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Motor speech Exam 2 > Hyperkinetic Dysarthria > Flashcards

Hyperkinetic Dysarthria Flashcards

1
Q

Due to lesions in the basal ganglia circuit it;s _______.

A

extrapyramidal

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2
Q

What does extrapyramidal mean?

A

It refers to those motor pathways that do not pass through the pyramids at the medullary-spinal level.

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3
Q

________ refers to those motor pathways that do not pass through the pyramids at the medullary-spinal level.

A

Extrapyramidal

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4
Q

What systems does hyperkinetic dysarthria affect?

A

All sub-systems, but it mainly affects prosody and rate of speech.

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5
Q

Some of the ______ dysarthrias reflect problems with sensorimotor integration for speech motor control.

A

hyperkinetic

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6
Q

Some of the hyperkinetic dysarthrias reflect problems with ______ ________ for speech motor control,

A

sensorimotor integration

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7
Q

Lesions resulting in ________ dysarthria cause speech characteristics related to abnormal rhythmic or irregular (so may be regular or irregular) and unpredictable, rapid or slow involuntary movements.

A

hyperkinetic

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8
Q

Lesions that result in hyperkinetic dysarthria cause what kind of speech characteristics related to movement?

A

abnormal, rhythmic or irregular may be regular or irregular and unpredictable, rapid or slow involuntary movements.

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9
Q

What do you need to keep in mind for hyperkinetic dysarthria in terms of movement?

A

That they are involuntary movements

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10
Q

In hyperkinetic dysarthria it looks in many cases that the person is producing _____ speech and then these _____ movements ______ the speech.

A

normal
involuntary
distort

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11
Q

Abnormal movements in hyperkinetic dysarthria may only be present during ______.

A

speech

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12
Q

What results in abnormal movements in hyperkinetic dysarthria?

A

Failure to inhibit cortical motor discharges. Also, there may be firing from the thalamus that isn’t inhibited causing these movements.
-There may be an imbalance between the excitatory and inhibitory neurotransmitter.

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13
Q

Abnormal movements in ________ dysarthria may be the result of a Failure to inhibit cortical motor discharges. Also, there may be firing from the thalamus that isn’t inhibited causing these movements.

A

hyperkinetic dysarthria

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14
Q

ACH is excitatory or inhibitory?

A

Excitatory

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15
Q

Dopamine is excitatory or inhibitory?

A

Inhibitory

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16
Q

What does the term hyper in hyperkinetic mean?

A

means movements that don’t belong, extra movement. The voluntary movements of these patients may be slow.

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17
Q

Why do we subdivide categories of movement disorders in hyperkinetic dysarthria?

A

Even though involuntary movements are the theme that tie these together as hyperkinetic dysarthria, there is considerable variability in each of them, in their character and underlying pathology.

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18
Q

What are the etiologies for hyperkinetic dysarthria?

A

Multiple, but mainly toxic-metabolic and idiopathic causes are the most frequent. Most are unknown etiologies.

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19
Q

How can hyperkinetic dysarthrias be distinguishable from other dysarthrias?

A

Just by visual observing - because of the strange movements.

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20
Q

Some of the bizarreness of the movements in hyperkinetic dysarthria may cause the person to be incorrectly diagnosed as having ________ problems.

A

psychogenic

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21
Q

What are the 9 categories of hyperkinetic dysarthria?

A
  1. dyskinesia
  2. myoclonus
  3. tics
  4. chorea
  5. ballism
  6. athetosis
  7. dystonia
  8. spasm
  9. tremor
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22
Q

What is dyskinesia?

A

Diskinesia occurs in hyperkinetic dysarthria and it refer to abnormal hyperkinetic, involuntary movement. It can occur in various part of the body.

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23
Q

What are abnormal, hyperkinetic, involuntary movements of the mouth, tongue and jaw called?

A

orofacial dyskenisias

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24
Q

What are orofacial dyskinesias?

A

abnormal hyperkinetic, involuntary movements in the mouth, tongue, and jaw. Don’t have to have any other parts of body involved.

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25
Q

What do orfacial dyskinesia usually result from?

A

prolonged use of anti-psychotic drugs

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26
Q

oral facial diskinesia that result from prolonged use of anti-psychotic drugs is also referred to as _______ ______.

A

tardive dykinesia

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27
Q

What are manifestation examples of tardive dyskinesia/oral facial dyskinesia?

A

lip smacking
pursuing and retraction of lips
tongue protrusion
opening or closing of jaw

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28
Q

______ is a diskinesia where you have motor restlessness demonstrated by pacing, moving around a lot, rubbing head. it is due to damage to basal ganglia circuit.

A

Akathisia

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29
Q

What is akathisia?

A

A type of dyskinesia (hyperkinetic dysarthria) where you have motor restlessness demonstrated by pacing, moving around a lot, rubbing head, etc. Due to damage in basal ganglia circuit.

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30
Q

What is myoclonus?

A

Single, involuntary, brief movements of body part -like a jerk, can be rhythmic or not - person cannot stop them. Can be spontaneous or brought on by certain stimuli, one such stimuli is voluntary movement itself. may occur in epilepsy.

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31
Q

________ is a Single, involuntary, brief movements of body part -like a jerk, can be rhythmic or not - person cannot stop them. Can be spontaneous or brought on by certain stimuli, one such stimuli is voluntary movement itself. may occur in epilepsy.

A

Myoclonus

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32
Q

Why does myoclonus occur?

A

Lesions from the cortex to the spinal cord.

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33
Q

What is a type of myoclonus?

A

Hiccups

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34
Q

______ are a type of myoclonus-spasms of the diaphragm and adduction of vocal cords.

A

Hiccups

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35
Q

Hiccuping can be a sign of involvement with the _____.

A

medulla

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36
Q

What are tics?

A

They are typically seen in tourette’s syndrome. They are rapid, patterned movement under partial voluntary control. The person may have some voluntary control over them.

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37
Q

Simple tics may look like _____ or ______, but complx tics don’t.

A

dystonia

myoclonus

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38
Q

What is chorea?

A

A hyperkinetic disorder of rapid involuntary, random purposeless movements of a part of body. It is nonrhythmic and random. can be present at rest and in voluntary movement. Can be subtle or severe.

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39
Q

There are various types of chorea, name the most well known.

A

Huntington’s Chorea - it is progressive and genetic

40
Q

What is ballism?

A

Abrupt contractions of muscles of limbs in hyperkinetic dysarthria- so bad that the person can fall down. They are large muscle contractions, not fine ones.

41
Q

_______ are Abrupt contractions of muscles of limbs in hyperkinetic dysarthria- so bad that the person can fall down. They are large muscle contractions, not fine ones.

A

Ballism

42
Q

What is athetosis?

A

The inability to keep a body part in one position. It is slow writhing purposeless motion. it is one type of cerebral palsy.

43
Q

What is dystonia?

A

Slow hyperkinesias exhibited by involuntary abnormal postures due to problems with antagonistic muscles. Can have quick myoclonic movements involved. Can occur in one part of body or several.

44
Q

If dystonia occurs in orofacial muscles it may be called _____ ______ dystonia.

A

focal mouth

45
Q

Writer’s cramp is a form of _____ and it is usually ______.

A

dystonia

nonrhythmic

46
Q

______ dystonia is also referred to as spasmodic torticollis.

A

Cervical

47
Q

What is cervical dystonia?

A

Also known as spasmodic torticollis - spasms of the neck muscles that causes the head to deviate to one side, or backward or forward.

48
Q

What is the difference between dystonia and dyskenisia?

A

Watch youtube video.

49
Q

What are spasms?

A

When you have involuntary muscular contractions. Spasms can cause motion and limit motion.

50
Q

Spams is also used to describe ____ abnormal postures.

A

dystonia

51
Q

What are two kinds of muscular contractions (spasms)?

A

tonic

clonic

52
Q

what are tonic spasms?

A

continuous

53
Q

What are clonic spams?

A

Repetitive and don’t last long

54
Q

What is a tremor?

A

The involuntary movement that is most common. It’s a rhythmic movement in one body part. Can occur when the muscle is at rest, resting tremor or action/intention termor

55
Q

What are two types of tremors?

A

Toxic tremors - due to meds or other toxins, withdrawls from drugs/alcohol
-cerebellar tremor-due to damage in cerebellum

56
Q

What is the etiology for hyperkinetic dysarthria?

A

Anything that damages basal ganglia or cerebellar circuit or indirect activation pathway (extrapyramidal).

57
Q

What are common disorders in which we see hyperkinetic dysarthria?

A
  • degenerative disease
  • vascular disorders
  • infectious processes
  • neopolasm
  • Tourette’s
58
Q

What is the most well known degenerative disease seen in hyperkinetic dysarthria?

A

Huntington’s Chorea or Huntington’s disease

59
Q

If you have a parent with Huntington’s disease, what are your chances of getting it?

A

50%

60
Q

Where does damage occur for patients with Huntington’s disease?

A

basal ganglia and in cortex

61
Q

How is Huntington’s disease/chorea distinguished?

A

chorea movements

You may also see dementia and personality changes-dysarthria and dysphagia

62
Q

What causes toxic metabolic conditions that can lead to h hyperkinetic dysarthria?

A

Antipsychotic durgs affect the neurotransmitters.

63
Q

Why is it important to make the determination of drug induced dysarthria?

A

If the drugs are withdrawn early enough, speech can go back to normal. If not, there may be permanent dysarthria.

64
Q

usually don’t see many ____ disorders causing hyperkinetic dysarthria unless there are _____ that affect basal ganglia or cerebellum.

A

vascular

strokes

65
Q

What is an infectious process that can cause hyperkientic dysarthria?

A

Sydenham’s chorea-seen in young people and may be associated with strep throat. It is typically temporary.

66
Q

What is a neoplasm disorder that may result in hyperkinetic dysarthria?

A

tumors of basal ganglia and thalamus

67
Q

What is touette?

A

It can be part of hyperkinetic dysarthria. Causes both verbal and motor tics. Cause probably related to problems with dopamine receptor.

68
Q

What are some nonspeech complaints by patients?

A

Nonspeech depends on specific disorder. Many repor can’t keep jaw, face, tongue still, report problems with swallowing or chewing. Some may be aware of abnormal movements, whereas others may not. Some have learned sensory tricks to hold back movements.

69
Q

What are specifric diseases with nonspeech and speech signs in hyperkinetic dysarthria?

A

-Chorea
-Action myoclonus
-Tics - Tourette’s syndrome
-Dystonia
-Spasmodic torticollis (Cervical dystonia)
-spasmodic dystonia
athetosis
-palatopharyngolaryngeal myoclonus (PPLM)
-Essential (organic) voice tremor

70
Q

What are non-speech finding in Chorea (hyperkinetic dysarthria)?

A

Normal size, strength, symmetry of oral facial features. Usually motor unsteadiness, when trying to round or retract lips, protrude tongue, or at rest. may see quick, involuntary, unpatterned movements. Swallowing difficulties are often seen and sometimes drooling.
-Look for unpredictable movements and breakdown in rate and prosody.

71
Q

How is speech assessed in Chorea?

A

vowel prolongation
reading
conversation
AMRs

72
Q

What are some speech signs of Chorea?

A
  • Phonation-respiration: sudden forced inspiration or expiration, excess loudness variations, strained- strangled voice, voice stoppage, transient breathiness.
  • Resonance: intermittent hypernasality and weak pressure consonants.
  • Articulation: irregular breakdown, distortions, distorted vowels. slow & irregular AMRs
  • Prosody: prolonged intervals & phonemes, inappropriate silences, variable rate, variable stress patterns. Prosodic components are prominent.
73
Q

What is action myclonus?

A

Not often seen for SLPs. It is different from other myoclonic disorders because it is induced by action and is more rhythmic.

74
Q

What is TIcs - Tourette’s syndrome?

A

Most are genetically related. Typically you see facial grimaces, eye-blinks, twitches of head. Can also include larger movements, spinning, jumping, etc. There are also vocal tics- which can include odd noises such as grunting, yelling, whistling, squeaking. Can include echolalaia, palilalia, and coprolalia - swearing compulsively
-Most cases are male
Can be accompanied by OCD

75
Q

Non-speech findings in dystonia?

A

Oral mech normal
slower than chorea
-may have problems with drooling swallowing, may have problems with social grimacing. Primarily are movements problems at rest, but sometimes occur in speech. May be waxing and waning.

76
Q

What is an example of dystonia?

A

lingual dyskinesia: tongue coming out while talking or jaw opening off and on while speaking - exacerbated by the action of speech. Botox is sometimes used to inject tongue. The speech problem is caused by these involuntary movements.

77
Q

How do some people improve dystonia movements?

A

With sensory tricks. ex. hold pipe to inhibit dystonia or hold a book to prevent tremors.

78
Q

What are some dystonia speech findings?

A
  • phonation: voice stoppages, strained- harsh voice, audible inspiration, excess loudness variation, alternating loudness, tremor-like voice.
  • Resonance: intermittent hypernasality
  • Articulation: distortions & irregular breakdown, distorted vowels, slow & irregular AMRs
79
Q

What is spasmodic dysphonia?

A

Caused by spasms of the laryngeal adductor or abductor muscles due to different causes.

80
Q

The causes of spasmodic dysphonia can be caused by?

A

neurogenic
psychogenic
unknown reasons

81
Q

What does Duffy say about spasmodic dysphonia caused by neurogenic vs non-neurogenic?

A

They should be separated for treatment purposes

82
Q

Voice in spasmodic dysaphonia is characterized by:

A

strained or breathy voice quality
onset is 45-50 years
can be exacerbated by stress and fatigue

83
Q

Adductor spasms (spasmodic dysphonia( complaints are:

A

increased effort and fatigue, may improve with alcohol, tight strained voice.

84
Q

Abductor complaints of spasmodic dysphonia are:

A

increased effort and fatigue with speaking, may improve with alcohol if tremor based, runs out of air.

85
Q

What is athetosis?

A

A type of cerebral palsy-speech characteristics similar to those with dystonia or chorea.

86
Q

What is palatophrayngeal myoclonus (PPLM)?

A

Abrupt movements of soft palate, pharyngeal walls, and laryngeal muscles.

87
Q

What are the effects of palatophrayngeal myoclonus (PPLM) on speech?

A

Not great. Can be mild intermittent hypernasality.

88
Q

Patients with palatophrayngeal myoclonus (PPLM) often complain of what?

A

Earclicks which is the opening and closing of ht Eustachian tube because of pharyngeal contractions.

89
Q

Hyperkinetic dysarthria sounds like what other dysarthria?

A

spastic

90
Q

What is essential (organic) voice tremor?

A

The voice tremor is usually with gradual onset, and worsens with fatigue and stress, may improve with alcohol and is often accompanied by hand or jaw tremor.

91
Q

What do you to hear essential (organic) voice tremor?

A

Do vowel prolongation in speech exam

92
Q

At what age does essential organic voice tremor start?

A

at any age, but often before 50.

93
Q

what are the treatments available for essential (organic) voice tremor?

A

Not much effective treatment. Botox helps some. Meds for limb tremor may help but meds don’t usually help with voice tremor.

94
Q

What helps distingus hyperkinetic dysarthria from other motor speech disorders?

A

the variable nature of the speech deviances.

95
Q

Read cases

A

8.1 & 8.4

Motor speech Exam 2 (3 decks)

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