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XXXMotor Speech

XXXSpastic Dysarthria

QuestionAnswer
Flaccid Dysarthria is caused by LMN damage
SPASTIC Dysarthria is caused by BILATERAL UMN DAMAGE
Spastic Dysarthria think of pushing something really rusty – requires lots of effort very effortful speech slow and labored speech reeaaallly slow and labored speech!
Spastic Dysarthria = weakness and slowness of the movements of speech due to slowness of the musculature
These typically get damaged together as they run closely together through the internal capsule extrapyramidal and pyramidal systems
Damage to indirect neural pathway known as the extrapyramidal system SPASTICITY
Weakness can be caused by damage to which two systems pyramidal and extrapyramidal
Direct = pyramidal
Indirect = extrapyramidal
How does spasticity affect muscle tone increased tone making it even harder to move because muscle is tense but also WEAK so REALLY hard to move it.
If a person has a stroke in only one hemisphere of the brain can they have spastic dysarthria? no
What if I person had spastic dysarthria but they had a stroke in only one hemisphere of the brain how could this be? They must have had a stroke previously in the other hemisphere which would put BOTH SIDES OUT.
Most likely cause of spastic dysarthria a stroke in the brainstem.
Could someone with TBI have spastic dysarthria? yes but it is more likely they would have mixed dysarthria.
If you have one stroke in ONE HEMISPHERE you cannot have spastic dysarthria. Was there another stoke in the other hemisphere prior? If yes
TBI COULD have spastic dysarthria but more likely to have mixed dysarthria.
What is the impact on VOT for voiceless consonants in a patient with spastic dysarthria? a patient with spastic dysarthria would have a SHORT VOT for voiceless consonants and vowel combinations.
Typically with a voiceless stop and vowel there is a longer lag but not with patients with spastic dysarthria.
Muscle spasticity in the vocal folds in a patient with spastic dysarthria can result in low pitch prosody issues and strangled vocal quality.
Strained strangled vocal quality in a patient with spastic dysarthria may relate to overly adducted vocal folds and muscle spasticity
Resonance issues are more prevalent in FLACCID dysarthria but can still occur in spastic dysarthria too.
Nasal emission is more prevalent in FLACCID dysarthria. It is uncommon in spastic dysarthria.
Drooling is an issue with spastic dysarthria – meds often used to help with social ramifications.
THESE THREE SPELL SPASTIC DYSARTHRIA SLOW SPEECH SLOW AMRS & STRAINED STRANGLED VOCAL QUALITY SLOW SPEECH RATE AND SLOW AND REGULAR SPEECH AMRS
SLOW AND REGULAR AMRS ARE TYPICAL FOR SPASTIC DYSARTHRIA.
Spastic Dysarthria vocal quality STRAINED VOICE. Slightly hypernasal at time but without nasal emission...
Prolonged words can result from spastic dysarthria because stiff muscles move sluggishly and slow and labored speech
UMNS are part of the CNS
UMNs originate in what part of the brain cortex and brainstem
Two neural pathways direct and indirect aka pyramidal and extrapyramidal
UMNS of the pyramidal originate in the motor areas of the cortex
UMN pyramidal tracts include which two tracts corticobulbar and corticospinal
What is it that transmits discreet skilled movements to the LMN? UMNs
Damage to the Extrapyramidal System = weakness increased spasticity/muscle tone and abnormal muscle reflexes
Spasticity = indirect
abnormal reflexes = indirect
weakness = direct and indirect
slowness of movement = direct
To have SPASTIC DYSARTHRIA what THREE FACTORS ARE IN PLACE damage to UMNs bilateral damage both extrapyramidal and pyramidal tracts are affected
What do you call if when the damage is UNILATERAL? UUMN DYSARTHRIA
Most common cause of Spastic Dysarthria brainstem stroke or two or more strokes in the cerebral hemispheres
ALS Amyotrophic Lateral Sclerosis
Amyotrophic Lateral Sclerosis progressive degeneration of UMNs and LMNs life expectancy 22 months after onset may be flaccid first or spastic first but end result is both which is called mixed dysarthria
TBI can be bilateral in both systems resulting in spastic or mixed dysarthria
Multiple Sclerosis immunologic disorder where myelin is destroyed in CNS resulting in spastic dysarthria as well as other types including ataxic and mixed depending on where dymyelination occurs
Other things that can cause Spastic Dysarthria brainstem tumor
Cereral anoxia can cause spastic dysarthria because it can cause widespread damage to UMNs bilaterally
Spastic dysarthria an also have imprecise consonants - most common characteristic!
Imprecise consonants are caused by slowness of movement and or reduced ROM in spastic dysarthritic patients
Velar muscles can be imipacted in spastic dysarthria due to reduced ROM of velar muscles resulting in hypernasality without nasal emission though...
Prosody in spastic dysarthria monopitch monoloudess short phrases slow rate of speech
Pseudobulbar Affect uncontrollable laughing or crying that may accompany spastic dysarthria
Drooling and dysphagia can occur with spastic dysarthria because of muscle weakness and spasticity
Key Evaluative Tasks with spastic dysarthria are conversational speech and reading speech AMRs and vowel prolongation
Treatment for phonation deficits in spastic dysarthria easy onset of phonation yawn and sigh
Treatment possibilities in spastic dysarthria decrease hyperadduction increase articulatory precision developing natural prosody decreasing hypernasality
Articulation treatments with spastic dysarthria intelligiblity drills phonetic placement exaggerating consonants minimal contrast drills
Prosody treatment with spastic dysarthria pitch range exercises intonation profiles contrastive stress drills chunking utterances into syntactic units
Treatment of resonance with spastic dysarthria palatal lift surgical intervention behavioral management techniques such as increasing loudness as long as it doesn't overly increase VF tension, open mouth position, use SeeScape for feedback. Do NOT slow speech as it is already super slow...
See Scape provides feedback on nasal emission