Case Study Spastic Dysarthria
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Faulkner University *
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Course
6351
Subject
Medicine
Date
Apr 3, 2024
Type
Pages
2
Uploaded by DoctorDonkeyPerson1053
Neurogenic Disorders I
Elizabeth Tray
An 80-year-old woman, Ms. Elizabeth Tray, was admitted to the hospital neurology
service with the sudden onset of speech difficulty. She had a 10-year history of
hypertension. Approximately a year prior to the current admission, she had a sudden
onset of dysarthria, dysphagia, and right-sided clumsiness, all of which resolved in 10
days.
Neurologic examination identified significant dysarthria, dysphagia, and left-hand
weakness, as well as hyperactive reflexes on the left. A diagnosis of a right internal
capsule or pontine infarct was made. Subsequent MRI and CT scans identified
moderate generalized atrophy and multiple focal areas of abnormality in the
hemispheric white matter bilaterally, consistent with subcortical ischemic disease.
Speech examination revealed both left and right lower facial weakness with reduced
range of movement on smiling, lip rounding, and lip puffing. Tongue protrusion and
lateralization were limited in range. Gag reflex was hyperactive, as was the sucking
reflex. Contextual speech was characterized by a hoarse, strained voice quality,
reduced loudness, imprecise articulation, hypernasality and monopitch/monoloudness.
Speech intelligibility was reduced. There was no evidence of aphasia or apraxia of
speech. There were also signs of PBA.
1. With which type of dysarthria does Ms. Tray present?
-
Spastic
2. How did the group members decide upon this diagnosis?
-
The PBA symptoms and hyperactive gag reflexes stood out as a key indicator of
spastic dysarthria. Bilateral damage (i.e. left and right facial weakness) indicated
bilateral UMN damage, and her strained and harsh vocal quality, monopitch, and
reduced intelligibility aligned with this diagnosis. She is having dysphagia signs
as well.
3. What are two long term goals and two short term goals the SLP might use with Ms.
Tray?
-
LTG1: Improve PBA symptoms
-
STG1: Patient will complete behavior modification training exercises to
resolve PBA episodes in 8 out of 10 opportunities
-
LTG2: Improve articulation and intelligibility
-
STG2: Patient will complete lip and jaw stretching and strengthening
exercises in 8 out of 10 opportunities
4. What are two therapeutic activities the SLP could use to target these goals?
-
exaggerated articulation
-
sustained jaw opening
-
tongue protrusion/lateralization/retraction
-
biofeedback
-
intelligibility drills
- Behavior Modification Training
-taking slow, deep breaths until episode subsides
-thinking/focusing on something else during an episode
-relaxing shoulder and facial muscles to reduce tension
-changing the position of the patient’s body
-support groups
-recognition of when an emotion is appropriate
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