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ESSENTIAL NEUROLOGY - PART 6

Điều quan trọng là nhớ sự sẵn có của thông tin liên lạc hỗ trợ cho các bệnh nhân với dysarthria nặng. Đây có thể là hình ảnh hoặc biểu đồ biểu tượng, thẻ bảng chữ cái, bảng xếp hạng từ khá đơn giản. Nhiều di động 'công nghệ cao hỗ trợ truyền thông kết hợp bàn phím và bài phát biểu tổng hợp cũng rất có giá trị đối với một số bệnh nhân. | 134 CHAPTER 8 It is important to remember the availability of communication aids for patients with severe dysarthria. These may be quite simple picture or symbol charts alphabet cards or word charts. More high tech portable communication aids that incorporate keyboards and speech synthesizers are also very valuable for some patients. Upper motor neurone lesions The upper motor neurones involved in speech have their cell bodies at the lower end of the precentral motor gyrus in each cerebral hemisphere. From the motor cortex the axons of these cells descend via the internal capsule to the contralateral cranial nerve nuclei 5 7 9 10 and 12 as shown in Fig. 8.17. Aunilateral lesion does not usually produce a major problem of speech pronunciation. There is some slurring of speech due to facial weakness in the presence of a hemiparesis. Bilateral upper motor neurone lesions on the other hand nearly always produce a significant speech disturbance. Weakness of the muscles supplied by cranial nerves 5-12 is known as bulbar palsy if the lesion is lower motor neurone in type see the next section in this chapter . It is known as pseudobulbar palsy if the weakness is upper motor neurone in type. Patients who have bilateral upper motor neurone weakness of their lips jaw tongue palate pharynx and larynx i.e. patients with pseudobulbar palsy have a characteristic speech disturbance known as a spastic dysarthria. The speech is slow indistinct laboured and stiff. Muscle wasting is not present the jaw-jerk is increased and there may be associated emotional lability. The patient is likely to be suffering from bilateral cerebral hemisphere cerebrovascular disease motor neurone disease or serious multiple sclerosis. Speech is slow indistinct laboured and stiff in patients with pseudobulbar palsy Lower motor neurone lesions and lesions in the neuromuscular junction and muscles The lower motor neurones involved in speech have their cell bodies in the pons and medulla Fig. 8.17 and their .