Chapter 7 Hypokinetic Dysarthria Flashcards
Hypokinetic Dysarthria is a related to problems with the
Basal ganglia control (extrapyramidal problems)
Hypokinetic Dysarthria is most often associated with which degenerative disease?
Parkinson’s
Hypokinetic Dysarthria reflects characteristics due to
- rigidity
- reduced range of motion
- reduced force of movement
- may be slow movements
- may be quick speech movements
Function of the basal ganglia
- facilitates movement
- regulates muscle tone
- regulates movements that support goal-directed movements
- controls postural adjustments in skilled movements
- Inhibits unnecessary movements
Damage to the basal ganglia control circuit can result in two types of problems:
Reduced movement
reduced inhibition of involuntary movements
Neurotransmitter associated with basal ganglia functioning
dopamine produced in the substantia nigra then sent to the striatum (caudate nucleus & putamen)
Dopamine
is a inhibitory mechanism,
% of Parkinson’s Patients with HD
50%
Classic Non Speech signs of PD
- Tremor at rest
- Pill rolling (finger mvmt)
- Rigidity (cogwheel)
- Bradykinesia (false/frozen mvmt)
- Hypokinesia (reduced mvmt)
- Posture problems
Non speech Hypokinesia Characteristics
- masked expressions of the face with unblinking eyes
- reduced arm swing
- micrographia
- festination (slow walk fast shuffle)
Hypokinetic Dysarthria Etiologies
Anything that can cause damage to the basal ganglia
Degenerative Etiologies
Parkinson’s
Alzheimer’s
Pick’s
Vascular Etiologies
- Multiple strokes affecting basal ganglia (vascular parkinsonism)
- Cerebral hypoxia (lack of O2)
Toxic-Metabolic Etiologies
Antipsychotic drugs that block dopamine receptors
Trauma Etiologies
TBI/ repeated head trauma to the substantia nigra
stereotactic ventrolateral thalamotomy
Infectious Etiologies
Viral Encephalitis (MMRs)
Patient Complaints
- Weak/quiet voice
- Speech rate is too fast
- words are imprecise and flat emotion tone
- difficulty starting speech
- may stutter/repeat
- fatigue has negative effect on speech
- swallowing and drooling problems
- stiff upper lip due to rigidity
Non Speech Clinical Findings
- Mask like face, unsmiling, unblinking
- Reduced mvmt of chest and abdomen while breathing
- drooling due to saliva accumulation from not swallowing
- head may not accompany eye movement
- tremor of jaw/lips at rest and while potruded
- Flat affect inconsistent with patient’s emotional state
Speech Clinical Findings
- monopitch/monoloudness
- reduced loudness
- reduced stress
- short rushes of speech
- overall increased rate of speech
- harsh breathy voice quality
- imprecise consonants
- difficulty initiating speech
- rapid blurred AMRs
- may have tremor on vowel prolongation
- palilalia
Best distinguishing speech characteristics
Fast rate short rushes of speech reduced stress monotone/monoloudness inappropriate silences breathiness
