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CSD 316 - Neurogenic Voice Disorders
Test 2
61
Communication
Undergraduate 3
02/17/2013

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Term
what causes flaccid dysarthria?
Definition
damage to the lower motor neurons
Term
what are some common clinical presentations of flaccid dysarthria?
Definition
after surgery, injury, CVA, tumor, or myasthenia gravis
Term
what is myasthenia gravis? how is it managed?
Definition
fatigue with extended use - it is medically managed
Term
how does flaccid dysarthria affect the voice?
Definition
the voice is breathy, hoarse, and there is diplophonia
Term
how do we treat flaccid dysarthria?
Definition
surgery or compensatory strategies
- bilateral is surgical
- unilateral is more SLP treated and we teach patients to try lifting, pushing, or pulling techniques
Term
what is a disorder of motor execution? what symptoms do we see with this?
Definition
dysarthria: there is a problem with the transmission of the signal, but the original brain message is fine

-- we see low tone, paralysis, and weakness
Term
what is a disorder of motor planning?
Definition
apraxia
Term
what causes unilateral upper motor neuron dysarthria?
Definition
the most common cause is a stroke, then tumor or trauma
Term
what does unilateral upper motor neuron dysarthria look like clinically?
Definition
mild dysphonia
Term
what are some common co-morbidities in unilateral upper motor neuron dysarthria?
Definition
aphasia or apraxia
Term
how does aphasia effect treatment for unilateral upper motor neuron dysarthria?
Definition
Aphasia may interfere with the client not telling you what they need or follow your directions
Term
how does apraxia effect treatment for unilateral upper motor neuron dysarthria?
Definition
Apraxia will lead to inconsistent areas and groping behaviors
Term
in which dysarthria do we get too much contraction so we get spasticity on one side?
Definition
unilateral upper motor neuron dysarthria
Term
how are spastic dysarthria and UUMN dysarthria different?
Definition
bilateral upper motor neuron damage: spastic
unilateral upper motor neuron damage: UUMN
Term
How does spastic dysarthria affect the voice?
Definition
-strained voice quality from over tightening of the folds
-harshness
-low pitch because of a greater degree of resistance to overcome so you have fewer cycles per second
-hypernasality
Term
what are common co-morbidities of spastic dysarthria?
Definition
TBI and lability
Term
How does a TBI affect treatment of spastic dysarthria?
Definition
the SLP may have bigger things to deal with, such as walking, eating, etc.
Term
how does lability affect spastic dysarthria treatment?
Definition
the patient may have trouble with emotional regulation
Term
what causes hypokinetic dysarthria? What's the usual diagnosis for patient's with this dx?
Definition
problems in the basal ganglia with reduced dopamine - usual diagnosis is Parkinson's disease
Term
what voice concerns do we encounter with hypokinetic dysarthria?
Definition
- monopitch
- monoloudness
- breathy
- hoarse
Term
what treatment options exist for hypokinetic dysarthria?
Definition
medication, surgery to correct bowing, and voice therapy (LSVT)
Term
which dysarthria is the only dysarthria associated with an increased rate of speech and decreased volume?
Definition
hypokinetic dysarthria
Term
when patient's have been treated for a long time for Parkinson's disease, what can result from extended treatment?
Definition
chroeiform chorea
Term
How do people with Parkinson's perceive their own voices?
Definition
They perceive their own voices as normal, but in reality there is a bowing of the VFs which lets air escape and results in a breathy quality
Term
what causes hyperkinetic dysarthria?
Definition
it isn't completely understood, but there are problems in the basal ganglia
Term
what voice-related problems does hyperkinetic dysarthria cause?
Definition
-variable pitch
-variable loudness
-harshness
Term
how is hyperkinetic dysarthria managed?
Definition
medication and voice therapy if appropriate
- in the early stages patients talk with a metronome, delayed auditory feedback, or use sensory tricks (touching finger to the jaw, etc.)
Term
latrogenic
Definition
doctor or intervention caused - anytime a patient comes in for medical assistance and ends up with a problem they didn’t have before.
Term
nosococomial
Definition
hospital acquired
Term
What answer choice should never be selected on the exam?
Definition
ataxic dysarthria -- caused by the cerebellum and affects prosody/gait
Term
what causes mixed dysarthria?
Definition
multiple lesion sites
Term
which diagnoses cause voice-related problems?
Definition
TBI, ALS, MS, CP
Term
how do we treat mixed dysarthria?
Definition
always treat the respiration problems first, then resonation because it's hard to understand someone with awkward resonance. Work on prosody and articulation last.
Term
CP usually results in a mix of what?
Definition
spastic and flaccid dysarthria
Term
when is onset of spasmodic dysphonia?
Definition
in adulthood
Term
what does spasmodic dysphonia affect?
Definition
connected speech
Term
which subset of spasmodic dysphonia is most common?
Definition
adductor
Term
what is adductor spasmodic dysphonia?
Definition
spasms of the adductor muscles - the person is talking and then they get a sudden burst of strained/strangled quality and the vocal folds close suddenly.
– This gives a harsh tone
Term
what is abductor spasmodic dysphonia?
Definition
get aphonic bursts where a person tries to phonate
Term
what are causes of spasmodic dysphonia?
Definition
focal dystonia
-focal: localized to one place
-dystonia: bad tone/something is going wrong from the brain to the muscle
Term
is spasmodic dysphonia a psychogenic disorder?
Definition
no
Term
what are symptoms of spasmodic dysphonia?
Definition
adductor: strangled voice quality
abductor: aphonic interruptions/breathiness
Term
what are co-occurring symptoms of spasmodic dysphonia?
Definition
blepharospasm- spasms of the eyelids
torticollis- twisted neck
graphospasm- spasm that effect the ability to write
oromandibular dystonia- bad muscle tone of the mouth and jaw
Term
blepharospasm
Definition
spasms of the eyelids
Term
torticollis
Definition
twisted neck
Term
graphospasm
Definition
Spasms that effect their ability to write (arm and hand)
Term
oromandibular dystonia
Definition
Bad muscle tone of the mouth and jaw
Term
what are treatment options for spasmodic dysphonia?
Definition
recurrent laryngeal nerve sectioning
botulinum toxin
voice therapy
Term
recurrent laryngeal nerve sectioning treatment for spasmodic dysphonia
Definition
current laryngeal nerve is cut to stop the impulses - but it's a temporary fix because it's not uncommon for the nerves to find their way back together
Term
botulinum treatment for spasmodic dysphonia
Definition
injection of botox into the muscles of the larynx can damp down the overactive neural input and allow patients to produce more normal voice for a time
Term
voice therapy treatment for spasmodic dysphonia
Definition
ONLY USEFUL IN ADJUNCT WITH BOTOX
Term
what is paradoxical vocal fold movement?
Definition
VFs don't move as directed - may close during breathing
Term
what is sometimes mistaken for asthma?
Definition
paradoxical VF movement
Term
what is treatment for paradoxical VF movement?
Definition
botox so the adductor muscles aren't closing off the airway - in severe cases the disorder may need a tracheostomy placement --- therapy can be helpful if we teach the patients how to relax the VFs
Term
what causes paradoxical VF movement?
Definition
maybe reflux, dystonia, or psychogenic? -- very unpredictable/triggered by exertion
Term
when can you identify paradoxical VF movement?
Definition
you can only identify during an attack
Term
an essential tremor is considered a what?
Definition
hyperkinetic dysarthria - most common of the movement disorders
Term
what is the most common of the movement disorders?
Definition
essential tremor
Term
what is an essential tremor related to?
Definition
genetics and aging
Term
is an essential tremor malignant or benign?
Definition
benign
Term
what is treatment for an essential tremor?
Definition
there is no way to eliminate it - our therapy is focused on diversion (EG: teach patients how to shorten vowels, raise the pitch so there will be more tension in the VFs and the tremor will be less prominent, and to speak quieter with lower intensity)
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