| Question | Answer |
| Ataxia | wide based gait- legs far apart when walking for better balance (ataxia) |
| Dysmetria | finger to nose test: Under or Overshoot (ataxia) |
| Hypotonia
Hypophonia
Hypomimia | Decreased muscle tone
(ataxia,flaccid)
reduced phonation - (hypo)
masked face, reduced eye blink
decreased phonation/soft voice- (hypo) |
| Intention tremor | tremor occurs with intended movement
(ataxic) |
| Nystagmus | Involuntary eye-jerk movement
(ataxic) |
| Atrophy | muscle shrinkage. Ex:Jaw, tongue
(flaccid) |
| fasciculations | wormy tremor at rest Ex:tongue
(flaccid) |
| chorea | fast "dance like" uncontrollable/unpredictable movements
(hyper) |
| dystonia | very slow movements
(hyper) |
| athetosis | slow movements (faster than dystonia)
(hyper) |
| Dyskinesia | not slow/not fast
(hyper) |
| Myoclonus | quick beating,rhythmic Ex:Velum
(hyper) |
| Tics | faster hyperkenetic movements
(hyper) |
| Tremor | resting termor,
benign essential tremor,
(hyper-general tremor)
intention tremor |
| rigidity | stiffness, cramping (cogwheel-little jerks)
(hypo) |
| bradykinesia | slow movement (latency)
(hypo) |
| resting tremor | tremor of muscle/limb while at not (not initiating)
(hypo) |
| akinesia | lack of movement, freezing
(hypo) |
| spasticity | resistance to stretching (clasp knife-sudden give way)
(spastic) |
| pathological reflexes | Jaw jerk
snout
suck
(spastic) |
| pseudobulbar affect
micrographia | uninhibited cry or laugh-(spastic)
very small writing- (hypo) |
| Dysarthria Definition | Group of MSDs associated w/ disturbed muscular execution or control of the speech mechanism due to cns/pns |
| Spastic: place of lesion | Bilateral chronic UMN |
| Spastic: Medical conditions/Neurological condition | Bilateral cortical stroke
cerebral palsy
unilateral cortical stroke |
| Spastic:Speech characteristics/ Auditory perceptual signs | harsh or tight/strained-strangled
hypernasality
slow rate |
| Spastic:non-speech movement deficits | AMRs sound REGULAR, SLOW rate
reduced ROM
Reduced force |
| Spastic: Neurological signs/neuro muscular characteristics | Hypertonia-spasticity (clasp knife)-Ex:arms,legs,VFS
Hyperactive gag
Primitive reflexes
Pseudo bulbar affect |
| Spastic:Speaker/Pt Complaint | Slow speaking rate
increased effort to speak
fatigue when speaking
chewing/swallowing difficulty
poor control of emotional function |
| UUMN: Place of lesion | unilateral acute cerebral hemispheres |
| UUMN: medical/Neurolofical conditions | Broca's Aphasia, Apraxia |
| UUMN: Speech/Auditory perceptual characteristics | Minimal effects
imprecise lingual consonants |
| UUMN:Non-speech movement deficits | reduced ROM & Force on side contralateral to lesion for tongue and lower face |
| UUMN:Neurological signs/neuromuscular characteristics | Test for Central Facial Weakness: Facial Droop but CAN wrinkle forehead,raise eyebrow,blink eye |
| UUMN:Speaker/Pt complaints | thick tongue |
| Hypokinetic: Place of lesion | Basal Ganglia: Substantia Nigra |
| Hypokinetic:Medical/Neurological conditions | Parkinsons |
| Hypokinetic:Speech/Auditory perceptual characteroistics | Hypophonia(pt may be unaware of)
Breathy(VF bowing-but sometimes compensate by being harsh or high pitch
Monopitch
Reduced stress
Inappropriate silences/delayed initiation (latency)
Rate disturbances:increased rate,repeated phonemes,short rushes of s |
| Hypokinetic: Nonspeech Movement Deficits | Very reduced ROM- non speech repetitive
Reduced ROM -individual movements |
| Hypokinetic:Neurologic signs/ Neurmuscular characteristic | Hypertonia-Rigidity (cogwheel-jerks)
Hypomimia
Resting tremor
Micrographia
Shuffling Gait
Loss of Arm swing when walking
Bradykinesia
Hypokinesia
Akinesia
Postural Instability
TRAP: Tremor[resting],Rigidity,Akinesia,Postural Instability |
| Hypokinetic:Speaker/Pt Complaints | Reduced Loudness (listener complaint)
Rapid rate
Mumbling or Stuttering
Difficulty initiating speech
Reports that "people tell them..."- not their perception
Stiff lip- also other stiffness and cramps |
| HYPERkinetic: Place of lesion | Basal Ganglia: Striatum |
| Hyperkinetic:Medical/neurological conditions | Dystonia, Huntington's CHorea |
| Hyperkinetic: CHOREA :Speech/Audiological perceptual characteristics | prolonged intervals
variable rate
inappropriate silences
excess loudness variations
prolonged phonemes
Sudden forced inspiration/expiration (audible inspiration)
Voice Stoppages (phonatory breaks)(phonatory instability) |
| Hyperkinetic: DYSTONIA :Speech/Audiological perceptual characteristics | Distorted Vowels
Harsh
Irregular artic breakdowns
Inappropriate silences
voice stoppages (phonatory:breaks,instability)
Improves w/ sensory trick. Ex. Bite block |
| Hyperkinetic: Non speech Movement deficits | not important clues for dx |
| Hyperkinetic: Neurological signs/Neuro muscular characteristics | Adventitious Movements:
Chorea
Dystonia
Dyskinesia
Tics
Myoclonus |
| Hyperkinetic: CHOREA :Speaker/Pt complaint | Effortful speech
Involuntary oral movements
chewing/swallowing difficulty |
| Hyperkinetic: DYSTONIA :Speaker/Pt complaint | Speech may be reported as normal
Neck movements and pain
Occasional Dysphagia
Awareness of sensory tricks that reduce spasm temporarily |
| Ataxic: Place of Lesion | Cerebellum |
| Ataxic: medical/neurological condition | Damage to Cerebellum, TBI ?
Unilateral Cortical stroke |
| Ataxic:Speech/ Auditory Perceptual Characteristics | Irregular articulatory breakdowns
Scanning Speech: prolonged phonemes& excess/equal stress in ea syllable
Excessive loudness variation
hyponasality
Vowel distortions
Voiced for Voiceless errors |
| Ataxic:Non speech Movement Deficits | Irregular AMRs-Uncoordinated (SMR)
ROM for individual and repetitive movements can be excessive |
| Ataxic:Common Neurological Signs/ Neuromuscular characteristics | Hypotonia
Broad based gait- wide for balance
Dysmetria
Intention tremor
Nystagmus |
| Ataxic:Speaker/Pt Complaint | "Drunk" speech
Stumbling over words
Biting Tongue or cheek when speaking/eating
Deterioration of Speech w/ alcohol
Poor coordination of breathing w/ speech |
| Flaccid: Place of lesion | PNS (CNs) |
| Flaccid: Medical/Neurological Conditions | Brain stem Stroke
Unilateral Cortical Stroke |
| Flaccid:Speech/Aud Percept | Depends on CN or Nerves involved and if its bilater or unilateral lesion |
| Flaccid: Stress Testing Speech. WHy? | Useful ti ID Myasthenia Gravis |
| What is Myasthenia Gravis | rapid fatigue of muscular contractions over a short period of time. Depletion of acetylcholine |
| Stress Test:Task and performance? | Rapid Counting 1-50
MG- if pt deteriorates after 10, then resumes normal function once rested |
| Flaccid:Non Speech Movement Deficits | Reduced: muscle TONE, RATE of individual movements, RANGE of repetitive movements |
| Flaccid:Neurological signs/Neurmuscular characteristics | Atrophy
Fasciculations
Hypotonia
Decreased gag- if high vagal lesion |
| Flaccid:Speaker/Pt complaint | Variation depending on the specific CN involved. Specific compensation depending on site of weakness
Perceptual Features: HYpernasaility, Audible inhalation/exhalation, imprecise vowel/consonant production |
| Mixed: Medical/Neurological conditions | ALS: Spastic-Flaccid
MS: Ataxic- Spastic
TBI: Spastic-Ataxic or Flaccid-Spastic
Stroke: Unilateral cortical |
| Differentiation between resting tremor associated with PD and Benign Essential Tremor | Resting tremor is degenerative. BET does not progress, but tends to improve w/alcohol. |
| CN V- Trigeminal: Function | Jaw elevation
General face sensation
General tongue sensation (ant 2/3) |
| CN V- Trigeminal: Tasks | Jaw elevation against resistance
6 Light and deep touch to pt face, eyes closed
Right/Left light touch to tongue, eyes closed |
| CN VII- Facial: Function | Upper and Lower Face
Taste to ant 2/3 tongue |
| CN VII- Facial: Tasks | Facial Movement:Wrinkle forehead,blink,smile,pucker
Salt water/ Sugar water: what do you taste |
| CN IX- Glosspahryngeal: Function | General sensation to post 1/3 tongue
Taste to Post 1/3 tongue |
| CN IX- Glosspahryngeal:Tasks | Test light touch
Test taste of something sour |
| CN X- Vagus : Function | Pharynx- velum
Larynx- Vfs
no speech sensory |
| CN X- Vagus : Tasks | Velar elevation: ee-ee-ee
Phonation:say "ah" for as long as you can
Pitch glide: say ah, increase pitch |
| CN XII - Hypoglossal : Function | tongue
no sensory |
| CN XII - Hypoglossal : Tasks | tongue at rest
lateralization
elevation/depression |
| Primitive Reflexives: | those which are present during infancy but tend to disappear during nervous system maturation. as brain degenerates/normal again primitive reflexes return. "release phenomena" |
| Snout Reflex | Test:light tap of finger on philtrum or tip of nose
Abnormal:puckering,protrusion/elevation of lower lip, depression of mouth angles |
| sucking reflex | Test:stroke upper lip, from lateral to medial
Abnormal: pursing of lips |
| Jaw refelx | Test:pt relaxed lips parted, jaw open. Tap chin
Abnormal: quickly close jaw |
| Test for Central Facial Weakness | Observe Facial Droop- ask to wrinkle,blink
Upper face DOES function: UMN lesion, contralteral, area 4 (facial region)
Upper face DOESNT function: CN VII lesion, same side as droop |
| why? | Because Upper face (eyebrows,eyelids,forehead) are 50:50/bilaterally innervated |
| AMRs | Articulatory agility
"pa pa pa "ta" "ka"
rapid and precise |
| SMRs | Sequencing /coordination
"Pataka" fast
suggests ataxia or apraxia |
| Additional observations to make during tasks | rhythm
ability to plose
articulatory precision
regularity/steadiness
loudness
pitch |
| High Vagal Lesion | Branches 1-3
palatal muscles & Larynx
Hypernasality
Soft Breathy voice
Cant raise pitch |
| Low vagal lesion (4) | Spare palate
inability to raise pitch
soft breathy voice |
| Low vagal lesion (5) | Spare palatal muscles
can raise pitch
Breathy Voice |
