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40 Cards in this Set
- Front
- Back
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Spastic Dysarthria |
a. type of speech disorder resulting from bilateral damage to UMNs
b. results in: -Spasticity -Slow and labored speech -Prolonged words (b/c slow) |
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UMNs Role in Spastic Dysarthria |
a. Review
-UMNs are part of the CNS -Originate in the cortex and brainstem -UMNs are grouped into the pyramidal and extrapyramidal systems b. Spastic dysarthria caused by bilateral damage to: -Pyramidal (direct) AND -Extrapyramidal (indirect) neural pathways |
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UMNs Role in Spastic Dysarthria (Continued) |
a. UMNs of the pyramidal system
-Originate in the motor areas of the cortex -Course down to the LMNs, which will then innervate the muscles b. UMN pyramidal tracts are divided into -Corticobulbar tract -Corticospinal tract c. Responsible for transmitting discrete skilled movements to the LMNs d. Damage results in: -Weakness* -Slowness of the speech musculature |
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Extrapyramidal System |
a. Complex network of pathways
b. Has numerous interconnections throughout brain (e.g., red nucleus and reticular formation) -UMNs of the extrapyramidal system eventually synapse with LMNs of the cranial and spinal nerves |
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Damage to Extrapyramidal System Causes |
a. Spacticity (Increased muscle tone)
b. Abnormal reflexes c. Weakness* NB: Typically, if there is damage to one system, there is damage to the other, because the neurons are close to each other |
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a
*Features of Disordered Movement in Bilateral UMN Lesions (4)* |
a. Spasticity (extrapyramidal)
b. Abnormal reflexes (extrapyramidal) c. Weakness (both pathways) d. Slowness of movement (pyramidal) |
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aa
Neurological Basis |
a. To have spastic dysarthria, u need 3 things:
-Damage to UMNs -Bilateral damage -Both the extrapyramidal and pyramidal tracts will be affected b. If damage is only unilateral, the result is UUMN (unilateral umn) dysarthria. |
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aaa
Etiologies of Spastic Dysarthira |
a. Most common cause: one stroke in the brainstem
b. Two or more strokes in the cerebral hemisphere c. Other (ALS, TBI, MS) NB: A single stroke in one of the hemispheres cannot cause spastic dysarthria |
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aaaa
Amyotrophic Lateral Sclerosis (ALS) |
a. Results in progressive degeneration of the UMNs and LMNs
b. Average life expectancy is 22 months from the onset c. The course of ALS varies across individuals -Some 1st present with LMN involvement (Flaccid dysarthria, atrophy) -Others primarily have UMN involvement (Spastic dysarthria) d. Hyperactive gag reflex and jaw reflexes NB: Eventually both UMNs and LMNs are affected resulting in a mixed dysarthria |
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aaaaa
Traumatic Head Injury (TBI) |
a. Damage can be extensive due to brain shifting in the cranium causing damage to
axons, brain tissue, and hemorrhaging b. People with TBI are likely to exhibit mixed dysarthria as well as spastic dysarthria |
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b
Multiple Sclerosis (MS) |
a. Immunologic disorder resulting in inflammation or complete destruction of the myelin covering the axons
b. MS can affect myelin anywhere in the CNS, thus, can result in spastic dysarthria as well as other types (ataxic, mixed) depending where demyelination occurs. |
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bb
Other Causes |
a. Brainstem tumor - functions like stroke by compressing both tracts
b. Cerebral anoxia - capable of widespread neural damage extending to UMNs bilaterally |
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bbb
Etiologies % of Spastic Dysarthria |
a. Vascular (31%) - Stroke (27%)
b. Degenerative (30%) - ALS (9%) c. TBI (10%) d. Demyelinating (6%) -MS e. Tumor (4%) |
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bbbb
Articulation |
a. Articulation Errors - *imprecise consonants* (Most common characteristic found)
b. Results in: -Short VOTs for voiceless consonants + v (longer lag than voiced consonants + v) -Incomplete articulatory contact -Incomplete consonant clusters -Vowel errors -Caused by slowness of movement and/or reduced range of movement during speech -Slower AMR |
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bbbbb
Phonation |
a. Harsh vocal quality (friction of air quality)--> By keeping the VF partially abducted, the patient is able to prevent the spastic muscle tone from closing the glottis too tightly
b. *Strained-strangled vocal quality* -Characterized by subglottic air being forced through a tight constriction due to spasticity of the laryngeal muscles c. Low pitch |
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c
Resonance |
a. Many patients have involvement of the velar muscles
-Velar movement was slow with a reduced range of movement -Resulting in hypernasality (not as pronounced as in flaccid) b. No nasal emission usually |
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cc
Prosody |
a. Monopitch intonation in connected speech
-Caused by overall spasticity of the laryngeal muscles b. Monoloudness -Also due to spasticity of the laryngeal muscles, thus, difficulty controlling/regulating subglottic pressure for loudness (b/c vf can't close well) c. Short phrases -Natural consequence of an abnormally tight larynx d. Slow rate of speech -Due to reduced speed and ROM of the articulators |
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ccc
Confirmatory Signs |
a. Pseudobulbar Affect
b. Drooling c. Dysphagia |
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cccc
Pseudobulbar Affect |
a. Uncontrollable crying or laughing due to damage of areas needed for inhibiting emotions
b. Emotion displayed can be independent of emotions felt c. Pharmaceutical therapies have not been very effective, but patient’s recovery progress may be of benefit (not effective b/c not related to emotions) d. Not all patients with spastic dysarthria display this affect, but it occurs more often in this type of dysarthria than with others |
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ccccc
Drooling |
a. Also can occur in other types of dysarthria, but most predominant in spastic dysarthria
b. Due to impaired oral control of saliva and/or less frequent swallowing c. Can be treated with cueing to swallow, as well as pharmaceutical treatments (that dry up saliva) NB: Becomes social issue - eg: eating, while drooling, in public |
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d
Dysphagia |
a. Chewing is more effortful
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dd
*Distinguishing Features of Spastic Dysarthria* (Cluster) |
a. Strained-strangled voice quality
b. Slow speech rate c. Slow, regular speech AMRs |
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ddd
*Spastic vs. Flaccid Dysarthria* |
a. Spastic:
-Bilateral UMN lesion -Hypernasality Tight, harsh or strained VQ b. Flaccid: -LMN lesion -Hypernasality + nasal emission -Breathy VQ |
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dddd
Key Evaluative Tasks |
a. Conversational speech and reading (connected!)
b. Speech AMRs c. Vowel prolongation |
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ddddd
Treatment Possibilities |
a. Decrease hyperadduction of the vocal folds
b. Increase articulatory precision c. Develop natural prosody d. Decrease hypernasality |
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e
Phonetic Treatment |
a. Relaxed phonation exercises:
-Easy onset of phonation -Yawn sigh NB: Practice! NB: Opposite of treatment for flaccid dysarthria |
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ee
Easy Onset of Phonation |
a. Patient exhales while producing a smooth quiet sigh
b. Sighs are shaped into vowels c. Patient can also begin words with breathy consonants /wh/ NB: Goal is to build toward easy phonations of sentences in conversation NB: This can be hard for some patients at first, so have them start w/ Yawn and Sigh Technique |
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eee
Yawn and Sigh |
a. Patient inhales slowly with an open mouth (yawn) and exhales while producing a smooth, quiet, prolonged sigh, which is shaped into a vowel
b. Then produce breathy consonant like /house/ (an easy transition from /ahh/) on exhale c. Then produce /wh/ in next step d. Goal is to build toward easy phonation in sentences NB: Yawning should relax the neck muscles NB: Sighing can be shaped into words similar to easy onset |
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eeee
Articulation Treatment |
a. Intelligibility drills
b. Phonetic placement c. Exaggerating consonants d. Minimal contrast drills |
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eeeee
Prosody Treatment |
a. Pitch range exercises
b. Intonation profiles c. Contrastive stress drills d. Chunking utterances into syntactic units |
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f
Pitch Range Exercises |
a. Addresses pitch & intonation
b. Make sure patient can distinguish between pitches first c. Use visual feedback, such as visi-pitch d. Have patient sing up and down the scale NB: Bio Feedback is physical feedback |
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ff
Intonation Profiles & Contrastive Stress Drills |
a. Both address pitch and intonation
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fff
Chunking Utterances into Syntactic Units |
a. Addresses breathing and natural speech pattern
b. Example: When to pause during a sentence |
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ffff
Resonance Treatment |
a. Palatal lift prosthesis
b. Surgical intervention c. Behavioral Mgmt techniques |
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fffff
Palatal Lifts |
a. Fit by prosthodontists
b. Person begins with a lift that is a little shorter and narrower than the ideal fit c. Patient builds tolerance for the appliance and material is gradually added on until the person has the best fit NB: This is ideal tx option for pt's with velo-pharyngeal insufficiency as primary complaint |
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g
Contrary Indications to Palatal Lift |
a. Person with mild VPI should first start with behavioral management, which may be enough
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gg
Factors Influencing Palatal Lift Success |
a. Patient compliancy
b. Cognition c. Intact language skills d. Family support e. Realistic expectations f. Co-existence of other MSD g. Dental health |
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ggg
Surgical Intervention |
a. Nasopharyngeal muscle augmentation using Teflon, silicone rubber, etc.
b. Pharyngeal flap procedures |
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gggg
Behavioral Mgmt Techniques |
a. Nonspeech and speech velopharyngeal musculature exercises with accompanying aerodynamic biofeedback
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ggggg
See-Scape |
a. Speech modification with biofeedback
b. Provides feedback on nasal emission NB: Might be helpful in providing visual feedback while working on decreasing hypernasality (e.g., individuals who are already fitted with the palatal lift) |
