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66 Cards in this Set

  • Front
  • Back
Lesions can occur at 4 levels:
brainstem, nerves, neuromuscular junction, muscles
Etiology

Vitamin DND CRaB
Vascular accident
Iatrogenic
Trauma
Anatomic Abnormalities
Muscle Disease
Infectious Disease
Neuromuscular Junction Disease
Demyelinating Disease
Neoplasm
Degenerative Motorneuron Disease
Cranial Mononeuropathy
Radiation Therapy
Bell's Palsy
General Characteristics
Weakness
Hypotonia
Diminished Reflexes
Atrophy
Fibrillations
Fasciculations
True or False

CN V Trigeminal is rarely the only cranial nerve affected in flaccid dysarthria
True
True or False

Unilateral damage to the CN V Trigeminal can have devastating effects on speech.
False
Characteristics of bilateral damage to CN V Trigeminal
mild-devastating effects on speech
reduced AMRs
inability to elevate jaw
changes in vowels, glides, liquids
Slowed rate
reduced precision (sensory dysarthria?)
Trigeminal neuralgia (splinting)
Damage to the CN VII motor nucleus or LMN tract in the pons suggests there may be damage to CN ____ as well. How about the auditory meatus?
CN VI Abducens (motor for eye)
CN VIII Vestibulocochlear
True or False

Bilateral lesions to CN VII are more typical.
No.

Therefore, oral motor characteristics are typically unilateral
True or False

Only motor portion of CN VII Facial has a clear role in speech
True
Damage to CN VII Facial

Oral motor characteristics, unilateral damage
affected side sags
eye open, unable to blink
drooling
pocketing of food
bite wounds to cheek/lip
fasciculations and atrophy (typically periorbital)
Damage to CN VII Facial

Speech Characteristics
often more visible than audible
flutter of cheeks (bilabial stops)
mismatch of AMR's (pa affected)
Precision reduced more than speed unless weakness is bilateral and severe
Effects of a bilateral lesion to CN VII Facial may be less obvious because of ____
symmetry
What nerve carries the sensory component of the gag reflex?
CN IX Glossopharyngeal
Damage to CN IX Glossopharyngeal

Oral motor characteristics
reduced gag or asymmetry of elicited gag response
reduced pharyngeal elevation during swallow
glossopharyngeal neuralgia
Damage to CN X Glossopharyngeal

Speech characteristics
cannot really be assessed directly
CN IX Glossopharyngeal is rarely damaged in isolation. Which nerve is often also damaged?
CN X Vagus
Which cranial nerve is the largest?
CN V Trigeminal
Which cranial nerve is the longest?
CN X Vagus
Cell bodies of CN X Vagus relevent to speech originate in the
nucleus ambiguus
3 branches of the vagus
pharyngeal
superior laryngeal
recurrent laryngeal
The pharyngeal branch of CN X Vagus supplies the muscles of the pharynx except ___, the muscles of the palate except ____.
the stylopharyngeus
tensor veli palatini
The pharyngeal branch of CN X Vagus is responsible for:
pharyngeal constriction and palatal elevation and retraction during speech and swallowing
The motor branch of the SLN (CN X Vagus) is the ____ branch and supplies the ____. It is responsible for:
external
superior pharyngeal constrictors and cricothyroid
lengthening the vocal cords for pitch adjustment.
The recurrent branch of the SLN supplies which laryngeal muscles?
All except the cricothyroid.
Deficits resulting from CN X Vagus damage depend on what two factors?
localization
whether injury is unilateral or bilateral
Bilateral lesions to the CN X Vagus typically occur ______, whereas unilateral lesions can occur ______.
in the brainstem (affecting other CNs as well)
intramedularly or extracranially
Damage to CN X Vagus above the pharyngeal branch: lesion site and muscles affected
Muscles: all intrinsic LN, pharyngeal, soft palate
Lesion: Brainstem
Dysphagia likely
Damage to CN X Vagus above the pharyngeal branch: Laryngeal and VP function characteristics
Laryngeal: moderate breathiness, hoarseness, reduced loudness, low pitch, weak cough.
VP: hypernasality, nasal emission, reduced gag, nasal regurgination.
Damage to CN X Vagus above the SLN: muscles affected
all intrinsic laryngeal and pharyngeal muscles but NOT typically soft palate
Dysphagia possible
Damage to CN X Vagus above the SLN; Laryngeal and VP function:
Laryngeal: moderate breathiness, hoarseness, low pitch, weak cough
VP not likely affected
Damage to CN X Vagus, SLN only. Muscles affected:
only cricothyroid (the thyroid cannot be tilted, stretching the VFs)
Swallow effects not hugely likely
Damage to CN X Vagus, SLN only. Laryngeal and VP effects:
Laryngeal: breathy, hoarse, reduced loudness, reduced pitch range
VP not affected
Damage to CN X Vagus, RLN only.
Muscles affected:
all intrinsic LN muscles except the cricothyroid.
Damage to the CN X Vagus, RLN only.
Laryngeal and VP effects:
Laryngeal: may be normal sounding, mildly breathy and/or hoarse, slightly reduced loudness, inhalatory stridor (VF at paramedian position), short phrases, diplophonia
VP not affected
CN XI Spinal Accessory cranial portion originates in and innervates
nucleus ambiguus; intermingles with fibers from CN X to help innervate the uvula, levator veli palatini and intrinsic laryngeal muscles. Can't be clinically separated.
Damage to CN XI Spinal Accessory cranial portion.
similar to CN X
True or False

Characteristics of lesions to CN XI Spinal Accessory spinal portion are similar to those of CN X Vagus
No. Cranial portion.
Spinal portion: reduced shoulder elevation, weakened head turning.
Bilateral damage to CN XI Spinal Accessory spinal portion may cause difficulty with
respiration, phonation and resonance due to head drooping down.
Spinal cord injuries above C3:
isolates respiratory muscles form the brainstem resulting in respiratory paralysis.
Spinal cord injuries C3-C5:
Diaphragm is paralysed bilaterally
Quick, 4 disorders that can affect respiration:
Myasthenia Gravis
Guillain Barre
ALS
SCI
_______ of spinal nerves is needed to affect speech:
Diffuse impairment
Spinal nerve lesions
Oral Motor/Respiratory findings:
shallow breathing
use of accessory muscles
flaring of nares
Spinal nerve lesions
speech characteristics
shortened phrases
reduced loudness
prosodic variations due to altered phrasing
decreased variability of pitch and loudness
CN XII Hypoglossal
Orignates in and innervates:
the medulla
intrinsic and extrinsic muscles of the tongue except palatoglossus
CN XII Hypoglossal lesions can typically affect which other CNs?
CN IX, X, & XI as well (pass in closs proximity)
CN XII Hypoglossal plays a crucial function in:
articulatory movements, chewing and swallowing
What can cause isolated damage to CN XII Hypoglossal?
intracranial metastasis
basilar skull lesions
iatrogenic
CN XII Hypoglossal, unilateral damage characteristics
tongue atrophy on ipsilateral weak side
fasciculations on weak side
tongue deviates on protrusion (to side of lesion)
reduced lateralization
mild articulatory imprecision which does not likely affect intelligibility.
CN XII Hypoglossal, bilateral damage characteristics
bilateral atrophy (hard to judge)
bilateral fasciculations
protrusion symmetrical but limited in range (or not at all)
saliva accumulation
pocketing of food in mouth
articulatory imprecision.
A condition where multiple cranial nerves are damaged:
Bulbar palsy
Bulbar palsy
Effects to speech are ___
cumulative
3 things that can cause bulbar palsy
intracranial pathology (typical)
neuromuscular junction diseases (always bilateral)
myopathies.
General Oral Motor Characteristics:

Lips
sag on affected side
drooling may be present
open mouth posture (bilateral lesion)
movements affected include closure, pucker, smile
General Oral Motor Characteristics:
Tongue
flabby and shrunken (atrophy) on affected side
fasciculations
movements affected include protrusion, lateralization, elevation
General Oral Motor Characteristics:
Palate
Droop on affected side
pulls toward non-paralyzed side
bilateral: droop both sides, uvula to tongue
reduced/absent gag
General Oral Motor Characteristics Respiration
reduced vital capacity
gasping for breath
impaired control of exhalation
shallow inhalation
inhalatory stridor
Inhalatory stridor is a ____ of flaccid dysarthria
hallmark
How does respiration affect speech?
phrase length
phrasing
loudness
prosody
General Oral Motor Characteristics

Phonation
breathy, hoarse, diplophonic, reduced pitch range, pitch breaks
General Speech Characteristics

Lesion to SLN
unilateral: rotated VF, voice mildly breathy/hoarse, reduced ability to alter pitch, mildly reduced loudness
bilateral: both VF shortened, bowed, epiglottis obscures anterior commisure, voice mild-mod breathy and/or hoase with inability to alter pitch.
General speech characteristics

Lesion to RLN & SLN
VF paralysed in abducted position
breathy or aphonic
reduced pitch
pitch breaks
shortened phrases due to air wastage
General speech characteristics

Articulation
imprecise consonants (severity depends on nerves affected)
reduced speech rate
speech can sometimes sound labored
General speech characteristics

Resonance
hypernasality (CN X pharyngeal branch)
nasal emission
reduced ability to produce pressure consonants
reduced loudness (damping effect or laryngeal valving or respiratory insufficiency)
General speech characteristics

Prosody
shortened phrases
inappropriate phrasing
reduced stress and intonation
monotone
Differentiating signs of flaccid dysarthria
hypernasality
nasal emission
continuous breathiness
audible inspiration (stridor)
rapid deterioration (weakness) of speech with continuous speaking and significant recovery with rest