Motor Speech Disorders - Spastic Dysarthria

Spastic Dysarthria is a result of …..

Bilateral Upper Motor Neuron damage AND Unilateral Upper Motor Neuron Damage

What components of speech can Spastic Dysarthria manifest in?

ALL! (PRRAP)

Phonatory

Resonatory

Respiratory

Articulatory

Prosody

Describe the difference between Spastic and Flaccid dysarthria?

Spastic can be Bilateral UMN damage or Unilateral UMN damage

Flaccid is only LMN damage

If both dysarthrias include weakness, what makes them different?

Flaccid - HYPOtonia

• Floppy, not lots of tone

Spastic- HYPERtonia

• too much tone, too much muscle tightness, decreased ROM

Name 4 perceptual characteristics of spastic dysarthria

• Slow rate

• strained or harsh VQ

• pitch breaks

• slow and regular AMR’s

Name 4 physical characteristics of spastic dysarthria

pathologic oral reflexes

lability of affect (laughing, crying uncontrollably)

hypertonia

hyperactive gag reflex

UMN originate in ….

• damage here causes impaired fine/skilled motor movements (i.e., speech)

• Bilateral UMN damage- Slow and Weak motor movements

the motor cortex

Damage to UMN in the Direct activation pathway causes…

Slow and weak skilled motor movements

Damage to UMN in the Indirect activation pathway /extrapyramidal tract causes…

Hypertonicity

Hyperreflexia

muscles resist movement

Positive Babinksi sign indicates …..

CNS damage

What is clonus

With spastic dysarthria, damage is usually done to ______ pathways.

A. Indirect Activation

B. Direct Activation

C. Both

Both!

Major Abnormalities in Spastic Dysarthria

Spasticity

Weakness

Reduced ROM

Slowness of Movement

Spasticity causes muscle tightness, creates too much tone.

Therefore you are not using your muscles to the best of ur ability (weakness)

that causes a reduced ROM which increases weakness

Slowness in movement is caused by the UMN is not sending info the LMN due to damage

this is…

Major Abnormalities in Spastic Dysarthria DESCRIBED

Differences in Spastic and Flaccid Dysarthria

Flaccid VQ breathy,

Spastic VQ: harsh, strained,

Degenerative Disease: primary lateral sclerosis (damage contained to UMN)

Vascular: strokes @ ——- lesion

Congenital: cerebral palsy

Traumatic

Inflammatory: leukoencephalitis, demyelinating disease

Toxic and metabolic diseases: ebceohalopathy

name 3 etiologies of Spastic Dysarthria

What do we assess in Motor Speech Disorders?

PRRAP

Phonation

respiration

resonance

articulation

prosody

Imprecise consonant production

vowel distortion

(ps this is in every dysarthria)

This can be tested in…..

Assessments for Articulation

Harsh VQ

Low pitch

harshness

strained-strangled

pitch breaks

This can be tested in…..

Assessments for Phonation

Hypernasality CAN occur

Velar muscles are slow and causes reduced in movement velar

not as severe as in flaccid dysarthria

usually does not include nasal emission

This can be tested in…..

Assessments for Resonance

Monopitch

monoloudness

reduced stress

short phrases

slow rate

excessive and equal stress

This can be tested in…..

Assessments for Prosody

Not much of an issue w/ spastic dysarthria

reduced inhalation and exhalation is most likely due to hyper-adduction of VF

This can be tested in…..

Assessments for Respiration

In addition to 5 components of speech, u also asses salient features of neuromuscular functions

Muscle strength

Speed of movement

ROM
Accuracy of Movement

Motor steadiness

Muscle tone

Most useful assessment tasks for identifying spastic dysarthria

conversational speech

oral reading

speech AMR’s

vowel prolongation

Relaxation and easy onset

help to reduce hyperadduction

head and neck relaxation

easy onset of phonation

yawn sign exercises

These reduce tension in the larynx, this is Treatment for….

Tx for Phonation in Spastic Dysarthria

Why would someone with spastic dysarthria present with breathiness?

it may be a compensatory strat in order to reduce the tightness in their VF

Stretching

traditional articulation

minimal contrast drills

this is Treatment for….

Tx for Articulation in Spastic Dysarthria

Pitch range

intonation

contrastive stress drills

chunking utterances into syntactic units

this is Treatment for….

Tx for Prosody in Spastic Dysarthria

Surgical

Prosthetic

Behavioral (e.g. visual feedback w/ mirror, see scape, reduced rate of speech, increase loudness)

this is Treatment for….

Tx for Resonance in Spastic Dysarthria

Contraindications for spastic dysarthria

• pushing

• pulling

• effortful closure

This promotes laryngeal contraction and we want it OPEN with spastic dysarthria

_______ Upper motor neuron Dysarthria results from damage to UMN on a single hemispere

UNITLATERAL

UUMN Speech deficits are typically much (less/more) significant than bilateral damage

LESS significant

exceptions to CN 12 , CN 7 bc they are mostly contralateral input

Unilateral input/contralateral control

tongue deviates to weaker side (bc it is only getting 1 signal from intact side)

Pt feels the tongue is slow and clumsy

Lower facial droop

UUMN is most apparent in tongue and lower face

Articulation in UUMN

Imprecise consonants

slow

Phonation in UUMN

Harsh VQ

VF are functioning but not normal functioning

• possibly due to aging

• One VF compensates for the other side

Resonance in UUMN

Hyper-nasality

• bilatera control from vagus x

Prosody and Respiration in UUMN

Rarely Impaired

conversational speech

speech AMR’s

• May not reflect the slowness demonstrated in connected speech

• /tuh/ and /kuh/ are the best

vowel prolongation

• help listen to VQ

These are ….

Assessments that are helpful for UUMN

intelligibility drills

phonetic placement

exaggerating consonants

minimal contrast drills

These are ….

Treatment for UUMN