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Terms in this set (46)
What is flaccid dysarthria caused by?
by injury or disease to one or more cranial or spinal nerves
what is flaccid dysarthria associated with?
with the final common pathway
what lesion caused flaccid dysarthria ?
a lesion to the lower motor neuron
Is there a large medical practice at a frequency comparable to other major single dysarthria types?
can sometimes reflect involvement of only a
single muscle group
where is damage to the final neuor pathoway seen in?
Cranial nerve and spinal nerves
what is considered damage?
what are clinical characteristics of flaccid dysarthria?
Rapid weakening and recovery with rest
What are 2 types of weakness?
what is paralysis ?
•the complete inability to
•when disease or injury inactivates all of the LMN input to a muscle
Not getting any efferent input innervation which causes paralysis
•reduced contraction and weakness
•some input to muscle remains viable
when there is reduction that's when you get a paresis
•Visible, arrhythmic, isolated twitches in resting muscle
•Invisible, spontaneous, independent contractions of individual muscle fibers
•Can be detected by electromyography (EMG) within about 1-3 weeks after a muscle is deprived of motor nerve supply
In healthy people does the oral cavity have rhythmic or aryhtmic movement?
speech characteristics assiacted with flaccid dysarthria
•Hypernasality if there is damage to the vagus above the pharyngeal branch or nerves invrvationg sof palate
•Monopitch if damage to cricothryroid to th vagus netve
•Nasal emission- hyponasaltyi on vowels you are more like to get NE
•Audible inspiration- recurrent layrgneal branc impaired
•Harsh or hoarse voice quality- more often hoards in FD
•Short phrases aireses from air wastage because VF aren't approximating as they should
the combination of symtoms form a
cluster that leads to a diagnosis
what characteristics does flaccid dysarthria NOT have?
Strained strangled phonation
progressive weakness with use
•Occurs when disease affects the neuromuscular (myoneural) junction
•Rapid weakening and recovery with rest are prominent in neuromuscular junction disease, such as myasthenia gravis.
What are the etiologies ?
•Degenerative (35%) most common
•Neuromuscular Junction Disease (7%)
•Muscle Disease (6%)
•Undetermined diagnoses and Other (23%)
•ALS (amyotrophic lateral sclerosis)
•Initial manifestations are sometimes confined to LMNs
Jerry Luis hosted a telethon for MD
•Complications of AIDS
These 2 are happening in the peripheral nervous system
(MS is not on here cus it happens in the CNS )
Trigeminal Lesion after exiting the brain stem
•Rarely the only cranial nerve involved in flaccid dysarthria
•In unilateral lesions, jaw will deviate to weak side when opened. It may not be perspective because the other side of the jaw can compensate since trigeminal is paired when innervating each side of jaw
•In bilateral lesions, jaw may hang open at rest
Trigeminal lesions: speech
•Alternate motion rates (AMR)
•Imprecision or slowness for "puh" may be greater than that for "tuh" or "kuh"
•Vowel prolongation may be normal
•Unilateral damage to motor portion of cranial nerve V generally does not perceptibly affect speech.
•Bilateral lesions can have a devastating effect.
sequential motor rate (SMR)
n DDK . This becomes an interest is when we suspect apraxia of speech. If we think its dysarthria then we test AMR
What is the differnece between AMR and SMR?
AMR is the same consonant syllable in variation and SMR is different sequence of syllables
Example of AMR
AMR= puh puh puh
Puh tuh kuh
Problems with AMR and SMR mean a lesion in
the trigeminal nerve
vowel prolongation test
Test for respritation and for many pt with flaccid dysarthria this can be normal. It usually doesnt not confirm FD right away
Facial Nerve Lesions
•Bilateral cranial nerve VII lesions are less common than unilateral lesions.
•Bell's palsy: isolated unilateral upper and lower facial nerve weakness
•85% of patients make a full recovery within a year
When there is weakness in the muscles there can be a visible flutter seen in this pt
Facial nerve: speech
•Flutter of the cheeks may be evident during conversation
•"Puh" may have reduced precision compared to "tuh" & "kuh"
•Bilabial stop distortions; problems with labiodentals
Facial nerve innervates the cheeks and gives us tension in them when talking. When there is weaknes in the you see a visible flutter. If there is damage to cranial nerve 7 there is more struggle when saying puh
Glossopharyngeal nerve lesions
•Rarely damaged in isolation
•Assessed by examining the gag reflex
•A normal gag can be present after intracranial section of cranial nerve IX, suggesting that cranial nerve X is also involved in pharyngeal function.
•The role of cranial nerve IX in speech cannot be accessed directly.
Is important to pharyngeal contraction . not a big impact in speech . And plays more of a role is dysphagia
Vagus nerve lesions
•The vagus includes pharyngeal, superior laryngeal, and recurrent laryngeal branches
•Pharyngeal branch supplies pharyngeal and palatal muscles
•Superior laryngeal branch supplies cricothyroid
•Recurrent laryngeal branch supplies other intrinsic laryngeal muscles
Lesions below the pharyngeal brance
spare the upper pharynx and velopharyngeal mechanism but cause paralysis or weakness of the cricothyroid and other intrinsic muscles on the side of the lesion.
if damage occured prior to the 3 brances of the vagus nevere
then they all 3 branches will be effected and have significant problems with phonations.
If it is prior to pharyngeal branch then
the soft palate and VP port will be impaired will have problems with resonances and hyper nasality.
If it is after the pharyngeal branch then
the muscles of the pharynx and soft palate are spared and wont have hyponasitly instead you'll have trouble with pitch and have a breathy or hoard voice because problem with VF .
In Unilateral VF paralysis significances flaccid dysarthria
You're getting a lot of air wastage causing a breathy voice
Vagus nerve lesions: speech
•Breathiness or aphonia
•Diplophonia (hear 2 pitches in a persons voice)
•Short phrases due to air wastage when VF are not fully approximating
Stridor (can hear audible inhalation when they breath
what conditions yield flaccid dysarthria?
unilateral VF paralysis.
If you have a 1 fold that is paralyzed in an abduction position then it is open and not making to the midline so the other vf is trying to meet the paralyzed vf and it is not closing all the way so you will have a breathy voice and produce far less speech
Hypoglossal nerve lesions- innervates extrnic and internsic part of the tongue
•In unilateral lesions, tongue may be atrophic and shrunken on weak side; fasciculations may be apparent
•Tongue deviates to weak side on protrusion
•The ability to push the tongue into the cheek against resistance is diminished
•In bilateral lesions, fasciculations may be present bilaterally
Most common symptom is : imprecise artic of the tongue .
Hypoglossal nerve lesions: speech
•Imprecise articulation of lingual phonemes
•Unilateral lesions are sometimes compensated for to a degree that allows perceptually normal speech.
•In AMRs, "puh" may be normal but "tuh" and "kuh" are affected.
•Imprecision and slowness for "kuh" usually greater than with "tuh"
what can be seen in a unilateral lesion?
One half of the tongue is working but the other half is not
, and the tongue can compensate for that to a certain degree that allow speech
what struggles with hypoglossal nerve lesions in speech with AMRs
Struggles with tuh and kuh because it involves the tongue movement but tuh is better than kuh cus kuh uses more part of the tongue
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