Hyperkinetic Dysarthria

Question 1

Definitions of Hyperkinetic Dysarthria

Answer 1

Perceptually distinguishable group of motor speech disorders manifested in any or all levels of speech
Most caused by dysfunction in basal ganglia
All produce involuntary movements that interfere with normal speech production

Question 2

“Hyperkinetic”

Answer 2

too much movement

Question 3

Each hyperkinetic movement disorder has its own

Answer 3

involuntary motions

Question 4

Neurologic Basis of Hyperkinetic Dysarthria

Answer 4

Many disorders that cause hyperkinetic dysarthria associated with damage to basal ganglia

Question 5

What Causes Hyperkinetic Movement?

Answer 5

Basal ganglia not well understood
Complex mechanisms within basal ganglia not well understood
Different disorders associated have nearly opposite effects on movement (example: Parkinson’s and Huntington’s)
Cause more complicated than a simple imbalance of one or two neurotransmitters

Question 6

Causes of Hyperkinetic Dysarthria

Answer 6

Chorea
Myoclonus
Tics
Essential tremor
Dystonia
Other causes: degenerative diseases, traumatic head injury, stroke, and infections

Question 7

Chorea

Answer 7

Movement disorder distinguished by random involuntary movements of limbs, trunk, head, and neck
Choreic motions
-Appear dancelike, smooth, and coordinated, but actually unpredictable, purposeless, and sometimes jerky or abrupt

Question 8

Sydenham’s chorea

Answer 8

Rare disorder affecting children after rheumatic fever

Question 9

Huntington’s disease

Answer 9

Progressive inherited disorder

Question 10

Stroke

Answer 10

Rare for stroke to cause chorea

Question 11

Tardive dyskinesia

Answer 11

Caused by taking certain antipsychotics

Question 12

Speech Characteristics of Hyperkinetic Dysarthria of Chorea

Answer 12

Degree of chorea influences how severely speech is affected

Distinctive speech errors include:
Prolonged intervals between syllables and words; variable speech rate; inappropriate silences; excess loudness variations; prolonged phonemes; rapid, brief inhalations or exhalations of air; voice stoppages; and intermittent breathy voice quality

Question 13

Myoclonus

Answer 13

Hyperkinetic movement disorder distinguished by involuntary and brief contractions of part, whole, or group of muscles in same area

Muscle contractions may appear singly, in repeating irregular pattern, or rhythmically
Can appear as part of many conditions:

Kidney failure, epilepsy, cerebral anoxia, strokes, traumatic head injury, and progressive neurologic diseases

Question 14

Tic Disorders

Answer 14

Tic: rapid movement that can be controlled voluntarily for a time, but performed frequently due to compulsive desire

Cause traced to mild brain damage or toxic reactions to medications in some cases, but no identifiable CNS disorder in most cases

Question 15

Essential (or Organic) Tremor

Answer 15

Benign hyperkinetic movement disorder that causes tremulous movements in affected body parts

Idiopathic

Most common hyperkinetic movement disorder

20% of patients with this problem also have organic voice tremor (prolonged vowel to hear tremor)

Question 16

Dystonia

Answer 16

Hyperkinetic movement disorder of muscle tone

Causes involuntary, prolonged muscle contractions that interfere with normal movement or posture

Slower, more sustained quality than seen in chorea, with contractions that wax and wane during ongoing movement

*Sensory tricks may be helpful (touch affected area, and dystonia ceases - not proven and don’t know why it sometimes works)

Question 17

Dystonia is characterized according to the number of affected body parts

Answer 17

• Focal dystonia (1 body part)
• Segmental dystonia (2 or more body parts)
• Generalized dystonia (almost entire body)
• Hemidystonia (2 or more body parts on one side of the body)

Question 18

Causes of dystonia

Answer 18

Spasmodic torticollis

Drug-induced

Meige syndrome (dystonic movements just around the eyes and sometimes other parts of the face)

Spasmodic dysphonia (muscles of vocal cords are affected, usually adductor muscles- sometimes abductor) have strain-strangled voice quality similar to spastic dysarthria

Question 19

Speech Characteristics of Hyperkinetic Dysarthria of Dystonia

Answer 19

Articulation: imprecise consonants, distorted vowels, irregular articulatory breakdowns, prolonged phonemes

Prosody: monopitch, monoloudness, inappropriate silences, shortened phrases

Phonation: harsh vocal quality, strained-strangled quality, excess loudness variation

Respiration and resonance: less impacted

Question 20

Key Evaluation Tasks for Hyperkinetic Dysarthria

Answer 20

Vowel prolongation
Alternate motion rates (AMRs)
Conversational speech and reading
Careful observation of associated involuntary movements

Question 21

Treatment of Hyperkinetic Dysarthria

Answer 21

Diverse treatment options

Based on medical or behavioral interventions

Question 22

Medical Treatments

Answer 22

Pharmacologic
-Drugs that suppress involuntary movements that cause speech deficits

Botox: most successful

Deep brain stimulation

Question 23

Behavioral Treatment for Huntington’s Disease

Answer 23

Early stages: maintain normal prosody and optimal rate

Middle stages: rate of speech, rhythmic breathing and relaxation, speaking on exhalation

Progressive dementia: work closely with caregivers

Question 24

Behavioral Treatment for Dystonia

Answer 24

Sensory tricks: idiosyncratic strategies that can suppress involuntary movement for a time

Bite blocks: to stabilize jaw during speech

Early onset of phonation

Question 25

Behavioral Treatment for Tic Disorders

Answer 25

Relaxation therapy and related treatments
Relaxation therapy
Supportive psychotherapy
Mental imagery
Habit-reversal procedures

Question 26

Collection of separate dysarthrias, each associated with

Answer 26

hyperkinetic movement disorder

Question 27

Caused by

Answer 27

involuntary movements interfering with voluntary attempts at speech

Question 28

Effects of each disorder on speech production vary

Answer 28

-Many associated with damage to basal ganglia

Question 29

Most common treatment

Answer 29

is drug-based