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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