Mixed dysarthrias are most commonly composed of how many types of dysarthrias?
2 dysarthrias is most common, then 3, 4, 5, and 6. All six is rare but possible.
Mixed dysarthria can occur when neurological damage extends into _____ or more parts of the nervous system?
two
What are the two things that determine which characteristics of the single dysarthrias appear in a particular diagnosis of mixed dysarthria?
location and extention of the neurological damage
Which will SLPs see more cases of... mixed dysarthria or pure dysarthria?
mixed dysarthria
What determines the speech characteristics of mixed dysarthria?
It's a combination of the characteristics found in the pure dysarthrias.
A patient's neurological damage is restricted to a single anatomical portion of the motor system. This results in which type of dysarthria?
Pure dysarthria
True or False: In most instances of mixed dysarthria, one of the dysarthric components will be much more noticeable than the others.
True-however it is posible for each component of a mixed dysarthria to appear more or less equal in prominence
The prominence of one dysarthric characteristic over another is usually the result of...what?
the severity and extent of the neurological damage
True or False: the relative prominence of one dysarthric component over another can change over time.
True. Example: ALS first results in flaccid dysarthia but as the disease progresses, it affects upper motor neurons as well and can become a mixed dysarthria.
Etiologies of Mixed Dysarthia would include:
Multiple Sclerosis, Multisystems Atrophy (which includes Shy-Drager Syndrome, Progressive Supranuclear Palsy, and Olivopontocerebellar Atrophy), Amyotrophic Lateral Sclerosis, Wilson's Disease, and Freidrich's Ataxia
What is Multiple Sclerosis? (MS)
A progressive disease in which the myelin covering of axons degenerates.
What is the most common demyelinating disease?
Multiple Sclerosis (MS)-occurs in about 100 per 100,000 of the population in the US and UK.
What is the etiology of Multiple Sclerosis (MS)?
The etiology of Multiple Sclerosis (MS) is unknown.Some evidence suggests that it may be an immunological disorder that is triggered by a virus.
Does Multiple Sclerosis (MS) affect more men than women or vice versa?
Multiple Sclerosis (MS) affects more women than men-a ratio of 1.7 to 1.
When does Multiple Sclerosis (MS) first appear in individuals?
In their 30s.
True or False: Multiple Sclerosis (MS) does not directly damage the axon.
True-the axon remains intact but the destruction of the protective myelin affects its function by slowing or stopping its ability to conduct neural impulses.
What are the symptoms of Multiple Sclerosis (MS)?
Visual disturbances (among the most common), chronic feelings of tiredness, weakness in the limbs, disturances of sphincter muscle control, dysarthria, numbness, burning sensations, itching, tingling, depression, and mild dementia (in advanced cases)
True or False: the course of Multiple Sclerosis (MS) doesn't vary much from patient to patient.
False-40% go through relapsing and remitting occurrences of their symptoms during the early stages of the disease, then begin a steady and slow progression of more significant symptoms. 20-30% maintaina relapsing and remitting course for the duration of their lives, 10-20% have a steady progression from the very outset, and 20% experience only one or two relapsing and remitting occurrences of symptoms and are otherwise unaffected by the disease.
True or False: Most individuals with Multiple Sclerosis (MS) demonstrate obvious motor speech deficits.
False-although MS can cause many types of dysarthia, most individuals with this disease do NOT demonstrate obvious motor speech deficits.
What are the most prominent speech errors in individuals with Multiple Sclerosis (MS)?
Deficits in loudness control, harshness, and impaired articulation.
What are the most common pure dysarthrias found in Multiple Sclerosis (MS)? (two)
Ataxia and spastic dysarthia
What is the most common mixed dysarthia associated with Multiple Sclerosis (MS)?
ataxic- spastic
A degenerative neurological disease that primarily affects neurons in the brainstem, basal ganglia, and autonomicnervous system...?
Shy-Drager Syndrome
True or False? Shy-Drager Syndrome is not usually fatal.
False. Shy-drager syndrome is often fatal several years after it's onset. Onset is typically in middle age and it progresses slowly.
Are l-dopa and other antiparkinson drugs effective in treating the parkinsonian symptoms (Bradykinesia, akinesia, and rigidity) in Shy-Drager Syndrome?
No
What are the symptoms of Shy-Drager Syndrome?
Parkinsonian symptoms (like bradykinesia, akinesia, rigidity), mild spasticity in the limbs, face or neck, problems regulating blood pressure, impotence, bowel and bladder dysfunction, poor papillary reaction to light. Signs of ataxia.
What the three most common types of mixed dysarthia in Shy-Drager Syndrome?
This disease causes the degeneration of neurons in the brainstem, basal ganglia, and cerebellum.
Progressive supranuclear palsy
True or False: Progressive supranuclear palsy follows a steadily progressive course.
True. The cause of PSP is unknown. It is usually fatal after several years.
What is the most characteristic symptom of Progressive Supranuclear Palsy?
gradual restriction of voluntary eye movements.
What are the symptoms of Progressive Supranuclear Palsy?
gradual restriction of voluntary eye movements, problems with walking and neck rigidity, generalized rigidity, mild spasticity of the limbs, face, or neck, dementia, dysphagia, involuntary closing of the eyelind (blepharospasm)and dysarthria.
What types of dysarthria are commonly associated with progressive supranuclear palsy?
Hypokinetic, spastic, or mixed hypokinetic. Ataxic dysarthria can also be present, freqently in conjunction with either hypokinetic or spastic dysarthria.
This disorder causes the gradual deterioration of neurons in the inferior olivary nucleus, pons, and cerebellum.
Olivopontocerebellar Atrophy
What is the inferior olivary nucleus?
A collection of neuron cell bodies in the brainstem near the cerebellar peduncles.
What is the cause and when is the onset of Olivopontocerebellar Atrophy?
Cause is unknown, although familial links have been clearly established in some cases. Onset of this disorder usually occurs when individuals are in their 30s or 4-s.
What are the symptoms of Olivopontocerebellar Atrophy?
Ataxic disturances of balance, uncoordinated movements of the arms and legs, tremor, numbness in the extremities, muscle spasms, problems with bowel and bladder control and dysarthria. Involuntary choreic movements and mild dementia have also been noted in some individuals.
Is there a cure for Olivopontocerebellar atrophy?
No. It progresses quire slowly and leads to death about 20 years after the first onset of symptoms.
What kind of dysarthria is most commonly associated with Olivopontocerebellar Atrophy?
Most frequently the mixed type...components of ataxic, spastic, flaccid or hypokinetic dysarthria.
What disease is often misdiagnosed initially as Parkinson's Disease?
Progressive Supranuclear Palsy
What disease might be misdiagnosed as Huntington's Disease?
Olivopontocerebellar Atrophy
What disease results int he progressive degeneration of motor neurons?
Amyotrophic Lateral Sclerosis-cause is unknown
What is the median age of onset in ALS?
65 years, though it can develop in individuals as young as 20 or as old as 90.
True or false: Males are affected more frequently than females by a ratio of 1.5 to 1.
True
What is the prognosis for people with ALS?
In nearly all cases, ALS is relentlessly progressive and is fatal within the first few months or years after onset. Most patients die from complications of pneumonia and respiratory failure.
Patients with ALS with spinal nerve involvement will demonstrate...what?
weakness in their arms and legs, loss of muscle tone, muscle atrophy, and decreased reflexes
Patients with ALS with cranial nerve involvement will demonstrate...what?
flaccid dysarthria, a reduced gag reflex, tongue atrophy, dysphagia, and facial and oral weakness.
Patients with ALs with involvement of the upper motor neurons of the corticobulbar tract will demonstrate...what?
spastic dysarthria, hyperactive gag reflexes, facial and oral weakness, and dysphagia
Patients with ALS with involvement of the upper motor neurons of the corticospinal tract will demonstrate...what?
Weakness and spasticity in the arms and legs, increased reflexes, and painful muscle cramps in the extremities.
What type of dysarthria is expected from someone that has ALs with mostly lower motor neuron involvement?
Flaccid Dysarthria.
What type of dysarthria is expected from someone that has ALs with mostly upper motor neuron involvement?
spastic dysarthria
What type of dysarthria is expected from someone that has ALs with upper and lower motor neuron involvement?
flaccid-spastic mixed dysarthria.
What are the three most prominent speech errors in patients with ALS?
imprecise consonants, hypernasality and harsh vocal quality.
True or False: Dementia is a symptom of ALS.
False.
True or False: Patients with ALs do not maintain their cognitive abilities throughout the course of the disease.
False. Patients with ALS do maintain their cognitive abilities throughout the course of the disease. Their bodily sensations, eye movements, and bladder control remain essential intact as well.
A rare hereditary disease that prevents the normal metabolism of dietary copper-instead of being excreted, excessive amounts of copper are deposited in the corneas of the eyes, kidneys, liver, and brain (especially in the basal ganglia).
Wilson's Disease.
When do the first signs of Wilson's Disease appear?
In the teens or twenties
What are the symptoms of Wilson's Disease...broken down into early and late?
Early-clumsiness, mild decreases in cognitivite abilities and subtle personality changes. Later-rigidity, bradykinesia, tremor, limb ataxia, dementia, dysphagia, and dysarthria. Also, dystonic and choreic movements. Emotional lability, severe depression, mania, behaviors having schizophrenic characteristics.
True or false-there is no treatment for people with Wilson's Disease.
False-effective treatments are available for nearly all individuals with this disease-most common treatment is oral dosages of penicillamine. It reduces the copper deposits in the body and often leads to dramatic improvements in the symptoms. Permanent damage can occur if not treated quickly-can be fatal within 2-3 years of first symptoms if untreated. Death usually occurs from liver failure.
What are the three most prominent speech errors in people with Wilson's Disease?
Reduced stress, monopitch and monoloudness.
What is the most noticeable dysarthria in Wilson's Disease?
Hypokinetic dysarthria.Also has speech errors that are characteristic of ataxic and spastic dysarthria... might appear alone, reflecting a pure rather than mixed dysarthria.
An inherited, progressive disorder that causes neuron degeneration in the cerebelllum, brainstem, and spinal cord.
Friedreich's ataxia-rare disorder that first becomes evident when individuals are ni their 20s, untreatable, and usually fatal within 10-15 years of the initial appearance of the symptoms, usually the result of heart failure or coma.
Early symptoms of Friedreich's ataxia are...
unsteadiness and clumsiness, with ataxia being present in the movements of the arms and legs. Mild dysarthria. As the disorder progresses...weakness and muscle atrophy in the arms and legs, visual deficits and SNHL can occur. They eventually develop dementia.
What is the most common pure dysarthria associated with Friedreich's ataxia?
Ataxic dysarthria...other types are possible though, especially spastic dysarthria.
What is the most common mixed dysarthria associated with Friedreich's ataxia?
Ataxic-spastic mixed dysarthria.
Which of the following diseases are/are NOT characterized by dementia? (MS, Shy-Drager Syndrome, PSP,Olivopontocerebellar Atrophy, ALS, Wilson's Disease, Freidreich's Ataxia)
MS-mild dementia may be noted in some advanced cases of the disease, Shy-Drager syndrome-NO, PSP-YES, Olivopontocerebellar Atrophy-mild dementia, ALS-NO, Wilson's Disease-YES, Freidreich's Ataxia-YES, some individuals eventually develop dementia.
What is the general rule regarding treatment of mixed ddysarthria?
The general rule in treating mixed dysarthria is to first treat the component that is most severely affecting speech production.
What order should the elements of mixed dysarthria be treated when they equally affect speech production?
1st-respiration, 2nd-resonation, 3rd-phonation, 4th-articulation, 5th-prosody. The reason for this is based on how the different components of speech support each other.
What are the five communicative stages that a patient with ALs will pass through as the disease progresses & what happens in them?
1. No detectable speech disorder-pts and family given general facts about the communication deficits associated with ALS. Start learning basics of Aug Comm systems.
2. Obvious speech Disorder with Intelligible Speech-active SLP involvement advising pts and family on how tom aximize the intelligibility of the patient's speech, introduction to voiec amplification. preliminary steps of choosing aug comm systems should be started.
3. Reduction in Speech Intelligibility-try to help increase of maintain a pt's intelligibility-with things with reduced rate of speech, breath group duration, palatal life, etc.
4. Residual Natural Speech and Augmentative Communication-pts rely heavily on aug comm device to supplement residential intelligible speech. Aug comm now becomes the primary method of communication-family and friends trained on how to best communicate with pt.
5. Loss of useful Speech-depend almost exclusively on aug com systems. a collection of low-tech aug procedures may also be used like yes/no, eye blinks, eye-pointing.
