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neuro-quiz 2

Terms in this set (143)

where is the lesion for flaccid dysarthria?
Somewhere between the brainstem or spinal cord and the muscles of speech
neuromuscular basis for flaccid dysarthria
LMN/Final Common Pathway
CN V: respiratory/phonatory effects
unilateral: none
bilateral: none
CN V: resonance effects
unilateral: none
bilateral: none
CN V: articulation effects
unilateral: none
bilateral: imprecise bilabials, labiodentals, lingual-dentals, lingual-alveolars, vowels, glides and liquids
CN V: prosody effects
unilateral: none
bilateral: slow rate (compensatory or primary)
CN VII: respiratory/phonatory effects
unilateral: none
bilateral: none
CN VII: resonance effects
unilateral: none
bilateral: none
CN VII: articulation effects
unilateral: mild distortion of bilabials and labiodentals, mild distortion of anterior lingual fricatives and affricates

bilateral: distortion or inability to produce bilabials and labiodentals,vowel distortion, anterior lingual fricative and affricate distortions
CN VII: prosody effects
unilateral: none
bilateral: slow rate (compensatory or primary)
CN X above pharyngeal branch: respiratory/phonatory effects
unilateral:
- breathiness
- reduced loudness
- reduced pitch
- short phrases
- hoarseness
- diplophonia

bilateral:
- breathiness
- aphonia
- short phrases
- inhalatory stridor
CN X above pharyngeal branch: resonance effects
unilateral:
- mild hypernasality
- nasal emission

bilateral:
- moderate + hypernasality
- nasal emission
CN X above pharyngeal branch: articulation effects
unilateral: none (mildly weak pressure consonants)

bilateral: weak pressure consonants
CN X above pharyngeal branch: prosody effects
unilateral: short phrases

bilateral: short phrases
CN X below pharyngeal branch: respiratory/phonatory effects
unilateral:
- breathiness
- reduced loudness
- reduced pitch
- short phrases
- hoarseness
- diplophonia

bilateral:
- breathiness
- aphonia
- short phrases
- inhalatory stridor

*same as above
CN X below pharyngeal branch: resonance effects
unilateral: none
bilateral: none
CN X below pharyngeal branch: articulation effects
unilateral: none
bilateral: none
CN X below pharyngeal branch: prosody effects
unilateral: short phrases
bilateral: short phrases
CN X superior branch only: respiratory/phonatory effects
unilateral:
- breathiness
- hoarseness

bilateral:
- breathiness
- hoarseness
- reduced loudness, pitch and range
CN X superior branch only: resonance effects
unilateral: none
bilateral:none
CN X superior branch only: articulation effects
unilateral: none
bilateral: none
CN X superior branch only: prosody effects
unilateral: short phrases
bilateral: short phrases
CN X recurrent branch only: respiratory/phonatory effects
unilateral:
- breathiness
- hoarseness
- reduced loudness
- diplophonia

bilateral:
- breathiness
- hoarseness
- reduced loudness
CN X recurrent branch only: resonance effects
unilateral: none
bilateral: none
CN X recurrent branch only: articulation effects
unilateral: none
bilateral: none
CN X recurrent branch only: prosody effects
unilateral:short phrases
bilateral: short phrases
CN XII: respiratory/phonatory effects
unilateral: none
bilateral: none
CN XII: resonance effects
unilateral: none
bilateral: altered
CN XII: articulation effects
unilateral:
- mildly imprecise lingual consonants

bilateral:
- mild to severe imprecise lingual consonants
CN XII: prosody effects
unilateral: none
bilateral: slow rate (compensatory or primary)
Spinal respiratory nerves: respiratory/phonatory effects
unilateral: none
bilateral:
- reduced loudness, pitch and variability
- strained voice
Spinal respiratory nerves: resonance effects
unilateral: none
bilateral: none
Spinal respiratory nerves: articulation effects
unilateral: none
bilateral: none
Spinal respiratory nerves: prosody effects
unilateral: none
bilateral:
- short phrases
- reduced pitch and loudness variability
what is myasthenia gravis?
- The most common neuromuscular junction disease
- Autoimmune disease characterized by rapid weakening of voluntary muscles with use and improvement in the rest
- Reflects autoimmune response against Ach receptors in the post-synaptic membrane at the motor endplate
- Muscle contraction progressively diminishes with use
- Majority of people have abnormality of the thymus gland
signs of myasthenia gravis
- ptosis
- facial weakness
- flaccid dysarthria
- dysphagia
- decreased lateral tongue force
- reduced tongue endurance
- reduced bite force
- inspiratory stridor
where is the damage for spastic dysarthria?
bilateral damage to indirect and direct activation pathways of the CNS
is spasticity associated with UMN disease or LMN disease?
UMN
Spastic dysarthria reflects the effects of _______ muscle tone?
excessive (hypertonicity)
is spastic dysarthria a problem of execution or planning?
execution
direct activation pathways
AKA pyramidal tracts or direct motor system
- form part of UMN system
- includes corticospinal and corticobulbar tracts
- bilateral (one from each hemisphere)
- innervate muscles on opposite side of body (only for muscles of lower face and tongue for speech muscles)
- facilitatory
- skilled discrete movements
indirect activation pathways
AKA extrapyramidal tract or indirect motor system
- part of UMN system
-originate from each hemisphere
- crucial for regulating reflexes and maintaining posture and tone
- inhibitory
damage to direct activation pathway
- loss of fine skilled movement
- hypotonia
- weakness is more prominent in distal muscles
- absent abdominal reflexes
- hyporeflexia
damage to indirect activation pathway
- increased muscle tone
- spasticity
- clonus
- decorticate/decrebrate posture
- hyperactive stretch reflexes
- babinski sign
- hyperactive gag reflex
clonus
repetitive reflex contraction that occurs when a muscle is kept under tension
patient complaints for spastic dyarthria
- speech is slow or effortful
- fatigue while speaking
- often have to speak slowly to be understood
- hard to speak fast
- nasal speech
- swallowing
- drooling
- difficulty controlling emotions (pseudobulbar palsy)
pseudobulbar palsy
bilateral spastic paralysis affecting the bulbar muslces
- reflects bilateral lesions of corticobulbar fibers
- spastic dysarthria
is dysphagia common with spastic dysarthria?
yes
nonspeech oral mech: spastic dysarthria
- at rest nasolabial folds may be smooth or flattened
- pseudobulbar affect
- jaw clonus
- hyperactive gag reflex
what are the most useful tasks for eliciting characteristics of spastic dysarthria?
- conversational speech and reading
- speech AMRs
- vowel prolongation
are stress testing and SMRs useful for distinguishing characteristics of spastic dysarthria?
no
neuromuscular deficits: spastic dysarthria
- slow rate
- reduced range
- reduced force
- excessive tone
prosodic excess: spastic dyarthria
- excess and equal stress
- slow rate
articulatory/resonatory incompetence: spastic dysarthria
- AMRs are slow but regular
- imprecise consonants
- distorted vowels
- hypernasality
prosodic insufficiency: spastic dysarthria
- monopitch
- monoloudness
- reduced stress
- short phrases
phonatory stenosis: spastic dysarthria
- low pitch
- harshness
- strained-strangled voice
- pitch breaks
- short phrases
- slow rate
ataxic dysarthria is associated with damage to the ______?
cerebellar control circuit
characteristics of ataxic dysarthria are mostly evident in ____ and _______?
articulation and prosody
does ataxic dysarthria reflect problems or neuromuscular execution or motor control?
motor control
ataxix dysarthria involves a breakdown in _____ and ______?
timing and coordination
each cerebellar hemisphere controls movements on the _______ side of the body?
ipsilateral
purkinjie cells
- inhibitory
- sole output neurons of the cerebellar cortex
primary connections for the cerebellums role in speech
1. reciprocal connections with the cerebral cortex
2. auditory and proprioceptive feedback from speech muscles, tendons and joints
3. reciprocal connections with brainstem components of indirect activation pathway
4. cooperation with the basal ganglia control circuit
what are the most common signs of cerebellar disease?
difficulties with standing and walking
titubation
rhythmic tremor of the body or head that can occur with cerebellar disease
- rocking of the trunk or head
nystagmus
- rapid eye movement
pendulousness
extremity has greater number of oscillations before coming to rest
impaired check and excssive rebound
large displacement of limb followed by overshoot beyond original position
dysmetria
disturbance in trajectory of a moving body part or inability to control movement range
- overshooting and undershooting
dysdiadochokinesis
errors in timing and speed of components of movement
- results in poor coordination
- test AMRs
- knee pat test
ataxia
movements are halting, imprecise, jerky, poorly coordinated and lacking speed/fluidity
intention tremor
apparent during movements or sustained postures
patient complaints for ataxic dysarthria
- slurred speech
- drunken quality of speech
- inability to coordinate breathing and speaking
- slowing speech rate improves intelligibilty
non speech oral mech: ataxic dysarthria
- non speech AMRs of jaw, tongue and lip may be abnormal
which tasks are most useful for determining characteristics of ataxic dysarthria
conversational speech, reading and speech AMRs
neuromuscular deficits associated with ataxic dysarthria
- innacurate direction
- irregular rhythm
- slow rate
- excessive to normal range
- normal to excessive formce
- reduced tone
articulatory inaccuracy: ataxic dysarthria
- irregular AMRs
- imprecise consonants
- irregular articulatory breakdowns
- distorted vowels
prosodic excess: ataxic dysarthria
- excess and equal stress
- prolonged phonemes
- prolonged intervals
- slow rate
phonatory prosodic insufficiency spastic
- harshness
- monopitch
- monoloudness
hypokinetic dysarthria is associated with ______ pathology?
basal ganglia control circuit
characteristics of ataxic dysarthria are most evident in ____, ______, and ______?
voice, articulation and prosody
what is the prototypic disease associated with hypokinetic dysarthria?
parkinsons
what is a significant contributer to hypokinetic dysarthria?
decreased range of movement
hypokinetic dysarthria prominently affects aspects of ______?
motor control
- preparation
- maintenance
- switching of motor programs
basal ganglia activities are associated with which activation pathway?
indirect
interconnections of basal ganglia
1. cortical, thalamic, and substantia nigra input to striatum
2. striatum input to the substantia nigra and globus pallidus
3. globus pallidus input to thalamus, subthalamic nucleus, red nucleus and reticular formation in the brainstem
functions of basal ganglia control circuit
- regulate muscle tone
- control postural adjustments during skilled movements
- regulate movements that control goal directed activities
- scale the force, amplitude and duration of movements
damage to basal ganglia control circuit
reduces movements or results in failure to inhibit involuntary movement
is basal ganglia inhibitory?
yes
what are the primary nonspeech clinical signs of parkinsonism?
- resting tremor
- rigidity
- bradykinesia/hypokinesia
- akinesia
- postural abnormalties
patient complaints for hypokinetic dysarthria
- report that others tell them their voice is quiet or weak
*although patients often deny changes
- fast rate
- hard to get speech started
- fatigue
- drooling
- swallowing
- upper lip feels stiff
non speech oral mech: hypokinetic dysarthria
- reduced blink frequency
- masked expression
- lack animation during social interaction
- swallow infrequently
- drooling
- tremor of jaw/lips
what will provide useful information for identifying characteristics of hypokinetic dysarthria?
conversational speech/reading, AMRs, and vowel prolongation
neuromuscular deficits associated with hypokinetic dysarthria
- slow rate for individual movements
- fast rate for repetitive movements
- reduced range
- reduced force
- excessive tone
prosodic insufficiency: hypokinetic dysarthria
- monopitch
- monoloudness
- reduced stress
- short phrases
- variable rate
- short rushes of speech
- imprecise consonants
phonatory/respiratory: hypokinetic dysarthria
- reduced loudness
- reduced utterance length
- repeated phonemes
- rapid or blurred AMRs
physical characteristics: hypokinetic dysarthria
- masked facial expression
- tremulous jaw, lip and tongue
- reduced range of motion on AMR tasks
- head tremor
hyperkinetic dysarthria is associated with the ___________
basal ganglia control circuit
hyperkinetic dysarthria has prominent effects on ______ and _______
prosody and rate
some of the subtypes for hyperkinetic dysarthria reflect problems with __________
sensorimotor integration for speech motor control
dyskinesia
characteristic of hyperkinetic dysarthria
- abnormal involuntary movements
orofacial dyskinesia
common side effect of antipsychotic drugs
- can occur without hyperkinesias
myoclonus
characteristic of hyperkinetic dysarthria
- involuntary single or repetitive brief, lightning-like jerks of a body part
- can be rhythmic or non-rhythmic
- cannot be inhibited willfully
action myoclonus
myoclonus brought on by movement
hiccups
a form of myoclonus produced by a brief spasm of the diaphragm with subsequent adduction of the vocal folds
tics
can be a characteristic of hyperkinetic dysarthria
- rapid, stereotyped, coordinated, or patterned movements that are under partial voluntary control
- irresistable urge to perform them
- tourettes
chorea
characteristic of hyperkinetic dysarthria
- involuntary, rapid, nonsteretypic, purposeless movement of a body part
- can be present at rest, sustained postures and voluntary movement
- can be degenerative, inflammatory or infectious in origin
ballismus
characteristic of hyperkinetic dysarthria
- involves gross, abrupt contractions of axial and proximal muscles
- can produce wild flailing movements
- stroke is the most common cause
- lesions of subthalamic nucleus
athetosis
characteristic of hyperkinetic dysarthria
- slow, writhing purposeless movements that tend to flow into one another
- combination of chorea and dystonia
dystonia
characteristic of hyperkinetic dysarthria
- involuntary abnormal postures resulting from excessive co-contraction of agonist and antagonistic muscles
- reflects impaired inhibition
spasm
characteristic of hyperkinetic dysarthria
- various abnormal muscle contractions
- usually involuntary

tonic- prolonged or continuos
clonic- repetitive, rapid in onset and brief in duration
tremor
characteristic of hyperkinetic dysarthria
- the most common involuntary movement
- involves rhythmic movements of a body part
resting tremor
occurs when body part is in repose
postural tremor
when body part is maintained against gravity
action tremor
during movement
terminal tremor
as the body part nears the target
essential tremor
occurs with sustained posture and action
- commonly affects the upper limbs, head or voice
cerebellar tremor
occurs during sustained postures and action
wing beating tremor
frequently present in wilsons disease
- severe postural tremor
- arms are held in outstretched position
chorea phonatory/respiratory
- sudden forced inspiration-expiration
- voice stoppages; transient breathiness; strained voice; excessive loudness
chorea resonance
hypernasality
tourettes phonation/respiratory
- coughing
- grunting
- throat clearing
- screaming
tourettes resonance
sniffling
tourettes articulation/prosody
- humming
- whistling
- lip smacking
- echolalia
- palilalia
- coprolalia
tourettes physical characteristics
- multiple motor tics
tourettes patient complaints
awarenss of tics
- inability to inhibit them
chorea articulation
distortions and irregular breakdowns
chorea prosody
- prolonged intervals and phonemes
- variable rate
- innapropriate silence
chorea patient complaints
effortful speech
- involuntary orofacial movements
action myoclonus phonatory/respiratory
ocassional adductor voice arrests
action myoclonus articulation/prosody
- slow rate
- decreased precision with increased rate
is action myoclonus normal at rest?
yes
patient complaints of action myoclonus
awareness of imprecise speech
dystonia phonatory/respiratory
- strained/harsh voice quality
- voice stoppages
- audible inspiration
- excess loudness
- voice tremor
dystonia resonance
hypernasality
dystonia articulation
- distorted vowels
- irregular articulatory breakdowns
- slow, irregular AMRs
dystonia prosody
- innapropriate silences
- excessive loudness variations
dystonia patient complaints
- effortful speech
- involuntary orofacial movements
- tricks that improve speech temporarily
- chewing and swallowing problems
UUMN dysarthria articulation/prosody
- imprecise articulation
- irregular articulatory breakdowns
- slow rate
- slow AMRs
- imprecise AMRs
UUMN dysarthria phonation
- harshness
- hoarseness
- decreased loudness
UUMN dysarthria resonance
hypernsality
UUMN dysarthria physical
- unilateral lower face weakness
- unilateral lingual weakness
UUMN dysarthria patient complaints
- slurred speech
- drooping lower face
- thick or heavy tongue
- drooling
- dysphagia
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