hyperkinetic Flashcards
what causes hyperkinetic dys?
lesions in the basal ganglia circuit (extrapyramidal)
what does the extrapyramidal tract refer to?
Those motor pathways that do not pass through the pyramids at the medullary-spinal level
what subsystems can hyperkinetic dys affect?
all but mainly prosody
these lesions cause speech characteristics that are related to?
abnormal, rhythmic or irregular and unpredictable, rapid or slow involuntary movements
What is a key factor in hyperkinetic dys?
involuntary movements
T or F. In hyperkinetic dys there are a variety of disorders in this category with a lot of variance among them.
True
T or F some disorders that cause hyperkinetic dys have really strange and bizarre movements that are associated with this disease that produce strange speech deviances.
True
In many cases of hyperkinetic dysarthria what causes the distorted speech?
Involuntary movements
Can abnormal movements only be present during speech?
Yes. (this is an important feature)
What are the abnormal movements a result of?
failure to inhibit cortical motor discharges
also might be firing from the thalamus that isn’t inhibited causing these movements.
also be caused by an imbalance btwn excitatory and inhibitory neurotransmitters (ACH/Dopamine)
what is the excitatory neurotransmitter?
ACH
what is the inhibitory neurotransmitter?
Dopamine
does hyperkinetic mean too fast of movements?
No it just means there are unwanted movements there (some of the voluntary movements of these patients may actually be slow)
T or F in hyperkinetic dys the theme that ties them together is the unwanted movements, but there is considerable variability in each of them, in their character and in their underlying pathology
True
what are the two most common etiologies of hyperkinetic dys?
toxic-metabolic and idiopathic
most are unknown
t or f. some of these bizarre movements may cause the person to be incorrectly diagnosed as having a psychogenic problem.
True
What are the categories of movements that are present in hyperkinetic dysarthria? (9)
MAD BC TST (acronym) Myoclonis Athetosis dyskinesia ballism chorea Tic Spasm Tremor
What is the term that refers to abnormal, hyperkinetic, involuntary movements. It is a general term for abnormal movements. It can occur in various parts of the body.
Dyskinesia
What is dyskinesia?
it is a general term for abnormal movements.
It refers to abnormal, hyperkinetic involuntary movements. Can happen in all parts of the body.
What is the type of dyskinesia when the abnormal movements occur in the mouth, tongue and jaw?
orofacial dyskinesia (no other body parts are involved)
What are the subcategories of dyskinesia?
orofacial dyskinesia, tardive dyskinesia, and akathisia
what is the type of dyskinesia that is caused by or related to the prolonged use of antipsychotic drugs.
tardive dyskinesia
can orofacial dyskinesia be a type of tardive dyskinesia?
YES.
what type of dyskinesia is where the ptnt has motor restlessness demonstrated by pacing, moving around a lot, rubbing head etc…
Akathisia
what is akathisia?
it is a type of dyskinesia where the patient has motor restlessness that is demonstrated by pacing, moving around a lot and rubbing head etc…
what is myoclonus
myoclonus is single involuntary brief movements of a body part-like a jerk. Can be rhythmic or not–person cannot stop them. can be spontaneous or brought on by certain stimuli (one such stimuli is voluntary movements themselves) may occur in epilepsy.
What category of movement can be present in epilepsy?
myoclonus.
What category of movement are hiccups in?
myoclonus
what are hiccups?
hiccups are a type of myoclonus. it is the spasm of the diaphragm and the adduction of the vocal cords. (hiccupping can be a sign of involvement with the medulla)
hiccups can occur with lesions from what?
from the cortex to the spinal cord.
Tics are usually seen in what syndrome?
Tourette’s
what are tics?
they are rapid, patterned movements under partial voluntary control. The person may have some voluntary control over them.
T or F when a person has tics–there is usually a strong, irrepressible urge to do these but the person may be able to control them for a while.
True
T or F tics can range from simple tics that may look like myoclonus and dystonia but tics can be complex like (jumping up, making noises, lip smacking)
True
what is chorea?
rapid involuntary and random purposeless movements of a part of the body, it is nonrhythmic and random. Can be present at rest and in voluntary movements. Can be subtle or severe.
What is a type of chorea?
Huntington’s chorea (progressive and genetic)
What is ballism?
abrupt contraction of muscles of the limbs-so bad the person can fall down (large muscle contractions not fine ones)
what is athetosis?
inability to keep a body part in one position. it is slow writhing purposeless motion it is one type of Cerebral palsy.
What is dystonia?
it is a slow hyerkinesias exhibited by involuntary postures due to problems with antagonistic muscles. Can have quick myoclonic movements involved. can occur in one part of the body of several. It is usually nonrhythmic.
If dystonia occurs in the orofacial muscles it may be called?
focal mouth dystonia (essentially the same thing as orofacial dyskinesia)
T or F. Writers cramp is a form of dystonia .
True
what is a spasm?
when you have involuntary muscular contractions. can cause both motion and limit motion. Tonic/clonic spasms
what is a tonic spasm.?
tonic spasms are continuous
what is a clonic spasm?
‘repetitive and don’t last long
what is the etiology of hyperkinetic dys?
anything that damages the basal ganglia or cerebellar circuit or indirect activation pathway (extrapyramidal)
what are the common disorders we see hyperkinetic dysarthria in?
degenerative dz toxic-metabolic vascular disorders infectious process neoplasm tourette's
What is Huntington’s chorea?
it is a degenerative dz that cause hyperkinetic dys.
it is inherited (genetic)
degenerative CNS disorder
if you have a parent with this dz you have a 50% chance of getting it
distinguished by chorea movements (may also see dementia and personality changes also dysarthria and dysphagia)
What is a toxic-metabolic condition that causes hyperkinetic dys?
antipsychotic drugs that affect the neurotransmitters (tardive dyskinesia)
often you see this in patients with schizophrenia
if the drugs are withdrawn from early enough the dysarthria will go away (can go away)
T or F. You normally don’t see a lot of vascular disorders that cause hyperkinetic dys. Unless there are strokes that affect the basal ganglia or cerebellum.
True
What is Sydenham’s chorea?
it is an infectious process that can cause hyperkinetic dys.
it is seen in young people and can be caused by strep throat normally it is temporary.
Where do the tumors have to be to case hyperkinetic dys?
basal ganglia and the thalmus
Tourettes causes what two type of tics?
verbal and motor
what do they think that tourettes is caused by?
related to problems with dopamine receptor
T or F. non-speech complaints are related to the specific disorder the ptnt has that is causing the dysarthria.
True
Many ptnts with hyperkinetic dysarthria report that?
they can’t keep jaw, face, tongue still, report problems of swallowing and chewing.
T of F. Some ptnts with hyperkinetic dys may not be aware of their abnormal movements
True
What are some non-speech and speech signs associated with chorea?
non-speech usually normal, size, symmetry, strength of oral facial features
-motor unsteadiness when trying to round or retract lips, protrude tongue or at rest, may see quick, unpatterned movements.
how do you want to assess speech in chorea?
AMR’s, reading, conversation, vowel prolongation
when assessing speech in chorea what do you want to look for?
unpredictable movements and breakdown in rate and prosody
- -phonation: want to look for forced inspiration or expiration, excess loudness variations, strained strangled voice quality, voice stoppages and transient breathiness
- -resonance: want to look at intermittent hypernasality and weak pressure consonants
- -Artic: irregular breakdown, distortions, distorted vowels. Slow and irregular AMR’s
- -Prosody: prolonged intervals and phonemes, inappropriate silences, variable rate, variable stress patterns (PROSODIC COMPONENTS ARE PROMINENT)
What are some non-speech signs of dystonia?
the movements are slower than chorea normally waxing and waning
- -oral mech normal
- -may have problems drooling, swallowing, and facial grimacing
- -primarily movement problems at rest but sometimes occur in speech
What as an example of dystonia?
tongue coming out while talking or jaw opening off an on by speaking
What can sometimes be used to help with dystonia?
botox injected into the tongue
what are the speech findings in dystonia?
Phonation: voice stoppages, strained-harsh voice, audible inspiration, excess loudness variation, alternating loudness, tremor like voice
Resonance: intermittent hypernasality
Artic: distortion and irregular breakdown, distorted vowels, slow and irregular AMR’s
what is spasmodic torticollis?
cervical dystonia.
affects the cervical muscles and not muscles innervated by the cranial nerves. Can also have facial spasms.
–speech deviances are related to deviances in neck postures
effects are usuall mild on speech and are primarily at the laryngeal level (pitch variability)
–speech findings:
artic/prosody: may have reduced rate and delayed speech initiation/ slow AMR’s
what is palatopharyngeal myoclonus?
abrupt movements of the soft palate, pharyngeal walls and laryngeal muscles (effects on speech are not great)
- -ptnt complains of earclicks (opening and closing of the ET)
- -can be mild intermittent hypernasality
What is action myoclonus?
no often seen by SLP’s it is different from other myoclonic disorders bc it is introduced by action and is more rhythmic
Tourette’s syndrome is?
most are genetically related. typically you see facial grimaces, eye-blinks, twitches of the head.
can also include larger movements (spinning, jumping)
–vocal tics
can include echolalaia, palilalia, coprolalia (swearing compulsively)
most cases are male 4:1
can be accompanied by OCD
Are tourettes syndrome more common in males or females?
males
What is an organic voice tremor?
the voice tremor is usually with gradual onset, and worsens with fatigue and stress, may improve with alcohol and is often accompanied by head or jaw or extremity movements
- -to assess do vowel prolongation
- -not much affective treatment (botox can help)
Spasmodic Dysphonia is caused by?
is caused by spasms of the laryngeal adductor or abductor muscles
what is spasmodic dysphonia characterized by?
strained or breathy voice quality
what are the 2 types of spasmodic dysphonia?
adductor spasm, abductor
adductor spasmodic dysphonia what happens?
vocal folds spasm together, increased effort or fatigue (tight strained voice)
abductor spasmodic dysphonia?
increased effort or fatigue with speaking, may run out of air v.folds spasm open
