bassich midterm (test two)
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| Ataxia | wide based gait- legs far apart when walking for better balance (ataxia)
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| Dysmetria | finger to nose test: Under or Overshoot (ataxia)
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| Hypotonia Hypophonia Hypomimia | Decreased muscle tone
(ataxia,flaccid)
reduced phonation - (hypo)
masked face, reduced eye blink
decreased phonation/soft voice- (hypo)
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| Intention tremor | tremor occurs with intended movement
(ataxic)
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| Nystagmus | Involuntary eye-jerk movement
(ataxic)
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| Atrophy | muscle shrinkage. Ex:Jaw, tongue
(flaccid)
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| fasciculations | wormy tremor at rest Ex:tongue
(flaccid)
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| chorea | fast "dance like" uncontrollable/unpredictable movements
(hyper)
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| dystonia | very slow movements
(hyper)
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| athetosis | slow movements (faster than dystonia)
(hyper)
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| Dyskinesia | not slow/not fast
(hyper)
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| Myoclonus | quick beating,rhythmic Ex:Velum
(hyper)
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| Tics | faster hyperkenetic movements
(hyper)
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| Tremor | resting termor,
benign essential tremor,
(hyper-general tremor)
intention tremor
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| rigidity | stiffness, cramping (cogwheel-little jerks)
(hypo)
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| bradykinesia | slow movement (latency)
(hypo)
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| resting tremor | tremor of muscle/limb while at not (not initiating)
(hypo)
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| akinesia | lack of movement, freezing
(hypo)
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| spasticity | resistance to stretching (clasp knife-sudden give way)
(spastic)
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| pathological reflexes | Jaw jerk
snout
suck
(spastic)
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| pseudobulbar affect micrographia | uninhibited cry or laugh-(spastic)
very small writing- (hypo)
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| Dysarthria Definition | Group of MSDs associated w/ disturbed muscular execution or control of the speech mechanism due to cns/pns
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| Spastic: place of lesion | Bilateral chronic UMN
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| Spastic: Medical conditions/Neurological condition | Bilateral cortical stroke
cerebral palsy
unilateral cortical stroke
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| Spastic:Speech characteristics/ Auditory perceptual signs | harsh or tight/strained-strangled
hypernasality
slow rate
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| Spastic:non-speech movement deficits | AMRs sound REGULAR, SLOW rate
reduced ROM
Reduced force
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| Spastic: Neurological signs/neuro muscular characteristics | Hypertonia-spasticity (clasp knife)-Ex:arms,legs,VFS
Hyperactive gag
Primitive reflexes
Pseudo bulbar affect
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| Spastic:Speaker/Pt Complaint | Slow speaking rate
increased effort to speak
fatigue when speaking
chewing/swallowing difficulty
poor control of emotional function
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| UUMN: Place of lesion | unilateral acute cerebral hemispheres
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| UUMN: medical/Neurolofical conditions | Broca's Aphasia, Apraxia
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| UUMN: Speech/Auditory perceptual characteristics | Minimal effects
imprecise lingual consonants
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| UUMN:Non-speech movement deficits | reduced ROM & Force on side contralateral to lesion for tongue and lower face
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| UUMN:Neurological signs/neuromuscular characteristics | Test for Central Facial Weakness: Facial Droop but CAN wrinkle forehead,raise eyebrow,blink eye
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| UUMN:Speaker/Pt complaints | thick tongue
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| Hypokinetic: Place of lesion | Basal Ganglia: Substantia Nigra
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| Hypokinetic:Medical/Neurological conditions | Parkinsons
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| 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
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| Hypokinetic: Nonspeech Movement Deficits | Very reduced ROM- non speech repetitive
Reduced ROM -individual movements
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| 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
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| 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
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| HYPERkinetic: Place of lesion | Basal Ganglia: Striatum
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| Hyperkinetic:Medical/neurological conditions | Dystonia, Huntington's CHorea
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| 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)
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| 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
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| Hyperkinetic: Non speech Movement deficits | not important clues for dx
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| Hyperkinetic: Neurological signs/Neuro muscular characteristics | Adventitious Movements:
Chorea
Dystonia
Dyskinesia
Tics
Myoclonus
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| Hyperkinetic: CHOREA :Speaker/Pt complaint | Effortful speech
Involuntary oral movements
chewing/swallowing difficulty
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| 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
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| Ataxic: Place of Lesion | Cerebellum
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| Ataxic: medical/neurological condition | Damage to Cerebellum, TBI ?
Unilateral Cortical stroke
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| 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
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| Ataxic:Non speech Movement Deficits | Irregular AMRs-Uncoordinated (SMR)
ROM for individual and repetitive movements can be excessive
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| Ataxic:Common Neurological Signs/ Neuromuscular characteristics | Hypotonia
Broad based gait- wide for balance
Dysmetria
Intention tremor
Nystagmus
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| 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
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| Flaccid: Place of lesion | PNS (CNs)
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| Flaccid: Medical/Neurological Conditions | Brain stem Stroke
Unilateral Cortical Stroke
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| Flaccid:Speech/Aud Percept | Depends on CN or Nerves involved and if its bilater or unilateral lesion
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| Flaccid: Stress Testing Speech. WHy? | Useful ti ID Myasthenia Gravis
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| What is Myasthenia Gravis | rapid fatigue of muscular contractions over a short period of time. Depletion of acetylcholine
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| Stress Test:Task and performance? | Rapid Counting 1-50
MG- if pt deteriorates after 10, then resumes normal function once rested
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| Flaccid:Non Speech Movement Deficits | Reduced: muscle TONE, RATE of individual movements, RANGE of repetitive movements
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| Flaccid:Neurological signs/Neurmuscular characteristics | Atrophy
Fasciculations
Hypotonia
Decreased gag- if high vagal lesion
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| 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
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| Mixed: Medical/Neurological conditions | ALS: Spastic-Flaccid
MS: Ataxic- Spastic
TBI: Spastic-Ataxic or Flaccid-Spastic
Stroke: Unilateral cortical
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| 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.
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| CN V- Trigeminal: Function | Jaw elevation
General face sensation
General tongue sensation (ant 2/3)
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| 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
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| CN VII- Facial: Function | Upper and Lower Face
Taste to ant 2/3 tongue
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| CN VII- Facial: Tasks | Facial Movement:Wrinkle forehead,blink,smile,pucker
Salt water/ Sugar water: what do you taste
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| CN IX- Glosspahryngeal: Function | General sensation to post 1/3 tongue
Taste to Post 1/3 tongue
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| CN IX- Glosspahryngeal:Tasks | Test light touch
Test taste of something sour
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| CN X- Vagus : Function | Pharynx- velum
Larynx- Vfs
no speech sensory
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| CN X- Vagus : Tasks | Velar elevation: ee-ee-ee
Phonation:say "ah" for as long as you can
Pitch glide: say ah, increase pitch
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| CN XII - Hypoglossal : Function | tongue
no sensory
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| CN XII - Hypoglossal : Tasks | tongue at rest
lateralization
elevation/depression
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| 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"
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| Snout Reflex | Test:light tap of finger on philtrum or tip of nose
Abnormal:puckering,protrusion/elevation of lower lip, depression of mouth angles
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| sucking reflex | Test:stroke upper lip, from lateral to medial
Abnormal: pursing of lips
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| Jaw refelx | Test:pt relaxed lips parted, jaw open. Tap chin
Abnormal: quickly close jaw
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| 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
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| why? | Because Upper face (eyebrows,eyelids,forehead) are 50:50/bilaterally innervated
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| AMRs | Articulatory agility
"pa pa pa "ta" "ka"
rapid and precise
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| SMRs | Sequencing /coordination
"Pataka" fast
suggests ataxia or apraxia
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| Additional observations to make during tasks | rhythm
ability to plose
articulatory precision
regularity/steadiness
loudness
pitch
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| High Vagal Lesion | Branches 1-3
palatal muscles & Larynx
Hypernasality
Soft Breathy voice
Cant raise pitch
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| Low vagal lesion (4) | Spare palate
inability to raise pitch
soft breathy voice
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| Low vagal lesion (5) | Spare palatal muscles
can raise pitch
Breathy Voice
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