Mix dysarthria

Total Flash Cards » 27
 
1. 

Mixed dysarthias are common because the ____ Figure 1-3 shows it to be the ___occurring dysarthria.

 

damage that causes dysarthia often affects more than one area or system.

-most frequently

 
2. 

You can have combination of how many? The component that ____is the first name given, such as flaccid-spastic. It is important to determine the types of mixed dysarthrias, the components, because ???.

 

-2 or more of these pure dysarthrias.

-dominates

-it may help rule out or confirm neurological diagnoses

 
3. 

Etiologies:

  • Commonly caused by more than one event, i.e.

 

multiple strokes, combination of neurological or degenerative diseases such as PD and stroke, chorea and stroke.

  • Often seen in degenerative diseases.
  •  
    4. 

    Types of mixed dysarthrias and percentages in Duffy’s practice:

    • 1)Flaccid-spastic –
    • 2)Hyperkinetic-hypokinetic
    • 3)Hypokinetic-spastic -
    • 4)Ataxic-flaccid-spastic –
    • 5)Ataxic-spastic –
    • 6)Other mixes –

     

    1)-42%

    2)-)-35%

    3)-7%

    4)-6%

    5023%

    6)-19%

     
    5. 

    ETIOLOGIES: Specific diseases associated with mixed dysarthrias:

    • Degenerative diseases – these often affect several parts of the motor system thus produce mixed dysarthrias. This is the most common etiology of mixed dysarthrias.

    1. Motor neuron disease - primarily affects upper or lower motor neurons or both.

    · Most common type is ___- has both UMN and LMN involvement. Commonly has mixed spastic-flaccid or flaccid-spastic components. ____ occurs in 1% to 5 % per 100,000. More ___affected than ___. 5% is familial. Onset for most is between ___to___ years. Often hard to diagnose. Nearly always fatal. Most die between __and__years after diagnosis. Some few live more than 12 years. Death usually due to respiratory failure – but person can be put on ventilator.

    Can be bulbar or spinal ALS. Patients with bulbar onset have ___ and ____ problems very early on. Those with spinal onset have problems with ___ first.

    Diagnosis confirmed by EMG findings of weakness.

    .

     

    -amyotrophic lateral sclerosis (ALS)

    -ALS

    -men/women

    -40 to 70 yrs

    -1 and 5

    -speech/swallowing

    -limbs

     
    6. 

    _____ – affects UMN only – may be hard to distinguish from ALS. It typically produces spastic dysarthria but is hard to differentiate from ALS.

     

    Primary lateral sclerosis (PLS)

     
    7. 

    ____________– affects LMN only – progressive limb wasting and weakness – may have some cranial nerve weakness as well. It is a motor neuron disease but typically produces only flaccid dysarthria, not mixed.

     

    Spinal muscle atrophies

     
    8. 

    _______________– primarily has LMN weakness of cranial nerve muscles. Dysarthria and dysphagia predominate. Similar to ALS without limb involvement. It is usually associated with flaccid dysarthria, not mixed

     

    Progressive Bulbar Palsy

     
    9. 

    Degen. disease

    1. ______ – it is a demyelinating disease – the myelination is attacked but the axon itself is not. It is the most common CNS disease affecting young and middle age adults between 20 to 40 years of age. It affects more women than men. Cause is unknown – may be related to autoimmune cause triggered by environmental and genetic interactions. Diagnosis is difficult – MRI often used for diagnosis.

     

    Degen. disease

    1. Multiple Sclerosis – it is a demyelinating disease – the myelination is attacked but the axon itself is not. It is the most common CNS disease affecting young and middle age adults between 20 to 40 years of age. It affects more women than men. Cause is unknown – may be related to autoimmune cause triggered by environmental and genetic interactions. Diagnosis is difficult – MRI often used for diagnosis.

     
    10. 

    Course of MS varies. Can be

    · ___ – only few episodes, then remission

    · ___ – comes and goes

    · ___ - comes and goes but progressively gets worse

    · ___– no remission

     

    Course of MS varies. Can be

    · Benign – only few episodes, then remission

    · Relapsing-remitting – comes and goes

    · Remitting-progressing - comes and goes but progressively gets worse

    · Progressive – no remission

     
    11. 

    Patient often exhibits problems with __ and other __difficulties and some ___deficits. ___ is not common.

    Most common type of mixed dysarthria is ___but any combination can occur. The type of dysarthria is more __than with other diseases.

     

    Patient often exhibits problems with vision and other sensory difficulties and some cognitive deficits. Dysphagia is not common.

    Most common type of mixed dysarthria is ataxic-spastic but any combination can occur. The type of dysarthria is more unpredictable than with other diseases.

     
    12. 

    ______________

    Is associated with cerebellar dysfunction but can also be associated with mixed spastic/ataxic dysarthria

     

    Frederich's Ataxia

    Is associated with cerebellar dysfunction but can also be associated with mixed spastic/ataxic dysarthria

     
    13. 

    ____________________

    It's a neurodegenerative disease associated with multisystem involvement May be confused with PD because it has similar symptoms such as __. ____and ______common and are evidenced early on in the disease. Mixed dysarthrias seen in this disease are combinations of hypokinetic, spastic and ataxic.

     

    1. Progressive Supranuclear Palsy

    It's a neurodegenerative disease associated with multisystem involvement May be confused with PD because it has similar symptoms such as bradykinesia. Dysphagia and dysarthria are common and are evidenced early on in the disease. Mixed dysarthrias seen in this disease are combinations of hypokinetic, spastic and ataxic.

     
    14. 

    1. _____

    It is similar to PSP and PD - but doesn't respond well to ____ . ____ Syndrome falls under this category of diseases. Types of mixed dysarthrias include hypokinetic, hyperkinetic, ataxic and spastic depending on the underlying pathologies

     

    1. Multiple Systems Atrophy

    It is similar to PSP and PD - but doesn't respond well to L-Dopa . Shy Drager Syndrome falls under this category of diseases. Types of mixed dysarthrias include hypokinetic, hyperkinetic, ataxic and spastic depending on the underlying pathologies.

     
    15. 

    _____ syndrome is a progressive neurologic disease – unknown etiology. First signs are usually blood pressure problems when standing, incontinence and decreased respiration and impotence. May also have problems with gait, dysarthria and dysphagia. Most common types of dysarthria associated with SDS are hypokinetic, ataxic, spastic and flaccid.

     

    Shy-Drager syndrome is a progressive neurologic disease – unknown etiology. First signs are usually blood pressure problems when standing, incontinence and decreased respiration and impotence. May also have problems with gait, dysarthria and dysphagia. Most common types of dysarthria associated with SDS are hypokinetic, ataxic, spastic and flaccid.

     
    16. 

    __________degeneration

    It is rare and involved impairment of cortex and basal ganglia. It presents most often with spastic-hypokinetic dysarthria, but can have ataxic and hyperkinetic components. (Primary progressive aphasia is sometimes put under this category.)

     

    Corticobasal degeneration

    It is rare and involved impairment of cortex and basal ganglia. It presents most often with spastic-hypokinetic dysarthria, but can have ataxic and hyperkinetic components. (Primary progressive aphasia is sometimes put under this category.)

     
    17. 

    · _______________________

    Effects tend to be diffuse and damage can impair several components, thus resulting in a mixed dysarthria.

     

    Toxic - metabolic conditions

    Effects tend to be diffuse and damage can impair several components, thus resulting in a mixed dysarthria.

     
    18. 

    _________It is a metabolic disorder leading to too much copper in brain, eyes and liver. It can be fatal. It often demonstrates brown rings around cornea of the eyes. Dysarthria is a predominant symptom - and typically involves two or more of these: hypokinetic, ataxic, and spastic.

     

    Wilson's disease

    It is a metabolic disorder leading to too much copper in brain, eyes and liver. It can be fatal. It often demonstrates brown rings around cornea of the eyes. Dysarthria is a predominant symptom - and typically involves two or more of these: hypokinetic, ataxic, and spastic.

     
    19. 

    __________

    Due to lack of oxygen to brain because of heart and lung problems. With loss of oxygen , brain damage occurs. Mixed dysarthrias often occur involving hypokinetic, hyperkinetic and ataxic dysarthrias.

     

    Hypoxic encephalopathy

    Due to lack of oxygen to brain because of heart and lung problems. With loss of oxygen , brain damage occurs. Mixed dysarthrias often occur involving hypokinetic, hyperkinetic and ataxic dysarthrias.

     
    20. 

    · _______

    Multiple strokes often affect multiple systems and produce mixed dysarthrias of any combination. If strokes affect brainstem, dysarthria may include flaccid, spastic and ataxic due to close proximity of pyramidal and extrapyramidal fibers.

     

    · Vascular disorders

    Multiple strokes often affect multiple systems and produce mixed dysarthrias of any combination. If strokes affect brainstem, dysarthria may include flaccid, spastic and ataxic due to close proximity of pyramidal and extrapyramidal fibers.

     
    21. 

    · _________

    TBI can produce any combination of dysarthrias. Mixed dysarthia is more common with TBI than single dysarthrias due to the diffuse injuries associated with TBI.

     

    · Trauma

    TBI can produce any combination of dysarthrias. Mixed dysarthia is more common with TBI than single dysarthrias due to the diffuse injuries associated with TBI.

     
    22. 

    _______

    Can affect various components of neurological system and produce various mixed dysarthrias.

     

    Tumor

    Can affect various components of neurological system and produce various mixed dysarthrias.

     
    23. 

    Infections and autoimmune diseases

    ___is a good example and can produce various _____ dysarthrias. The type of dysarthias depend on the _____ that is presenting with AIDs as various conditions can result.

     

    Infections and autoimmune diseases

    AIDS is a good example and can produce various mixed dysarthrias. The type of dysarthias depend on the condition that is presenting with AIDs as various conditions can result.

     
    24. 

    ALS

    · ____is often the first sign.

    · The majority are ____ by the time death occurs.

    · Most need ___ intervention within approximately___years of diagnosis and use them about __years before death.

    · Dysarthria may not be ___throughout the entire disease.

     

    ALS

    · Dysarthria is often the first sign.

    · The majority are unintelligble by the time death occurs.

    · Most need AAC intervention within approximately 3 years of diagnosis and use them about 2 years before death.

    · Dysarthria may not be mixed throughout the entire disease.

     
    25. 

    · Dysarthria has components of both __ and ___ when it is mixed and either of those can predominate

    Symptoms of each of those types can occur, i.e. with spasticity - pathological reflexes and pseudobulbar effect can occur; with flaccidity - fasiculations and atrophy can occur.

    · Other symptoms can also occur that aren't seen with single dysarthrias

     

    Dysarthria has components of both flaccid and spastic when it is mixed and either of those can predominate.

    Symptoms of each of those types can occur, i.e. with spasticity - pathological reflexes and pseudobulbar effect can occur; with flaccidity - fasiculations and atrophy can occur.

    · Other symptoms can also occur that aren't seen with single dysarthrias

     
    26. 

    q tremor or "_________" in voice is commonly seen, especially in vowel prolongation. (The cause is not known.)

    q ________- due to turbulence in voice from saliva that builds up in pyriform sinuses and on vocal folds due to reduced swallowing and clearing of secretions.

     

    q tremor or "flutter" in voice is commonly seen, especially in vowel prolongation. (The cause is not known.)

    q wet or gurgly voice - due to turbulence in voice from saliva that builds up in pyriform sinuses and on vocal folds due to reduced swallowing and clearing of secretions.

     
    27. 

    _________ can be severely affected due to hypernasality, reduced ability to build up intraoral air pressure and weakness of tongue

     

    Intelligibility can be severely affected due to hypernasality, reduced ability to build up intraoral air pressure and weakness of tongue.