Hyperkinetic Dysarthria Flashcards
Hyperkinesis means
excessive involuntary movements
- It is a group of MSDs, each associated with a hyperkinesia
Neurological basis
- damage to basal ganglia
- imbalance of dopamine and Ach
- PD patients > “on cycle”
Structure and function on Motor System
basal ganglia and cerebellum smooth and coordinate rough motor impulses from the associated cortex
- they send them to PMC via the thalamus
Basal ganglia
- caudate nucleus = striatum
- putamen = lenticular nucleus
- globus pallidus = pallidum
- dense with gray matter (cell bodies)
- output to cortex via thalamus
Substantia Nigra
- substantia nigra contains dopaminergic neurons
- reduced dopamine in striatum: TRAP
=Hypokinetic dysarthria - loss of neurons in stratum: involuntary movements
= hyperkinetic dysarthria
chorea
- rapid, involuntary movement
- limbs, trunk, head, neck
- “chorea” = dance
- Sydenham’s chorea: rare, idiopathic; childhood
- huntington’s disease: psychiatrist found out about it
** progressive
** etiologies: genes on chromosome #4
** degeneration of basal ganglia and cerebral cortex
** onset in middle age - stroke:
** rarely causes chorea
** BG or nearby structures
** Hemiballism: contralateral to the lesion
Important note of Speech characteristics of HD
They have normal speech until movements interrupt.
Speech characteristics - prosody
- prolonged intervals
- variable speech rate
- monopitch
- inappropriate silences
- monoloudness
Speech characteristics - articulation
- imprecise consonants
- distorted vowels
- prolonged phonemes
Speech characteristics - phonation
- harsh voice quality
- excess loudness variations
- strained-struggle voice
- breathy voice (intermittent)
- voice stoppages
Speech characteristics - respiration/resonance
- unexpected inhalations and exhalations
- intermittent hypernasality in some patients
Essential (organic) tremor
- idiopathic
- faster than tremor in PD
- action (or intention) tremor
- no other neurological signs
- essential voice tremor: contractions of laryngeal muscles
Dystonia
- a disorder of muscle tone
- slow, sustained
- “waxing and waning”
- can be constant and fixed
Dystonia: spasmodic dysphonia
- many features of a focal dystonia
- involuntary VF movements during phonation
- contractions are vigorous and active
** adductor SD > strained-strangled - most common type
** abductor SD > breathy or aphonic
** mixed SD
Key evaluation tasks
- vowel prolongation
- AMRs
- conversational speech/reading
- observation of involuntary movements
Medical treatment of HD
usually treated pharmacologically to suppress involuntary movements
- not consistently effective
- adverse effects
Botox
- botulism toxin: comes out from food poisoning instance
- interferes with Ach transmission
Treatments for HD
- Voice therapy for SD
- prevent hyperfunction - sensory tricks: not recommended by Dr. B
- bite blocks - to stabilize mouth
Voice therapy for SD
Counseling > effects of Botox
- schedule: go back every 3-4 months
- risks: be breathiness for a few days, modified vocal rest
/h/ onset (adductor type)
- contrast heart and art
- think about /h/ but not making /h/ voice
continuous voicing (abductor type)
