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XXX AtaxicDysarthria

XXX Ataxic Dysarthria

QuestionAnswer
Ataxic Dysarthria results from damage to the cerebellum
Most noticeable characteristic for Ataxic Dysarthria problems with articulation and prosody
Speech characteristics of ataxic dysarthria reflect a breakdown in motor organization and control 14.6% of all dysarthrias
Ataxia: lack of order
What does the cerebellum do? responsible for the coordination of timing and force of muscular contractions - planning of timing and force for skilled, voluntary movememts are appropriate for an intended task.
The cerebellum also: processes sensory information from all over the body and integrates that information into execution of a movement
What are Cerebellar Peduncles? Cerebellar Peduncles are bundles of neural tracts. There are three in the human brain.
The Cerebellum communicates with the CNS via what? The Cerebellum communicates with the CNS via the Cerebellar Peduncles
What is the name of the first neural pathway? The first neural pathway/peduncle is called the Inferior Peduncle.
What does the Inferior Peduncle do? The Inferior Peduncle is the first neural pathway and it receives sensory information from entire body regarding position of body parts before, during and after a movement. It monitors timing and force of movements while they are being performed.
What is the name of the second neural pathway? The second neural pathway is called the Middle Peduncle.
What does the Middle Peduncle do? The Middle Peduncle is the Second Pathway and it receives preliminary information from the cortex regarding planned movements. Next the cerebellum coordinates these planned movements by integrating the sensory info into refined smooth movements.
When the Middle Penduncle coordinates planned movements with sensory info to refine it and smooth it it does it according to: current condition of the body.
After the smoothing and refining process of the middle peduncle where does this information go? It gets sent back to the cortex via the thalamus.
What is the name of the 3rd Pathway in the Cerebellar Control Circuit? The Superior Peduncle is the 3rd Pathway.
What does the Third/Superior Peduncle do? The Superior/Third Penduncle is the MAIN output channel to the CNS. It sends processed motor signals to the motor areas of the cortex thus completing the corticocerebellar control circuit.
The peduncles make up what? The Cerebellar Control Circuit. This is how motor impulses once processed and refined get to the motor areas of the cortex.
The additional tracts that travel out of the Superior/Third Peduncle, what do they connect? The additional tracts of the 3rd/Superior Peduncle connect the cerebellum directly to neurons of the extrapyramidal tract.
The Superior/Third Peduncle transmits what kinds of commands and to where? The Superior/Third Peduncle transmits cerebellar commands to the cortex and to the extrapyramidal tract.
The Middle Peduncle/2nd Peduncle / Pathway transmits what kind of information and to where? The Middle/2nd Peduncle transmits planned movements from the association cortex to the cerebellum.
The Inferior/1st Pathway in the Cerebellar Control Circuit/1st Peduncle transmits what kind of information and to where? The First Peduncle/1st Pathway/Inferior Peduncle transmits info from the entire body to the cerebellum.
What is the possible effect of the cerebellum on speech? Planned motor impulses of a planned speech act sent from the cortex to cerebellum then the cerebellum then coordinates and refines prelim speech movements via sensory info. then info is sent to thalamus for addl refinement and then sent to motor cortex.
Maybe the cerebellum influences speech in this way: The cerebellum could influence speech through its connections to the extrapyramidal system. The cerebellum can make rapid adjustment in the timing and force of movements to compensate for unexpected change in the circumstances of a movement...
In summary, the cerebellum may affect speech by it's dual ability to coordinate and modify planned and ongoing speech movements which is an important part of the motor speech system.
What are some clinical characteristics of Cerebellar Lesions? Cerebellar Ataxia: movement deficits of timing, force, range, and direction. Disordered stance and gait: broad based, truncal instability. Intention tremors. Ocular motor abnormalities. Hypotonia. Problem with motor learning.
How does a person with a cerebellar lesion walk? Like a drunker sailor; bent forward with feet wide apart, trying to keep balance with irregular steps.
Where is the localization of speech within the cerebellum? Unclear. Ataxic dysarthria generally results from bilateral or generalized damage to cerebellum. When lesions are focal, the following areas are affected: superior peduncle, lateral hemispheres, paravermal regions.
Ataxic Dysarthria etiologies: degenerative 34% vascular 16% Demyelinating: 15%
Degenerative Diseases Friedreich's Ataxia Olivopontocereballar Atropy (OPCA)
Friedreich's Ataxia: progressive, hereditary, spinocerebellar disease Onset in 20's life expectancy im 40s Symptoms: cerebellar ataxia, LMN weakness, Extrapyramidal signs such as spasticity, dysarthria Possible dementia and sensorineural deafness
OPCA Olivopontocerebellar Atrophy
OPCA hereditary, progressive cerebellar DISORDER Atrophy in middle cerebellar pendunce, cerebellum and pons Symptoms: cerebellar ataxia most common, Parkinsonism, Dementia
Stroke - Vascular Disorders Lesions are most commonly caused by Ischemic, ruptured aneurysms, AVMs (ateriovenous malfomations), cerebellar hemorrhage.
A cerebellar stroke will result in: sudden onset of limb ataxia, problems with balance, visual deficits, ataxic dysarthria
Toxic Conditions that can cause ataxia: acute and chronic alcohol consumption lead and mercury poisoning cyanide These are treatable and reversible.
Metabolic Conditions that can cause ataxia: Prolonged vitamin E or B12 deficiency
Neurotoxic Conditions that can cause ataxia: Neurotoxic levels of certain drugs such as Dilantin (anticonvulsant)
Traumatic Brain Injury can cause Ataxia: Diffuse damage. Cerebellar penduncles are vulnerable to the twisting and rotational forces of a TBI. Boxers can suffer from repeated cerebral injuries and pathologic changes to the cerebellum and other areas of the CNS.
Neoplastic Disorders: Tumors within or exerting mass effects on the cerebellum can lead to cerebellar signs. 3%
Nonspeech Characteristics of Ataxic Dysarthria: normal oral mechanism exam; non speech AMRs of jaw, lips and tongue may be irregular (most apparent in wiggling of the tongue or retraction and pursing of lips)
Speech Characteristics of Ataxic Speech: predominantly an articulatory and prosodic disorder. Imprecise Consonants, Distorted vowels, Excess and Equal Stress, Irregular Articulatory Breakdown
Patient Perceptions and Complaints relevant to Ataxic Dysarthria slurred speech, drunker quality, dramatic deterioration in speech it little alcohol consumption, sometimes difficulty coordinating breath with speaking, mild severity may present with 'stumble over words.' Intelligiblity improves with decrease in rate.
Ataxic Dysarthria patients may bite what? They may bite their cheeks or tongue while talking or eating but swallowing is seldom a problem.
Articulation Problems with Ataxio Dysarthria: Imprecise Consonants Distorted vowel (slurred due to probs with timing, force, range and direction of movements required for speech) Irregular articulatory breakdowns (especially in multisyllabic words, compression of syllables.)
Prosody specfic to stress with Ataxic Dysarthria Excess nd Equal Stress: tendency to put equal stress on syllables or words that have varied stress patterns (ie: BA BY vs. BA by) Excessive stress on unstresed syllables and words, each syllable sounds as if it is being produced separately.
Prosody specific to prolonged phonemes or prolonged intervals in ataxic dysarthria? prolongations might be caused by decreased muscle tone which results in general slowness in the contraction of the speech muscles and a slow rate
Other speech characteristics for Ataxic Dysarthria besides excess and equal stress and prolonged phonemes? Monopitch and monoloudness and Scanning Speech, Harshness of phonation, voice tremor possible.
What is Scanning Speech? slow deliberate production of syllables.
Are there resonance concerns with Ataxic Dysarthria? No: Resonance is typically normal. There may be intermittant hypernasality.
How might respiration be affected in a patient with ataxic dysarthria? The uncoordinated movements in the respiatory muscles can contribute to some of the prosodic abnormalities.
Primary Distinguishing Speech Characteristics: THE CLUSTER: Irregular Articulatory Breakdowns Irregulaar Speech AMRS Excess and Equal Stress Distorted Vowels Prolonged Phonemes
What are the Key Evaluative Tasks for Ataxic Dysarthria: Speech AMRS: pay attention to rate and rhythm Converational Speech, reading, and repeating sentences containing MULTISYLLABIC WORDS, Look for irregular articulatory breakdowns and prosodic abnormalities
Treatment for Respiration Concerns in pts with Ataxic Dysarthria: work on coordination not strengthening. Slow and controlled exhalation: inhale fully and exhale slowly and steady. Increase difficulty by having pts. exhale for 3 seconds, stop for 1, then continue to exhale work up to 3 sequences with each breath.
Respiration Therapeutic Tasks: speak immediately on exhalation. make sure phonation begins the moment pt begins exhale. Have pt put hand on abdomen - the moment the hand goes 'in' begin phonation. Stop phonation early / optimal breath group.
What is an optimal breath group? Time when to take a breath to avoid speaking on insufficient air supply. Calculate optimal breath groups. As coordination improves, increase length.
Prosody Therapy should include what for pts with Ataxic Dysarthria? Rate control - because intelligibility generally improves with decreased rate. Reciting syllables to a metronome, finger tapping, cued reading material.
How do you use a metronome with ataxic pts.? Recite syllables to it. One syllable is produced for each beat. This is ONLY used to et the pt to a more acceptable rate. Once this is achieved the pt works on keeping their rate down independently.
How do you use finger tapping with a pt with ataxic dysarthria? These might be low tech but still really helpful...This can be used instead of a metronome where the clinician sets a rate by tapping her/his finger.
How do you use cued reading material with a pt with ataxic dysarthria? The clinician points to words at the desired speaking rate. Read slower, then Slash marks are used to indicate where to pause. chunking utterances into syntactic units ie: in the morning (inhale) I go shopping.
What is the therapeutic approach for Prosody with a pt with Ataxic Dysarthria? Stress and Intonation drills. Constrastive Stress Drills (ie: Bob hit BILL? WHO hit Bill? BOB hit Bill.) Pitch range exercises. Intonation profiles.
What is the therapeutic appropach for Articulation with pts with Ataxic Dysarthria? Intelligibility Drills Phonetic Placement Exaggerating Consonants Minimal Contrast Drills
What do we look for in AMRS? Rate Rhythm Articulation
What are the primary speech characteristics of Ataxia? Irregular Articulatory Breakdowns Irregular Speech AMRs - RHYTHM IS OFF... Excess and Equal Stress Distorted Vowels Prolonged Phonemes RHYTHM is OFF!
Ataxic Speech AMRS p p p pp p p pp
Can you diagnose someone as having ataxia based on imprecise consonants? No because other disorders have imprecise speech too...
Some ataxia pts. have very mild prosody concerns while others have very unusual prosody patterns (excess and equal stress)
Articulatory Breakdowns in pts with Ataxic Dysarthria have a very specific kind: UNPREDICTABLE Articulatory Errors/Breakdowns.
When you have unequal stress due to ataxic dysarthria: you end up with prolonging even the unstressed syllable - same loudness, high in pitch and stress, and can no longer tell which syllables are stressed.
Biggest areas of concern with Ataxic Dysarthria: articulation and prosody
Ataxia is due to damage to the cerebellum
May notice pts with ataxic dysarthria speaking in this way drunken slurred quality or trying REALLY HARD to speak CLEARLY... movement of lips, teeth, mandible to overcompensate, slow down, AMRs are very pronouncedly off in rhythm,imprecise articulatory breakdowns, stress and syllable breaks are way off.
With a pt with ataxic dysarthria what do you find with the oral mechanism exam? Oral mechanism exam appears normal, good range, no weakness, just coordination issues!
Repeat a sentence and read Grandfather Passage; with ataxic pts they should both sound the same; speeh has same concerns in BOTH scenarios...
Ataxic Dysarthria is what percent of all dysarthrias? 14%
Range of articulation concerns can range with ataxic pts from mild to severe
Ataxia means a LACK OF ORDER. Muscles may still have the capacity to move but there are problems with timing and force,, speed, range of motion... Things like you would need to play piano for example...
Therapy one step at a time. For example: Read slower. Then incorporate slash marks. The start using contrastive stress drills. Eventually end up with improved speech!
Be sure you know HOW to do articulation exercises! Ie: intelligibility drills, phonetic placement, exaggerating consonants, and minimal contrast drills.