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XXX UUMN

QuestionAnswer
What happens when there is only unilateral damage to upper motor neurons? UUMN can happen
Most cranial nerves serving the speech muscles receive unilateral or bilateral innervation? Most cranial nerves serving the speech muscles receive BILATERAL innervation from the UMNs.
Right UMN damage will result in lower left side of the face weakness and tongue weakness
Damage to right UMN will result in lower left side of face an tongue weakness
Severe damage to UMN can result in hemiplegia but more usually the result is unilateral weakness
Unilateral weakness resulting from damage to the UMN can affect the tongue in what way? The tongue movement can be slow with a reduced ROM
What could cause a hemi-lower facial droop? Damage to the right UMN.
If there is damage to the Right UMN, how might the tongue deviate? The tongue might deviate due to UMN lesion and would deviate to the affected side when protruded. Therefore a Right UMN damange would result in the tongue deviating to the left.
Patient may complain of their tongue feeling slow and clumsy if their tongue is impacted by an UMN lesion
UMNs bilaterally innervate which speech mechanisms? UMNs bilaterally innervate the velum, pharynx, and larynx and thus these structures should not be affected by UUMN damage... however...
Even though UMN's bilaterally innervate speech mechanisms, a UUMN can still impact structures additional to tongue and lower face. We know this due to mild hypernasality and harsh voice quality can result from UUMN damage even though it shouldn't technically happen...
UUMN Dysarthria accounts for only what percentage per Duffy's Data? 9% of motor speech disorders fall into the UUMN category.
Damage to an UMN on ONE SIDE (UUMN) results in what? Weakness of the lower face, lips, tongue on the opposite side of the lesion.
UUMN damage is permanent or temporary? It could be either.
UUMN is often accompanied by weakness in the extremities of the opposite side. Weakness in the extremities of the opposite side of the UUMN is an accompanying trait.
What are some Etiologies of UUMN? Anything that can cause damage to UMNs on one side of the brain. Usually, this is Stroke.
The most frequent cause of UUMN is Stroke
91% of the UUMN cases according to Duffy and Folger was: Stroke
UUMN lesions can occur in this part of the brain UUMN lesions can occur in any part of the brain that contains UMNs including cortical and subcortical areas.
Internal capsule, pericapsular region, frontal lobe, thalamus, midbrain, pons, cortical and subcortical areas: areas where a UUMN could occur.
How can a tumor cause a UUMN? Tumors are not a common etiology but if they destroy UMNs, displace UMNs or compress blood flow leading to death of UMN cells they could cause a UUMN. More likely though that they would cause BILATERAL effects which is NOT a UUMN.
Brain tumor could be a direct cause of UUMN by destroying nearby UMNs as it grows: there would be degradation of transmission of the UMN impulses to the LMNs.
Brain tumor could be a direct cause of UUMN by displacing UMNs The direct pressure would compromise the function of the neurons
Brain tumor could be a direct cause of UUMN by compressing arteries or veins serving the UMNs which would interfere with blood flow to and from the UMN cells.
Tumors are not a common cause of UUMNs because Tumors more likely cause tumors more likely cause bilateral damage.
UUMN in the right hemisphere could also cause cognition problems
UUMN tends to be mild but can come with apraxia, aphasia or cognition issues.
The focus of UUMN treatment is often focused on aphasia, language issues, apraxia or cognition issues but not so much as a dysarthria problem.
Tongue has only this kind of innervation: CONTRALATERAL
UUMN is MOSTLY a problem of the TONGUE and therefore these speech characteristics often present: slow AMR and imprecise articulation
Why does a person get slow AMR and imprecise articulation with a UUMN? Because range of motion is decreased and there is also a decrease in fine motor control.
Is phonation impacted with a UUMN? Not usually. The primary symptom of a UUMN is ARTICULATION. Some people get hypernasality but only very mildly and in a small number of patients.
Only a small percentage of patients get very mild hypernasality resonance issues and phonation issues with UUMN
Imprecise Articulation is key with UUMN
Can the patient or the clinician PREDICT errors with a UUMN? Yes! With a UUMN the patient or clinician CAN PREDICT ERRORS! Heavy with articulation errors but PREDICTABLY so.
Bilateral damage to Upper Motor Neurons that includes both the Pyramidal and Extrapyramidal Neural Pathways Spastic Dysarthria
If damage is only unilateral, the result is Unilateral Upper Motor Neuron Dysarthria, (UUMN Dysarthria.) UUMN is unilateral damage to UMNs.
Severity of UUMN damage can range from mild to moderate
How can phonation be impacted with a UUMN? Mild to moderate harsh vocal quality. Duffy and Folger: 39% of UUMN patients.
How can resonance be impacted with a UUMN? Duffy and Folger:11% of UUMN cases had hypernasality. A UUMN lesion alone could only result in a very mild hypernasality. Other causes of hypernasality could be illness or a prior lesion.
Summary of UUMN: key deviant speech characteristic = imprecise articulation.
Other features that MAY occur with UUMN slowed rate of speech, harshness, hypernasality (very mild if present) and irregular articulatory breakdowns (?)
How would you conduct Key Evaluative Tasks to detect a UUMN? Review medical chart for site of lesion. Connected speech sample. AMR Task. Prolonged Vowel.
Treatment of UUMN Dysarthria: use traditional treatments for dysarthria but in general if other disorders are co-occurig then dysarthria is generally the last priority. Use Traditional Articulation Tasks.
Traditional Articulation Tasks: Intelligibility Phonetic Placement Exaggerating Consonants Minimal Contrast Drills