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Ataxic and UUMN Dysarthria

Terms in this set (15)

Ataxic NAB
-damage to cerebellum
(cerebellar control circuit)
-deficit in movement deficits of timing, force, range, direction

Disordered stance and gait - broad-based with truncal instability• Intention tremors• Ocular motor abnormalities• Hypotonia• Motor learning difficulties
atxia
discoordination
Ataxic Etiologies
=bilateral or genralized damage to cerebellum

-hereditary ataxias
-fridedreich's ataxia

-OPCA
-Stroke
-TBI
-Tumors (rarer)
-toxic conditions
-metabolic conditions
Friedreichs Ataxia
= a hereditary autosomal recessive trait that occursprimarily in individuals of Acadian descent• South Louisiana has a relatively high incidence ofthis disorde

• Recessive gene can lie dormant for generations untilsuddenly two people with the gene have children• If both parents carry the gene, there is a 1 in 2 chancethe child will be a carrier, and a 1 in 4 chance they willdevelop ataxia• Usually shows up in early teens w/ lower extremityweakness. Lifespan - 40s (20-35 yrs after onset)• Speech/swallowing become impaired in many cases, soSLP services are recommended in addition to otherrehab assistance to help maintain functio
Ataxia Hallmarks
= Irregular articulatory breakdowns, irregular speech AMRs,excess and equal stress*Predominantly a disorder of articulation and prosody• Pt. may complain of...
• "drunken" speech quality, "stumbling" over words• Dramatic deterioration of speech with little alcohol intake
• Quickly running out of breath (difficulty coordinating breathing withspeech)

• Improved intelligibility when rate is decreased (think - pacing board) withdecreased rate

• Biting cheeks and/or tongue when talking quickly or eating
Ataxia AX tasks
OMECH
• Should be normal/typical

• Conversational speech and reading•

• Non-speech AMRs

• Repetition of sentences containing multisyllabic words
UUMN
unilateral upper motor neuron
UUMN NB
damage to UMNs on one side. Both direct and indirect action pathways.

• Remember - most speech muscles receive bilateral innervations from CNs /UMNs

• Exception: CN VII Facial (lower face) and CN XII Hypoglossal (tongue)
• UMN damage may result in relatively mild and/or temporary affectscontralateral to the lesion, particularly the tongue/face.

• Weakness in the lower face, lips, and tongue (contralaterally)

• Weakness can be permanent or temporary

• An be accompanied by weakness of extremities (contralaterally)

• Severe damage = hemiplegia

• Velum, pharynx, and larynx receive bilateral UMN innervation, soshould not be affected (theoretically).
UUMN NB Typical Presentation:
• unilateral (contralateral) lingual weakness and reduced ROM

• Hemi-lower facial droop (may be mild)
• Tongue deviates to weak side (common in >50% of cases)
• Patient may complain of tongue feeling "slow," "thick," and/or"clumsy"
UUMN R UMN damage=
lower left side of face and tongue weakness
UUMN L UMN damage =
lower right side of face and tongue weakness
UUMN Etiologies
= unilateral UMN damage

• Vascular• Stroke (ischemic or hemorrhagic), subdural hematomas• Most frequent cause (~90%)• Lesions may occur in any part of the brain containing UMNs, includingcortical and subcortical areas (e.g., internal capsule, pericapsularregion, frontal lobe, thalamus, midbrain, or pons)

• Focal lesions• Rare but possible - many focal lesions (TBI or degenerative diseases)have more widespread effects

.• Tumors• Rare but possible - can cause UUMN if it starts focally, but oftenprogresses to spastic. If tumors first present as UUMN it is likely due topressure / compression of tissues and blood flow.
UUMN Hallmarks
imprecise articulation

• may include:
• slow rate, vocal harshness, mild hypernasality

• Generally mild or moderate in severity, and can betemporary
UUMN non-diagnostic symptoms:
• (limb) Hemiparesis
• Hemisensory deficits
• aphasia
• AOS
• visual deficits
• cognitive impairments (RHD)
Key AX tasks:
Full / thorough awareness of site of lesion• Why?
• OMECH• Why?
• Connected speech sample• Why?
• AMR task• Why?
• Vowel prolongation• Why?
• *Some AX tasks for UUMN are exclusionary.• Meaning...?
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