Quiz 2 Info For Motor Speech- Flaccid Dysarthria

Front 1

flaccid dysarthria is caused by

Back 1

impairment of the LMNs of the cranial or spinal nerves Ex. damage to the PNS

Front 2

characteristics of flaccid dysarthria (2)

Back 2

-weakness in the speech and/or respiratory musculature
- weakness can result in:(possibly but not all)slow-labored articulation, hypernasal resonance, horse-breathy phonation (most common)

Front 3

what is the neurological basis of flaccid dysarthria (2)

Back 3

- damage to the lower motor neurons or 'final common pathway'
- any disorder that disrupts the flow of neural impulses along the LMN that innervate muscles of respiration, phonation, articulation, prosody, or resonance

Front 4

what are 5 confirmatory signs of flaccid dysarthria

Back 4

1. weakness (usually see)
2. hyptonia and reduced reflexes (usually see)
3. atrophy (might see-co occur)
4. fasciculations (might see-co occur)
5. progressive weakness with use in some cases (small number of cases)

Front 5

if damage occurs to any of the following or a combination of the following, the motor impulses sent to the muscles for speech will be distorted or stopped completely (6)

Back 5

1. trigeminal
2. facial
3. glossopharyngeal
4. vagus
5. accessory
6. hypoglossal

Front 6

trigeminal CN V attaches at the level of the

Back 6

pons

Front 7

trigeminal cn V is divided into how many branches and what are they called

Back 7

1. opthalamic
2. maxillary
3. mandibular (imp for speech)

Front 8

why is mandibular branch the most imp for speech production

Back 8

innervates muscles that elevate and lower the jaw

Front 9

unilateral damage to the CN V trigeminal nerve has what 4 effects

1. weakness?
2. deveiate?
3. confirmatory sign?
4. speech production?

Back 9

1. weakness in the jaw muscles ont he same side as the damage
2. jaw may deviate twoard theaffected sidewhen opened(pusing from both sides)
3. muscle atrophy will occur over time, resulting in asymmetrical appearance
4. minimal effect on speech production (the other side can compensate)

Front 10

bilateral damage to the CN V trigeminal nerve has what 3 effects
1. jaw?
2. which sounds affected?
3. speech rate?

Back 10

1. person will have difficulty or will not be able to raise their jaw.
2. wich souds will jaw movement affect the most?
- bilabial
-labiodental, linguadental, linguaalevolar
- vowels, glides, and liquids
3. rate of speech will be reduced

Front 11

can someone produce sound wihtout pushing jaw up??

Back 11

no

Front 12

sensory affects of bilateral damage to the trigeminal nerve

Back 12

no sensation to face causes problems

Front 13

what are two major branches of the facial nerve CN VII

Back 13

1. cervicofacial branch: innervates lower facial muscles
2. temporofacial branch: innervate upper face

Front 14

lower motor neuron lesion to the facial nerve CN VII
-above the point of division results in:
-below the point of division results in:

Back 14

above: entire ipsilateral facial weakness
below: muscles innervated by the specific branch will be affected

Front 15

Upper motor neuron lesion:

UMNs of the corticobulbar tract innervate:

Back 15

the LMNs of the two branches of the facial nerve

Front 16

Facial nerve::

upper face receives _____UMN innervation

Back 16

bilateral UMN inneravtaion

Front 17

lower face receives UMN

Back 17

UMN innervation from teh contralateral side of the brain

Front 18

Facial nerve:

what will happen if there is right LMN lesion above the point of division?

Back 18

entire right face damage

Front 19

what will happen if there is right corticobulbar tract damage

Back 19

lower left face damage

Front 20

unilateral damage to the facial nerve results in (3)(speech characteristics)

Back 20

- mild distortion of bilabial and labiodentals
- flutter of the cheeks
- reduced precision of/pa/ for AMRs

Front 21

bilateral damage to the facial nerve (2)

Back 21

- distortion or inability to produce bilabials and labiodentals
- slow rate

Front 22

glossopharyngeal nerve CN IX originates at the level of the

Back 22

medulla

Front 23

the glossopharyngeal nerve CN IX courses out to the _______ innervating the (2)

Back 23

courses out to the pharynx innervating the stylopharyngeus and superior pharyngeal constrictors

Front 24

the superior pharyngeal constrictors assists in....

- what will test the function of the CN IX

Back 24

superior pharyngeal constrictors assist in elevating and opening the upper pharynx (back of throat)- affect articulation

- gag reflex will test the function of CN IX (glossopharyngeal nerve)

Front 25

what is the exact contribution of CN IX glossopharyngeal nerve to speech

Back 25

unclear because of close approximation of the vagus nerve but most likely articulation and resonance affected.

Front 26

Vagus nerve (X) is very important for

Back 26

speech

Front 27

vagus nerve (CN X) originates at.... just below....

Back 27

originates at the medulla just below the CN IX.

Front 28

vagus nerve (CN X) courses near

Back 28

CN IX and CN XI

Front 29

describe vagus nerve CN X

Back 29

long and serves many parts of the body (larynx, intestines, heart, velum)

Front 30

what are three important branches of CN X for speech production

Back 30

1. pharyngeal branch
2. external superior laryngeal nerve branch
3. recurrent laryngeal branch

Front 31

pharyngeal branch of CN X innervates

Back 31

muscles of hte pharynx and soft palate

Front 32

pharyngeal branch of CN X is responsible for (2)

Back 32

1. pharyngeal constriction
2. palatal elevation and retraction

Front 33

unilateral damage to pharyngeal branch of CN X results in

Back 33

the affected side of the velum hanging lower than the unaffected side-> generally does not result in VPI (velo pharyngeal insuficiency)- enough compensation

Front 34

bilateral damage of pharyngeal branch of CN X results in

Back 34

hypernasality- pressure consonants will be distorted - can't hold in air- inter oral pressure, stops, fricatives, affricates

Front 35

external superior laryngeal nerve branch of CN X innervates the

Back 35

cricothyroid

Front 36

what does the cricothyroid do

Back 36

stretches and tenses the VFs, thus controls pitch

Front 37

unilateral damage to external superior laryngeal nerve branch of CN X will

Back 37

have a mild effect on varying pitch

Front 38

bilateral damage to external superior laryngeal nerve branch of CN X will (3)

Back 38

1. decreased loudness- maybe
2. increased breathiness- maybe
3. monotone (decreased pitch variation)- most obvious

Front 39

recurrent laryngeal branch of CN X supplies

Back 39

motor innervation to all the intrinsic laryngeal muscles except for the cricothyroid

Front 40

recurrent laryingeal branch of CN X is important for

Back 40

VF adduction and abduction

Front 41

unilateral damage to recurrent laryngeal branch of CN X may result in

Back 41

on VF being fixed in the paramedian position - causing breathy phonation and decreased loudness (not all patients, some may sound close to normal with compensation)

Front 42

bilateral damage to recurrent laryngeal branch of CN X can

Back 42

fix both VFs in the paramedian position resulting in inhalatory stridor (still can phonate, not well, breathy, horse)

Front 43

accessory nerve (XI) merges with

Back 43

vagus nerve

Front 44

spinal portions of accessory nerve XI supply

Back 44

motor innervation for the sternocleidomastoid and trapezius

Front 45

damage to vagus nerve means there is also damage in

Back 45

accessory nerve

Front 46

hypoglossal nerve (CN XII) provides

Back 46

motor innervation for all intrinsic lingual muscles and most of the extrinsic

Front 47

unilateral damage to hypoglossal nerve (CN XII) results in 4

Back 47

-weakness on the same side as the nerve damage
- damaged side with atrophy
- protrusion will deviate twoard the affected side
- mild articulatory distortions

Front 48

bilateral damage to hypoglossal (CN XII) will result in (6)

Back 48

-bilateral muscle will atrophy and weakness
- reduced ROM-> imprecise articulation
- difficulty with pronouncing alveolars and velars

Front 49

UMN innervation of hypoglossal CN XII is contralateral only -> damage to the L UMNs results in

Back 49

weakness in the R side of the tongue

Front 50

what are 8 etiologies of Flaccid dysarthria?

Back 50

1. physical trauma
2. brainstem stroke
3. myasthenia gravis
4. guillain-barre syndrome
5. polio
6. tumors
7. muscular dystrophy
8. progressive bulbar palsy

Front 51

what are three types of physical trauma

Back 51

surgical trauma, head injury, neck injury

Front 52

physical trauma cuased waht percent of flaccid dysarthria cases

Back 52

33

Front 53

4 procedures that are at risk

Back 53

1. carotid endarterectomy (removal of plaque in artery)
2. cardiac surgery
3. removal of head and neck tumors
4. dental surgery

Front 54

CHI stands for

Back 54

closed head injury

Front 55

CHI can cause

Back 55

blows to the head and/or falls that will also damage the cranial nerves of speech production

Front 56

what is CVA

Back 56

blood flow to the brain is interrupted

Front 57

a stroke in one ofthe brainstem arteries can result in

Back 57

damage of the neurons served by that artery

Front 58

brainstem stroke: if blood supply is blocked then

Back 58

neurons will die

Front 59

severity of impairment due to brainstem stroke depends on

Back 59

the number of LMNs damaged due to a stroke

Front 60

myasthenia gravis affects

Back 60

the neuromuscular junction where the LMNs meet muscle tissue

Front 61

what are the primary symtpoms of myasthenia gravis

Back 61

rapid fatigue of muscle contraction

recovery after rest

Front 62

myasthenia gravis is caused by

Back 62

antibodies that damage parts of the muscle tissue that receive acetylcholine

Front 63

decrease in ach receptors results in

Back 63

the muscle not being able to use all the ach produced by the motor neuron

Front 64

with myasthenia gravis, the speech characteristics during PROLONGED speaking tasks: (4)

Back 64

- hypernasality
- decreased loudness
- breathy voice quality
- decreased articulatory precision

Front 65

Guillain- Barre syndrome is

Back 65

progressive inflammatory loss of myeline sheath (demyelination) generally int eh PNS

(info transmission) info in nervous system not processed as quickly

Front 66

guillain-barre syndrome can occur after

Back 66

some infections and immunizations

Front 67

progression of guillain-barre syndrome is

Back 67

rapid

Front 68

4 early symptoms of a patient with guillain-barre syndreom

Back 68

weakness and numbness in limbs early on

flacccid dysarthria and dysphagia

Front 69

recovery rate of people with guillain-barre syndrome?

Back 69

recover from this syndrome over a few weeks or months, but 5% die during the acute stages or may have permanent weakness

Front 70

polio is

Back 70

infectious viral disease

Front 71

polio attacks

Back 71

cell bodies in LMNs

Front 72

polio most often affects

Back 72

cervical and thoracic spinal nerves, resulting in respiratory weakness

Front 73

if there is respiratory weakness in a person with polio, then the speech characteristics may include: (4)

Back 73

- labored inhalation during speech
- shortened phrases
- speaking on residual air
- decreased loudness

Front 74

in 10-15% of cases of polio...

Back 74

LMNs in CN V, VII, IX, and X can also be affected

then person with have problems past respiratory system

Front 75

what are three other causes of flaccid dysarthria

Back 75

1. tumors
2. muscular dystrophy
3. progressive bulbar palsy

Front 76

what will tumor do

Back 76

will compress on brainstem, neck, or orofacial structure

Front 77

what is mucular dystrophy? results in?

Back 77

progressive degeneration of muscle tissue

results in weakness of muscles served by cranial nerves

Front 78

prgressive bulbar palsy is a type of? can affect?

Back 78

- a type of ALS
- can affect UMNs, but predominantly affects the LMNs

Front 79

with progressive bulbar palsy, if both UMN and LMNs are affected then...

Back 79

the person can have a mixed dysarthria

Front 80

what are the resonance characteristics of someone with flaccid dysarthria? (5)

Back 80

1. hypernasality (test with mirror
2. nasal emission (can't hear)
3. weak pressure consonants
4. shortened phrases- due to inefficiency in air usage
5. resonance deficits primarily reflect bilateral damage to the pharyngeal branch of CNX

the first three are the most obvious

Front 81

what are the characteristics of articulation of a person with flaccid dysarthria? (3)

Back 81

imprecis consonants
- large range in severity b/c depends on which CN invovled
- often the result of damage to the facial and hypoglossal nerves- most serious impact on articulation
-bilateral damage to CN VII will impact bilabials and labiodentals and vowels requiring lip rouding

Front 82

bilateral damage to CN XII will have an affect on which phonemes?

Back 82

alveolar and any lingual sound

Front 83

bilateral damage to the trigeminal can result in difficulty

Back 83

elevating the jaw sufficiently to bring the articulators into contact with each other

Front 84

what are the phonatory characteristics of a person with flaccid dysarthria?

Back 84

phonatory incompetence
- incomplete adduction of the VFs- due to damage to recurrent laryngeal nerve of CN X- breathy, stridor

Front 85

combined presence of what two voice qualities are strong indicators for the diagnosis of flaccid dysarthria?

Back 85

hypernasality and breathy voice

Front 86

what are the respiration characteristics of a person with flaccid dysarthria? (4)

Back 86

- respiration may be a component of flaccid dysarthria if the C and T spinal nerves responsible for innervating the diaphragm and intercostals are damaged
- inadequate amount of subglottic air pressure for speech resulting in:
- reduced loudness
- shortened phrase lenght
-strained voice quality
(first two more important)

Front 87

respiration and phonation are closely related, so how do you know if the person has poor respiratory suppor or decrease phonatory competence? (2)

Back 87

- have person produce a good cough
- ask person to produce a hard glottal stop

Front 88

if person has a breathy cough and sharp glottal stop then...

Back 88

respiratory problem

Front 89

if person has a breathy cough and weak glottal stop may indicate

Back 89

- possible phonatory problem (adduction minimally)
- may be respiration as well but don't know)

Front 90

what are 4 characteristics of prosody of a person with flaccid dysarthria

Back 90

1. monopitch (monotone)
2. monoloudness
3. reduced voice range profile- can't use full scale
4. the combination of reduced loudness and pitch range can occur in other types of dysarthria, thus are not diagstostic markers for flaccid dysarthria

Front 91

what are four types of tasks used to evaluate specific characteristics of flaccid dysarthria?

Back 91

- conversational speech sample
- alternate motion rate (AMR)
- prolonged phoantion of vowel
- speech stress test

Front 92

conversation speech sample tests (4)

Back 92

- resonance, articulation, respiration, prosody

Front 93

alternate motion rate will show

Back 93

slowed rate of phoneme production

Front 94

prolonged phonation of a vowel will assess

Back 94

voice quality

Front 95

speech stress test will assess

Back 95

fatiguing of hte speech mechanisms

Front 96

treatment of flaccid dysarthria; what is said about oral strengthening tasks?

Back 96

- value of these exercises is questionable
- it is suggested that strengthening exercises are most often appropriate for pts with a sever or a mild weakness (rationale: if doesn't help-> at least won't hurt)

Front 97

treatment for resonance deficits: (3)

Back 97

surgery
prosthese
modification of speech

Front 98

what are two surgery options?

Back 98

1. pharyngeal flap
2. teflon injection

Front 99

what is a prostheses

Back 99

palatal lift

Front 100

what are 6 characteristics of a good candidate for prosthese for treatment of resonance deficit with flaccid dysarthria?

Back 100

1. hypernasality is their most serious speech production deficit
2. stable medical condition
3. have enough teeth onto which the lift can be attached
4. no hyperactive gag reflex or significant oral spasticity
5. they have the patience and motivation to use the lift
6. ability to independently insert and remove the device

Front 101

how should speech be modified?

Back 101

increase loudness
reduce rate of speech
use a more open mouth position during speech (exagerated jaw movement of opening mouth when talk)

Front 102

what are five tasks use for treatment of phonation deficits

Back 102

1. pushing and pulling- effortful closure techniques
2. holding breath
3. hard glottal attack (not target, only method of acheiving target)
4. head turning toward the affected area in order to bring paralyzed vocal fold to midline (when not in public)
5. sideways pressure on larynx( push on thyroid cartilage right below jaw bone)
4.

Front 103

what are four tasks used for treatment of prosody

Back 103

1. pitch range exercises
2. intonation profiles
3. contrastive stress drills
4. chunking utterances into syntactic units


prosody treatment is the same for each motor speech disorder

Front 104

what are pitch range exercises

Back 104

patient needs to discriminate bt different pitches (high/low)

Front 105

what is intonation profiles

Back 105

drawing a line like on a treadmill to the intonation pattern of the phrase like good morning

Front 106

what is contrastive stress drills?

Back 106

putting stress in certain parts of sentences

Front 107

what is chunking utterances into syntactic units?

Back 107

breaking up into phrases to help mark places to breath

Front 108

treatment for damage to the hypoglossal nerve: traditional articulation treatment (4) first three are best ones

Back 108

1. intelligibility drills
2. phonetic placement
3. exaggerating consonants
4. minimal contrast drills

Front 109

what is an intelligibility drill

Back 109

child teaches himself how to fix mistake to be more intelligible

Front 110

what is phonetic placement

Back 110

showing patient how to produce sound by imitating and looking in mirror

Front 111

what is exaggerating consonants

Back 111

helps improve intelligibility- aka over articulation

Front 112

what is minimal contrast drills

Back 112

words that are the same except for one sound

Front 113

treating respiratory weakness: (4)

Back 113

1. correct posture
2. compensatory devices
3. speaking immediately on exhalation
4. cueing for complete inhalation