CSDS 213: Exam 2 Unit 6

Causes of Unilateral Upper Motor Neuron Dysarthria (UUMND)

Caused by damage to Upper Motor Neurons (UMN), in one hemisphere OR the other, that supply the cranial or spinal nerves involved in speech production.

(most recently recognized form of dysarthria and the least severe)

What weakness does UUMN damage result in?

The lower face is the only spot getting unilateral innervation

It is going to be contralateral - damage in the opposite side from the lesion

Primary issue in UUMND

ARITULATION DEFICITS

May have slow, clunky speech

Some cases have a mild impact on their voice

UUMN Damage in left hemisphere

may co-occur with Aphasia or Apraxia

Can’t address speech until they have language**

UUMN Damage in right hemisphere

may co-occur with visual or cognitive deficits

See some cognitive and personality issues

Severity of speech problems

mild to moderate, and they may be temporary or persistent.

They may not be prioritized for treatment, because of the other co-occuring conditions

May impact their ADLs more than the speech - higher priority than speech

Damage to UUMN is caused be

Caused by focal (localized) lesions to the Right OR Left hemisphere (not usually a disease or infection, or a closed brain injury)

Stroke

Tumor

TBI

Stroke

most frequent cause (91% of cases)

Can occur in any part of the brain that has UMNs, but only on 1 side

Tumor

that is restricted to one side, not very common

as the tumor grows it can damage UMN, could squeeze/restrict the blood flow to UMN

TBI

localized brain injury that is only affecting one side

An open gunshot wound or a knife - localized to one side

Speech Characteristics of UUMND

Speech effects are usually considered mild to moderate

Mild impairments may be short-term with recovery occurring in days or weeks

If co-occurring deficits, (i.e., aphasia or apraxia) it may be difficult to diagnose the dysarthria (i.e., verbal output might be limited) - Have to have language to diagnose speech

Articulation

Phonation

Resonance

Prosody and Respiration

Articulation

Imprecise consonant production = primary issue

Cause of weakness and reduced range of motion (like a Novocaine experience)

Slow AMRs in 30% of cases

Phonation

Harsh vocal quality may occur in about 39% of cases

Doesn’t really make sense because the larynx is still getting innervation from the non-damaged side

Could be that there is just some added weakness in the laryngeal muscles that we can’t explain

The voice issues may be caused by a totally different medical issue that is unrelated

Resonance

Hypernasality may be noted in about 11% of patients

No neurologic explanation, VP port should still be getting innervation from the other side

Same theories as with phonation

Prosody and Respiration

Unaffected

Only thing might be a mildly reduced rate of speech

Differential Diagnosis of UUMND

Site of lesion

Facial Symmetry

Conversational speech/reading sample

Facial Symmetry

Might be a little droop on one side of the lower face - might be the only indicator that they had a stroke (depending on its severity)

Conversational Speech/Reading Sample

looking for imprecise artic and reduced rate of speech - usually only consonants are impacted

AMRs some reduced rate and imprecise

Oral motor - signs of weakness and asymmetry in the lower face

On the vowel prolongation - might hear some of those mild harshness in the voice (maybe some air leakage as a result of fatigue)

Treatment for UUMND

Focus on Traditional Treatments for Articulation Problems

Traditional Treatments for Articulation Problems

Intelligibility drills: Maybe use some longer/complex stimulus items/sentences - can they use the exaggerated consonants technique to be more intelligible

Phonetic placement: If they have a specific problem in one sound or two

Exaggerated consonants: For patients with some intelligibility issues in connected conversational speech

Minimal contrast drills