Hyperkinetic Dysarthria

Question 1

Hyperkinesis means

Answer 1

excessive involuntary movements
- It is a group of MSDs, each associated with a hyperkinesia

Question 2

Neurological basis

Answer 2

• damage to basal ganglia
• imbalance of dopamine and Ach
• PD patients > “on cycle”

Question 3

Structure and function on Motor System

Answer 3

basal ganglia and cerebellum smooth and coordinate rough motor impulses from the associated cortex
- they send them to PMC via the thalamus

Question 4

Basal ganglia

Answer 4

1. caudate nucleus = striatum
2. putamen = lenticular nucleus
3. globus pallidus = pallidum

• dense with gray matter (cell bodies)
• output to cortex via thalamus

Question 5

Substantia Nigra

Answer 5

• substantia nigra contains dopaminergic neurons
• reduced dopamine in striatum: TRAP
  =Hypokinetic dysarthria
• loss of neurons in stratum: involuntary movements
  = hyperkinetic dysarthria

Question 6

chorea

Answer 6

• 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

Question 7

Important note of Speech characteristics of HD

Answer 7

They have normal speech until movements interrupt.

Question 8

Speech characteristics - prosody

Answer 8

• prolonged intervals
• variable speech rate
• monopitch
• inappropriate silences
• monoloudness

Question 9

Speech characteristics - articulation

Answer 9

• imprecise consonants
• distorted vowels
• prolonged phonemes

Question 10

Speech characteristics - phonation

Answer 10

• harsh voice quality
• excess loudness variations
• strained-struggle voice
• breathy voice (intermittent)
• voice stoppages

Question 11

Speech characteristics - respiration/resonance

Answer 11

• unexpected inhalations and exhalations
• intermittent hypernasality in some patients

Question 12

Essential (organic) tremor

Answer 12

• idiopathic
• faster than tremor in PD
• action (or intention) tremor
• no other neurological signs
• essential voice tremor: contractions of laryngeal muscles

Question 13

Dystonia

Answer 13

• a disorder of muscle tone
• slow, sustained
• “waxing and waning”
• can be constant and fixed

Question 14

Dystonia: spasmodic dysphonia

Answer 14

• 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

Question 15

Key evaluation tasks

Answer 15

1. vowel prolongation
2. AMRs
3. conversational speech/reading
4. observation of involuntary movements

Question 16

Medical treatment of HD

Answer 16

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

Question 17

Treatments for HD

Answer 17

1. Voice therapy for SD
   - prevent hyperfunction
2. sensory tricks: not recommended by Dr. B
3. bite blocks - to stabilize mouth

Question 18

Voice therapy for SD

Answer 18

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)