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CSD 420
Dysarthrias
| Term | Definition |
|---|---|
| Hypokinetic Dysarthria | Movements of structure of speech systems become erased entirely or reduced in range of motion |
| Parkinson's Disease: Non-Speech Symptoms | Stooped posture w/ lack of arm swing when walking; Festination, Hypomimia, Bradykinesia, Akinesia, Hyopkensia |
| Festination | Shuffling gait of short & quick footsteps (shuffling & dragging feet) |
| Hypomimia | Reduced amount of movement in the face creating distinctive masked appearance & lack of facial expression |
| Bradykinesia | Inability or difficulty initiating movement |
| Akinesia | Freezing or immobility; complete lack of movement |
| Hypokinesia | Reduced amount of movement |
| Hyperkinetic Dysarthria | Created by extra & involuntary movements that interfere with speech production; damage to basal ganglia & cerebellum |
| Etiologies of Hypokinetic Dysarthria | Damage to basal ganglia or its connection to other CNS structures; degenerative diseases, strokes, toxins, TBIs, infectious diseases |
| Etiologies of Hyperkinetic Dysarthria | Stroke, trauma, tumor, infectious diseases, degenerative diseases, congenital conditions, toxins |
| Etiology | The cause |
| Huntington's Chorea | Atrophy of basal ganglia; severity can increase over time |
| Tourette Syndrome | Tic disorder; echolalia; copralalia |
| Spasmodic Dysphonia | Disorder of extra movement at the level of vocal folds; adductor; abductor |
| Echolalia | Compulsive repetition of another's utterances |
| Copralalia | Compulsive repetition of swear words |
| Dysarthria | A group of motor speech disorders caused by damage to the CNS or PNS that creates weakness, slowness, incoordination, for abnormal muscle tone in musculature used to produce speech |
| Primary Dysarthrias | Flaccid, Spastic, Unilateral Upper Motor Neuron, Ataxic, Hypokinetic, Hyperkinetic |
| Uni | One |
| Bi | Two |
| Hyper | More |
| Hypo | Less |
| Ipsi- | Same side |
| -kinetic | Movement |
| -tonic | Muscle Tone |
| Lateral | Sides |
| Flaccid Dysarthria | Damage to lower motor neurons; affects articulation, resonance, voice production, or respiration |
| Etiologies of Flaccid Dysarthria | Brainstem strokes, polio, HIV/AIDS, ALS, Myasthenia gravis, Guillain-Barre syndrome |
| 3 Branches Trigeminal Nerve | Ophthalmic, Maxillary, & Mandibular |
| Ophthalmic Branch | Sensory Branch |
| Maxillary Branch | Sensory Branch |
| Mandibular Branch | Motor to Mandible |
| Flaccid Dysarthria - Trigeminal (V) Nerve Damage | Synapses with the CNS at the pons; damage may lead to inability to elevate the mandible for speech & mastication |
| Flaccid Dysarthria - Facial (VII) Nerve Damage | Complex nerve that serves sensory & motor functions; divided into 4 branches: temporal, buccal, zygomatic, mandibular |
| Temporal Branch | Innervates muscles around eyes & movement of forehead for facial expression |
| Buccal Branch | Innervates muscles of the lower face to control lips & compression of forehead for facial expression |
| Zygomatic Branch | Innervates muscles of the lower face to control lips & compression of cheeks |
| Mandibular Branch | Innervates muscles of the lower face to control lips & compression of cheeks |
| Flaccid Dysarthria - Vagus (X) Nerve Damage | Complex & large cranial nerve; courses through the head & neck before reaching thorax |
| Pharyngeal Plexus: Unilateral Damage | Resonance Issues |
| Pharyngeal Plexus: Bilateral Damage | Flaccid weakness on both sides of the velum; bilateral weakness of uvula & velum |
| Superior Laryngeal Branch: Unilateral Damage | Extrinsic portion innervates the cricothyroid muscle which tenses the vocal folds & regulates pitch; monotone voice |
| Superior Laryngeal Branch: Bilateral Damage | Weakens both cricothyroid muscles so increase monotony |
| Recurrent Laryngeal Branch: Unilateral Damage | Paralysis or paresis of same side vocal fold; voice will sound breathy/hoarse |
| Recurrent Laryngeal Branch: Bilateral Damage | Vocal folds paralyzed at midline |
| Flaccid Dysarthria - Hypoglossal (XII) Nerve Damage | Originates in the medulla; innervates the intrinsic (fine motor) & extrinsic (gross motor) muscles |
| Signs of Flaccid Dysarthria | Hypotonia, muscle atrophy, possible fasciculations, hyporeflexia (lack of reflexes) |
| Spastic Dysarthria | Created by spasticity in muscles associated with speech production |
| Hallmark Characteristics of Spastic Dysarthria | Imprecise articulation, strained/strangled voice quality, excess & equal stress |
| Anatomical Basis of Spastic Dysarthria | Upper motor neurons are descending tracts of axons that begin in cerebral cortex & travel within the CNS to synapse with LMNs of PNS; origin of spastic dysarthria is bilateral damage to UMNs |
| Etiologies of Spastic Dysarthria | Stroke, trauma, toxins, diseases, cerebral palsy |
| Signs of Spastic Dysarthria | Hypertonia, hyperreflexia, resistance to passive movement, spasticity in the limbs & articulators |
| Lesion Effects | Lesion bilaterally to the UMNs will create effects seen on both sides of the body; will not be constrained to a single articulator or speech system; spasticity will be seen on both sides of the body |
| UUMN | Unilateral Upper Motor Neuron Dysarthria |
| Unilateral damage to the UMNs due to... | Stroke within a single cerebral hemisphere or one side of brainstem |
| UUMN treatment | Transient & may resolve spontaneously with no intervention |
| Ataxia Dysarthria | Incoordination (slushy or drunken-like speech); weakness will not be present (all oral & facial structures will appear normal at rest) |
| Anatomical Basis of Ataxic Dysarthria | Result of damage to the cerebellum (responsible for monitoring & correcting errors) |
| Etiologies of Ataxic Dysarthria | Any process that damages the cerebellum or its connection to the CNS; diseases; stroke; toxins; trauma |
| Signs of Ataxic Dysarthria | Poorly controlled & coordinated movement, ataxic gait, titubation, nystagmus |
| Ataxic Gait | Feet usually spread broadly apart with irregular footsteps & a greater likelihood of falls |
| Titubation | Small, quick back & forth rhythmic movement of a body part |
| Nystagmus | Rapid back & forth motion of the eyes |
| Non-Speech Compensatory Strategies | Ask for clarification, maintain eye contact, listen actively/attentively, get closer, modify environment to reduce noise |
| Hypernasality Compensatory Strategies | Occlude the nares during speech; increase the degree the speaker's mouth opens during speech to allow more air & sound to pass through |
| Speech Intelligibility Compensatory Strategies | Slow or increase rate of speech; exaggerate articulation to approximate normal articulation |
| Inappropriate Breath Support Compensatory Strategies | Take more breaths during production of an utterance; initiate speech at the very beginning of expiration to maximize breath support |
| Restorative Strategies: Medical Management | Pharmacological Treatment (know/understand how meds may impact motor & cognitive abilities); Surgical Intervention (injections into paralyzed vocal fold, pharyngeal flap for hypernasal resonance) |
| Restorative Strategies: Stretching Exercises | Articulator is moved through its full range of motion |
| Active Stretching | Client is doing the stretch themselves |
| Passive Stretching | Something or someone else is doing the stretching |
| Restorative Strategies: Relaxation Techniques | Relaxation of the musculature may allow a more appropriate production of voice or articulation (laryngeal massage, neck massage) |
| Management of Dysarthria | Restorative Strategies (restore lost function); Compensatory Strategies (reduce the impact on speech by providing strategies) |
Created by:
rianna.aasen
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