Exam 3 - Hypokinetic Dysarthria Flashcards
neurological basis of hypokinetic dysarthria
basal ganglia
common speech characteristics of hypokinetic dysarthria
harsh or breathy vocal quality
reduced vocal loudness
abnormal speaking rates
hypokinetic dysarthria most evident in these subsystems:
phonation
articulation
prosody
hypokinetic dysarthria is unique bc only dysarthria with:
INCREASED rate of speech
mainly one cause: parkinsonism
mainly one cause of hypokinetic dysarthria
parkinsonism
hypokinetic means
less motion
hypokinetic dysarthria has reduced movement, but NOT
reduced tone
reduced movement includes
shuffling gate
masked facies
reduced eye blinking
role of basal ganglia
smooth/refine + postural support
primary characteristics of parkinsonism
resting tremor
brady kinesia
rigidity
spasticity
akinesia
disturbances of postural reflexes
bradykinesia
slow + reduced movement (shuffling gate, micrographia)
akinesia
delay/pause before response
causes of parkinsonism
dysfunction in basal ganglia
***imbalance in dopamine and acetylcholine
reduction in dopamine causes
too much acetylcholine
decreased dopamine levels result in
spasticity and rigidity of muscles
inhibitory neurotransmitter
dopamine
excitatory neurotransmitter
acetylcholine
major causes of hypokinetic dysarthria
idiopathic parkinson’s disease
neuroleptic-induced parkinsonism (psych-med induced)
postencephalitic parkinsonism (viral)
less common causes of hypokinetic dysarthria
traumatic head injury
toxic metal poisoning
stroke
hypokinetic dysarthria non-speech symptoms
tremor
bradykinesia
rigidity
akinesia
disturbed postural reflexes
prosody of hypokinetic dysarthria
monopitch
reduced stress
monoloudness
short phrases
rushed-sounding speech
articulation of hypokinetic dysarthria
imprecise consonants
repeated phonemes
palilalia
phonation of hypokinetic dysarthria
harsh/breathy
aphonia
low pitch
respiration of hypokinetic dysarthria
sometimes noted
resonance of hypokinetic dysarthria
if present, mild hypernasality
eval for hypokinetic dysarthria
oral mech exam
vowel prolongations
DDKs
conversation speech and reading
Pharmacologic Tx of hypokinetic dysarthria
L-Dopa (levodopa) - precursor of dopamine
anticholinergic drugs - decrease acetylcholine activity
surgical Tx of hypokinetic dysarthria
deep brain stimulation
stem cell implantation - more research needed
behavioral Tx of hypokinetic dysarthria
Speech therapy
behavioral Tx for parkinsonism
behavior/instrumentation based tasks important part of clinical treatment plan
articulation
phonation
respiration
prosody
most common articulation deficit of parkinsonism
imprecise consonants d/t reduced range of motion in articulators
*can be compounded by increased rate
articulation Tx of parkinsonism
rate reduction
stretching
traditional articulation tasks
phonation Tx of parkinsonism
pushing/pulling procedure (increase force)
hard glottal attack
voice amplifiers
instrumental biofeedback
LSVT
Speak out
why harsh/breathy vocal quality w hypokinetic dysarthria
vocal folds adduct only partially
+ possible poor respiratory support
respiration Tx of parkinsonism
speaking immediately on exhalation
cueing for complete inhalation
slow and controlled exhalation
stop phonation early
optimal breath group
respiratory muscle strength training (RMST)
prosody Tx of parkinsonism
slowing rate
intonation profiles
contrastive stress drills
chunking utterances into syntactic units
hypokinetic dysarthria is closely associated with
parkinsonism
most common cause of hypokinetic dysarthria
idiopathic parkinson’s disease
SUMMARY: hypokinetic dysarthria Tx involves targeting:
articulatory precision
increasing phonatory effort
promoting more natural prosody
rate control tasks
