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113 Cards in this Set

  • Front
  • Back
flaccid dysarthria is caused by
impairment of the LMNs of the cranial or spinal nerves Ex. damage to the PNS
characteristics of flaccid dysarthria (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)
what is the neurological basis of flaccid dysarthria (2)
- 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
what are 5 confirmatory signs of flaccid dysarthria
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)
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)
1. trigeminal
2. facial
3. glossopharyngeal
4. vagus
5. accessory
6. hypoglossal
trigeminal CN V attaches at the level of the
trigeminal cn V is divided into how many branches and what are they called
1. opthalamic
2. maxillary
3. mandibular (imp for speech)
why is mandibular branch the most imp for speech production
innervates muscles that elevate and lower the jaw
unilateral damage to the CN V trigeminal nerve has what 4 effects

1. weakness?
2. deveiate?
3. confirmatory sign?
4. speech production?
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)
bilateral damage to the CN V trigeminal nerve has what 3 effects
1. jaw?
2. which sounds affected?
3. speech rate?
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
can someone produce sound wihtout pushing jaw up??
sensory affects of bilateral damage to the trigeminal nerve
no sensation to face causes problems
what are two major branches of the facial nerve CN VII
1. cervicofacial branch: innervates lower facial muscles
2. temporofacial branch: innervate upper face
lower motor neuron lesion to the facial nerve CN VII
-above the point of division results in:
-below the point of division results in:
above: entire ipsilateral facial weakness
below: muscles innervated by the specific branch will be affected
Upper motor neuron lesion:

UMNs of the corticobulbar tract innervate:
the LMNs of the two branches of the facial nerve
Facial nerve::

upper face receives _____UMN innervation
bilateral UMN inneravtaion
lower face receives UMN
UMN innervation from teh contralateral side of the brain
Facial nerve:

what will happen if there is right LMN lesion above the point of division?
entire right face damage
what will happen if there is right corticobulbar tract damage
lower left face damage
unilateral damage to the facial nerve results in (3)(speech characteristics)
- mild distortion of bilabial and labiodentals
- flutter of the cheeks
- reduced precision of/pa/ for AMRs
bilateral damage to the facial nerve (2)
- distortion or inability to produce bilabials and labiodentals
- slow rate
glossopharyngeal nerve CN IX originates at the level of the
the glossopharyngeal nerve CN IX courses out to the _______ innervating the (2)
courses out to the pharynx innervating the stylopharyngeus and superior pharyngeal constrictors
the superior pharyngeal constrictors assists in....

- what will test the function of the CN IX
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)
what is the exact contribution of CN IX glossopharyngeal nerve to speech
unclear because of close approximation of the vagus nerve but most likely articulation and resonance affected.
Vagus nerve (X) is very important for
vagus nerve (CN X) originates at.... just below....
originates at the medulla just below the CN IX.
vagus nerve (CN X) courses near
describe vagus nerve CN X
long and serves many parts of the body (larynx, intestines, heart, velum)
what are three important branches of CN X for speech production
1. pharyngeal branch
2. external superior laryngeal nerve branch
3. recurrent laryngeal branch
pharyngeal branch of CN X innervates
muscles of hte pharynx and soft palate
pharyngeal branch of CN X is responsible for (2)
1. pharyngeal constriction
2. palatal elevation and retraction
unilateral damage to pharyngeal branch of CN X results in
the affected side of the velum hanging lower than the unaffected side-> generally does not result in VPI (velo pharyngeal insuficiency)- enough compensation
bilateral damage of pharyngeal branch of CN X results in
hypernasality- pressure consonants will be distorted - can't hold in air- inter oral pressure, stops, fricatives, affricates
external superior laryngeal nerve branch of CN X innervates the
what does the cricothyroid do
stretches and tenses the VFs, thus controls pitch
unilateral damage to external superior laryngeal nerve branch of CN X will
have a mild effect on varying pitch
bilateral damage to external superior laryngeal nerve branch of CN X will (3)
1. decreased loudness- maybe
2. increased breathiness- maybe
3. monotone (decreased pitch variation)- most obvious
recurrent laryngeal branch of CN X supplies
motor innervation to all the intrinsic laryngeal muscles except for the cricothyroid
recurrent laryingeal branch of CN X is important for
VF adduction and abduction
unilateral damage to recurrent laryngeal branch of CN X may result in
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)
bilateral damage to recurrent laryngeal branch of CN X can
fix both VFs in the paramedian position resulting in inhalatory stridor (still can phonate, not well, breathy, horse)
accessory nerve (XI) merges with
vagus nerve
spinal portions of accessory nerve XI supply
motor innervation for the sternocleidomastoid and trapezius
damage to vagus nerve means there is also damage in
accessory nerve
hypoglossal nerve (CN XII) provides
motor innervation for all intrinsic lingual muscles and most of the extrinsic
unilateral damage to hypoglossal nerve (CN XII) results in 4
-weakness on the same side as the nerve damage
- damaged side with atrophy
- protrusion will deviate twoard the affected side
- mild articulatory distortions
bilateral damage to hypoglossal (CN XII) will result in (6)
-bilateral muscle will atrophy and weakness
- reduced ROM-> imprecise articulation
- difficulty with pronouncing alveolars and velars
UMN innervation of hypoglossal CN XII is contralateral only -> damage to the L UMNs results in
weakness in the R side of the tongue
what are 8 etiologies of Flaccid dysarthria?
1. physical trauma
2. brainstem stroke
3. myasthenia gravis
4. guillain-barre syndrome
5. polio
6. tumors
7. muscular dystrophy
8. progressive bulbar palsy
what are three types of physical trauma
surgical trauma, head injury, neck injury
physical trauma cuased waht percent of flaccid dysarthria cases
4 procedures that are at risk
1. carotid endarterectomy (removal of plaque in artery)
2. cardiac surgery
3. removal of head and neck tumors
4. dental surgery
CHI stands for
closed head injury
CHI can cause
blows to the head and/or falls that will also damage the cranial nerves of speech production
what is CVA
blood flow to the brain is interrupted
a stroke in one ofthe brainstem arteries can result in
damage of the neurons served by that artery
brainstem stroke: if blood supply is blocked then
neurons will die
severity of impairment due to brainstem stroke depends on
the number of LMNs damaged due to a stroke
myasthenia gravis affects
the neuromuscular junction where the LMNs meet muscle tissue
what are the primary symtpoms of myasthenia gravis
rapid fatigue of muscle contraction

recovery after rest
myasthenia gravis is caused by
antibodies that damage parts of the muscle tissue that receive acetylcholine
decrease in ach receptors results in
the muscle not being able to use all the ach produced by the motor neuron
with myasthenia gravis, the speech characteristics during PROLONGED speaking tasks: (4)
- hypernasality
- decreased loudness
- breathy voice quality
- decreased articulatory precision
Guillain- Barre syndrome is
progressive inflammatory loss of myeline sheath (demyelination) generally int eh PNS

(info transmission) info in nervous system not processed as quickly
guillain-barre syndrome can occur after
some infections and immunizations
progression of guillain-barre syndrome is
4 early symptoms of a patient with guillain-barre syndreom
weakness and numbness in limbs early on

flacccid dysarthria and dysphagia
recovery rate of people with guillain-barre syndrome?
recover from this syndrome over a few weeks or months, but 5% die during the acute stages or may have permanent weakness
polio is
infectious viral disease
polio attacks
cell bodies in LMNs
polio most often affects
cervical and thoracic spinal nerves, resulting in respiratory weakness
if there is respiratory weakness in a person with polio, then the speech characteristics may include: (4)
- labored inhalation during speech
- shortened phrases
- speaking on residual air
- decreased loudness
in 10-15% of cases of polio...
LMNs in CN V, VII, IX, and X can also be affected

then person with have problems past respiratory system
what are three other causes of flaccid dysarthria
1. tumors
2. muscular dystrophy
3. progressive bulbar palsy
what will tumor do
will compress on brainstem, neck, or orofacial structure
what is mucular dystrophy? results in?
progressive degeneration of muscle tissue

results in weakness of muscles served by cranial nerves
prgressive bulbar palsy is a type of? can affect?
- a type of ALS
- can affect UMNs, but predominantly affects the LMNs
with progressive bulbar palsy, if both UMN and LMNs are affected then...
the person can have a mixed dysarthria
what are the resonance characteristics of someone with flaccid dysarthria? (5)
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
what are the characteristics of articulation of a person with flaccid dysarthria? (3)
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
bilateral damage to CN XII will have an affect on which phonemes?
alveolar and any lingual sound
bilateral damage to the trigeminal can result in difficulty
elevating the jaw sufficiently to bring the articulators into contact with each other
what are the phonatory characteristics of a person with flaccid dysarthria?
phonatory incompetence
- incomplete adduction of the VFs- due to damage to recurrent laryngeal nerve of CN X- breathy, stridor
combined presence of what two voice qualities are strong indicators for the diagnosis of flaccid dysarthria?
hypernasality and breathy voice
what are the respiration characteristics of a person with flaccid dysarthria? (4)
- 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)
respiration and phonation are closely related, so how do you know if the person has poor respiratory suppor or decrease phonatory competence? (2)
- have person produce a good cough
- ask person to produce a hard glottal stop
if person has a breathy cough and sharp glottal stop then...
respiratory problem
if person has a breathy cough and weak glottal stop may indicate
- possible phonatory problem (adduction minimally)
- may be respiration as well but don't know)
what are 4 characteristics of prosody of a person with flaccid dysarthria
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
what are four types of tasks used to evaluate specific characteristics of flaccid dysarthria?
- conversational speech sample
- alternate motion rate (AMR)
- prolonged phoantion of vowel
- speech stress test
conversation speech sample tests (4)
- resonance, articulation, respiration, prosody
alternate motion rate will show
slowed rate of phoneme production
prolonged phonation of a vowel will assess
voice quality
speech stress test will assess
fatiguing of hte speech mechanisms
treatment of flaccid dysarthria; what is said about oral strengthening tasks?
- 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)
treatment for resonance deficits: (3)
modification of speech
what are two surgery options?
1. pharyngeal flap
2. teflon injection
what is a prostheses
palatal lift
what are 6 characteristics of a good candidate for prosthese for treatment of resonance deficit with flaccid dysarthria?
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
how should speech be modified?
increase loudness
reduce rate of speech
use a more open mouth position during speech (exagerated jaw movement of opening mouth when talk)
what are five tasks use for treatment of phonation deficits
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)
what are four tasks used for treatment of prosody
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
what are pitch range exercises
patient needs to discriminate bt different pitches (high/low)
what is intonation profiles
drawing a line like on a treadmill to the intonation pattern of the phrase like good morning
what is contrastive stress drills?
putting stress in certain parts of sentences
what is chunking utterances into syntactic units?
breaking up into phrases to help mark places to breath
treatment for damage to the hypoglossal nerve: traditional articulation treatment (4) first three are best ones
1. intelligibility drills
2. phonetic placement
3. exaggerating consonants
4. minimal contrast drills
what is an intelligibility drill
child teaches himself how to fix mistake to be more intelligible
what is phonetic placement
showing patient how to produce sound by imitating and looking in mirror
what is exaggerating consonants
helps improve intelligibility- aka over articulation
what is minimal contrast drills
words that are the same except for one sound
treating respiratory weakness: (4)
1. correct posture
2. compensatory devices
3. speaking immediately on exhalation
4. cueing for complete inhalation