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Dysarthrias, Dementia and TBI highlights

Terms in this set (56)

Oral communication problems noted with dysarthria include?
respiratory,articulatory, phonatory, resonatory, and prosodic disturbances caused by weakness, incoordination, or paralysis of speech muscles.
Movements characteristic of dysarthria are?
reduced range/speed, involuntary weakened, unsteady, inaccurate movements, and
abnormal muscle tone
Respiratory issues associated with dysarthria?
forced, audible inspiration and expriations that end with grunt interrupt speech
Phonatory issues associated with dysarthria?
problems with pitch (abnormal, breaks, monopitch, etc.), loudness disorders, and
vocal quality problems (harsh, rough, breathy, strained).
Articulation issues associated with dysarthria?
imprecise productions, prolongations, repetitions, breakdowns, distortions, weak
productions
Prosodic issues associated with dysarthria?
variable rates of speech, shorter phrases, uneven stress, and inappropriate pauses
Resonance issues associated with dysarthria?
hypernasality, hyponasality, nasal emissions
Other features of dysarthria?
variable/irregular diadochokinetic rate, compulsive
repetitions (palilalia), and overall decreased intelligibility of speech.
Damage to cerebellar system - predominantly articulation and prosodic problems
Ataxic
Movement disorders -over/undershooting targets, uncoordinated, jerky/slow/halting movements
Ataxic
Imprecise consonants, irregular breakdowns, distortion
of vowels
Ataxic
Monopitch, monoloudness, and harshness
Speech Quality - DRUNKEN speech
Ataxic
Damage to motor units of cranial or spinal nerves (lower motor neuron involvement)
Flaccid
Conditions include myasthenia gravis and votulism, vascular diseases/brainstem strokes, infections, demyelinating diseases - Guillian-Barre Syndrome, degenerative, diseases, surgical trauma
Flaccid
Harsh voice, monopitch, monoloudness
Flaccid
Damage to Basal Ganglia (extrapyramidal system)
Hyperkinetic & Hypokinetic
Associated with Huntington's disease
Hyperkinetic
Jerks (myoclonus), tics, tremors, spasms, severe extremity contractions
Dystonia, abnormal postures, spasms of neck muscles and eye closure
Hyperkinetic
Tremor/strained/harsh voice, vocal stoppage , hypernasality and noise
Hyperkinetic
Contributing conditions: progressive degenerative diseases - PARKINSON'S, Alzheimer's and Pick's, multiple strokes, bilateral strokes, inflammation, tumor, drug toxicity, hydrocephalus
Hypokinetic
Tremors in muscles at rest
Mask-like face with no smiling/infrequent blinking (Like Muhammed Ali)
Hypokinetic
Phonatory - low, monopitch, monoloudness, harsh/breathy voice
Prosody - reduced stress, silent intervals, rushes of speech, short phrases, variable rates
Hypokinetic
Damage to upper motor neurons - lesion sites in cortical areas, basal ganglia, internal capsule, pons, and medulla are common
Spastic
Movement - reduced range, slow, loss of fine/skilled movement, increase of, muscle tone
Spastic
Overactive gag reflex
Hyperadduction of VFs with inadequate closure of port
Spastic
Articulation - imprecise and distorted
Phonation - strained/breathy/harsh voice, low pitch with breaks, short phrases, hypernasality
Spastic
A combination of 2 or more dysarthrias. 2 type combo more common than 3 or more.
Mixed
Most common mixed forms are flaccid-spastic and ataxic-spastic
·
Mixed
Mixed flaccid-spastic is associated with________ (Lou Gherig)
Mixed ataxic-spastic is associated with _____________
-amyotrophic lateral sclerosis (ALS)

-Multiple Sclerosis
Damage to the upper motor neurons that supply cranial and spinal nerves involved in speech production
Unilateral Upper Motor Neuron Dysarthria (UUMN)
Unilateral lower face, tongue, palatal weakness, along with hemiplegia/hemiparesis
UUMN
Phonatory - harsh strained voice, reduced loudness Prosodic - slow rate increasing in segments, excess/equal stress, monopitch, monoloudness, low pitch, short phrases
UUMN
Dysphagia, apraxis, aphasia, right hemisphere syndrome
UUMN
An acquired neurological syndrome characterized by persistent/progressive, deterioration in cognition, visuospatial skills, language, memory, emotion, and
behavior/personality.
Dementia
Is classified as cortical, subcortical, or mixed.
In cortical, intellectual precedes motor and in subcortical, motor precedes intellectual.
Dementia
Caused by prolonged alcohol abuse - may be associated with Dementia
Wernicke-Korsakoff syndrome
Cortical
· Intellectual and language deterioration precedes motor
· Onset typically in 70s and 80s, more women than men, more prevalent in families with Down syndrome hx
· Genetic inheritance or mutations in mitochondria and disturbed immune functions may be cause
Dementia of Alzheimer type
Neurofibrillary tangles - thickened/tangled structures in nerve cells, dendrites,axons
Dementia of Alzheimer type
Neuritic plaques - called senile plaques - cortical/ subcortical tissue degeneration, cerebral cortex and hippocampus are vulnerable, and destroys synaptic connections
Dementia of Alzheimer type
Early state symptoms: subtle memory issues, pronounced issues with learning/visuospatial problems, poor reasoning in social situations, behavior changes (self-neglect/avoidance), depression, disorientation, etc
Dementia of Alzheimer type
Later-stage _________: intensified early-stage symptoms, severe memory problems, visuospatial problems, intellectual deterioration, hyperactive/restless, problems with self-care, orientation tasks, arithmetic issues, lack of affect, initiative, paranoid,
aggressive, inappropriate humor, seizures/jerks, incontinence
Dementia of Alzheimer type
Typically onset between ages of 40 and 60
Pick's = atrophy may be focal in anterior front, temporal lobes, orbital frontal lobe, and medial temporal lobe Pick bodies = dense intracellular formation
o Pick cells = ballooned/inflated neurons
Frontotemporal Dementia
-Pt exhibits behavior disorders, social disorders, compulsiveness, excessive eating, delusions, etc..
Pts may exhibit impaired judgement, emotional disturbances, depression, withdrawal, irritability, euphoria, exaggerated self-esteem
Frontotemporal Dementia
Lewy bodies - small spots found on top of brainstem in the substantia nigra which cause reduced inhibitory dopamine loss
- Frontal lobe atrophy = widening sulci
Dementia Associated with Parkinson's disease
Pt exhibits Apathy, confusion, hallucination, delirium, micrographia
Dementia Associated with Parkinson's disease
2 main causes of infectious Dementia (infectious diseases that lead to dementia)
HIV/AIDS
-Dementia has slow onset - rapid deterioration in final stages
-Language issues are not prominent until mutism in final stage
Creutzfeldt-Jakob disease
-fatigue/sleep disturbances
Left neglect - Reduced awareness of left side of body
o Denial of illness
o Confabulation - person with paralyzed hand claims to paint with that hand
Right Hemisphere Syndrome
Attentional deficits - reduced awareness/arousal
Problems understanding others' emotions, recognizing/describing expressed emotions,
understanding emotional tone, expressing emotions
Right Hemisphere Syndrome
TBI -Brain injury at point of impact is called?
coup injury
TBI- Brain injury opposite side impact is called ?
contrecoup injury
True or False- Acceleration-deceleration more serious, TBI than a penetrating TBI?
True-
head set into motion by physical forces -
brain moving within and striking the inside of the skull results in injury.
Assessment tools for TBI include-
Glasgow Coma Scale, Brief Test of Head Injury,
Comprehensive Level of Consciousness, Galveston Orientation and Amnesia Test, Disability Rating Scales, Rancho Los Amigos Levels of Cognitive Function
Two most important TBI treatments are?
Cognitive Rehabilitation
Direct Communication Training
Direct behavioral procedures, systematic reinforcement
of attending behaviors, appropriate discourse, topic maintenance, self-correction, etc. will result in an increase
Direct Communication Training
Cognitive Rehabilitation
clinician trains components such as attention, visual
processing, and memory
Withholding attention from irrelevant/inappropriate responses is an appropriate technique in communication training? True / False
True
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