Motor Speech Exam 1: Flaccid dysarthria & other LMN disorders

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Motor Speech Exam 1: Flaccid dysarthria & other LMN disorders
2014-09-30 01:21:45
flaccid dysarthria motor speech

Flaccid dysarthria A&P, characteristics
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  1. 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
  2. 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
  3. 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
  4. 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
  5. CNVII (facial)
    2 branches
    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
  6. 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
  7. 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
  8. LMN disorder signs
    Hyporeflexia, muscle hypotonia, fasciculation, atrophy, focal or systemic
  9. How does head injury affect LMN?
    • CN VII and VIII
    • CVA, hypoxia, fatigue, memory impairment, concentration deficits, anxiety, thoracic trauma
  10. Unknown etiology causing flaccid dysarthria
    Bell's Palsy: Speech & Unilateral damage...bilateral...
    CN X:
    • 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
  11. Myasthenia gravis
    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
  12. Bulbar palsy
    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
  13. Speech motor evaluation of flaccid dysarthria
    Indicators of impaired respiratory support may include..
    • Intelligibility tests
    • Cranial nerve signs
    • Loudness differences, abnormal breathing patterns
  14. Respiratory concerns of flaccid:
    Patient's presenting complaints-may provide initial evidence of respiratory or phonatory involvement. Complaints may include....?
    Attention to...?
    • 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
  15. 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

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