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Flashcards in The Dysarthrias Deck (30):
1

What are the seven dysarthrias?

  • Flaccid
  • Spastic
  • Hypokinetic
  • Hyperkinetic
  • Unilateral Upper Motor Neuron
  • Ataxic
  • Mixed

2

Describe Flaccid Dysarthria. What can it be caused by? Where can the damage happen? What can it be the result of? What stroke can cause this? What does the presentation of dysarthria depend on? What can the impulses not reach? What does it result in (what side)?

  • Can be caused by anything that damages the lower motor neuron
  • Damage can happen anywhere along the nerve
  • May be the result of a severed nerve or Stretching/twisting of the nerve
  • Brainstem stroke or tumor
  • Presentation of the dysarthria will depend on which nerve(s) have been damaged
  • Impulses can’t reach the muscles
  • Results in muscle weakness on the ipsilateral side as the lesion
     

3

Describe the causes of flaccid dysarthria (4)

 

  • Trauma (surgical, physical)
    • C-spine injury
    • Carotid  Endarectomy
    • Cardiac Surgery
    • Dental Surgery
  • Autoimmune/Inflammatory
    • Myasthenia Gravis, Guillain-Barre
  • Viral (polio)
  • Degenerative
    • Muscular Dystrophy, Progressive bulbar palsy
       

4

Describe the symptoms of flaccid dysarthria. Resonance, Articulation, Phonation, Respiration, Prosody.


•Resonance (vagus nerve Damage)

  • Hypernasality- #1 most noticable
  • Nasal Emissions
  • Weak pressure Consonants
  • Decreased phrase length

•Articulation (facial nerve Trigeminal and/or hypoglossal

  • Imprecise consonants- #2 most noticable
  • Ranges from Mild-unintelligible
  • Facial nerve, Hypoglossal nerve

•Phonation

  • Breathy vocal quality/aphonia # 3 most noticable

•Respiration

  • Reduced loudness
  • Shortened phrase length

•Prosody

  • Monopitch
  • Monoloudness

5

What are the three most noticable symptoms of flaccid dysarthria?

 

  1. Hypernasality
  2. Imprecise consonants
  3. Breathy vocal quality/aphonia

6

Describe flaccid dysarthria evaluation. What tasks do you do? What does each task show with flaccid dysarthria?

 

  • Connected speech tasks (Conversation, Oral reading) to Identify:
    • Hypernasality
    • Imprecise consonants
    • Shortened Phrases (due to respiratory)
    • Monopitch/Monoloudness
  • Alternate and sequential motion Rate 
    • Slowed phoneme production
  • Sustained Vowel
    • Respiratory weakness
    • Phonatory incompetence
       

7


http://www.youtube.com/watch?v=_L9k0VnQAV8
 

“This video shows a woman with flaccid dysarthria performing alternate motion rates (AMR's). She has bilateral cranial nerve XII damage causing poor tongue strength/ROM. The pt also displays cranial nerve X damage with reduced palatal movement causing hypernasality.”

8

What is Myasthenia Gravis?

Myasthenia Gravis- Antibodies against the neurotransmitter receptors at the neuromuscular junction

9

Describe spastic dysarthria. What is it caused by? What is it characterized by?


•Caused by Bilateral Upper motor neuron lesions to both the direct and indirect activation systems (more than one stroke)
•Characterized by

  • increased muscle tone (spasticity),
  • weakness
  • abnormal muscle reflexes (sometimes)
     

10

What are some etiologies of spastic dysarthria (5)?


•Bilateral strokes (or other lesions)
•Amyotrophic Lateral Sclerosis (ALS)

  • Upper Motor neuron type (early stages)

•Traumatic Brain injury
•Multiple sclerosis
•Anoxia
 

11

Describe the symptoms of spastic dysarthria. Articulation, Phonation, Resonance, Prosody


•Articulation

  • Imprecise consonants
  • Vowel distortions

•Phonation

  • Harsh/strained vocal quality (due to overly adducted vocal folds)
  • Low pitch

•Resonance

  • Hypernasality
    • Less severe than flaccid

•Prosody

  • Monopitch
  • Monoloudness
  • Slow rate of speech with short phrases

Most effortful form of dysarthria

 

12

Describe spastic dysarthria evaluation. What are the tasks? What do each look like with spastic dysarthria?


•Connected speech tasks:

  • Hypernasality
  • Articulation
  • Prosody

•Alternate motion rate

  • Slow articulatory rate

•Sustained vowel

  • Harsh vocal quality

13

Describe unilateral upper motor neuron dysarthria. What is it caused by? What will it cause weakness to? Why can it be mild? Where is it most evident? How can it be severe? Why is this dysarthria seen often?

  • Caused by any damage to the Upper motor neuron on only one side.
  • Will cause weakness of the contralateral articulators (tongue may deviate to one side)
  • Can be mild due to some bilateral innervation of head and neck structures
  • Most evident in the lower face/ tongue due to unilateral innervation. (not seen in top of face because there is bilateral innervation there and unilateral nnervation to lower half of face)
  • Can be severe with significant lesions
  • Seen often because stroke usually affects one side
     

14

Describe the symptoms of unilateral upper mototr neuron dysarthria. Artculation, Phonation, Resonance


•Articulation

  • Imprecise consonants
  • Slow articulatory rate

•Phonation

  • Harsh Vocal quality

•Resonance

  • Hypernasality (rare)

 

Labial weakness – left side

Speech disorder, not language

Hallmark – imprecise consonants

hemiparesis

15

Describe evaluation of unilateral upper motor neuron dysarthria. What are the tasks? What would you find?


•Connected speech tasks

  • Identify irregular articulatory breakdowns

•Alternate motion rate

  • Slow articulatory rate

•Prolonged vowel

  • Harsh vocal quality

16

Describe ataxic dysarthria. What is it caused by? What can damage impact? What is it characterized by (hallmarks)? 


•Caused by damage to the cerebellum
•Damage Can impact both the direct and indirect activation systems
•Characterized by:

  • Slurred, “drunken” quality
  • Errors in Timing and precision of movements
  • Equal syllable stress
     

17

WHat are some etiologies that can cause ataxic dysarthria (6)?


•Degenerative Cerebellar conditions
•Chronic Alcohol abuse
•Stroke
•Toxic conditions
•Traumatic Brain Injury
•Tumors
 

18

Describe the symptoms of ataxic dysarthria. Articulation, Phonation, Prosody


•Articulation

  • Imprecise consonants
  • Vowel Distortions
  • Irregular breakdown

•Phonation

  • Harsh vocal quality
  • Vocal tremor

•Prosody

  • Equal and Excess Stress - Forcing every syllable out
  • Prolonged Phonemes
  • Prolonged intervals between phonemes - Too much pause between syllables
  • Monopitch/monoloudness
  • Slow Rate

Need to correct balance

Voice unsteady

Intonation – all syllables are same length

Tremor in voice, imprecise consonants, slow, equal syllables, extra time in between

Prosody – marks stress, but not consistently

19

Describe evaluation of ataxic dysarthria. What are the tasks? What may you find with each?


•Connected speech tasks containing many multisyllabic words

  • Prosodic irregularity
  • Irregular Articulatory breakdowns

•Alternating movement rates (AMR)

  • Slow articulatory rate
  • Irregular rhythm

•Sustained vowel

  • Harsh vocal quality
  • Vocal Tremor


 

20

Describe hypokinetic dysarthria. What is it caused by? What are most cases? What is there a lack of (what does this cause)? What is it characterized by?


•Typically Caused by basal ganglia dysfunction.
•Most cases are a form of Parkinsonism
•A lack of dopamine (inhibitory neurotransmitter) causes imbalance in the basal ganglia.
•Characterized by:

  • Reduced Loudness
  • Decreased range of motion (for articulation - don't move mouth a lot, causing imprecision)
  • Slow rate/ increased rate of speech

 

  • Pressive speech – if freeze cant initiate, if move (talk) can’t stop
  • Miscalibration - think being perfectly loud

21

Describe the causes of hypokinetic dysarthria (4). What do these lead to?


•Multiple Etiologies:

  • Idiopathic (don’t know what causes them)
  • Neuroleptic-Induced (antipsychotics)
  • Postencephalitic (viral)
  • Trauma

•that lead to Parkinson’s-like symptoms:

  • Muscle rigidity
  • tremor
  • Decreased range of motion
  • Slow movement
  • Decreased facial expression
  • Difficulty starting and stopping movements
  • Flat affect
     

22

Describe the symptoms of hypokinetic dysarthria. Articulation, phonation, respiration, resonanace, prosody


•Articulation

  • Imprecise consonants (Decreased Range of motion, eg. stops become fricatives)
  • Repeated phonemes and words

•Phonation

  • Harsh or Breathy vocal quality
  • Low pitch

•Respiration

  • Shallow Breath support

•Resonance

  • Hypernasality (occasional and mild)

•Prosody

  • Monopitch
  • Reduced stress
  • Monoloudness
     

23

Describe hypokinetic dysarthria evaluation. What are the tasks? What would you find?


•Connected speech tasks:

  • Prosodic errors
  • Reduced loudness

•Alternating Motion Rates

  • Imprecise Consonants
  • Variable articulatory rates
  • Blurring syllables

•Sustained Vowel

  • Vocal quality

 

Repeated phoneme

Hardly moved

Barely opened mouth

Rigidity 

24

Describe one treatment for hypokinetic dysarthria (parkinson's). Is it structures? What does it emphasize? How many/which taks are repeated daily? 

LSVT LOUD

•Well researched treatment designed specifically for patients with Parkinson’s
•Highly programed and intensive approach
•emphasizes loud voice and frequent repetition.
•3 daily tasks completed everyday

  • Sustained vowel
  • Highs and Lows
  • Functional phrases
     

25

Describe hyperkinetic dysarthria. What is it caused by? What likely plays a role? What is it characterized by?


•A group of motor speech disorders Caused by Dysfunction and/or damage in the basal ganglia
•Exact process not fully understood
•A neurotransmitter imbalance likely plays a role
•Characterized by:

  • Excessive Involuntary movements that interfere with speech
  • Intermittent errors
     

26

Which disorders can cause hyperkinetic dysarthria (7)?


•Chorea

  • Huntington’s

•Stroke (rare)
•Tardive Dyskinesia
•Tic disorders
•Myoclonus
•Essential tremor (action tremor)
•Dystonia

  • Spasmonic dysphonia

27

Describe the symptoms of hyperkinetic dysarthria. Articulation, phonation, respiration, resonance, prosody


•Articulation

  • Imprecise consonants
  • Distorted Vowels
  • Prolonged phoneme

•Phonation

  • Periods of Harsh/strained and breathy vocal quality
  • Excessive loudness
  • Voicing breaks

•Respiration

  • unexpected inhalations/exhalations

•Resonance

  • Hypernasality

•Prosody

  • Prolonged intervals between syllables/ inappropriate silences
  • Variable rate
  • Monopitch/monoloudness

 

28

Describe evaluation with hyperkinetic dysarthria. What are the tasks? What might you find?


•Connected speech tasks:

  • Articulation errors
  • Prosodic errors
  • Phonotory errors
  • Respiratory irregularity inhalations/exhalations

•Alternating Motion Rates

  • Irregular articulatory breakdowns
  • Variable speech rate

•Vowel Prolongations

  • Vocal quality
  • Vocal tremor
  • Involuntary pitch and loudness variation

•Careful observation of  associated involuntary movements


 

29

Describe mixed dysarthria. What is it caused by? What is it a combination of? What is it characterized by?


•Caused by damage to more than one part of the motor system
•A combination of two or more types of dysarthria
•Will be characterized by a mix of the features of the dysarthrias represented.  
 

30

What are disorders that may cause mixed dysarthria?


•Multiple Sclerosis

  • May appear as a focal lesion or diffuse

•Multisystems Atrophy

  • Shy-Drager syndrome
  • Progressive Supranuclear Palsy

•Amyotrophic Lateral Sclerosis (ALS)