Flaccid Dysarthria

Front 1

Lesions can occur at 4 levels:

Back 1

brainstem, nerves, neuromuscular junction, muscles

Front 2

Etiology

Vitamin DND CRaB

Back 2

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

Front 3

General Characteristics

Back 3

Weakness
Hypotonia
Diminished Reflexes
Atrophy
Fibrillations
Fasciculations

Front 4

True or False

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

Back 4

True

Front 5

True or False

Unilateral damage to the CN V Trigeminal can have devastating effects on speech.

Back 5

False

Front 6

Characteristics of bilateral damage to CN V Trigeminal

Back 6

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)

Front 7

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?

Back 7

CN VI Abducens (motor for eye)
CN VIII Vestibulocochlear

Front 8

True or False

Bilateral lesions to CN VII are more typical.

Back 8

No.

Therefore, oral motor characteristics are typically unilateral

Front 9

True or False

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

Back 9

True

Front 10

Damage to CN VII Facial

Oral motor characteristics, unilateral damage

Back 10

affected side sags
eye open, unable to blink
drooling
pocketing of food
bite wounds to cheek/lip
fasciculations and atrophy (typically periorbital)

Front 11

Damage to CN VII Facial

Speech Characteristics

Back 11

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

Front 12

Effects of a bilateral lesion to CN VII Facial may be less obvious because of ____

Back 12

symmetry

Front 13

What nerve carries the sensory component of the gag reflex?

Back 13

CN IX Glossopharyngeal

Front 14

Damage to CN IX Glossopharyngeal

Oral motor characteristics

Back 14

reduced gag or asymmetry of elicited gag response
reduced pharyngeal elevation during swallow
glossopharyngeal neuralgia

Front 15

Damage to CN X Glossopharyngeal

Speech characteristics

Back 15

cannot really be assessed directly

Front 16

CN IX Glossopharyngeal is rarely damaged in isolation. Which nerve is often also damaged?

Back 16

CN X Vagus

Front 17

Which cranial nerve is the largest?

Back 17

CN V Trigeminal

Front 18

Which cranial nerve is the longest?

Back 18

CN X Vagus

Front 19

Cell bodies of CN X Vagus relevent to speech originate in the

Back 19

nucleus ambiguus

Front 20

3 branches of the vagus

Back 20

pharyngeal
superior laryngeal
recurrent laryngeal

Front 21

The pharyngeal branch of CN X Vagus supplies the muscles of the pharynx except ___, the muscles of the palate except ____.

Back 21

the stylopharyngeus
tensor veli palatini

Front 22

The pharyngeal branch of CN X Vagus is responsible for:

Back 22

pharyngeal constriction and palatal elevation and retraction during speech and swallowing

Front 23

The motor branch of the SLN (CN X Vagus) is the ____ branch and supplies the ____. It is responsible for:

Back 23

external
superior pharyngeal constrictors and cricothyroid
lengthening the vocal cords for pitch adjustment.

Front 24

The recurrent branch of the SLN supplies which laryngeal muscles?

Back 24

All except the cricothyroid.

Front 25

Deficits resulting from CN X Vagus damage depend on what two factors?

Back 25

localization
whether injury is unilateral or bilateral

Front 26

Bilateral lesions to the CN X Vagus typically occur ______, whereas unilateral lesions can occur ______.

Back 26

in the brainstem (affecting other CNs as well)
intramedularly or extracranially

Front 27

Damage to CN X Vagus above the pharyngeal branch: lesion site and muscles affected

Back 27

Muscles: all intrinsic LN, pharyngeal, soft palate
Lesion: Brainstem
Dysphagia likely

Front 28

Damage to CN X Vagus above the pharyngeal branch: Laryngeal and VP function characteristics

Back 28

Laryngeal: moderate breathiness, hoarseness, reduced loudness, low pitch, weak cough.
VP: hypernasality, nasal emission, reduced gag, nasal regurgination.

Front 29

Damage to CN X Vagus above the SLN: muscles affected

Back 29

all intrinsic laryngeal and pharyngeal muscles but NOT typically soft palate
Dysphagia possible

Front 30

Damage to CN X Vagus above the SLN; Laryngeal and VP function:

Back 30

Laryngeal: moderate breathiness, hoarseness, low pitch, weak cough
VP not likely affected

Front 31

Damage to CN X Vagus, SLN only. Muscles affected:

Back 31

only cricothyroid (the thyroid cannot be tilted, stretching the VFs)
Swallow effects not hugely likely

Front 32

Damage to CN X Vagus, SLN only. Laryngeal and VP effects:

Back 32

Laryngeal: breathy, hoarse, reduced loudness, reduced pitch range
VP not affected

Front 33

Damage to CN X Vagus, RLN only.
Muscles affected:

Back 33

all intrinsic LN muscles except the cricothyroid.

Front 34

Damage to the CN X Vagus, RLN only.
Laryngeal and VP effects:

Back 34

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

Front 35

CN XI Spinal Accessory cranial portion originates in and innervates

Back 35

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.

Front 36

Damage to CN XI Spinal Accessory cranial portion.

Back 36

similar to CN X

Front 37

True or False

Characteristics of lesions to CN XI Spinal Accessory spinal portion are similar to those of CN X Vagus

Back 37

No. Cranial portion.
Spinal portion: reduced shoulder elevation, weakened head turning.

Front 38

Bilateral damage to CN XI Spinal Accessory spinal portion may cause difficulty with

Back 38

respiration, phonation and resonance due to head drooping down.

Front 39

Spinal cord injuries above C3:

Back 39

isolates respiratory muscles form the brainstem resulting in respiratory paralysis.

Front 40

Spinal cord injuries C3-C5:

Back 40

Diaphragm is paralysed bilaterally

Front 41

Quick, 4 disorders that can affect respiration:

Back 41

Myasthenia Gravis
Guillain Barre
ALS
SCI

Front 42

_______ of spinal nerves is needed to affect speech:

Back 42

Diffuse impairment

Front 43

Spinal nerve lesions
Oral Motor/Respiratory findings:

Back 43

shallow breathing
use of accessory muscles
flaring of nares

Front 44

Spinal nerve lesions
speech characteristics

Back 44

shortened phrases
reduced loudness
prosodic variations due to altered phrasing
decreased variability of pitch and loudness

Front 45

CN XII Hypoglossal
Orignates in and innervates:

Back 45

the medulla
intrinsic and extrinsic muscles of the tongue except palatoglossus

Front 46

CN XII Hypoglossal lesions can typically affect which other CNs?

Back 46

CN IX, X, & XI as well (pass in closs proximity)

Front 47

CN XII Hypoglossal plays a crucial function in:

Back 47

articulatory movements, chewing and swallowing

Front 48

What can cause isolated damage to CN XII Hypoglossal?

Back 48

intracranial metastasis
basilar skull lesions
iatrogenic

Front 49

CN XII Hypoglossal, unilateral damage characteristics

Back 49

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.

Front 50

CN XII Hypoglossal, bilateral damage characteristics

Back 50

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.

Front 51

A condition where multiple cranial nerves are damaged:

Back 51

Bulbar palsy

Front 52

Bulbar palsy
Effects to speech are ___

Back 52

cumulative

Front 53

3 things that can cause bulbar palsy

Back 53

intracranial pathology (typical)
neuromuscular junction diseases (always bilateral)
myopathies.

Front 54

General Oral Motor Characteristics:

Lips

Back 54

sag on affected side
drooling may be present
open mouth posture (bilateral lesion)
movements affected include closure, pucker, smile

Front 55

General Oral Motor Characteristics:
Tongue

Back 55

flabby and shrunken (atrophy) on affected side
fasciculations
movements affected include protrusion, lateralization, elevation

Front 56

General Oral Motor Characteristics:
Palate

Back 56

Droop on affected side
pulls toward non-paralyzed side
bilateral: droop both sides, uvula to tongue
reduced/absent gag

Front 57

General Oral Motor Characteristics Respiration

Back 57

reduced vital capacity
gasping for breath
impaired control of exhalation
shallow inhalation
inhalatory stridor

Front 58

Inhalatory stridor is a ____ of flaccid dysarthria

Back 58

hallmark

Front 59

How does respiration affect speech?

Back 59

phrase length
phrasing
loudness
prosody

Front 60

General Oral Motor Characteristics

Phonation

Back 60

breathy, hoarse, diplophonic, reduced pitch range, pitch breaks

Front 61

General Speech Characteristics

Lesion to SLN

Back 61

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.

Front 62

General speech characteristics

Lesion to RLN & SLN

Back 62

VF paralysed in abducted position
breathy or aphonic
reduced pitch
pitch breaks
shortened phrases due to air wastage

Front 63

General speech characteristics

Articulation

Back 63

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

Front 64

General speech characteristics

Resonance

Back 64

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

Front 65

General speech characteristics

Prosody

Back 65

shortened phrases
inappropriate phrasing
reduced stress and intonation
monotone

Front 66

Differentiating signs of flaccid dysarthria

Back 66

hypernasality
nasal emission
continuous breathiness
audible inspiration (stridor)
rapid deterioration (weakness) of speech with continuous speaking and significant recovery with rest