Voice Disorder Ch.5: Voice Problems Associated With Nervous System Involvement

Front 1

nervous system

Back 1

control of body functions (temperature, fas exchange, by product disposal), controls all systems in the body, even self regulating ones. control in higher brain centers. starting and stopping motor activity. coordination needed for phonation, respiration (which is ongoing) and artic. disease, malformation or injury will affect control capabilities.

Front 2

PNS

Back 2

control in lower brain centers. throughout the body outsides of the cranium and spinal cord. carries instructions to organs and muscles. mantaining muscle tone in a state of readiness. incoming sensori info into lower and higher centers is critical for control feedback, external feedback (visual) and internal feedback (i.e. pain)

Front 3

nervous system and respiration

Back 3

respiration is different for speech than for life support. a high level of control and coordination is needed, timed with voice and artic. first the larynx protexts the airway. control and coord of the laryngeal muscles is highly developed.

Front 4

afferent, sensory, autonomic

Back 4

sympathetic nervous system: prepares body for stressful situations (fight or flight). parasympathetic restores body to normal.

Front 5

efferent motor

Back 5

includes: upper motor neuron (cortex and pyramidal tracts). extrapyramidal (reticular substance), cerebellar, nuclear (lower motor neurons

Front 6

efferent: upper motor neurons

Back 6

cortex tracT: internal capsule, medulla, spine, lesions here cause different phonatory problems that cause spasticity or paralysis.

Front 7

efferent: extrapyramidal tract

Back 7

reticular substance (basal ganglia, deep brain, cerebellum. shy dager and parkinsons. lesions cause problems in coordination of laryngeal function --> athetoid movements (continuous).

Front 8

efferent: cerebellum

Back 8

control of pitch and loudness. finishing school for movement. lesions here --> cerebellar ataxia and changes in velocity of lip and jaw movements. lesions reflected as slurred or uncoordinated despite normal muscle tone and sensation. ataxia (choppy/spastic), nystagmus (eye movements), gait problems

Front 9

efferent: nuclear (lower motor neurons)

Back 9

brain stem and medulla. cranial nerves directly innervating the voice mechanisms. lesions to vagus (sup and rec laryngeal nerve) causes uni or bi VF paralysis. affects function of palate, pharynx, tongue, face and VOICE.

Front 10

neurogenic voice problems

Back 10

vary by what went wrong where. three general categories of phonatory dysfunction: abdudction or adduction problems, stability problems, coordination problems

Front 11

abduction/adduction problems: hypoadduction: myasthenia gravis (MG)

Back 11

chronic autoimmune neuromuscular disease characterized by weakness of the skeletal muscles of the body 2/2 inadequate release of the neurotransmitter ACh at the myoneural junction. weakening of striated muscls and prolonged return of function after activation. relatively rare, occurs twice as often in women (30s). and much earlier than in men (60s).

Front 12

symptoms of MG

Back 12

bulbar symptoms such as ptosis (droopy eyelids). leg weakness, fatigue, dysphonia, blurred vision, diplopia (double vision), fluctuation of function, restoration of function after rest. treated pharmacologically.

Front 13

voice characteristics of MG

Back 13

breathiness, hoarseness, vocal fatigue, vocal weakness with use, Dx tool--> count to 100 and they become fatigued.

Front 14

physiological signs of MG

Back 14

sluggishness of VF abduction, inability to maintain proper tension and glottic closure in any muscles over time, improves with rest.

Front 15

abduction/adduction problems: hypoadduction: Parkinsonism

Back 15

progressive degenerative, affects basal ganglia (substantia nigra--> depletion of dopamine). rigidity, resting tremor, reduced ROM of limbs, neck, head, decreased facial expression. shallow breathing. slowness of mvmt. bradykinesia: loss of automatic mvmts (blink, swallow).

Front 16

etiology of Parkinsonism

Back 16

etiology: virus, head trauma, toxic build up, drugs, vascular trauma, carbon monoxide, antipsychotic drugs. 75% have speech and voice disorders. 100% have problems as progress. treat voice, swallow, drooling, resonance and respiration.

Front 17

laryngeal involvement of Parkinson's

Back 17

difficulty initiating phonation, reduced volume, low pitch, excessive speaking rate, monopitch or low pitch (rigidity), harshness, breathiness (hypotonicity), tremulousness. very similiar to lewy body disease.

Front 18

abduction/adduction problems: hypoadduction: shy-dager syndrome

Back 18

variant of PD (Parkinson's plus), degeneration of autonomic nervous system. appears later middle age and affects men more than women. multiple system atrophy, postural hypotension (drop in blood pressure upon standing), impotence, sphincter probs, possible biochemical abnormality. 5-10 yr life span post dx. affects control and coord of speech and voice. abductor paralysis. worse than Parkinsons.

Front 19

abduction/adduction problems: hypoadduction: peripheral nerve paresis/paralysis

Back 19

lesions that affect the vagus nerve somewhere along course from base of skull to larynx par/par the laryngeal muscles. primary voice symptom: breathiness. may have bi adductor paralysis with neither VF moving to midline (no phonation/severe dysphagia). position of VF paralysis depends on if sup. laryngeal nerve is affected. also affects pitch changes.

Front 20

peripheral nerve contd

Back 20

for respiration, may need trach or excision of one or part of VF for airway integrity. 80% is uni paralysis with left TVC involved more than rt. high base of skull lesions include base of skull, tumor, Ca of nasopharynx or trauma. low vagal lesions: neuritis, mono, sarcoidosis, infections, viruses. 10% recover sponataneously.

Front 21

dx of paralysis

Back 21

in peds includes: stridor, abnormal cry, feeding difficulty and cyanosis (turning blue). hard to differentiate from fixation or arytenoid joint or dislocated arytenoid.

Front 22

upper motor neuron disorders: pseudobulbar palsy

Back 22

hyperaduction problem. (aka suprabulbar or supranuclear) bilateral lesions in corticobulbar tracts (down spine). progressive lesions usually the result of stroke (loss of coordination and inhibition). both pyramidal and extrapyramidal tracts affected.

Front 23

characteristics of pseudobulbar palsy

Back 23

spastic dysarthria, dysphagia and lability. excess and equal stress, imprecise articulation and hypernasality. harsh and strain/struggle (hyperactive lateral cricoarytenoid), breathy (hyperactive posterior cricoarytenoid, hypertonicity of abductors), monopitch and too low, monoloudness (spasticity restricts ability to vary subglottic pressures), respiratory probs.

Front 24

extrapyramidal disorders: ALS

Back 24

progressive degeneration of the motor neurons in the spine causing both muscle spasticity and weakness. upper and lower mn involved. phonatory stability (long term-tremor) problem. voice characteristics: hoarsness, strain/struggle, hypernasal, spasticity, harshness (bowing of VF 2/2 flaccidity). NO THERAPY.

Front 25

huntington's chorea

Back 25

hyperadduction. genetic, progressive, neurological. shows in mid 30s. disease of the basal ganglia, genetic or acquired resulting in abrupt, jerky, purposeless mvmt (dictates voice characteristics): hoarse, harsh, monopitch, strain/struggle, swallowing.

Front 26

cerebellar disorders: cerebellar ataxia

Back 26

lesions int he cerebellum create problems with coord of mvmt. errors in rate, range, direction and force. hypotonia, excess and equal stress, irreg artic breakdown, harsh, monopitch, low pitch, strain struggle, pitch breaks.

Front 27

arnold-chiari malformation

Back 27

congenital: cerebellum and brainstem elongated, squeezed into spinal column. affects cranial nerves. laryngeal stridor and abductor paralysis.

Front 28

lower motor neuron disorders: spasmodic dysphonia

Back 28

acquired, but unknown origin. neurogenic prob. physiologic causes: faulty snesory processing, not really spastic because LMN involved, treatment difficult= botox, voice amp, relaxation

Front 29

voice characteristics of spasmodic dysphonia

Back 29

adductor SD: strain, struggle, intermittent stoppages, popcorn. Abductor: breathy, drops in pitch, vowel prolongations. larynx is normal. hyperad seen, voice and jaw tremor, facial jerks, asymmetries of face.

Front 30

generalized nervous system damage: multiple sclerosis

Back 30

multiple scarring of the white matter in the CNS. appears in early adulthood (50/ 100,000), two kinds: remission and exacerbation/unrelenting. gradually increasing incoordination, spasticity and weakness of muscles/larynx.

Front 31

MS voice characteristics:

Back 31

swallow probs, weakness affects VF closure, spasticity affects control over adduction, incoordination affects periodicity of vibration. impaired loudness control, harshness, hypernasality, F0 unchanged. hypertonicity, low air flows, high lung pressures, larynx normal. managed with drugs.

Front 32

lesions of the peripheral nerve

Back 32

vagus nerve lesions most common cause of VF paralysis. etiologies: neuritis after URI, mono, parapharyngeal infections, neoplasms, trauma, surgery.

Front 33

sup. laryngeal nerve

Back 33

SLN higher in the next, innervates the cricothyroid muscles and adducts the VF and stretches them to raise pitch.

Front 34

recurrent laryngeal nerve (RLN)

Back 34

lower in the neck, innervates all the other laryngeal muscles, intrinsic and extrinsic. lesion may create uni or bi ad paralysis.

Front 35

adductor paralysis

Back 35

VFs dont moves to midline

Front 36

abductor paralysis

Back 36

VFs dont move away from midline

Front 37

voice characteristics of peripheral nerve damage

Back 37

unilat paralysis (breathiness, hoarseness, occasion diplophonia, increased airflows/lung pressure) bil adductor paralysis (near normal voice, inspiratory stridor)

Front 38

essential tremor (long term tremor)

Back 38

regular involuntary muscle mvmts in the head, limbs, tongue, palate and larynx. absent at rest, worse upon sustained contraction and with mvmt. voice characteristics: tremor with reg modulation of freq. physiological: normal laryngeal structure, regular mvmt may be observed.

Front 39

generalized nervous system-unknown disorders: tourettes

Back 39

develops btw 2 and 13. twitch, grimace, facial ticks, unusual sounds and barks, coprolalia (blurting explatives). need to touch, pharmocological control of disease. diminishes through adulthood.