Dysarthria Types and Treatments

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Questions and Answers

What is the primary focus of LSVT Loud treatment?

  • Improving articulation through delayed feedback
  • Increasing vocal pitch variation
  • Enhancing sensory awareness of loudness and effort (correct)
  • Utilizing pace boards for effective speech rate

What is the purpose of delayed auditory feedback in speech therapy?

  • To slow speech rate and potentially enhance articulation accuracy (correct)
  • To make speech more monotone and quicker
  • To improve the patient's pitch and intonation
  • To facilitate the use of contrastive stress drills

Which treatment option requires a two-day training to become certified?

  • Intonation profiles
  • Chunking utterances
  • Pacing boards
  • LSVT Loud (correct)

Which method is characterized by chunking utterances into syntactic units?

<p>Contrastive stress drills (D)</p> Signup and view all the answers

What is the recommended frequency of sessions for LSVT Loud treatment?

<p>4x per week for 1 month (B)</p> Signup and view all the answers

What common complaint is associated with unilateral upper motor neuron dysarthria?

<p>Slurred speech (D)</p> Signup and view all the answers

What type of dysarthria may develop during treatment with levodopa?

<p>Hyperkinetic dysarthria (B)</p> Signup and view all the answers

Which of the following is a common associated neurological symptom for unilateral upper motor neuron dysarthria?

<p>Aphasia (C)</p> Signup and view all the answers

What effect does myasthenia gravis have on speech?

<p>Fatigue and deterioration with speaking (B)</p> Signup and view all the answers

Which treatment is recommended for imprecise consonants in unilateral upper motor neuron dysarthria?

<p>Intelligibility drills (C)</p> Signup and view all the answers

What is a characteristic finding in the speech of individuals with unilateral upper motor neuron dysarthria?

<p>Harsh voice quality (C)</p> Signup and view all the answers

What is a possible medical intervention for myasthenia gravis?

<p>Pyridostigmine bromide (B)</p> Signup and view all the answers

In unilateral upper motor neuron dysarthria, which area of the face is more affected?

<p>Lower face (C)</p> Signup and view all the answers

What is a suggested strategy for managing respiratory weakness in patients with speech difficulties?

<p>Limit speaking to short phrases (D)</p> Signup and view all the answers

Which of the following symptoms is likely associated with bulbar palsy?

<p>Drooling and tongue feels thick (B)</p> Signup and view all the answers

What type of treatment is recommended for improving resonance issues?

<p>Phonetic placement drills (D)</p> Signup and view all the answers

Which medical condition can lead to the deterioration of speech characteristics due to damage to several cranial nerves?

<p>Muscular dystrophy (A)</p> Signup and view all the answers

What adjustment can be made to help a patient with phonation difficulties?

<p>Practicing breath control techniques (D)</p> Signup and view all the answers

Which cranial nerve damage may lead to decreased respiratory support and complicate speech?

<p>Vagus nerve damage (B)</p> Signup and view all the answers

In patients with speech deterioration, what is often recommended to help manage phonation?

<p>Using hard glottal attacks (A)</p> Signup and view all the answers

What symptom might a patient with cranial nerve damage most likely exhibit?

<p>Hypernasal voice (C)</p> Signup and view all the answers

What is a major drawback of sensory tricks used in treating certain movement disorders?

<p>They may stop working after a period of time (C)</p> Signup and view all the answers

Which surgical intervention is primarily performed to manage tremors and dyskinesia?

<p>Pallidotomy (C)</p> Signup and view all the answers

What is the primary function of Botox injections in patients with spasmodic dysphonia?

<p>Blocking the release of acetylcholine (B)</p> Signup and view all the answers

Which medication has shown significant benefit for speech in patients with laryngeal and respiratory dystonia?

<p>Artane (C)</p> Signup and view all the answers

Which of the following treatments is indicated for the management of jaw opening and closing dystonias?

<p>Botox injections (C)</p> Signup and view all the answers

What complication can arise from recurrent laryngeal nerve resection?

<p>Unilateral vocal fold paralysis (C)</p> Signup and view all the answers

Which treatment is not mentioned as effective for oromandibular dystonia?

<p>Surgical intervention on the spinal cord (C)</p> Signup and view all the answers

What type of injection has been reported to reduce severity in drug-resistant oromandibular dystonia?

<p>Diluted lidocaine and alcohol (A)</p> Signup and view all the answers

What distinguishes essential tremor from Parkinson's tremor?

<p>Essential tremor disappears at rest while Parkinson's does not. (A)</p> Signup and view all the answers

Which medication is reported to be effective for relieving essential tremor of the head and voice?

<p>Methazolamide (Neptazane) (C)</p> Signup and view all the answers

Which surgical procedures are mentioned as treatments for managing tremor?

<p>Pallidotomy, thalamotomy, and deep brain stimulation (D)</p> Signup and view all the answers

Which best describes the speech characteristics associated with chorea?

<p>Imprecise consonants and variable prosody. (D)</p> Signup and view all the answers

What challenge is faced in treating respiration in individuals with chorea?

<p>Involuntary respiratory movements cannot be behaviorally treated. (D)</p> Signup and view all the answers

What can be a characteristic of speech during a choreic episode?

<p>Variable rate with inappropriate silences. (B)</p> Signup and view all the answers

Which of the following neurological disorders is associated with chorea?

<p>Huntington's Disease (C)</p> Signup and view all the answers

Which voice characteristics might be observed in an individual experiencing severe voice tremor?

<p>Strained and breathy voice quality. (C)</p> Signup and view all the answers

What is the main focus of management activities for cerebellar ataxia?

<p>Behavioral modifications to improve motor control (A)</p> Signup and view all the answers

Which symptom is most commonly associated with hypokinetic dysarthria?

<p>Rapid speech rate (D)</p> Signup and view all the answers

Which neurological system is primarily affected in hypokinetic dysarthria?

<p>Basal ganglia (D)</p> Signup and view all the answers

What is a common patient complaint in individuals with hypokinetic dysarthria?

<p>Voice cannot be heard in noisy environments (A)</p> Signup and view all the answers

Which potential treatment focuses on improving breath support in hypokinetic dysarthria?

<p>Speaking at the beginning of exhalation (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic symptom of hypokinetic dysarthria?

<p>Increased mobility (D)</p> Signup and view all the answers

What could be a potential medical diagnosis related to hypokinetic dysarthria?

<p>Parkinson’s disease (D)</p> Signup and view all the answers

In terms of resonance, how might individuals with Parkinson's disease be affected?

<p>Mild hypernasality present in about 10% of cases (C)</p> Signup and view all the answers

Which technique is suggested for improving articulation in hypokinetic dysarthria?

<p>Intelligibility drills (A)</p> Signup and view all the answers

Which of the following is a key feature of treatment for phonation issues in hypokinetic dysarthria?

<p>Effortful closure techniques (B)</p> Signup and view all the answers

Flashcards

Hypokinetic Dysarthria

A speech disorder characterized by slow, slurred speech with reduced volume and clarity. Typically seen in conditions like Parkinson's disease.

Delayed Auditory Feedback (DAF)

A technique used to improve speech clarity and volume by delaying auditory feedback. This helps patients hear their own speech more clearly and adjust their articulation.

LSVT Loud

A research-based treatment program designed to improve speech loudness, clarity, and overall speech quality in individuals with Parkinson's disease.

LSVT Loud Treatment Parameters

A specific component of LSVT Loud treatment that focuses on increasing vocal effort and loudness.

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Rate Reduction Techniques

A speech therapy technique that involves slowing down speech rate, often using visual aids for pacing. This method aims to improve articulation and intelligibility.

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Articulatory Undershooting

The inability to fully move the articulators, causing speech sounds to be produced with less precision than normal.

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Pitch Range Exercises

A group of speech exercises that target intonation and pitch range, aiming to improve speech clarity.

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Chunking into Syntactic Units

A set of exercises that aim to improve speech intelligibility by targeting the rate and rhythm of speech.

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Speech System Deficit Treatment

A type of speech therapy technique that helps individuals with dysarthria improve their speech by focusing on specific aspects of the speech production process, such as articulation, respiration, and phonation.

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Basal Ganglia Pathology

The lack of dopamine in the basal ganglia causes a disruption in the smooth, coordinated movement of the body, resulting in a range of symptoms, including tremors, muscle rigidity, and slow movements.

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Modifying Rate and Prosody

A set of speech therapy techniques that emphasize the use of facial expressions and gestures to enhance speech intelligibility and naturalness.

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Hypokinetic Dysarthria - Cause

This disorder has roots in the basal ganglia, a crucial area for regulating voluntary movement.

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Pharmacologic Treatment for Cerebellar Ataxia

Medications are not usually effective but in cases of episodic ataxia, Diamox might be helpful.

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Behavioral Therapy

A type of therapy that focuses on teaching individuals with dysarthria strategies to improve their speech by using external aids, such as visual cues, gestures, or assistive technology.

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Unilateral Upper Motor Neuron (UMN) Dysarthria

A type of dysarthria characterized by slurred speech, thick tongue, drooling, and a heavy feeling on the affected side of the face.

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Myasthenia Gravis

A condition where the body's immune system attacks the neuromuscular junction, resulting in muscle weakness and fatigue, especially during sustained effort.

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Flaccid Dysarthria

A type of dysarthria characterized by weakness and lack of coordination of the muscles involved in speech.

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Acetylcholine

A neurotransmitter that plays a crucial role in muscle contractions.

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Pyridostigmine Bromide (Mestinon)

A medication used to treat Myasthenia Gravis.

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Levodopa (L-dopa)

A medication commonly used to treat Parkinson's Disease.

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Fluctuating Dysarthria

A type of dysarthria that can occur in patients with Parkinson's Disease, often as a side effect of medication.

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Deterioration with speaking

Characterized by progressive weakness of the muscles involved in speech production, leading to difficulties with breathing, phonation, resonance, articulation, and prosody.

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Bulbar Palsy

A condition affecting the muscles responsible for speech and swallowing, caused by damage to cranial nerves that control these functions.

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Blowing for strength

A type of respiratory treatment that involves strengthening the muscles used for breathing and controlling the flow of air during speech.

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Abdominal girdling

A technique that involves using the abdominal muscles to support breathing during speech, enhancing vocal intensity and endurance.

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Hard glottal attack

A vocal technique that emphasizes a forceful start of voice production by quickly closing the vocal folds and releasing air for sound.

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Phonetic placement

A compensatory strategy used to improve articulation by focusing on the precise placement of the tongue, lips, and jaw.

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Inhale deeply, speak at onset of exhalation

A method of improving breathing control during speech by taking a deep breath and speaking at the start of exhalation.

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Controlled exhalation

Strategies for controlling the airflow during speech, including taking deep breaths, speaking with a slow and controlled exhale, and using postural adjustments to support breathing.

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Action Tremor

A tremor that appears when a person is moving or performing an action, but disappears when the person is at rest. It is a common neurological disorder.

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Resting Tremor

A tremor that occurs when a person is at rest and decreases when they move. It is a characteristic feature of Parkinson's disease.

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Methazolamide (Neptazane)

A medication used to treat essential tremor, particularly affecting the head and voice.

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Chorea

A type of involuntary movement characterized by rapid, jerky, unpredictable movements of the limbs, trunk, face, and head. It is often associated with neurological disorders such as Huntington's disease.

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Choreic Dysarthria

A type of dysarthria caused by chorea, resulting in rapid, variable speech with irregular articulation and unpredictable pauses or changes in loudness.

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Choreatic Vocal Quality

The vocal quality associated with choreic dysarthria, characterized by strained, strangled, and variable loudness, sudden pauses, and breathy speech due to rapid and irregular inspiratory and expiratory movements.

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Choreic Respiration

An irregular and unpredictable respiratory pattern characteristic of choreic dysarthria, often resulting in rapid and sudden inhalations and exhalations.

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Choreatic Articulation

An articulation disorder caused by chorea, resulting in imprecise consonants, distorted vowels, irregular articulation breakdown, and prolonged phonemes.

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Pallidotomy

A surgical procedure where a portion of the globus pallidus is destroyed to reduce tremors, dyskinesia, and dystonia. It is a treatment option for severe symptoms in conditions like Parkinson's disease.

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Botox Injection for Dystonia

Botulinum toxin (Botox) injections are used to treat focal dystonias, especially those affecting the jaw, tongue, and vocal cords. The toxin temporarily blocks the release of acetylcholine, a neurotransmitter that controls muscle contraction, leading to muscle relaxation.

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Recurrent Laryngeal Nerve Resection

This surgery involves cutting a portion of the recurrent laryngeal nerve, causing unilateral vocal fold (VF) paralysis. This prevents the hyperadduction of the VF that occurs in spasmodic dysphonia, resulting in smoother voice production.

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Artane for Dystonia

Artane (trihexyphenidyl) is a medication primarily used for Parkinson's disease, but it has shown effectiveness in managing laryngeal and respiratory dystonia. It helps improve speech by reducing abnormal muscle contractions in the vocal cords and breathing muscles.

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Oromandibular Dystonia

A type of dystonia affecting the muscles around the mouth and jaw. This condition can interfere with speech and swallowing.

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Spasmodic Dysphonia

A voice disorder characterized by involuntary muscle spasms in the vocal cords, leading to a strained, effortful voice or a sudden break in voice production.

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Deep Brain Stimulation (DBS)

A neurosurgical procedure that involves stimulating specific areas of the brain with electrical impulses to alleviate movement disorders. It has been shown to be effective for tremor, dyskinesia, and dystonia.

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Lingual Dystonia

A rare type of dystonia that affects the muscles of the tongue, often resulting in involuntary tongue protrusion. Botox injections can be used to help relax these muscles.

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Study Notes

Spastic Dysarthria

  • Characterized by bilateral upper motor neuron lesions
  • Slow speech rate, increased effort, tiring easily
  • Poor control of emotions (potential for amitriptyline intervention)
  • Excessive muscle tone/spasticity in limbs, impacting fine motor skills
  • Abnormal reflexes (e.g., suck, snout, jaw jerk, gag) are possible
  • Possible medical conditions include CVA, multiple lacunar strokes, brainstem tumor, various degenerative, toxic/metabolic, or inflammatory diseases
  • Treatment options include Botox injections (for reducing VF spasticity), less common recurrent nerve resection to paralyze a vocal fold, medication (e.g., Dantrium), and increasing loudness/open mouth articulation patterns.

Ataxic Dysarthria

  • Cerebellar dysfunction causing uncoordinated movements
  • Speech sounds like the speaker is drunk or stumbling over words.
  • Potential for difficulty with biting the tongue or cheek when eating
  • Speech deteriorates with alcohol intake
  • Broad-based stance and gait instability are common
  • Characterized by issues with timing, force, range, and direction of movements, without weakness or tone issues
  • Potential medical causes include degenerative (e.g., Frederick's ataxia), vascular (aneurysm, etc.), tumor, toxic/metabolic (e.g., chronic alcohol abuse), severe malnutrition, neurotoxic effects of drugs (e.g., Dilantin, lithium, and valium).
  • Treatment involves teaching/coaching strategies for speaking, and rate modification or other articulation, stress, and pitch exercises.

Hypokinetic Dysarthria

  • Caused by basal ganglia pathology (dopamine deficiency)
  • Speech is often too fast
  • Speech quality and emotion are significantly decreased
  • Problems with loudness and control of emotion in speech
  • Rigid face with a "mask-like" expression
  • Common medical diagnosis is Parkinson's disease
  • Other possible medical conditions include multiple or bilateral strokes affecting the basal ganglia, toxic/metabolic effects from antipsychotics or toxic metal poisoning, viral encephalitis; or stroke.
  • Treatment options include speaking at the start of exhalation, controlled exhalation, voice amplifiers, and stretching exercises for articulators. Prosthetic assistance may be necessary in some severe cases.

Unilateral UMN Dysarthria

  • Characterized by slurred speech, a heavy feeling on the affected side of the face, issues with drooling and thick tongue
  • Often co-occurs with aphasia or apraxia if lesion is in the left hemisphere; if in the right hemisphere, speech often co-occurs with cognitive deficits
  • Central facial weakness (lower more affected than upper)
  • Possible medical conditions include vascular issues (e.g., stroke in the carotid or middle cerebral arteries).
  • Treatment strategies focus on intelligibility drills, exaggerated articulation, and minimum contrast drills.

Hyperkinetic Dysarthria

  • Speech characterized by involuntary movements, typically not under voluntary control
  • Possible causes include various factors, not fully understood
  • Treatment strategies may involve modifications in rate and intonation to compensate for involuntary movements and help with intelligibility.

Myasthenia Gravis

  • Symptoms involve weakness and fatigue, particularly with frequently repeated movements, speech can be affected
  • Characterized by problems at the neuromuscular junction.
  • Treatment involves medications (e.g., pyridostigmine bromide), and in some cases, surgery (e.g., thymectomy).

Flaccid Dysarthria

  • Result of damage to the lower motor neurons
  • Speech characterized by weakness and fatigue, the speech deteriorates as the speech continues.
  • Common treatment approaches include medication or other interventions to increase strength or support movement. Some possible interventions include Botox injection, speech amplifiers, and other methods to support resonance.

Dystonia and Athetosis

  • Characterized by prolonged muscle contractions that cause abnormal postures
  • Possible causes for these problems include cerebral palsy, focal brain damage, and dystonia.
  • Common treatment approaches include therapies, and medications like Botox.

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