Hyperkinetic Dysarthria Flashcards
Is it perceptually distinguishable?
yes
Unifying theme of Hyperkinetic d.s?
involuntary movements
Frequency?
Higher than any other major single dysarthria type
Hyperkinesia definition
- abnormal or excessive involuntary movement
- most are rapid, unsustained, and unpatterned
Hyperkinesias occur when _____ is expected
steadiness
Extrapyramidal system
- Ventrolateral nucleus of the thalamus
- BG control circuit - inhibitory effect on thalamus
- Cerebellar CC sometimes implicated
Most common concomitant diseases
- Huntington’s
- Dystonia
- Toxic-metabolic causes
- Meige’s
- Tourette’s
Huntington’s Disease
- inherited, degenerative
- cause: severe neuronal loss in caudate nucleus & putamen
- symptoms: chorea, dementia, personality changes, dysarthria, dysphagia
Dystonia musculorum deformans
- inherited degenerative
- begins as focal, then spreads
- Symptoms: postural deformities of neck, trunk, and extremeties
- Cause: neuronal loss in dentate nucleus, striatum, and globus pallidus
Toxic-Metabolic etiologies
- antipsychotics
- anti-parkinsonism drugs
- alcohol withdrawal
Meige’s syndrome
- focal dystonia
- blepharospasms - involuntary blinking
- unknown etiology
Most prominent speech characteristic of Hyperk.
Prosody!
- abnormal rhythmic or irregular & unpredictable rapid or slow involuntary movements
Other speech characteristics
Interrupted AMRs
Unpredictable breakdowns of articulation & rate
Can have strained VQ
Nonspeech characteristics
Adventitious movement of jaw, tongue, face, and palate
Pt perceptions
- slurred, hard to get out
- tightness, shakiness (not the same as spastic)
- Sensory tricks
Sensory tricks
- touching a part of your body to stop some other involuntary movement
- sometimes can desensitize and stop working
Dyskinesia
General term referring to abnormal, involuntary movements, regardless of etiology
Athakesia
- subjective sense of restlessness, continuous jerky movements
- can occur in Parkinsonism and PD
Orobuccal dyskinesia
- repetitive lip smacking, pursing, puffing, etc
- can be misinterpreted as facial expressions so don’t assume it’s controlled
Myoclonus
- involuntary single or repetitive jerks
- displaces a body part
- can be spontaneous or induced
- action myo: brought on by movement
- palatopharyngolaryngeal myo: associated w/ lesions in Guillain-Mollaret triangle area
- hiccups are a form!
Tics
- rapid, non-rhythmic, coordinated movements under partial voluntary control
- motor or vocal
- simple tics diff to distinguish from myo or dystonia
- complex tics coordinated; include jumping, smacking, etc
Chorea
- rapid, involuntary, purposeless movements
- unsteadiness and impersistence
- can appear as restlessness
- can be degenerative
Ballismus
- high amplitude flinging movements
- flailing
Athetosis
- relatively slow hyperkinesias
- slow, writhing, purposeless movements ,FLOW from one to the other
- sometimes a symptom of dystonia
Dystonia
- abnormal posture w/ inappropriate sustained contraction of muscles
- can be phasic
- can be primary or secondary
- includes cervical dystonia/spasmodic torticollis
Cervical dystonia / spasmodic torticollis
- tonic or clonic spasms of neck muscles
- considered BG disorder
Tonic spasm
- prolonged or continuous
Clonic spasm
- repetitive, rapid in onset, brief in duration
Tremor
- most common
- rhythmic (periodic) movements of a body part
- resting
- postural (when body part maintained against gravity)
- action (during movement)
- Terminal (when nears a target)
- Essential (w/ sustained posture)
- wing-beating
Spasmodic dysphonia of essential voice tremor
- Adductor or Abductor types, or mixed
- remissions rare
- action-induced
- can begin w// flu-like illness or during period of stress
