Mixed Dysarthrias & Related Disorders – Vocabulary Flashcards

A comprehensive set of vocabulary flashcards summarizing definitions, etiologies, clinical features, speech characteristics, and treatment principles related to mixed dysarthrias and their associated neurologic conditions.

Mixed Dysarthria

A motor-speech disorder caused by lesions in two or more components of the motor system, resulting in characteristics of multiple pure dysarthrias.

Incidence of Mixed Dysarthrias

Account for ~26 % of all dysarthrias and ~25 % of all motor-speech disorders (Mayo Clinic data).

Primary Cause Category

Degenerative diseases are responsible for roughly 78 % of mixed dysarthrias.

Degenerative + Vascular Etiology

Combined degenerative and vascular disease explains about 84 % of mixed dysarthria cases.

Amyotrophic Lateral Sclerosis (ALS)

Most common motor-neuron disease; involves UMN and LMN degeneration and typically produces mixed flaccid-spastic dysarthria.

ALS – Typical Survival

Course of 2–5 years (occasionally up to 12); death usually due to respiratory failure.

ALS – Speech Pattern

Labored, slow speech; short phrases; hypernasality; strained-strangled or groaning voice; monopitch and monoloudness.

Progressive Supranuclear Palsy (PSP)

Tauopathy affecting basal ganglia, midbrain, and brainstem; presents with vertical gaze palsy, early falls, and mixed spastic-hypokinetic dysarthria.

PSP – Diagnostic Voice Features

Monopitch, hoarseness, prolonged VOT, hypernasality, excess/equal stress, imprecise articulation, slow rate.

Corticobasal Degeneration / Syndrome (CBS)

Neurodegenerative disorder with asymmetric cortical & extrapyramidal signs; often causes mixed spastic-hypokinetic dysarthria.

CBS – Alien Limb Phenomenon

Involuntary extremity movements and mirror actions linked to parietal lobe damage in corticobasal syndrome.

Friedreich’s Ataxia

Autosomal-recessive spinocerebellar disease producing ataxic and spastic (often mixed) dysarthrias.

Multiple System Atrophy (MSA)

Synucleinopathy with parkinsonism, ataxia, spasticity, and autonomic failure; dysarthria commonly mixed hypokinetic-ataxic-spastic.

MSA-P

MSA subtype dominated by parkinsonian features; dysarthria tends to be hypokinetic ± spastic/ataxic.

MSA-C

MSA subtype dominated by cerebellar signs; dysarthria largely ataxic ± spastic/hypokinetic.

Shy-Drager Syndrome

Old term for MSA with severe autonomic dysfunction; may include spastic-ataxic-hypokinetic dysarthria and laryngeal stridor.

Spinocerebellar Ataxias (SCA)

Hereditary disorders affecting cerebellum plus other motor areas; can yield any mix of ataxic, spastic, hypokinetic, hyperkinetic, and flaccid dysarthrias.

Chronic Traumatic Encephalopathy (CTE)

Progressive tauopathy from repeated head trauma; cognitive/behavioral changes with mixed hypokinetic or ataxic dysarthria.

Multiple Sclerosis (MS)

Acquired demyelinating CNS disease; most common speech problem is spastic-ataxic or other mixed dysarthria, usually mild.

Wilson’s Disease

Autosomal-recessive copper-metabolism disorder with Kayser-Fleischer rings; produces mixed hypokinetic-ataxic-spastic dysarthria.

Wing-Beating Tremor

Classic arm tremor of Wilson’s disease when arms are outstretched, often accompanied by dysarthria.

Manganese Toxicity

Basal ganglia poisoning (occupational, IV ephedrone, liver disease) causing mixed dystonic-hypokinetic dysarthria.

Hypoxic Encephalopathy

Diffuse brain injury from lack of oxygen; may yield combinations of hypokinetic, hyperkinetic, and ataxic dysarthria.

Osmotic Demyelination Syndrome

Rapid correction of hyponatremia or liver disease leading to pontine/extrapontine myelin loss; dysarthria (30 % presenting) can be spastic, ataxic, or hyperkinetic.

Hepatocerebral Degeneration

Neurologic complications of chronic liver disease; possible hypokinetic, hyperkinetic, spastic, or ataxic dysarthria.

Brainstem Stroke and Dysarthria

Single brainstem infarcts often yield mixed spastic-ataxic-flaccid dysarthria due to proximity of UMN, cerebellar, and cranial-nerve pathways.

Traumatic Brain Injury (TBI)

Produces mixed dysarthria in ~⅓ of survivors; severity varies and improves more in younger patients.

Neoplasm-Related Dysarthria

Brainstem or posterior-fossa tumors cause mixed spastic, ataxic, and/or flaccid dysarthria via mass effect or infiltration.

Dysarthria & Infectious Diseases

Meningitis, encephalitis, AIDS can create diffuse or multifocal lesions leading to mixed dysarthrias.

Major Mixed Pattern: Flaccid-Spastic

Most frequent combination (≈68 %); nearly always associated with ALS.

Major Mixed Pattern: Ataxic-Spastic

≈7 % of mixed cases; common causes include stroke, MSA, and MS.

Major Mixed Pattern: Hypokinetic-Hyperkinetic

≈4 %; often seen in Parkinson’s disease with medication-induced dyskinesias.

Major Mixed Pattern: Ataxic-Hypokinetic

≈4 %; linked to MSA, PSP, or other parkinsonian syndromes.

Major Mixed Pattern: Spastic-Hypokinetic

≈3 %; typically associated with PSP or MSA.

Speech Subsystems (Treatment Order)

Prioritize respiration → resonance → phonation → articulation → prosody when all components are equally impaired (Dworkin, 1991).

AAC in Mixed Dysarthria

Augmentative and Alternative Communication tools recommended, especially for progressive conditions like ALS.

Voice Banking

Recording a patient’s voice for future synthetic use; advised for progressive diseases such as ALS.

Listener Strategies

Environmental and interactive adjustments taught to communication partners of individuals with dysarthria.

Flaccid-Spastic Respiratory Signs

Decreased respiratory support yielding monoloudness and prolonged intervals (Swigert).

Flaccid-Spastic Phonation

Low pitch, harsh, strained-strangled, or wet vocal quality due to UMN + LMN damage.

Flaccid-Spastic Resonance

Hypernasality typically without nasal emission.

Flaccid-Spastic Articulation

Imprecise consonants caused by reduced strength and speed.

Flaccid-Spastic Prosody

Reduced stress, monotone, prolonged phonemes and intervals.

Spastic-Ataxic Articulation

Sudden breakdowns with imprecise consonants in conversational speech.

Spastic-Ataxic Prosody

Impaired loudness and pitch control; excess/equal stress possible.

Hypokinetic-Spastic-Ataxic Signature

Slow rate, monotone, excess/equal stress with hoarse voice and possible hypernasality (Swigert).

Duffy’s ‘Words of Wisdom’

Clinicians should report uncertainty honestly because dysarthria components often overlap and perceptual judgments have limits.

Progressive Muscular Atrophy

Motor-neuron disease affecting LMNs only; if speech is involved, dysarthria is purely flaccid.

Progressive Bulbar Palsy (PBP)

LMN weakness in cranial nerves; dysarthria is flaccid unless UMN signs emerge.

Primary Lateral Sclerosis (PLS)

UMN-only degeneration; often progresses to ALS; produces spastic dysarthria.

Supranuclear Ophthalmoparesis

Inability to perform vertical eye movements, especially downward gaze; hallmark of PSP.

Autonomic Dysfunction in MSA

Orthostatic hypotension, urinary issues, and laryngeal stridor often present with mixed dysarthria.

Palilalia

Compulsive, rapid repetition of one’s own words or phrases; can occur in PSP and CBS.

Echolalia

Automatic repetition of another’s speech; may appear in CBS.

Yes–No Confusion

Inappropriate yes/no responses without aphasia; characteristic finding in left-hemisphere corticobasal syndrome.

Kayser-Fleischer Ring

Golden-brown corneal ring diagnostic of Wilson’s disease.

Sunflower Cataract

Copper-colored lens opacity in Wilson’s disease, confirming abnormal copper deposition.

Penicillamine Therapy

Chelating treatment that lowers copper and can dramatically improve Wilson’s-disease dysarthria if begun early.

Facial Myokymia

Rippling eyelid or facial muscle movements seen in MS and other demyelinating conditions.

Ocular Signs in PSP vs. PD

PSP shows vertical gaze palsy and early falls; PD shows more resting tremor and responds to L-dopa.

‘Clunking Swallow’ in ALS

Audible bolus passage caused by impaired bulbar muscles, signaling dysphagia.

Respiratory Stridor in MSA

Noisy inhalation due to vocal-fold dystonia; may require tracheotomy in severe cases.

Action Myoclonus

Shock-like movements during voluntary acts; may follow hypoxic encephalopathy and affect speech.

Central Pontine Myelinolysis (CPM)

Osmotic demyelination of pons causing dysarthria, dysphagia, oculomotor issues, and quadriplegia.

Extrapontine Myelinolysis (EPM)

Osmotic demyelination outside pons; speech presentation similar to CPM.

Dystonia’s Facial ‘Vacuous Smile’

Fixed, expressionless grin in Wilson’s disease due to dystonic facial muscles.

On–Off Phenomenon (PD)

Fluctuating motor control from levodopa; contributes to mixed hypokinetic-hyperkinetic dysarthria.

Mirror Movements

Unintentional contralateral limb actions mimicking voluntary movement; seen in CBS.

UMN vs. LMN Oral Signs

UMN damage: hyperactive gag, slow movement; LMN damage: weak gag, fasciculations, reduced tone.

Listener Comprehension Strategies

Using eye contact, topic cues, and repair requests to enhance understanding of disordered speech.

Cerebellar Control Circuit

Neural loop essential for timing & coordination; damage produces ataxic elements in mixed dysarthria.

Basal Ganglia Dysfunction

Leads to hypokinetic or hyperkinetic characteristics within mixed dysarthrias.

Pseudobulbar Affect

Pathologic laughing/crying linked to UMN damage; common in spastic or mixed flaccid-spastic dysarthria.

Respiration-First Treatment Rationale

Adequate breath support underpins phonation, resonance, articulation, and prosody.

Example Treatment Sequence

If a patient shows hypernasality, imprecise consonants, and monopitch, target hypernasality first, then articulation, then prosody.

Ataxic Speech Markers

Irregular breakdowns, excess/equal stress, prolonged intervals, scanning speech pattern.

Hypokinetic Speech Markers

Monopitch, monoloudness, reduced loudness, short rushes, variable rate.

Spastic Speech Markers

Strained-strangled voice, slow rate, monopitch, monoloudness, low pitch.

Flaccid Speech Markers

Hypernasality with nasal emission, breathy voice, shortened phrases, imprecise consonants.

Hyperkinetic Speech Markers

Sudden voice stoppages, variable loudness, involuntary vocal noises, irregular artic disruptions.

Ataxic-Spastic-Hypokinetic Combination

Mixed dysarthria typical of PSP or MSA, reflecting multisystem degeneration.