Motor Speech Disorders: Flaccid Dysarthria

Dollar Tree Finds and Weekend Updates

• The speaker mentions going to Dollar Tree every Friday after audiology.
• They enjoy watching Dollar Tree videos and using the store's items in therapy with students.
• The speaker jokes about a construction event.
• The speaker recounts Starbucks visit: getting to the drive-through, encounters a driver not moving when the light turns green, honks gently, and then realizes there's a police officer present. The speaker feared getting pulled over but was not.

Introduction to the Day's Activity

• Participants will write answers on whiteboards and keep a tally of correct responses.
• The activity involves answering questions related to the nervous system.

Nervous System Quiz

• Question 1: This system consists of the brain and the spinal cord. What am I? Answer: Central Nervous System.
  Note: CNS is the correct answer.
• Question 2: This system is composed of 12 pairs of cranial nerves and 31 pairs of spinal nerves. What am I? Answer: Peripheral Nervous System
  Note: Peripheral Nervous System is the correct answer.
• Question 3: I am a prominent part of the brain. What am I? Answer: Cerebrum.
  Note: Cerebrum is the correct answer, also known as cerebral.
• Question 4: I am the surface of the cerebrum, and I'm about two to five millimeters in thickness, six layers of nervous system stuff, and I get gray in color. What am I? Answer: Cerebral Cortex.
  Note: Cerebral Cortex is the correct answer.
• Question 5: I sit between the cerebrum and the spinal cord. I'm divided into three areas, and I act as a passageway for descending and ascending neural tracts that travel between the cerebrum and the spinal cord. What am I? Answer: Brainstem.
  Note: Brainstem is the correct answer.
• Question 6: I coordinate my other movements so muscles will subtract with the right amount of force at appropriate times when I want. Answer: Cerebellum.
  Note: Cerebellum is the correct answer. The speaker uses ballet and leg analogies to remember its function.
  Cerebrum vs Cerebellum: To help remember think of the cerebellum balancing the cerebrum. ballet + legs = cerebellum
• Question 7: I'm considered the most important cells of the nervous system. What am I? Answer: Neuron.
  Note: Neuron is the correct answer.
• Question 8: I carry impulses away from the CNS. Away away. Where are y'all? Answer: Efferent Nerves.
  Note: Efferent Nerve is the correct answer. To help memorize, although away starts with the letter A think of the opposite E.
• Question 9: I'm a chemical released by the terminal of an exon that either excite or inhibit the firing of an adjoining neuron. What am I? Answer: Neurotransmitter.
  Note: Neurotransmitter is the correct answer. This is similar to a chemical reaction.
• Question 10: I share a couple pulses toward the CNS. Alright. So it's the opposite of e for e. Answer: Afferent Receptor.
  Note: Afferent Receptor is the correct answer, and the opposite of Efferent.
• Question 11: I am located in the uppermost portion of the temporal lobe. I analyze tone patterns and sound properties as well as localization of sounds. If I'm compromised, I will have a loss of sound localization. What am I? Answer: Primary Auditory Cortex.
  Note: Primary Auditory Cortex is the correct answer.
• Question 12: I'm located in the most posterior end of the occipital lobe. I perform preliminary analysis of depth, integration of visual information from both eyes. If I'm compromised, I will have a loss of conscious awareness of visual stimulation. Answer: Primary Visual Cortex.
  Note: Primary Visual Cortex is the correct answer.
• Question 13: I am located in the postcentral gyrus, and I received the first neural input about bodily sensations, pressure, temperature, touch, and proprioception. If I am compromised, I will have the inability to identify objects by touch. Answer: Primary Sensory Cortex.
  Note: Primary Sensory Cortex is the correct answer.
• Question 14: I am located in the temporal lobe. I recognize complex visual stimuli, integrate auditory stimuli with other centers of the brain, and form memories. If I am compromised, I will have visual agnosia, amnesia, and high levels of distractibility. Answer: Prefrontal Cortex.
  Note: Prefrontal Cortex is the correct answer.
• Question 15: I'm located between the primary sensory cortex and the occipital lobe. I integrate bodily sensations with visual information and control visually guided movements and hand eye coordination. If I am compromised, there will be impairments manipulating objects, sensory neglect of half the body, and reading and writing deficits. Answer: Peri[arietal Lobe.
  Note: Peri[arietal Lobe is the correct answer.
• Question 16: I'm located between the primary visual cortex and parietal and temporal lobes. I perform complex analysis of visual impulses from primary from the primary visual cortex. If I'm compromised, there will be motion blindness, color blindness, and prochagion. Whatever. Look at you, fancy. Answer: Visual Association Cortex.
  Note: Visual Association Cortex is the correct answer. It is suspected that Brad Pitt might suffer from this condition.
• Question 17: If a person is diagnosed with Huntington's or Parkinson's disease, there's a compromise in this area. I act as a filter to prevent unwanted movements or neckline. Answer*: Basal Ganglia.
  *Note*: Basal Ganglia is the correct answer.
• Question 18: I've heard when the affected body part is still, and I typically disappear during movement when I'm on. What time? Answer: Resting Tremor.
  Note: Resting Tremor is the correct answer. Symptoms are only seen at rest.
• Question 19: I am observed only during the performance of voluntary movements, like reaching for a glass of water and it’s not pressing at rest. Whatever. Answer: Intention Tremor.
  Note: Intention Tremor is the correct answer. Symptoms are observed during voluntary movements.
• Question 20: I'm located deep into the basal ganglia, and I have been described as the doorway through which subcortical systems of the nervous system communicate with the cerebral cortex. Practically every sensory impulse from the body passes through me on the way to the cortex. What am I? Answer: Thalamus.
  Note: Thalamus is the correct answer.
• Question 21: If damage in any part of the motor system affects the muscles of speech production, the result can be a. What am I? Answer: Motor Speech Disorder.
  Note: Motor Speech Disorder is the correct answer.
• Question 22: What are the five components or processes that are essential for normal speech production? Answer: Respiration, Phonation, Articulation, Resonance, Prosody.
  Note: Respiration, Phonation, Articulation, Resonance, Prosody is the correct answer.
• Question 23: Because of disturbances in the neuromuscular control of the speech mechanism, production of speech is impaired. Answer: Dsarthria.
  Note: Dsarthria is the correct answer.
• Question 24: I'm defined as a deficit in the ability to sequence the correct movement needed to carry out a familiar action. Answer: Apraxia.
  Note: Apraxia is the correct answer.
• Question 25: If you want to assess for a motor speech disorder but don't have sophisticated devices to objectively measure the components of speech production, you will have to use. Answer: Oral Motor Exam.
  Note: Oral Motor Exam is the correct answer. During the exam, make sure to check: Strength, steadiness, speed, range, accuracy, tone (muscle).
  Remember: Speech/Swallowing situations have the same motor functions.
• Question 26: I am small involuntary movements that may occur in a muscle when motor innervation has been lost after damage to the hypoglossal nerve. You will see small nonrhythmic dimpling across the surface of the tongue. Answer: Fasciculations.
  Note: Fasciculations is the correct answer.
• Question 27: I cannot be observed directly. You need instrumentation like a mirror or a nasal endoscope to cutie. However, you can indirectly observe my function, not me, but my function, by having me produce a sharp pop and and or a glottal a glottal stop. Answer: Larynx and vocal folds.
  Note: Larynx and vocal folds is the correct answer.
• Question 28: It's a patient's ability to move the articulator rapidly. They eject smoothly in repetitive motion. I am a key evaluation task for motor speech disorders as I provide information on speed and rhythm of syllable production. What am I? Answer: Alternating Motion Rates (AMR).
  Note: Alternating Motion Rates (AMR) is the correct answer.
• Question 29: I'm a task that screens for a disorder caused by rapid fatigue of the muscles during sustained motor activity. What task am I? And what disorder might I have if I present with rapid deterioration of articulation, resonance, or formation when completing this test? Answer: Stress testing of the speech mechanism, and the disease or the disorder is myasthenia gravis.
  Note: Stress testing of the speech mechanism, and the disease or the disorder is myasthenia gravis is the correct answer. The patient should have the person count from 1-100 during the motor speech exam to check for any fatigue or complaints.
• Question 30: I'm a task that assesses a patient's ability to move the articulators in a rapid rapid, smooth sequence of motions. What task am I? Answer: Sequential Motion Rate (SMR).
  Note: Sequential Motion Rate (SMR) is the correct answer.

Introduction to Flaccid Dysarthria

• The group will listen to someone diagnosed with flaccid dysarthria to identify key characteristics, such as hypernasality, breathiness, and low muscle tone.

Characteristics of Flaccid Dysarthria

• Flaccid Dysarthria primary characteristics are: hypernasality, imprecise consonants, and breathiness

Patient Audio Analysis

• The client is a 74-year-old man with a brain stem stroke, diagnosed with dysarthria.
  • Analysis:
    • Hypernasality noted.
    • Slightly monotone.
    • Articulation affected.
    • Intelligibility is about 5/10.
    • The patient also had his teeth fall out, as the dentures we not glued in properly.

Flaccid Dysarthria Explained

Flaccid Dysarthria Impacts: Low motor neurons meaning the muscles have low tone, droopy, and weakness.

Pizza Challenge Analogy:

• Flaccid dysarthria muscle with no cheese, tone is low.

• Spastic dysarthria tough like a rock.

• The damage to spinal or cranial nerves. Often caused by something in the brainstem.

Cranial Nerve Location: Where the cranial nerves are housed. So lower motor neurons are our cranial nerve pairs

Automaticity of Motor Movements: The motor movements are automatic. You dont have to think too hard. So the brain innervates with the nerve. And the nerve tells the muscle what to do. When one get damages the other is damaged. Meaning either the muscles will become weak, damaged, and have difficulty doing what they’re supposed to be doing.

Causes

• Strokes: Ischemic vs. Hemorrhagic
  *Hemorrhagic strokes have more effect that Ischemic strokes.
• Tumor: Compress the nerves.
• Virus/Bacterial infections: Polio resurgance
• Physical Trauma: Motor vehicle, accidents.
• Head and Neck Cancer: Elective procedures are too close to the nerves.

Spinal Nerve: the phrenic nerve innervates the diaphragm. if the phrenic nerve, then it affects the diaphragm.

Specific Disorder Examples

• myasthenia gravis
• EON bar
• Yulia
• muscular dystrophy
• surgical instruments
• strokes

Lower motor or for flaccid dysarthria considerations:

• They can become weak. They may become paralyzed, and eventually, they may atrophy.

Cranial Nerves Motor areas

• the trigeminal nerve: If there is unilateral damage: The jaw side will compensate. Bilarteral is more difficult.
  Que: jaw sling.
• Facial Nerve Branch: depending on where the facial nerve is damaged and it it lateral than the face will react differently.
• Upper Motor Neuron damage: IF there is unilateral damage: means that damage hasn’t gotten down. So less of a noticeable difference. if they lower get damaged than is more of a noticeable difference.
  Note: If muscles, you’re gonna get sort of that whole unilateral weakness. So muscle strength, the muscle, accuracy, things like that, because all those pieces are gonna kinda tell you what sort of things are working well and what sort of things are not working well.
• Glossopharyngeal nerve: Articulation issues because they can effect pharynx. So the pharix assist in creating sounds.
• The Vagus nerve: Branch is the one that is going to take care of our veal.
  *If damaged, if it's unilateral velum may be able to compensate with help from nice treatment cues.
  *if somebody has and that velum is, like, sort of hanging and kind of droopy, and it's just not able to close effectively to keep the airflow where it should be going when we make our nasal sounds. But with cues you help eliminate.
  Treatment and Cues: talk a little louder or over articulate your speech, they might do a resection of the velum and sort of do surgery to kind of, like, put that put it back together a little tighter.
• Palatal lift: is when the person goes to a prosthodontist.
  Pros: retainer that helps the hard and soft palate.
  Cons: feels heavy, feels like something in the way, interfere, doees help with nasally.
• Laryngeal nerve branch: Vagus nerve branches the recurrent nerve branch.
  Hoarse Voice.If you can only get only the spread into the voice
• Spinal accessory: sugar: If there's damage to the vagus nerve, you probably have damage to the spinal accessory nerve to because they are so close together. When they're close together, we can't necessarily separate. When they affected their both damaged.
• hypoglossal: Damage. So our hypo coastal nerve is responsible for our tongue movement, and so articulations going to be affected. Also our voice what they are. So if the muscles of our tongue are affected, we're gonna have some articulation issues

Common flaccid dysarthria reasons:

• People having a procedure by the carotid artery/arteries
• Most common is Physical damage.

Stroke Considerations

strokes can be anywhere in the brainstem

Myathenaisa Gravis information:

• Myasthenia Gravis: Acetylcholine the neurotransmitters, so it’s that isn’t it the neuron in the receiving in it doesn’t receiving in the in is received. The reason that the the peroson that
  Is an auto immune deficiency/issue. as long as they are resting and getting the interaction is working properly. If muscles themselves are weak due to the fact that the neurotransmitter isn’t doing what it’s sposed to be doing. So however that might be like a family the best way we can get
  
  It effects both kids and adults.

Medical Diagnosis: Gulian Bar explanation:

• vaccinations, they think, vaccination and so the person person has the reaction
  What is is: If we’re looking nice. So the neuron begins to demyelinate and all that protection that the for the neuron is slowly withering away.

Recvoery process: