Types of Dysarthria Chart

LMD - weakness, fasciculations, deviation of tongue on same side of lesions (unless bilateral), upper and lower facial muscles affected same side as lesion UMD - Spasticity, deviation of tongue away from lesion, forehead spared, no fasciculations. Some disease like ALS affect both UMN and LMN. PLANNING, EXECUTING OR REGULATING ? TYPE SUBTYPE UMN?LMN? AREA OF BRAIN SPEECH SYMPTOMS Ataxia hereditary and sporadic ataxias UMN Cerebellum (left) HALLMARK IS LACK OF regulating COORDINATION: Articulation & prosodic abnormalities, alterations of the normal timing pattern, with prolongation of certain phonemes and a tendency to equalize the duration of syllables when speaking. As the severity of the dysarthria increases, the patient may also lengthen more segments as well as increase the degree of lengthening of each individual segment.Common abnormalities in speech modulation, rate of speech, explosive or scanning speech, slurred speech, irregular stress patterns, and vocalic and consonantal misarticulations. Eg repeating P will either be very slow, or very irregular like popcorn. Struggle with words more than sounds CAUSES Can be hereditary eg in freidreichs or acquired eg cerebellar stroke, M.S, tumors Flaccid Spastic Bilateral LMN unilateral HALLMARK IS WEAKNESS of individual muscles.. Tires after repetition.Perceptual effects of flaccid dysarthria can include hypernasality (“b” and “D” sound like “m” and “n”, air release thru nose as they say “S” because velum not lowered), imprecise consonant productions, breathiness of voice, and affected nasal emission.also problems eating, nasal regurgitation, pocketing etc Damage to CNX will cause vocal cords to be either stuck open or shut - either harsh or breathy, stridor, monopitch, low volume and short phrases, patients tire quickly. Damage to V:: Poor jaw closure, drooling, Damage to VII - one sided facial droop, ipsilateral, both top and bottom of face - recall includes tear duct), fasciculations ( (cranial nerve 7 is only bilaterally innervated in the lower quarter)) Damage to XII - tongue deviates to damaged side, imprecise articulation Execution (muscular and cranial nerve issues) Damage to one or more cranial or spinal nerves (called the motor unit) caused by neoplasms, degenerative diseases, surgery etc unm Motor cortex (peri sylvian Weakness of GROUP of muscles. The speech is harsh Planning (and execution) Bi- lateral stroke (rare), tumors, Primary UUNM unilateral um fissure )both sides, or cortico bulbar tract or “strain-strangle” in vocal quality (like Thelma/Selma), with reduced rate, low pitch, and consonant errors. Patients often have associated features of pseudobulbar palsy, including dysphagia, exaggerated jaw jerk and gag reflexes, and easy laughter and crying (synonyms: emotional incontinence, pseudobulbar affect, or pathological laughter and crying). Another variant is the opercular syndrome. Unilateral. Usually left lobe motor cortex (if language affected) Sudden onset dysarthria, Look for tongue tip deviation (s, th, t) and LOWER facial weakness.Less severe , (because the other side can take over) most nerves, only noticeable places where unilateral innervation ie. lower face and XII for protruding tongue) weakness in face , possible jaw weakness and respiratory, mild, temporary. If left sided, accompanied by apraxia of speech and aphasia. Slurred speech, drooling, mild dysphagia. MAY ALSO HAVE SPACICITY since CVAs attack more than one discreer area. If right, cognitive deficit and aprosodia (pitch, intonation, stress). lateral sclerosis (ALS) Planning (and execution) Nearly always Stroke, occasionally tumor, trauma, demyelination Unlike LMD, will affect opposite side, and will only affect lower quarter. Any sounds involving protrusion or genioglossus will be hard - p and t hard, slow, k not hard Imprecise articulation Irregular articulatory breakdowns Slow and irregular AMRsHoarsenessReduced loudness Apraxia of speech Hypokinetic dysarthria um Um indirect pathway Problems planning speech -will planning get phonemes wrong but will make INCONSISTENT errors, get better with repetition, gropes for words rather than tiring. Does not normally produce hypernasality Basal ganglia lack of dopamine which switches motor control on and off, poor feedback HALLMARK - reduced volume regulating (not tremor - the tremors are resting not intentional) they won’t be aware of volume issue Dysphonia - breathy, rough voice, respiratory insufficiency Reduced articulation - reduced tongue and lip movement, MUMBLING speech (but not aware - carer will say he’s mumbling, patient will say she's deaf) Reduced pitch - monotone Masked face AMR/SMR - difficulty spacing, Parkinson's, Parkinsonism, Occasionally tbi, or basal ganglia stroke can get faster, but can be irregular Hyperkinetic dysarthria Spasmodic (either adductor or abductor type) dysphonia or organic voice tremor Basal Ganglia failure to inhibit involuntary movements TOO MUCH MOVEMENT (not too fast speaking!)involuntary, compulsive, unwanted, extra movements, esp jaw and tongue, face. Spasmodic = Neurologic, focal, speech-induced dystonia.Difficult to distinguish non-neurological voice disorders from spasmodic dysphonia. is not due to spasticity. It’s due to spasm (dystonia).Adductor type most common at 90%. This is hyperadduction strained /squeezed character, vocal folds snap shut. Creaky. Abductor = breathy/aphonic, vocal folds stay open. Can also have a mixed type. Voice normal when singing- holding a note, worse when emotions Voice tremor - difficult holding a note caused by essential tremor Dystonia - muscle contractions, caused often by antipsychotics. Sustained abnormal posture. Can be: Spasmodic dystonia - see vocal fold spasms above (not technically hyperkinetic dys) Huntington’s Tardive dyskinesia (cause by antipsychotic drugs) Tourettes Tremor (more common here than in parkinsons unless parkinson patients have too much medication) Tardive dystonia - unwanted lip and jaw movement - side effect of meds. Very hard to eat Chorea - rapid, irregular movements,continuous, can be small, distal and proximal muscles. Can be caused huntingtons but also be temporary caused by bacterial infection Tics - are not totally involuntary, but can be irresistible, can be distracted. Pressure builds the urge. Mixed Mostly ALS (nixed flaccid and spastic) M.S (attaxic and spastic) MSA (multiple system atrophy) PSP: Progressive Supranuclear Palsy. Mistaken for Parkinson's age. 55-70 years. Dysarthria & dysphagia early (unlike PD)ultHypokinetic/spa stic/ataxic. MSA - Multiple System Atrophy often mistaken for PD Suggested examples of wording for referral to neurology wording: ⚫ “This person has speech symptoms which suggest bilateral upper and lower motor neuron involvement, which is becoming increasingly worse. This pattern of speech difficulty is incompatible with a diagnosis of single cerebral stroke.” ⚫ Or patient with parkinsons who also has other types of dysarthrias: ● “This person has a mixed hypokinetic-spastic-ataxic dysarthria that can not be explained by Parkinson’s alone. This mixed dysarthria presentation could be accounted for by progressive conditions which affect multiple components of the motor system, such as PSP or MSA.”