Hyperkinetic Dysarthria Flashcards
Definitions of Hyperkinetic Dysarthria
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
“Hyperkinetic”
too much movement
Each hyperkinetic movement disorder has its own
involuntary motions
Neurologic Basis of Hyperkinetic Dysarthria
Many disorders that cause hyperkinetic dysarthria associated with damage to basal ganglia
What Causes Hyperkinetic Movement?
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
Causes of Hyperkinetic Dysarthria
Chorea Myoclonus Tics Essential tremor Dystonia Other causes: degenerative diseases, traumatic head injury, stroke, and infections
Chorea
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
Sydenham’s chorea
Rare disorder affecting children after rheumatic fever
Huntington’s disease
Progressive inherited disorder
Stroke
Rare for stroke to cause chorea
Tardive dyskinesia
Caused by taking certain antipsychotics
Speech Characteristics of Hyperkinetic Dysarthria of Chorea
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
Myoclonus
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
Tic Disorders
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
Essential (or Organic) Tremor
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)
Dystonia
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)
Dystonia is characterized according to the number of affected body parts
- 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)
Causes of dystonia
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
Speech Characteristics of Hyperkinetic Dysarthria of Dystonia
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
Key Evaluation Tasks for Hyperkinetic Dysarthria
Vowel prolongation
Alternate motion rates (AMRs)
Conversational speech and reading
Careful observation of associated involuntary movements
Treatment of Hyperkinetic Dysarthria
Diverse treatment options
Based on medical or behavioral interventions
Medical Treatments
Pharmacologic
-Drugs that suppress involuntary movements that cause speech deficits
Botox: most successful
Deep brain stimulation
Behavioral Treatment for Huntington’s Disease
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
Behavioral Treatment for Dystonia
Sensory tricks: idiosyncratic strategies that can suppress involuntary movement for a time
Bite blocks: to stabilize jaw during speech
Early onset of phonation
Behavioral Treatment for Tic Disorders
Relaxation therapy and related treatments Relaxation therapy Supportive psychotherapy Mental imagery Habit-reversal procedures
Collection of separate dysarthrias, each associated with
hyperkinetic movement disorder
Caused by
involuntary movements interfering with voluntary attempts at speech
Effects of each disorder on speech production vary
-Many associated with damage to basal ganglia
Most common treatment
is drug-based
