Motor Speech Exam 1: Flaccid dysarthria & other LMN disorders
Home > Flashcards > Print Preview
The flashcards below were created by user
on FreezingBlue Flashcards
. What would you like to do?
Flaccid dysarthria results from damage to the __ ___ ___ or any component of the motor unit. What are the components of the motor unit?
What cranial nerves are affected?
- lower motor neuron (final common pathway), all movements affected
- cell body, axon, neuromuscular junction, muscle fibers
- 5, 7, 9, 10, 11, 12; damage can be unilateral or bilateral
What are the primary clinical characteristics of flaccid dysarthria? What is tone?
- Weakness, hypotonia (floppiness), diminished reflexes
- May also see atrophy, fasciculations
- Electrical background activity in muscles
What are some etiologies of flaccid dysarthria?
What is paralysis?
What is paresis?
- Congenital, demyelinating (Guillen barre), infectious/inflammatory, degenerative (ALS), neuromuscular (myasthenia gravis)metabolic, neoplastic, traumatic, vascular
- Complete inability to contract muscle
- Reduced ability to contract muscle, weakness
Trigeminal nerve (V)
Elevator muscles of mandible
- Elevates/depresses jaw
- Tensor palatini-raises velum
- unilateral damage=no significant effects
- bilateral=consequential effects
- Masseter, temporalis, pterygoids
- Digastric, geniohyoid, mylohyoid, platysma
Lesion before branching= damage to...
Branch of facial nerve serving upper face receives bilateral innervation from UMN--damage results in...
Branch of facial nerve serving lower face received unilateral innervation from opposite side of brain so lesion results in...
- Ipsilateral side of face
- UMN lesion: minimal effects d/t bilateral innervation
- LMN lesion: contralateral lower face weakness
CN IX: Innervates muscles that help shape ___
involved in ___
CN X: 3 branches
- pharynx, gag reflex
- pharyngeal, superior & recurrent laryngeal; adductors and abductors--innervates all intrinsic laryngeal muscles
- Superior laryngeal branch unnerves cricothyroid
- Recurrent innervates rest
CN XI: innervates muscles of pharynx and larynx; accessory muscles of reparation such as ___ and ___
CN XII: Unilateral or bilateral damage results in...
- steernocleidomastoid, trapezius
- weakness, atrophy, fasciculations
LMN disorder signs
Hyporeflexia, muscle hypotonia, fasciculation, atrophy, focal or systemic
How does head injury affect LMN?
- CN VII and VIII
- CVA, hypoxia, fatigue, memory impairment, concentration deficits, anxiety, thoracic trauma
Unknown etiology causing flaccid dysarthria
Bell's Palsy: Speech & Unilateral damage...bilateral...
- Bell's Palsy: usually unilateral, sudden onset, rule out other problems like acoustic neuroma;
- Unilateral: not much audible effect
- Bilateral: Labial sounds
- result of surgery, usually unilateral; damage d/t trauma is usually bilateral effects depend on lesion
Age of onset?
Muscle weakness? Other symptoms?
- Age varies with type, generally random; more prevalent in women than men <40 and vice versa
- Weakness is variable, varies with time of day and level of activity; Chewing and swallowing difficulties at end of meal
- Also show ocular weakness, fatigue, dysphagia, speech problems
- Symptoms vary with stress, exertion, heat, infection, PMS, pregnancy
- Reflexes, sensation, coordination are normal
- Autoimmune disorder, affects neuromuscular junction, decrease amount of Ach that binds to receptor
- Treat w/ meds, surgery, thymectomy
Progressive disease; Denervation of muscles innervated from medullary cranial nerves (IX-XII). Initial sign is often ___ and ___ problems
What are speech signs?
- Dysphagia, speech
- Hypernasality, imprecise consonants, breathy voice, mono pitch
Speech motor evaluation of flaccid dysarthria
Indicators of impaired respiratory support may include..
- Intelligibility tests
- Cranial nerve signs
- Loudness differences, abnormal breathing patterns
Respiratory concerns of flaccid:
Patient's presenting complaints-may provide initial evidence of respiratory or phonatory involvement. Complaints may include....?
- Fatigue during speech
- SOB at rest, during exertion, or during speech
- Ability to only say a few words per breath
- Inability to increase loudness or shout
Cough vs. Glottal coup?
Sustained phonation time is also used a s a very general estimate of respiratory/phonatory capacity. What are caveats of this?
- Weak cough with limited abdominal and thoracic excursion suggest its at the respiratory system
- Weak glottal coup implies that the issue is at the vocal folds
- Confounded by interactions of effort and loudness, more accurately reflects maximum respiratory capacity rather than breath support for speech, age effects can be profound
What would you like to do?
Home > Flashcards > Print Preview