Neuro Exam #3

T/F Cognitive and language disorders often co-occur with motor speech disorders.

T/F Cognitive and language disorders often co-occur with motor speech disorders.

true

T/F Individuals with apraxia of speech display muscle weakness.

false

T/F Apraxia of speech usually co-occurs with some level of aphasia

true

T/F An unimpaired speaker usually can produce ten repetitions of some sort of alternating motor movement (ex. Lateralizing your tongue back and forth) per second

false; five

T/F Many degenerative diseases initially present with disordered motor movements that can produce speech problems well before other signs of the disease arise

true

T/F Flaccid dysarthria is often a result of a lesion to one or more of the cranial nerves associated with speech production

true

T/F Bilateral damage to the vagus nerve will cause unilateral weakness of the velum and consequence significant levels of hypernasal resonance

false

T/F Upper motor neurons are primarily divided into the pyramidal and extrapyramidal tracts

true

T/F When damage occurs to the upper motor neurons the direct activation pathway is often more effected than the indirect activation pathway

false (simultaneously)

T/F A positive Babinski sign displayed in adults is diminutive of a lower motor neuron lesion

false (upper)

T/F Oral motor exercises are not usually recommended to address motor speech disorders

true

___ is an excess of involuntary movements, too many movements to be appropriate

hyperkinetic

____ is a lack of appropriate muscle tone, loose muscle tone

hypotonia

____ is a total loss of movement, whereas ____ is a partial or incomplete loss of movement (weakness)

paralysis; paresis

lower motor neuron are also referred to as the

final common pathway

The __ nerve innervates most of the muscles of the pharynx and velum

vagus

The __ muscle modulates the pitch of the voice

cricothyroid

__ are small, erratic and visual contractions of muscle tissue that can also be present within atrophied muscles

fasciculations

The pyramidal tract is also called the ______

direct activation pathway

The underlying motor characteristic of ___ dysarthria is motor incoordination

ataxic

Ataxia dysarthria is the result of pathology of what part of the brain

cerebellum

____ is the progression of normal handwriting to abnormally diminutive handwriting

micrographia

___ is an involuntary slow and writhing movement

athetosis

_____ is bilateral, involuntary, irregular, and possible wild or violent movement of the extremities

ballism

____ is involuntary, quick, dance-like movement of the feet, arms, extremities, head, and chest

chorea

___ is an involuntary and sudden muscle contraction

spasm

___ is an involuntary, quick, repetitive, and stereotyped movement

tic

Name three characteristics of apraxia of speech

visible groping, articulation errors, slowed rate, limited prosody, aware of errors and make corrections, often in conjunction with aphasia

Define oral apraxia

the patient is unable to do oral motor movements not involving speech

When completing an oral mech exam, what do you need to assess

range/rate of motion, strength, accuracy, muscle tone, symmetry

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). This approach facilitates speech by pairing the action of an intact system with the actions of an impaired speech system to facilitate operation of the speech system

intersystemic reorganization

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). This approach relies on motor planning and on the principle of neuroplasticity to attempt to reestablish motor planning abilities for speech

articulatory-kinematic

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). This approach routinely pairs an specific physical activity like gestures with the simultaneous production of the target word

intersystemic reorganization

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). This approach relies on motor practice, intensive and repetitive production of movement (drill) to increase articulatory ability

articulatory-kinematic

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). The sound production treatment by Wambah is an example of this approach

articulatory-kinematic

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). This approach uses either low or high tech strategies

AAC

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). The PROMPT treatment is an example of this approach.

articulatory-kinematic

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). The dynavox can be used for long term or short term

AAC

There are three main approaches to treating Apraxia of Speech (articulatory-kinematic (AK), intersystemic reorganization (IR), AAC). Melodic Intonation Therapy is an example of this approach

articulatory-kinematic

Describe the muscle tone and strength and underlying neurological problem in flaccid dysarthria

Damage to the lower motor neurons and has low tone and weakness

Describe the muscle tone and strength and underlying neurological problem in spastic dysarthria

hypertonia and resistance to passive movement BUT weakness in muscles; upper motor neuron (bilateral)

Describe the muscle tone and strength and underlying neurological problem in unilateral upper motor neuron dysarthria

upper motor neuron (unilateral); hypertonia BUT more mild weakness

Describe the muscle tone and strength and underlying neurological problem in ataxia

cerebellum; incoordination

Describe the muscle tone and strength and underlying neurological problem in hypokinetic

reduced movement and range of motion; basal ganglia

Describe the muscle tone and strength in hyperkinetic

involuntary movement

The mandibular branch of the trigeminal cranial nerve fulfills an important motor function, the innervation of the muscles of the ____

mandible

___ is a strong confirmatory sign of lower motor involvement

hyporeflexia

The section of the direct activation pathway which serves the central nervous system is the ___ tract

pyramidal

___ dysarthria results from pathology of the basal ganglia or its connection to other structures in the central nervous system

hypokinetic

Hypokinetic or hyperkinetic, rigid muscle tone

Hypokinetic

Hypokinetic or hyperkinetic, created by the presence of extra and involuntary movement that interferes with speech production

hyperkinetic

Hypokinetic or hyperkinetic, basal ganglia ceases to function appropriately because of the lack of the neurotransmitter dopamine

Hypokinetic

Hypokinetic or hyperkinetic, individuals with Parkinson's disease often demonstrate this type of dysarthria

Hypokinetic

Hypokinetic or hyperkinetic, common speech characteristics include imprecise consonants, distorted vowels, and harsh voice quality

hyperkinetic

Hypokinetic or hyperkinetic, Huntington's Chorea and Tourette's syndrome may lead to this type of dysarthria

hyperkinetic

Myasthenia gravis or guillain-barré, autoimmune response that usually presents a week or two after a variety of acute viral infections

guillain-barré

Myasthenia gravis or guillain-barré, chronic autoimmune disease caused by antibodies attacking at the neuromuscular joint

myasthenia gravis

Myasthenia gravis or guillain-barré, means serious muscle weakness

myasthenia gravis

Myasthenia gravis or guillain-barré, rapidly progresses to more significant and potentially life threatening weaknesses

guillain-barré

Myasthenia gravis or guillain-barré, weakness increases quickly with activity and improves with rest

myasthenia gravis

Myasthenia gravis or guillain-barré, effects only striated muscles

myasthenia gravis

Myasthenia gravis or guillain-barré, respiratory muscles may be so weak as to require the patient to be placed on a ventilator to be kept alive

guillain-barré

Myasthenia gravis or guillain-barré, ptosis is often the first symptom

myasthenia gravis

Myasthenia gravis or guillain-barré, difficulty chewing and swallowing

myasthenia gravis

Cranial nerves 3 4 6 synapse at the level of the _____

midbrain

Cranial nerves 5 and 7 synapse at the level of the ____

pons

Cranial nerves 9 10 11 and 12 synapse at the level of the

medulla

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), this is a disorder of extra movement present at the level of the vocal folds

spasmodic dysphonia

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), presents during early childhood and mostly effects males

Tourettes

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), disorder involving the presence of vocal or motor tics

Tourettes

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), There are three types: adductor, abductor, and mixed

spasmodic dysphonia

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), terminal and progressive disease producing dementia and abnormal motor signs

Huntington's Chorea

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), begins in milder forms but severity increases over time

Huntington's Chorea

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), Atrophy occurs in other areas of the brain in the frontal lobes, causing personality changes and cognitive decline

Huntington's Chorea

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), unknown etiology but is thought to have a genetic component that effects the basal ganglia

Tourettes

(Huntington's Chorea, Tourettes, or spasmodic dysphonia), adductor type creates a strained and strangled voice quality

spasmodic dysphonia

Define apraxia of speech and how does this differ from childhood apraxia of speech

Apraxia of speech is a neurological speech disorder reflecting an impaired capacity to plan or program sensorimotor commands; known (apraxia of speech) vs. unknown etiology (childhood apraxia of speech)

List the four systems an SLP needs to assess during a motor speech evaluation

respiratory, resonatory, articulatory, phonatory

What are the three hallmark signs of spastic dysarthria

imprecise articulation, strained voice, and excess stress

The indirect activation pathway is involved in the transmission of impulses associated with autonomic functions. What are those three functions?

muscle tone regulation, reflex inhibition, and postural support

What are the three speech characteristics of someone with flaccid dysarthria

hypernasality, harsh voice, imprecise consonants, monopitch

An SLP has a patient that has been diagnosed with aphasia, dysarthria, apraxia, and dysphagia. How does an SLP determine which areas to start working on first

assess and see which is effecting them the most functionally

Given aphasia, dysarthria, apraxia, and dysphagia, what would you need to make sure is probably doing just fine before the patient is discharged

dysphagia

When completing an oral mech exam, what is the difference between observing a structure and function of an oral articulator? Give an example.

structure (how it looks, symmetry) function (check correct muscle movement, make someone say oo-ee)

List three things a speech pathologist needs to know about multiple sclerosis

difficult to diagnose (presents with any neurological sign), present with any central nervous system based dysarthria (spastic/ataxic is a common mixture), waxing and waning of the presence of dysarthria

List three strategies a person with dysarthria may use while talking

slow down, exaggerate articulation, increase effort of correct positioning

T/F An individual with apraxia of speech might produce very different error patterns on repeated attempts of the same word.

true

T/F During a motor speech evaluation, an SLP notices her patient demonstrates abnormal tone the SLP might theorize that this person has apraxia of speech.

false

T/F During a motor speech evaluation, an SLP notices her patient demonstrates paresis of the tongue, the SLP might theorize that this person has a dysarthria

true

T/F During a motor speech evaluation, an SLP notices her patient demonstrates involuntary movement, such as lingual fasciculations, the SLP might theorize that this person has Broca's aphasia.

false

T/F Dysarthria is a single disorder caused by a single lesion.

false

T/F Bilateral damage to the trigeminal nerve is a far more dire situation for mastication and speech than a unilateral damage.

true

T/F A tongue that is unilaterally weak involuntarily deviates upon protrusion toward the strong side

false

T/F Mixed dysarthria is encountered clinically far more than any other individual dysarthria type

true

T/F The hallmark sign of hypokinetic dysarthria is variable and often above normal rate of speech

true

T/F In ataxic dysarthria, weakness is present and all the oral and facial structure appear normal when at rest.

false