of drive or motivation to speak
- difficulty initiating and sustaining the cognitive and motor effort required for speech
- apparent absence of thoughts to be communicated
- Muteness of AM is associated with an apparent reluctance to perform even simple motor activities in spite of preserved arousal ad alertness, basic motor and sensory abilities, visual tracking ability, and at least some fundamental cognitive abilities.
- patients typically have their eyes open, seemingly alert and on the verge of responding to simple requests and questions--but are basically unresponsive and apathetic
- may exhibit vegetative jaw and facial movements, and may swallow food after it's placed in their mouth, often only after significant delay.
- speech may be brief, aphonic, whispered or reduced in loudness, and monotone
- articulation and intelligibility is often more intact than phonation and prosody
39
What are some etiologies for akinetic mutism?
- stroke involving the anterior cerebral arteries (frontal lobe)
- bifrontal subarachnoid hemorrhage secondary to aneurysm
- additionally, possible causes could include: encephalitis, severe hydrocephalus, anoxia, and thalamotomy
40
What is the basic formula for an impressions/ diagnostic statement?
patient presents with SEVERITY DX characterized by DESCRIPTION.
ex: patient presents with severe hypo kinetic dysarthria characterized by breathy-hoarse vocal quality, reduced vocal loudness, and occasional accelerated speech rate.
41
See study guide for more samples of an impressions/diagnostic statement.
...
42
What does the acronym SMART stand for?
- specific-target a specific area or environment
- measureable-quantify or at least suggest an indicator of progress
- assignable-specify who will do it
- realistic-state what results can realistically be achieved, given available resources.
- timely (or time-based) specify when the result(s) can be achieved
43
What is the "formula" for a smart goal?
pt will ACTION with PERCENTAGE of ACCURACY given AMOUNT OF ASSISTANCE.
ex: patient will speak in single sentence utterances with 90% intelligibility with familiar communication partners given occasional assistance.
44
See study guide for more examples of SMART goals
...
Fall '14-218 (FINAL EXAM)
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