Ataxic Dysarthria (PPT only) – Flashcards
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Underlying feature of ataxic dys?
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INCOORDINATION. Characterized by: - overshooting or undershooting targets - slurred speech
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Definition of ataxic dys
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- A dysarthria associated with damage to the cerebellar system and characterized by speech errors relating primarily to timing, giving equal stress to each syllable; - articulation problems are typically characterized by intermittent errors ranging from mild to severe; vocal quality can be harsh with monotonous pitch and volume; - prosody may range from reduced to unnatural stress. - There may also be difficulty coordinating breathing and speech
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Ataxic dysarthria is a disorder of...
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sensorimotor control for speech production that results from damage to the cerebellum or to its input and output pathways.
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The dragging and blurred quality of ataxic dyarthric speech has sometimes been likened to...
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"drunken speech"
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Ataxic means...
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widespread coordination and comes from the Greek word for lack of order.
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Limb symptoms
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- wide stance - difficulty standing still - movements tend to be large and uncoordinated - can't walk a straight line
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Social stigma
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Perception of "drunken speech" often leads to social isolation
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Anatomy of the cerebellum
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- The circuitry of the cerebellum involves inter-connections with other parts of the brain that are connected to the cerebral cortex...more important is the MOTOR PLANNING portions. These portions go through the thalamus. - creates a loop from the cerebellum to cortex to thalamus to cerebellum again
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Damage to cerebellum means...
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the message to generate correct movement is not going out.
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The cerebellum is located...
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- in the posterior fossa of the brain. - behind the pons and the medulla
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How many hemispheres in the cerebellum?
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2
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Lesions in ataxic dysarthria are usually (bilateral/unilateral)
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Bilateral, but they do not need to be.
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Lesions in ataxic dysarthria are usually bilateral...in the ____, _____ or _____
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- vermis - diffuse or generalized
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The cerebellum also has connects to muscles at the __________.
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periphery
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Implications of connections to muscles at the periphery...
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- The cerebellum is informed by the cortex about the intended movements that it wishes to accomplish. - it's also informed by the periphery about the results of these movements. - The cerebellum takes responsibility for coordinating and making sure that the movement occurs in a smooth and coordinated way, so, it gets the INTENTION (of movement), matches them up and makes ERROR CORRECTIONS.
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How does cerebellum accomplish all this?
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By processing sensory information from all over the body and integrating that information into execution of movement.
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Neurological basis of ataxic dysarthria
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- damage to cerebellum or to the neural pathways (cerebellar control circuits) that connect the cerebellum to the other parts of the CNS cause ataxic dys. - Cerebellum is significant part of motor system - Primary function is to COORDINATE the TIMING and FORCE of muscular contractions so that skilled voluntary movements are appropriate for an intended task.
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Ataxic dysarthria often occurs from...
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damage to the cerebellar control circuit
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Ataxic dysarthria reflects a breakdown in...
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motor organization and control
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Effects of ataxic dysarthria are most evident in ____ and ____
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articulation and prosody
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Cerebellar control circuit
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- cerebellar hemispheres control movement on the ipsilateral side of the body - lateral cerebellar hemispheres of posterior cerebellar lobe help coordinate SKILLED VOLUNTARY MUSCLE activity and TONE - cerebellum monitors adequacy of movement based on feedback from muscles, tendons, and joints.
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Dysmetria
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disturbance in controlling aim or range of movement (e.g., overshooting or undershooting target)
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Dysdiadochokinesis
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decomposition of movement - rapid fatigue with repetition.
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ataxic movements
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halting, imprecise, jerky, poorly coordinated, reduced speech and lacking fluidity of movement
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Intention (or kinetic) tremor
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Tremor that occurs as target is being approached, but timing and range are OK. Typically seen as target is approximated.
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Clinical Findings
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- ataxic dys results from Bilateral or generalized cerebellar disease - difficulties with standing or walking - broad-based stance, instability, frequent falls. - titubations - nystagmus - hypotonia - movement errors: force, speed, range, direction, timing
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titubations
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rhythmic tremor of body or head
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nystagmus
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involuntary rapid movement of eyes
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hypotonia
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decreased resistance of passive movement
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Etiologies of ataxic dys
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- degenerative - vascular - neoplastic - trauma - toxic/metabolic conditions - other
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degenerative etiologies
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Hereditary Ataxias: - Fredreich's - olivopontocerebellar atrophy - MS
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Vascular etiologies
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- Aneurysms - Arteriorvenous malformations (AVMs) - cerebellar hemorrhage - occlusion in vertebobasilar system
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Trauma
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- TBI - dementia
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Toxic-Metabolic conditions
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- alcohol abuse - malnutrition - drug side effects: Anti-seizure (i.e., anti-convulsant) meds: Dilantin, Tegretol
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Other etiologies
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- hypothyroidism - normal pressure hydrocephalus
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Patient Complaints
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- Slurred speech with drunken quality - difficulty coordinating breathing with speech - bite cheeks or tongue while talking - stumble over words
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Clinical Findings: More!
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- Usually occurs with other signs of cerebellar disease - oral mechanism exam is often normal - irregular non-speech AMRs - irregular speech AMRs - may have associated cognitive deficits
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Speech Clusters with Ataxic dys
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- Articulatory inaccuracy - prosodic excess - phonatory-prosodic insufficiency
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Articulatory inaccuracy cluster
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- imprecise consonants, - irregular articulatory breakdowns, and - vowel distortions
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Prosodic excess cluster
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- excess and equal stress - prolonged phonemes - prolonged intervals - slow rate
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Phonatory-prosodic insufficiency cluster
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- harshness - monopitch - monoloudness
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Therapy for Ataxic Dysarthria
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Subsystems: - Respiratory - Rate Control - Resonance - Voice - Artic - Prosody
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Respiratory therapy for ataxic dys
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- increase breath control - focus on slow and controlled respiration - help maintain postural support - speak immediately on exhalation - do yawn-sigh for breathing in and out and coordinating sound. Then shape into words, phrases - stop phonation early
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Rate control therapy for ataxic dys
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- recite syllables to a metronome, finger, or hand-tapping - read cued reading material - chunk phrases together
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Resonance therapy
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NOT applicable
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Voice therapy
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- increase volume control - medical evaluation and intervention for vocal tremor
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Artic Therapy
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- muscle force training - phonemic practice - intelligibility drills - exaggerated consonants
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Prosody (stress) therapy
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- contrastive stress drills - pitch range exercises - intonation profiles - chunking utterances into syntactic units
