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Spastic Dysarthria (often mixed with another dysarthria)
- perceptually distinct, it is produced by bilateral damage to the IAP and the DAP of the CNS
- -really effortful
- -weakness+spasticity=UMN disease
- -excessive muscle tone and weakness of speech
- -a problem of neuromuscular execution
- -multi lesions bilaterally
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DAP (skilles discrete movements) Lesions
- disruption of messages to the FCP
- -unilateral UMN lesions do not really have an effect on jaw, velopharyngeal, laryngeal or lingual speech movements
- -loss of fine skilled movements, hypotonia, weakness (bilateral lesions)
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IAP (reflexes posture tone: Inhibitory) Lesions
increased muscle tone, spasticity, clonus (repetitive reflex contraction), posture, hyperactive stretch reflex, babinski sign, hyperactive gag refelx
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spastic paralysis
spasticity, weakness, ROM, slowness of movement
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Etiologies of Spastic
- TBI
- PLS (early ALS but confined to the UMN)
- Spastic CP
- Vascular disorders (must be bilateral)
- inflammatory disease
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speech characteristics:
- -Strained harsh voice quality
- -monopitch monoloudness, slow rate and slow and regular AMRs
- -hyperadduction of the vocal folds
- -hypernasality
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clinical characteristics
- -dysphagia, drooling, weak face and tongue, pseudo bulbar affect
- -reflexive or emotional facial expressions are slow
- -Range is limited, force is reduced, tone is excessive
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Patient perspectives
- slow and effortful speech
- -difficulty swallowing
- -fatigue
- -over active gag reflex
- -difficulty controlling expression of emotion
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OME findings
- jaw strength is normal
- face weak bilaterally
- lips reduced rom bilaterally
- tongue reduced rom and strength
- AMRs slow and reduced rom
- cough and coup may be weak
- jaw jerk is common
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Spastic vs Flaccid
- spastic-bilateral UMN, strangled harsh voice
- flaccid- LMN, hypernasality more severe, nasal emissions, breathy voice
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treatments
- -medication to help with spasticity
- -PBA=medications or BM
- -pitch range exercises
- -resonance exercises
- -relaxation techniques
- -muscle strengthening
- -contrastive stress drills
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