173 Questions
What is the primary symptom of Myasthenia Gravis?
Rapid fatigue of muscular contractions over a short period of time, with recovery after rest
Which of the following is NOT a characteristic of flaccid dysarthria?
Increased loudness
What is the neurological basis of flaccid dysarthria?
Damage to the lower motor neurons or 'final common pathway'
Which of the following is NOT a potential etiology of flaccid dysarthria?
Parkinson's disease
What is the primary anatomical difference between flaccid dysarthria and spastic dysarthria?
Flaccid dysarthria involves damage to the lower motor neurons, while spastic dysarthria involves damage to the upper motor neurons.
Which of the following is a characteristic of Guillain-Barré syndrome?
Rapid progression of paralysis over days or weeks
What is the primary cause of hypernasality according to the passage?
Abundance of air in the nasal cavity when it is not needed
What is the primary effect of flaccid dysarthria on respiration according to the passage?
Reduced loudness
What is the purpose of the speech stress test (counting to 100) described in the passage?
To evaluate the patient's ability to maintain precision, speed, and accuracy
What is the primary reason the passage advises against using oromotor exercises for the treatment of flaccid dysarthria?
They are not evidence-based practice
What is the primary effect of flaccid dysarthria on prosody according to the passage?
Reduced pitch and loudness variations
Which of the following is a key evaluation task for eliciting characteristics of flaccid dysarthria?
Sustained phonation of a vowel
What type of nerve damage can lead to difficulty in elevating the jaw for bringing the articulators into contact with each other?
Trigeminal nerve damage
Which phonemes are likely to be impaired with bilateral hypoglossal nerve damage?
Phonemes requiring elevation of the tongue tip
What is the impact of bilateral damage to CN VII on articulation?
Difficulty with bilabials and labiodentals
Which voice quality is a strong indicator for the diagnosis of flaccid dysarthria?
Breathy voice quality
What is the result of adductor damage to the vocal folds?
Breathy vocal quality
What causes incomplete adduction (closure) of the vocal folds in phonatory incompetence?
Damage to recurrent laryngeal nerve
What is the primary effect of unilateral damage to the hypoglossal nerve (CN XII)?
Weakness or paralysis in the half of the tongue on the same side as the nerve damage, causing the tongue to deviate toward the affected side when protruded
What is the primary effect of unilateral damage to the corticobulbar tract on the lower face?
Weakness or paralysis on the ipsilateral side of the lower face
What is the primary cause of the harsh, strained voice quality in spastic dysarthria?
Incomplete adduction of the vocal folds resulting in air leakage during phonation
What is the primary cause of the monotonous pitch and loudness in spastic dysarthria?
Reduced ability to contract and relax the laryngeal muscles due to increased muscle tone
Which neural pathways must be bilaterally damaged for spastic dysarthria to occur?
Pyramidal and extrapyramidal systems
What is the primary reason for the slow rate of speech in spastic dysarthria?
Reduced speech and range of motion of the articulators due to increased muscle tone
Which of the following is NOT a characteristic of spastic dysarthria?
Breathy voice quality
What is the primary cause of the short phrases in spastic dysarthria?
The energy expended on forcing air through hyperadducted vocal folds
What is the primary cause of hypernasality in spastic dysarthria?
Spasticity in the velar muscles, reducing the range of soft palate movement
Which of the following is a non-speech characteristic of spastic dysarthria?
Drooling
What is the primary cause of the low pitch in spastic dysarthria?
Increased muscle tone in the laryngeal muscles
Which of the following is a common etiology of spastic dysarthria?
Stroke
What is the average life expectancy for individuals with Amyotrophic Lateral Sclerosis (ALS)?
22 months
Which of the following is NOT a characteristic of spastic dysarthria in ALS?
Flaccid vocal quality
What is the primary reason that Traumatic Brain Injury (TBI) can cause mixed dysarthria?
Widespread damage to cortical, subcortical, and brainstem structures
What is the primary effect of myelin damage in Multiple Sclerosis (MS)?
Disruption of communication signals to and from the brain
What is the key difference between Radiologically Isolated Syndrome (RIS) and Clinically Isolated Syndrome (CIS) in the context of Multiple Sclerosis (MS)?
RIS has some lesions on scans but not enough for a full diagnosis, while CIS has one big flare but not enough lesions on scans
Which of the following is a key evaluation task for assessing spastic dysarthria?
Assessing oral reflexes
How does spastic dysarthria differ from flaccid dysarthria in terms of vocal quality?
Spastic dysarthria has a harsh, strained vocal quality, while flaccid dysarthria has a breathy vocal quality
What is the primary cause of hypernasality in spastic dysarthria?
Damage to the pharyngeal branch of the vagus nerve
What is the primary concern for a neurologist specializing in the treatment of movement disorders?
Managing patients who move excessively or minimally
What is the main characteristic of hypokinetic disorders?
Lack of voluntary and automatic movements
Which condition accounts for approximately half of all hypokinetic movement disorders?
Parkinsonism
What is the difference between hyperkinesia and hypokinesia?
Hyperkinesia involves rapid movements, while hypokinesia involves a lack of voluntary and automatic movements.
Which term best describes the characteristic presentation of patients with hypokinetic disorders during an examination?
Best observed while unaware and moving slowly
What is the most recognized form of hypokinesia?
Parkinsonism
What is the primary function of the thalamus?
It serves as a relay between sensory and motor systems and the cerebral cortex.
What is the primary effect of delayed auditory feedback on speech production?
It causes patients to slow down their rate of speech.
What is the primary cause of rigidity in Parkinson's disease?
Decreased availability of dopamine.
What is the primary effect of Parkinson's disease on speech production?
Breathy voice, fast rate, difficulty in initiation.
What is the primary effect of the lesion damage in hypokinetic dysarthria?
Damage to the basal ganglia causing tremors, difficulty initiating movements, and speech changes.
What is the primary characteristic of hypokinetic dysarthria?
All of the above.
Which speech characteristic is most commonly associated with Parkinson's in the context of hypokinetic dysarthria?
Monopitch
What is the primary cause of harsh or breathy voice quality in hypokinetic dysarthria?
Incomplete vocal fold closure
Which of the following is a primary characteristic of hypokinetic dysarthria affecting respiration?
Shallow breath support
What is the neurological basis for hypokinetic dysarthria?
Impaired function of the basal ganglia control circuit
Which of the following evaluation tasks is key for detecting prosodic errors in individuals with hypokinetic dysarthria?
Conversation speech assessment
What is the unique feature associated with speech characteristics in Parkinson's progression?
'Increased rate of speech'
Which abnormality contributes to the voice characteristics in hypokinetic dysarthria?
'Incomplete VF closure'
What characteristic defines the articulation difficulties in hypokinetic dysarthria?
'Reduced RoM'
Which of the following is NOT a cardinal motor feature of Parkinson's disease?
Muscle weakness
What is the key difference between Early Onset Parkinson's Disease (EOPD) and Late Onset Parkinson's Disease (LOPD)?
EOPD has a more benign prognosis with initial rigidity and bradykinesia, while LOPD has more postural instability and gait difficulties.
What is the primary cause of the resting tremor in Parkinson's disease?
Dysfunction in the basal ganglia control circuit
What is the primary cause of the muscular rigidity observed in Parkinson's disease?
Increased muscle tone due to dysfunction in the basal ganglia
Which of the following is a common non-motor impairment associated with Parkinson's disease?
Hallucinations
What is the primary cause of the slow and restricted movements (bradykinesia) in Parkinson's disease?
Dysfunction in the basal ganglia control circuit
What is the primary cause of the difficulty initiating movements (akinesia) in Parkinson's disease?
Dysfunction in the basal ganglia control circuit
Which of the following is a characteristic of the postural instability seen in Parkinson's disease?
Difficulty maintaining balance when walking
What is the primary cause of the excessive saliva production (sialorrhea) in Parkinson's disease?
Decreased spontaneous swallowing due to motor impairments
Which of the following is a potential side effect of dopamine medication used to treat Parkinson's disease?
Hallucinations
What is the primary function of the basal ganglia?
Coordinating voluntary movements
Which neurotransmitter is associated with the symptoms of Parkinson's disease?
Dopamine
What is the primary function of the globus pallidus?
Refining and smoothing planned movements
Which treatment strategy is commonly used for Parkinson's disease?
All of the above
What is the primary role of acetylcholine in the basal ganglia?
Excitatory
Which part of the basal ganglia is responsible for supplying dopamine?
Substantia nigra
What is the primary effect of an imbalance between dopamine and acetylcholine in the basal ganglia?
Reduced movement and rigidity
Which part of the basal ganglia is considered an input nucleus?
Corpus striatum (caudate and putamen)
What is the primary symptom associated with hypokinetic dysarthria?
Reduced range of motion
What is the primary role of the basal ganglia in motor learning?
Refining and smoothing learned movements
What is the primary characteristic that distinguishes hyperkinetic disorders from other movement disorders?
Excessive involuntary movements
Which of the following is NOT considered a common hyperkinetic disorder according to the passage?
Parkinson's disease
Which of the following movement categories is LEAST likely to interfere with speech and communication in hyperkinetic dysarthria?
Automatic movements
What is the primary reason for the slow rate of speech observed in spastic dysarthria?
Impaired coordination of articulatory movements
Which of the following is a key characteristic of hypokinetic dysarthria that affects respiration?
Decreased respiratory support for speech
What is the primary function of the basal ganglia in relation to movement control?
Coordinating complex motor sequences
What is a common characteristic of hyperkinetic dysarthria?
Involuntary movements
Which neurotransmitter imbalance may result in hyperkinetic dysarthria?
Dopamine and acetylcholine
What unique movement pattern is associated with chorea?
Rapid, purposeless movements
What is the neurological basis for hyperkinetic dysarthria involving the cerebellum?
Disruption in thalamocortical pathways
What is the primary movement effect on communication in individuals with hyperkinetic dysarthria?
Interference with walking
Which anatomical structures are primarily affected in Huntington's disease?
Basal ganglia and cerebral cortex
How do individuals with severe chorea attempt to modify their movements?
By making the movements more purposeful
What is the primary cause of difficulty in functional daily living skills in individuals with severe hyperkinetic dysarthria?
Severe involuntary movements
Which of the following is a characteristic of chorea?
Relatively quick, unpredictable, coordinated movements
What is the primary characteristic of myoclonus?
Sudden, brief contractions of a single muscle or body part
Which of the following is a characteristic of tics?
Motor or vocal behaviors that can be controlled voluntarily
What is the primary characteristic of dystonia?
Sustained, involuntary contractions of antagonist muscles
Which of the following is a characteristic of essential tremor?
An oscillatory, rhythmic movement of one or more body parts
What is the primary characteristic of restless leg syndrome?
An unpleasant, crawling sensation in the legs or arms
Which of the following is a key evaluation task for eliciting characteristics of flaccid dysarthria?
Conversational speech sample to assess respiration and nasality
What is the primary reason for the slow rate of speech observed in flaccid dysarthria?
Damage to the cervical and thoracic spinal nerves innervating respiratory muscles
Which of the following is the primary cause of hypernasality in flaccid dysarthria?
Impaired coordination of the soft palate and posterior pharyngeal wall
What is the primary effect of myasthenia gravis on speech production, as described in the passage?
Complete loss of ability to communicate (aphonia) during prolonged speech tasks
Which of the following is NOT recommended for the treatment of flaccid dysarthria, according to the passage?
Oromotor exercises to increase awareness of speech structures
What is the primary cause of the breathy vocal quality observed in flaccid dysarthria?
Reduced subglottic air pressure resulting in excess air during phonation
What is the primary characteristic of flaccid dysarthria?
Hypernasality and breathy voice quality
Which nerve damage can result in difficulty elevating the jaw for bringing the articulators into contact?
Trigeminal nerve (CN V)
What is the primary cause of the breathy vocal quality in flaccid dysarthria?
Incomplete adduction of the vocal folds due to damage to the recurrent laryngeal nerve
Which of the following is NOT a potential etiology of flaccid dysarthria?
Amyotrophic Lateral Sclerosis (ALS)
What is the primary reason for the slow and labored articulation in flaccid dysarthria?
Weakness in the speech musculature due to lower motor neuron damage
Which of the following is a characteristic of Myasthenia Gravis, a potential cause of flaccid dysarthria?
Rapid fatigue of muscular contractions over a short period of time
Which nerve damage can result in misarticulations of phonemes requiring elevation of the tongue, especially the tongue tip?
Hypoglossal nerve (CN XII)
What is the primary cause of the hypernasal resonance in flaccid dysarthria?
Velopharyngeal incompetence due to damage to the vagus nerve
Which nerve damage can result in inhalatory stridor in flaccid dysarthria?
Recurrent laryngeal nerve
Which of the following is a potential etiology of flaccid dysarthria?
Physical trauma causing diffuse damage to lower motor neurons
What is the average life expectancy for individuals with Amyotrophic Lateral Sclerosis (ALS)?
22 months
What is the primary effect of myelin damage in Multiple Sclerosis (MS)?
Disruption of communication signals, causing symptoms like numbness, tingling, and speech problems
What is the key difference between Radiologically Isolated Syndrome (RIS) and Clinically Isolated Syndrome (CIS) in the context of Multiple Sclerosis (MS)?
RIS involves lesions on scans but not enough for a full diagnosis, while CIS involves one big flare-up with suspected MS but no worthwhile lesion loads on scans
What is the primary cause of the difficulty initiating movements (akinesia) in Parkinson's disease?
Neurotransmitter imbalance in the basal ganglia
Which of the following is a common etiology of spastic dysarthria?
Traumatic brain injury
What is the primary effect of bilateral damage to the pharyngeal branch of the vagus nerve (CN X)?
Impaired swallowing and risk of aspiration
Which of the following is NOT a potential etiology of flaccid dysarthria?
Parkinson's disease
What is the primary cause of the harsh, strained voice quality in spastic dysarthria?
Impaired vocal fold adduction
What is the primary effect of unilateral damage to the corticobulbar tract on the lower face?
Weakness and paralysis on the contralateral side of the face
Which of the following is NOT a characteristic of spastic dysarthria?
Flaccid paralysis of the articulators
What is the most prominent speech characteristic of hypokinetic dysarthria?
Monopitch, reduced stress, and monoloudness
Which of the following is a key characteristic of hypokinetic dysarthria that affects respiration?
All of the above
What is the primary cause of the harsh or breathy voice quality in hypokinetic dysarthria?
Incomplete vocal fold closure during phonation
Which evaluation task is key for detecting prosodic errors in individuals with hypokinetic dysarthria?
Conversation speech
What is the unique feature associated with speech characteristics in Parkinson's disease progression?
Increased severity of speech symptoms over time
What is the primary effect of the dysfunction in the basal ganglia control circuit on speech in hypokinetic dysarthria?
All of the above
What is the primary characteristic that defines the articulation difficulties in hypokinetic dysarthria?
Imprecise consonants due to reduced range of motion
Which of the following is a common physical characteristic associated with hypokinetic movement disorders?
Rigidity
What is the primary role of the basal ganglia in relation to motor control?
Initiation and planning of voluntary movements
What is the primary cause of the difficulty initiating movements (akinesia) in Parkinson's disease?
Excessive inhibition of the motor cortex by the basal ganglia
What is the primary function of the thalamus according to the passage?
It serves as a relay between sensory and motor systems and the cerebral cortex.
What is the primary characteristic that distinguishes hyperkinetic disorders from other movement disorders?
The presence of excessive involuntary movements.
What is the primary effect of delayed auditory feedback on speech production according to the passage?
It causes patients to slow down their rate of speech.
Which of the following is a key characteristic of chorea according to the passage?
Relatively quick, unpredictable, coordinated movements of the limbs, head, face, mouth, and neck.
What is a common characteristic of hyperkinetic dysarthria according to the passage?
Excessive, uncontrolled movements that interfere with speech production.
What is the primary cause of the resting tremor in Parkinson's disease according to the passage?
Lack of dopamine supply from the basal ganglia.
Which of the following is NOT a characteristic of flaccid dysarthria according to the passage?
Difficulty initiating movements (akinesia).
Which of the following is NOT a potential etiology of flaccid dysarthria according to the passage?
Abnormally increased and uncontrollable activity or muscular movements.
Which movement category is LEAST likely to interfere with speech and communication in hyperkinetic dysarthria according to the passage?
Automatic movements.
What is the primary cause of the harsh, strained voice quality in spastic dysarthria?
Spasticity of the laryngeal muscles, resulting in a tight hyperadduction of the vocal folds
What is the primary reason for the slow rate of speech observed in spastic dysarthria?
Reduced range of motion of the articulators
Which of the following is a common etiology of spastic dysarthria?
Stroke
What is the primary cause of hypernasality according to the passage?
Spasticity in the velar muscles, which slows and reduces the range of soft palate movement
What is the primary cause of the monotonous pitch and loudness in spastic dysarthria?
Spasticity in the laryngeal muscles, reducing the ability to vary vocal fold tension
What is the significance of bilateral damage for the occurrence of spastic dysarthria?
Bilateral damage to both the pyramidal and extrapyramidal neural pathways is necessary for spastic dysarthria to occur
What is the primary cause of the short phrases observed in spastic dysarthria?
The energy expended on forcing subglottic air through hyperadducted vocal folds
Which of the following is NOT a characteristic of spastic dysarthria mentioned in the passage?
Nasal emission
What is the neurological basis of spastic dysarthria?
Bilateral damage to the upper motor neuron tracts, affecting both the pyramidal and extrapyramidal systems
Which of the following is a non-speech characteristic of spastic dysarthria mentioned in the passage?
Drooling
Which of the following is NOT a cardinal motor feature of parkinsonism?
Hyperkinesia (excessive movements)
Which form of parkinsonism is considered the most common and has an unclear etiology?
Idiopathic Parkinson's disease (IPD)
What is the typical frequency range of resting tremors observed in Parkinson's disease?
4 to 6 oscillations/sec
What is the term used to describe the constant resistance to movement due to increased muscle tone in parkinsonism?
Muscular rigidity
Which of the following is a characteristic of akinesia, a feature of parkinsonism?
Difficulty initiating movements
Which of the following is NOT a common associated impairment in Parkinson's disease?
Increased spontaneous swallowing events
What is the term used to describe the phenomenon where anti-parkinson medication loses its long-lasting effect, leading to a return of symptoms?
Wearing-off spells
Which of the following is a potential side effect of dopamine medication used in Parkinson's disease?
Addictive and compulsive behaviors
Which characteristic is more prevalent in patients with Late Onset Parkinson's Disease (LOPD) compared to Early Onset PD (EOPD)?
Postural instability and gait difficulties
What is the term used to describe the intermittent change in resistance during movement due to rigidity in parkinsonism?
Cogwheel resistance
What is the primary function of the basal ganglia in relation to movement?
Smoothing and refining planned movements
Which neurotransmitter imbalance is associated with the symptoms of Parkinson's disease?
Reduced dopamine and excess acetylcholine
What is the primary function of the substantia nigra in relation to the basal ganglia?
Supplying the basal ganglia with dopamine
Which structure is considered an input nucleus of the basal ganglia?
Corpus striatum
What is the primary function of the globus pallidus within the basal ganglia?
An output nucleus for refined movement signals
Which part of the basal ganglia control circuit receives information about planned movements from the cortex?
Corpus striatum
Which neurotransmitter is considered excitatory in the basal ganglia?
Acetylcholine (ACh)
What is a common treatment strategy for Parkinson's disease aimed at addressing the dopamine deficiency?
L-dopa (levodopa) replacement therapy
Which nuclei are considered intermediary nuclei in the basal ganglia control circuit?
Globus pallidus externa, substantia nigra, and subthalamic nucleus
Which part of the basal ganglia is responsible for transmitting refined movement signals to the motor cortex?
Substantia nigra and globus pallidus interna
Study Notes
Flaccid Dysarthria
- Etiology: Caused by impairment of the Lower Motor Neurons (LMNs) of the cranial or spinal nerves, resulting in damage to the Peripheral Nervous System (PNS).
- Unilateral or Bilateral LMN Damage: Can result in asymmetrical or symmetrical speech characteristics.
-
Etiologies of Flaccid Dysarthria:
- Physical trauma
- Brainstem stroke
- Myasthenia Gravis
- Guillain-Barre Syndrome
- Acquired virus
- Poli
- Tumors
- Muscular Dystrophy
- Progressive Bulbar Palsy
-
Myasthenia Gravis:
- A disease that affects the neuromuscular junction
- Primary symptom: rapid fatigue of muscular contractions over a short period, with recovery occurring after rest
- Speech characteristics: hypernasality, decreased loudness, breathy voice quality, and decreased articulatory precision
-
Guillain-Barre Syndrome:
- Results in the progressive inflammatory loss of the myelin sheath around axons (demyelination)
- Affects motor neurons more than sensory neurons
Neurological Basis of Flaccid Dysarthria
- Damage to Lower Motor Neurons: Disruption to the flow of neural impulses along the LMN that innervate muscles of respiration, phonation, articulation, prosody, or resonance
-
Characteristics:
- Weakness in speech and/or respiratory musculature
- Weakness can result in slow-labored articulation, hypernasal resonance, and hoarse-breathy phonation
- Specific acoustic features depend on which nerves were affected and the resulting degree of weakness
Speech Characteristics of Flaccid Dysarthria
-
Articulation:
- Imprecise consonants
- Often result of damage to the facial and hypoglossal nerves
- Bilateral damage to CN VII can impact bilabials, labiodentals, and vowels requiring lip rounding
- Damage to the trigeminal can result in difficulty elevating the jaw sufficiently to bring the articulators into contact with each other
-
Phonation:
- Phonatory incompetence
- Incomplete adduction (closure) of the vocal folds due to damage to the recurrent laryngeal nerve
- Damage to the adductor and abductor muscles can cause weak or paralyzed muscles
-
Respiration:
- Inadequate amount of subglottic air pressure for speech
- Resulting in reduced loudness, shortened phrase length, strained/breathy voice quality, and reduced time for sustained phonation
-
Prosody:
- May demonstrate monopitch and monoloudness
- Result of weakened laryngeal muscles that are unable to make fine VF adjustments needed for normal pitch and loudness variations
Key Evaluation Tasks for Eliciting Specific Characteristics of Flaccid Dysarthria
- Conversational Speech Sample: Evaluate for low vocal volume, slow rate of speech, hypernasality, imprecise consonants, and shortened phrase length
- Alternate Motion Rate (AMR) Tasks: Evaluate for slowed rate of phoneme production
- Prolonged Phonation of a Vowel: Evaluate for voice quality
- Speech Stress Test: Evaluate for fatiguing of speech mechanisms and difficulty keeping up with precision, speed, and accuracy
Treatment of Flaccid Dysarthria
- Do not use oromotor exercises: No definitive research supporting their benefits
- Pass on oromotor exercises: No functional value and only brings awareness to structures
-
Treatment based on the cranial nerve affected:
- Trigeminal Nerve (V)
- Facial Nerve (VII)
- Vagus Nerve (X)
- Hypoglossal Nerve (XII)
Spastic Dysarthria
-
Speech Characteristics:
- Imprecise articulation
- Harsh voice quality
- Strained-strangled voice quality
- Low pitch
- Hypernasality
- Monotonous pitch and loudness
- Poor prosody/use of intonation
- Short phrases
- Slow rate of speech
-
Non-speech characteristics:
- Pseudobulbar affect
- Drooling
Neurological Basis of Spastic Dysarthria
-
Role of Upper Motor Neurons (UMNs) in Spastic Dysarthria:
- Bilateral damage to the UMN tracts
- Increased muscle tone of spasticity in various muscles, including the vocal tract
- Resulting in weakness, reduced range of motion, and decreased fine motor control
-
UMNs of the Pyramidal System:
- Originate in the primary motor cortex
- Course down to the LMNs
- Responsible for transmitting discrete skilled movements to the LMNs
-
UMNs of the Extrapyramidal System:
- Complex network of pathways
- Originate primarily in the cortex and brainstem
- Eventually synapse with LMNs of the cranial and spinal nerves
-
Significance of Bilateral Damage:
- For spastic dysarthria to occur, three factors need to be in place: damage to UMNs, bilateral damage, and both the extrapyramidal and pyramidal tracts will be affected
-
Etiologies of Spastic Dysarthria:
- Stroke (most common cause)
- Traumatic brain injury
- Tumor### Amyotrophic Lateral Sclerosis (ALS)
- Results in progressive degeneration of Upper Motor Neurons (UMNs) and Lower Motor Neurons (LMNs)
- Average life expectancy is 22 months
- Course of ALS varies across individuals, with some presenting with LMN involvement (e.g., flaccid dysarthria, atrophy) and others with UMN involvement (e.g., spastic dysarthria, hyperactive gag reflex, and jaw reflexes)
- Eventually, both UMNs and LMNs are affected, resulting in a mixed dysarthria
Traumatic Brain Injury (TBI)
- Can cause bilateral damage to the pyramidal and extrapyramidal systems
- Damage can be extensive due to brain shifting in the cranium, causing linear and rotational movements, stretched and torn axons, and lacerated brain tissue
- People with TBI are likely to exhibit mixed dysarthria, including spastic dysarthria
Multiple Sclerosis (MS)
- Disease that impacts the brain and spinal cord of the Central Nervous System (CNS)
- Exact cause of MS is unknown, but the immune system attacks the brain and spinal cord, resulting in inflammation or complete destruction of the myelin covering the axons
- Disruption of communication signals causes numbness, tingling, mood changes, memory problems, pain, fatigue, speech problems, blindness, and/or paralysis
- Can affect myelin anywhere in the CNS, resulting in spastic dysarthria, as well as other types (ataxic, flaccid, mixed) depending on the location of demyelination
Key Evaluation Tasks for Spastic Dysarthria
- Conversational speech and reading to evaluate resonance, articulation, and prosody impairments
- AMR task to demonstrate slow rate of phoneme production
- Vowel prolongation to evoke phonatory deficits
Basal Ganglia Functions
- Regulate muscle tone
- Regulate movements that support goal-directed movements
- Control postural adjustments during skilled movements
- Adjust movements to the environment
- Assist in learning new movements
- The basal ganglia includes 5 nuclei: corpus striatum, claustrum, amygdala, substantia nigra, and subthalamic sails
- Can be classified into 3 groups: input nuclei, intermediary nuclei, and output nuclei
Hypokinetic Dysarthria
- A motor speech disorder associated with dysfunction in the basal ganglia control circuit
- Accounts for approximately 8.3% of motor speech disorders and 9.1% of all dysarthrias
- Most commonly associated with Parkinson's disease
- Speech characteristics include:
- Voice: harsh-hoarse voice quality
- Articulation: reduced range of motion
- Respiration: reduced vital capacity and reduced phonation time
- Prosody: reduced and monoloudness, low rate with intermittent rapid bursts
- Key evaluation tasks: conversational speech, speech alternate motion rates, and vowel prolongation
Hyperkinetic Dysarthria
- A motor speech disorder associated with excessive involuntary movements
- Commonly seen in hyperkinetic disorders such as restless leg syndrome, dystonia, chorea, tics, myoclonus, and tremors
- Hyperkinetic movements can be described based on how they are induced, the complexity of the movements, and their suppressibility
- Characteristics of hyperkinetic disorders include:
- Abnormally increased and sometimes uncontrollable activity or muscular movements
- Too much movement, too much acetylcholine, and not enough dopamine### Hyperkinetic Dysarthria
- Characterized by variable articulation, harshness, and prosodic abnormalities
- Involuntary movements can vary in severity and type, affecting daily living skills
- Etiologies include hyperkinetic movement disorders, such as chorea, dystonia, and myoclonus
- Neurological basis involves an imbalance between dopamine and acetylcholine, leading to hyperkinesia
- Lesions in the cerebellar control circuit can also cause hyperkinetic dysarthria
Hyperkinetic Dysarthria and Movement
- Movements can range from subtle to obvious, affecting various body parts
- Each hyperkinetic disorder has a unique characteristic movement pattern
- Associated movement disorders and diseases include chorea, Huntington's disease, dystonia, myoclonus, and tremor
Chorea
- Characterized by rapid, involuntary, random, and purposeless movements
- Can appear as restlessness or jitteriness in mild cases
- Severe cases can interfere with walking, swallowing, speech, and other discrete movements
Huntington's Disease
- Inherited autosomal dominant degenerative CNS disorder
- Caused by gradual degeneration of neurons in the basal ganglia and cerebral cortex
- Characterized by expansion of CAG repeats in the IT15 gene
Other Hyperkinetic Movement Disorders
- Dystonia: sustained, involuntary contractions of antagonist muscles
- Myoclonus: sudden, brief contractions of a single muscle or body part
- Tremor: oscillatory, rhythmic movement of one or more body parts
- Restless leg syndrome: unpleasant, crawling sensation in the legs or arms, particularly during sitting and relaxation
Hyperkinetic Dysarthria
- Perceptually distinguishable from other dysarthrias
- Caused by dysfunction in the basal ganglia, extrapyramidal system, and cerebellar control circuit
- Muscle tone can range from hypotonic to hypertonic, fluctuating during one utterance
- Speech is characterized by irregular, involuntary movements that distort, slow, or interrupt communication
Flaccid Dysarthria
- Caused by impairment of the lower motor neurons of the cranial or spinal nerves
- Etiologies include physical trauma, brainstem stroke, myasthenia gravis, and Guillain-Barré syndrome
- Speech characteristics include hypernasality, decreased loudness, breathy voice quality, and decreased articulatory precision
- Weakness in the speech and/or respiratory musculature can result in slow-labored articulation, hypernasal resonance, and hoarse-breathy phonation
Neurological Basis of Flaccid Dysarthria
- Damage to the lower motor neurons or 'final common pathway'
- Either unilateral or bilateral damage to the LMN
- Flaccid dysarthria is a disruption to the flow of neural impulses along the LMN that innervate muscles of respiration, phonation, articulation, prosody, or resonance
Spastic Dysarthria
- Caused by bilateral damage to the upper motor neurons
- Speech characteristics include imprecise articulation, harsh voice quality, and monotonous pitch and loudness
- Resonance is characterized by hypernasality, and prosody is affected by poor use of intonation
- Non-speech characteristics include pseudobulbar affect, drooling, and slow rate of speech
Neurological Basis of Spastic Dysarthria
- Role of UMN in spastic dysarthria
- Increased muscle tone of spasticity in various muscles, including the vocal tract, caused by bilateral damage to the upper motor neuron tracts
- Damage to the pyramidal and extrapyramidal systems can result in weakness, increased muscle tone, and abnormal muscle reflexes
Learn about the etiology and key characteristics of flaccid dysarthria, a speech disorder caused by impairment of the Lower Motor Neurons (LMNs) in the cranial or spinal nerves. Explore various causes such as physical trauma, brainstem stroke, Myasthenia Gravis, Guillain-Barre Syndrome, and more.
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