Motor Speech Quiz #6

Spast*ic Dysarthria

spas*tic dysarthria results form damage to which pathways?

bilateral upper motor neuron pathways (pyramidal and extrapyramidal) of CNS

damage causing spas*tic dysarthria must be:

bilateral

which motor neurons are primarily involved in spast*ic dysarthria?

upper motor neurons

spast*ic dysarthria commonly affects which speech subsystems?

respiration, phonation, resonance, and articulation

spast*ic dysarthria reflects the effects of:

excessive muscle tone and weakness on speech

approximately what percentage of dysarthrias are classified as spast*ic dysarthria?

7.3%

damage to the pyramidal tract (direct motor pathway) primarily impairs:

skilled, discrete movements

immediately after pyramidal tract damage, muscle tone is typically:

reduced

over time, muscle tone in spast*ic dysarthria becomes:

hypertonic (spast*ic)

which reflex is commonly positive following upper motor neuron damage?

Babinski sign

damage to the extrapyramidal system (indirect motor pathway) primarily affects:

regulation of reflexes, maintaining posture and tone

reflexes following extrapyramidal damage eventually becomes:

hyperactive

what abnormal finding is commonly associated with upper motor neuron damage?

clonus

oral reflexes in spast*ic dysarthria are often:

pathological

UMN lesions result in:

spasticity, weakness, reduced range of movement, and slowness of movement

weakness and slowness are particularly noticeable in which strucutures?

tongue and lips

spasticity is most noticeable in:

laryngeal muscles

what type of reflex abnormality may occur in spast*ic dysarthria?

abnormal reflexes

degenerative causes for spast*ic dysarthria accounts for what percentage?

60%

spast*ic dysarthria is more commonly associated with which disorder than other dysarthrias?

vascular disorders

vascular and degenerative diseases together account for over:

75% of spast*ic dysarthria

what are other causes of spast*ic dysarthria?

inflammatory, demyelinating, traumatic, metabolic diseases

bilateral strokes involves what arteries that may produce spast*ic dysarthria?

middle and posterior cerebral arteries

why are bilateral cerebral strokes often necessary to produce spastic dysarthria?

upper motor neuron pathways are widely separated in the cerebral hemispheres (more likely if two or more cerebral strokes)

a single infarct is more likely to cause spast*ic dysarthria if it occurs in the:

brainstem (pathways in closer proximity)

about what percentage of strokes occur in the brainstem?

25%

among dysarthrias caused by brainstem stroke, which type is most common?

spast*ic (50-90%)

what are other causes of spast*ic dysarthria?

• TBI

• Congenital (Cerebral Palsy)

• Inflammatory (infections in brain tissue - viral or bacterial meningitis or encephalitis; MS - inflammation and destruction of myelin sheath) —> can result in spast*ic dysarthria if bilateral damage

• Tumors in brainstem

• Cerebral anoxia

Amyotrophic Lateral Sclerosis (ALS) is:

• degenerative neurologic disease of unknown cause

• terminal, with average life expectancy of 15-22 months from time of onset

• causes spast*ic dysarthria when UMN involvement is predominant

• eventually affects from UMNs and LMNs, resulting in flaccid-spast*ic mixed dysarthria

characteristics of spast*ic dysarthria include:

• combined effects of weakness AND spasticity in a manner that slows movement and reduces its range and force

• reflects excessive muscle tone which becomes easily fatigued

• patient descriptions are that they are speaking against resistance; speech is slow and effortful

primary speech characteristics of spast*ic dysarthria include:

• harsh voice quality

• strained-strangled vocal quality

• low pitch

• slow rate

• pitch breaks

• slow and regular AMRs

• imprecise consonants

• monopitch/monoloudness

• excess and equal stress

• hypernasality

• short phrases

what are the four clusters of deviant speech characteristics in spast*ic dysarthria?

• prosodic excess

• articulatory-resonatory incompetence

• prosodic insufficiency

• phonatory stenosis

prosodic excess

excess and equal stress, slow rate

articulatory-resonatory incompetence

• inprecise consonants, voiced-voicless errors; incomplete articulatory contact; incomplete consonant clusters

• distorted vowels

• hypernasality - spastic velar muscles (reduced ROM and slow)

prosodic insuficiency

• monopitch, monoloudness - caused by overall tenseness in the muscles

• reduced stress, short phrases, slow rate

phonatory stenosis characteristics include:

low, pitch, harshness (air leaking through tight vocal folds), strained-stranged voice, pitch breaks, slow rate

pseudobulbar affect is:

• uncontrollable crying or laughing that can accompany damage to UMNs of brainstem

• appears to be caused by damage to part of brain important in inhibiting emotions

drooling is due to:

due to impaired oral control or saliva or less frequent swallowing

true or false: hypernasality is present in both flaccid and spast*ic dysarthrias, but is not as severe in spast*ic dysarthria

true

there are no ________ in spast*ic dysarthria.

nasal emmisions

what vocal characteristic is present in spast*ic dysarthria?

strained-strangled vocal quality

what vocal characteristic is present in flaccid dysarthria?

breathy vocal quality

what is associated more with spast*ic dysarthria?

pseudobulbar effect (lability)

bulbar palsy is:

• atrophy and weakness in muscles innervated through medulla, including tongue, velum, larynx, and pharynx

• caused by damage to LMNs

pseudobulbar palsy is considered:

• weakness and slowness in same muscles

• caused by damage to UMNs

what damage causes spast*ic dysarthria?

bilateral damage to upper motor neurons of pyramidal and extrapyramidal systems

what damage causes flaccid dysarthria?

damage to LMNs

phonation in spast*ic dysarthria is considered:

tight; strained-strangled

phonation in flaccid dysarthria is considered:

breathy

reflexes in spast*ic dysarthria present as:

hyperreflexes

reflexes in flaccid dysarthria present as:

reduced or absent oral reflexes

true or false: slow speech rate combined with harsh or strained-strangled voice only occurs in spastic dysarthria

true

what characteristics are associated with spast*ic dysarthria more than any other dysarthria?

pseudobulbar affect and drooling

what are the key evaluation tasks for spast*ic dysarthria?

• conversational speech and reading

  • assesses resonance, articulation, and prosody

• AMRs

  • demonstrates slow rate of phoneme production

• vowel prolongation

  • evokes phonatory deficits

treatment for spast*ic dysarthria includes:

• patient specific

• primary treatment goals target

  • phonation (#1), articulation, prosody, resonance

• respiration usually not significantly affected

examples of reducing tone in spast*ic dysarthria includes:

• massage

• biofeedback

• botox injections

• antispasmodic drugs

symptoms of articulation deficits in spast*ic dysarthria include:

weakness, reduced speed of movement, reduced range of movement

what is a primary articulation error in spast*ic dysarthria?

imprecise consonant production

treatment of articulation deficits in spast*ic dysarthria include:

tongue stretching and lip stretching (as well as traditional articulation exercises)

traditional articulation treatments with spast*ic dysarthria are recommended for:

imprecise consonant productions

for articulation treatment of spast*ic dysarthria it is important to concentrate on:

increasing patient awareness of articulation errors and practicing best phoneme production (includes intelligibility drills, phonetic placement, exaggerating consonants, minimal contrast drills)

treatment of prosody deficits in spast*ic dysarthria includes:

• activities that help patient regain vocal-tract flexibility

• pitch range exercises

• intonation profiles

• contrastiv stress drills (ex: pop - bop)

• chunking utterances into syntactic units (ex: the boy was wearing a bright blue hat with a big star.)

hypernasality in spast*ic dysarthria is caused by:

slowness and reduced range of movement

treatment of resonance deficits in spast*ic dysarthria includes:

• surgical and prosthetic treatments

  • pharyngeal flap procedure, teflon injections (puffs up mass), palatal lift

• decreasing velar hypertonicity

• behavioral based treatments

  • visual feedback, increased loudness

summary of spast*ic dysarthria

• caused by any process resulting in bilateral damage to pyramidal and extrapyramidal systems

• results in muscle weakness and slowness of articulators during speech (bilateral pyramidal damage) and increased muscle tone (spasticity) in articulators (bilateral damage to extrapyramidal system)

• characterized by imprecise consonants, monopitch, monoloudness, reduced stress, and harsh vocal quality

• treatment concentrates on reducing increased muscle tone by relaxation and stretching; traditional articulation exercises can target imprecise consonant production

treatment of phonation deficits in spast*ic dysarthria include:

head and neck relaxation; easy onset of phonation; yawn sigh exercises (ex: yawn and then release production)

in spast*ic dysarthria increased muscle tone in the larynx causes the vocal folds to:

involuntarily adduct too tightly during phonation (causing harsh or strained-strangled vocal quality caused by hyper adduction of vocal folds)