benchmark 3 - final Flashcards
hyperkinetic dysarthria is what level of motor organization
extrapyramidal
t/f abnormal involuntary movement are often called hyperkinesia
true
what are the 3 main cerebral structures of extrapyramidal level
basal ganglia
subthalamic nucleus
substantia nigra
hyperkinetic dysarthria symptoms
- involuntary, unprogrammed, extra movements
- occurs in any muscles or group of muscles
- the inhibitory nature of extrapyramidal level is inhibited
- result from a failure of extrapyramidal level to inhibit the extra impulses from the cortex
3 general classifications of hyperkinetic dysarthria
quick, slow, tremor
what is QUICK hyperkinetic dysarthria
- quick, unsustained, involuntary movements
- myoclonus: FASTEST
- tourette’s (tics): FAST
- chorea: SLOWER than tics and clonus
myoclonus (quick hyper)
- FASTEST hyperkinetic disorder
- characterized by involuntary single or repetitive brief jerks of a body part
- sudden large transient “shock like” contraction –> can be momentarily postponed/reduced
- involuntary, irregular jerks in chest, larynx, VP, lips, tongue and jaw
- irretractable hiccups
- idiopathic or brain/spinal injury; meds reaction
myoclonus: essential assessment
conversational speech is usually unaffected
respiration, phonation and vowels are unprogrammed
palatal myoclonus (resonance) –> tends to go away during sleep
AMR/SMR: fleeting interruptions
Tourette’s (tics) (quick hyper)
- involuntary, compulsive, rapid, nonrhythmic movement –> can be postponed but not suppressed
- postponing can make worst
- rapid and arrhythmic tic movements
- odd vocalizations
- facial grimaces
- slower palatal myoclonus (resonance)
- etiology is unknown
Tourette’s (tics): essential assessment
Type of quick hyperdysartheira
- simple phonic tics (noises) –> like sniffing, throat clearing, barking
- complex phonic tics (linguistically meaningful) –> coprolalia (profanity), echolalia, palilialia, loud talking
Chorea (quick hyper)
- quick rapid involuntary, irregular, fleeting, unpredictable, non stereotyped movement
- contraction than release = smoother dance-like movement
- can occur at rest but increases with voluntary movement
t/f Sydenham’s chorea is not progressive
true
two common type of chorea
- sydenham’s –> childhood fever
- huntington’s chorea –> progressive genetic with dementia
Chorea essential assessment
- **every aspect of speech is affected
- highly variable, can not predict
- respiration –> bursts of loudness
- phonation –> roughness, strain-strangled, low pitch
- articulation –> irregular breakdown, variable rate, prolonged phonemes
- AMR/SMR –> slow, unpredictable
- vowel –> short, irregular pitch
Slow hyperkinetic dysarthria
- Athetosis –> slow
- Dystonia –> slowest
Athetosis - slow hyperkinetic dysarthria
- involuntary, irregular, unpredictable, non-stereotyped movements interfering with all skilled movement –> slightly slower than chorea
- stiff, high muscle tone, hypercontraction
- fluctuating b/w flaccid spastic tone, distal movement, tremors increase with stress
- shallow noisy stridor breathing
- facial grimacing
- etiology –> early onset from birth trauma and anoxia OR later onset –> stroke; tumor in basal ganglia
Athetosis - slow hyperkinetic dysarthria –> essential asessment
conversational speech
- bursts of loudness
- groaning voice, explosive, phonation arrest
- lack of coordination of voicing and articulation
- amr/smr –> unpredictable
- vowel –> reduced duration, irregular pitch
Dystonia - slow hyperkinetic dysarthria
- involuntary, random movements interfere with all skilled movements; action-induced (not seen at rest); contractions build up slowly; reduced strength
- primary dystonia is hereditary; secondary is brain trauma or inflammation (encephalitis)
3 types of dystonia
- generalized
- segmental
- isolated/focal
generalized dystonia
generalized –> whole body; starts in childhood with foot turning in
- symptoms improve with sensory tricks such as touching chin,face or pencil b/w teeth during speech (more of a sensory feedback issue than psychological)
- breathing irregular, abnormal posture
- larynx - indirect exam –> VFs appear normal; endoscopy –> reveals involuntary hyperadd/abduction during speech
- involuntary movements in velopharynx and lips, tongue jaw
segmental dystonia
- segmental –> 2+ structures; starts as adult; clenching in eyes+lips/jaw = meige; clenching in jaw+tongue = oromandibular meige
isolated/focal dystonia
- isolated/focal –> one area, starts as adult
types: spasmodic dysphonia (laryngeal dystonia; most common); blepharospasm (difficult to open eyes); torticollis (humped to one side); limb dystonia (writers cramps) - females are more affected
- action induced –> speaking; symptoms emerge during connected speech
- improves with laugh, singing, whisper, etc.
generalized dystonia - essential assessment
- bursts of loudness
- rough, strangled voice
- breathy
- irregular articulatory breakdown with prolonged phonemes
- amr/smr: reduced duration
- vowels are reduced, variability in pitch
two types of spasmodic dystonia
adductor ->
- 80-90% of cases
- larynx stiffens and forcefully adducts the VFs
- hyperadduction including glottic closure increases subglottic pressure
- spasms occur on voiced sounds
- strained strangled voice
- effortful phonation
abductor –>
- spasms in posterior cricoarytenoid muscles
- involuntary abduct VFs
- occurs on voiceless speech sounds
- prolonged voiceless sounds (prolonged H—-arry)
- breathy voice
differential diagnosis for adductor vs abductor spasmodic dysphonia
adductor –> spasms occur on voiced speech sounds (difficult to say aunt annie’s alligator)
abductor –> prolonged voiceless sounds (difficult to say H—-ary; h—–at)
hyperkinetic dysarthria - tardive dyskinesia and tremors
results from exposure to neuroleptic drugs –> usually goes away after stopping meds
preventable
types:
tardive dyskinesia –> akathisia, difficulty not moving; occurs during sleep and rest; smacking of lips, tongue protrusion, rapid, involuntary jerking/slow movements
what is akathisia
restlessness; quivering
seen in tardive dyskinesia
slow hyperkinetic dysarthria - tremors - types
tremors affecting speech or motor control
rest tremor –> no
action/kinetic –> yes; connected speech
postural –> yes; sustained sounds
isometric –> yes; motor strength
physiological tremor –> yes; connected speech and sustained sounds
what is an essential tremor
stand alone tremor with no other issues
mild = change in F0 and loudness; rhythmic changes in pitch and loudness
moderate to severe = connected speech
severe = voice arrests
what is a tremor as a symptoms
tremors are symptoms of PD, CP, ALS, MS, etc
what is anarthria
absence of speech due to loss of movement supporting speech production
occurs with brainstem stroke
what is mutism
absence of speech that is not anarthria
2 types akinetic and cerebellar
akinetic = happens due to diminished motivation
cerebellar = post brain surgery to remove tumor
locked-in syndrome
occurs due to brainstem stroke
anarthria is accompanied by total immobility of the body except eye movement and blinking
apraxia - cortical level
insert screenshot
- breakdown in programming motor movement
- individual muscles are good
- affect any type of learned motor function
apraxia - cortical level - etiology
- stroke or acquired brain injuries
- dementia
- PD and HD
ideomotor apraxia
incorrect initiation of gestures and motor planning, sequencing, planning, groping
ideational apraxia
incorrect use of items; seen in dementia
t/f apraxia of speech can be motor component of aphasia
true –>
aphasia may be primary disorder - usually Broca’s
important to assess language as well
apraxia - larynx assessment
perseverate, groping errors at adduction (onset of phonation)
apraxia - essential assessment
- type of errors is relatively consistent
- usually more difficult when they repeat the model
- altered prosody; aphonic
- articulation - struggles initiating speech; errors increase with longer words (thick, thicken, thickening), intrusive “schwa”
- SMR: irregular articulatory breakdowns; MORE impaired than AMR
- AMR: more difficult on complex sequence and repeat words of increasing length
- *deterioration of accuracy with repeating words of increasing length
nonverbal oral movement apraxia assessment
disorder of planning and executing nonspeech oral motor movements
- cough, smile, blow, puffy cheeks, protrude tongue
- assess spontaneous and volitional speech
automatic speech movements assessment for apraxia
automatic speech movements
- count 1-30
- days of week
- sing HBD (singing is usually easier)
volitional speech in apraxia
The problem lies with the inability to plan the movements of articulators for the purposes of volitional (on command) speech, thus it is often referred to as a “motor planning disorder.” The term volitional in the context of Apraxia means that the child has difficulty making speech movements when he/she is consciously aware of trying to do so or in instances
differential diagnosis of dysarthria and apraxia
t/f when apraxia co-occurs with dysarthria there is diffuclty with sequencing and intiaiting movement; concominant motor weakness
true
why assess apraxia at SW level, multisyllabic, sentence level
increased complexity = greater breakdown
pot –> potter –> pottery
t/f initiating motor planning is difficult in apraxia
true
framework for therapy
motor learning theory –> work on meaningful linguistic units; feedback; self-correction; random practice
cognitive load –> give one stimulus at a time; work on several areas in one session; may motivate, might be too hard, must monitor performance to determine
t/f chunking (phrase modiciation) is important for breath support
true
t/f to facilitate respiration like increase/reduce loudness patient is prompted to take deeper breaths and then start phonation after inhale
true
t/f to facilitate phonation semi-occluded vocal tract exercises generate back pressure and efficient VF vibration
true
t/f to facilitate resonance by increasing resonance focusing on oral resonance; bark like a seal or blowing exercises
true
t/f apraxia is more a language based treatment than dysarthria
true
management of apraxia of speech guidelines
apraxia programs
eight step continuum -> watch, listen, say it with me
PROMPTS
