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MSD Exam Sarah > Hyperkinetic Dysarthria > Flashcards

Hyperkinetic Dysarthria Flashcards

1
Q

dyskinesia:

A

abnormal movements

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2
Q

Hyperkinetic dysarthria is due to lesions in the:

A

basal ganglia circuit – it’s extrapyramidal

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3
Q

Extrapyramidal refers to:

A

those motor pathways that do not pass through the pyramids at the medullary-spinal level

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4
Q

Hyperkinetic dysarthria can affect which subsystems:

A

any sub-systems. But it mainly affects prosody in speech

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5
Q

Lesions to the basal ganglia (extrapyramidal system) can cause speech characteristics related to (4):

A

abnormal
rhythmic or irregular (so may be regular or irregular)
unpredictable
rapid or slow involuntary movements.

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6
Q

What is the key thing to keep in mind with hyperkinetic dysarthria?

A

Involuntary movements

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7
Q

T/F

There is a variety of disorders in this category with a lot of variance among them

A

T

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8
Q

Are abnormal movements present during speech and other movements?

A

No.

Abnormal movements may only be present during speech – important feature

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9
Q

Why do abnormal movements occur in hyperkinetic dysarthria? (3)

A

Abnormal movements 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

Another cause of these movements may be that there is an imbalance between the excitatory and inhibitory neurotransmitters

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10
Q

AcH is _____

A

excitatory

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11
Q

Dopamine is ____

A

inhibitory

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12
Q

The term hyper in hyperkinetic means:

A

movements that don’t belong, extra movements

not too fast speed in movement

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13
Q

voluntary movements of hyperkinetic dysarthria patients may be

A

slow

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14
Q

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

A

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

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15
Q

What is the underlying theme of movements with hyperkinetic dysarthrias?

A

involuntary movement

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16
Q

Are all involuntary movements with hyperkinetic dysarthria similar in nature?

A

No,

Considerable variability in movement, character and underlying pathology

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17
Q

Etiologies of hyperkinetic dysarthria:

A

multiple etiologies

  • main known cause: toxic-metabolic
  • idiopathic causes are the most frequent (Most are unknown etiologies)
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18
Q

How can these hyperkinetic dysarthrias be distinguished from other dysarthrias?

A

By visual observing-because of the strange movements

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19
Q

Some of the bizarreness of the movements with hyperkinetic dysarthrias may cause the person to be incorrectly diagnosed as having:

A

a psychogenic problem

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20
Q

Categories of hyperkinetic dysarthias (9):

A
  1. Dyskinesia (e.g. Tardive dyskinesia)
  2. Myoclonus
  3. Tics
  4. Chorea
  5. Ballism
  6. Athetosis
  7. Dystonia
  8. Spasm
  9. Tremor
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21
Q

Dyskinesia

A

Refers to abnormal, hyperkinetic, involuntary movements

A general term for abnormal movement

Dyskinesia can occur in various part of the body

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22
Q

Orofacial dyskinesias:

A

Dyskinesias that occur in the mouth, tongue and jaw and don’t have to have any other parts of body involved

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23
Q

Tardive dyskinesia:

A

Dyskinesis related to prolonged use of antipsychotic drugs

Often seen in patients with schizophrenia who have taken antipsychotic drugs.

Orofacial dyskinesias may be tardive dyskinesias

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24
Q

Akathisia (in the category of dyskinesias):

A

Motor restlessness demonstrated by pacing, moving around a lot, rubbing head, etc.

Due to damage in BG circuit

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25
Q

Myoclonus:

A

Single involuntary, brief movements of a 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.

Occurs with lesions from the cortex to the spinal cord.

Hiccups are a type of myoclonus – spasms of the diaphragm and adduction of vocal cords. Hiccuping can be a sign of involvement with the medulla

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26
Q

Tics:

A
  • typically seen in Tourette’s syndrome
  • rapid, patterned movement under partial voluntary control
  • The person may have some voluntary control over them.
  • There is usually a strong, irrepressible urge to do these but the person may be able to control them for a little while
  • Simple tics may look like dystonia or myoclonus, but complex tics don’t (examples – jumping up, making noises, lip smacking).

(Read “Anthropologist from Mars” by Oliver Sachs)

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27
Q

Chorea:

A
  • rapid-involuntary, random purposeless movements of a part of body
  • nonrhythmic and random
  • can be present at rest and in voluntary movement
  • can be subtle or severe
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28
Q

Huntington’s Chorea:

A
  • type of chorea
  • it is progressive/degenerative
  • It is inherited, genetic dz
  • CNS disorder
  • Damage occurs in the basal ganglia and in cortex
  • Easily distinguished by chorea movements
  • May also see dementia and personality changes
  • Also dysarthria and dysphagia
29
Q

If someone has Huntington’s Chorea, what are the chances their child will have it?

A

50%

30
Q

Ballism:

A
  • abrupt contractions of muscles of limbs
  • so bad that the person can fall down
  • large muscle contractions, not fine ones
31
Q

Athetosis

A
  • inability to keep a body part in one position

- slow writhing purposeless motion

32
Q

CP is a type of:

A

athetosis

33
Q

Dystonia

A
  • slow hyperkinesias exhibited by involuntary abnormal postures due to problems with antagonistic muscles
  • can have quick myoclonic movments involved
  • can occur in one part of body or several
  • If occurs in orofacial muscles – it may be called focal mouth dystonia (essentially the same as orofacial dyskinesia
  • Writer’s cramp is a form of dystonia
  • It is usually nonrhythmic
34
Q

What is focal mouth dystonia?

A

Dystonia occuring inthe orofacial muscles (essentially the same as orofacial dysinesia)

35
Q

What is a writer’s cramp?

A

a form of dystonia

36
Q

Spasm

A
  • when you have involuntary muscular contractions
  • tonic ones are continuous
  • clonic ones are repetitive and don’t last long
  • Spasms can both cause motion and limit motion
    (e. g. if you limit your movements because you are having a spasm of a muscle)
  • Spasm is also used to describe dystonia abnormal postures
37
Q

Tonic spasms are:

A

continuous

38
Q

Clonic spasms are

A

repetitive and don’t last long

39
Q

Tremor:

A
  • the involuntary movement that is most common
  • rhythmic movement in one body part
  • Can occur when the muscle is at rest or in action
  • Also, toxic tremors
40
Q

2 types of Tremors:

A
  1. at rest –> resting tremor

2. action –> intention tremor

41
Q

Toxic Tremors

A

– due to meds, or other toxins, withdrawal from drugs/alcohol.

42
Q

Cerebellar tremor is due to:

A

damage in cerebellum

43
Q

Etiologies of hyperkinetic dysarthria (6):

A

Common disorders in which we see hyperkinetic dysarthria:

  1. Degenerative disease
  2. Toxic-metabolic conditions
  3. Vascular disorders
  4. Infectious processes
  5. Neoplasm
  6. Tourette’s
44
Q

Where is the damage with hyperkinetic dysarthria?

A

Basal ganglia or cerebellar circuit (indirect activation pathway (extrapyramidal))

45
Q

Degenerative disease that cause hyperkinetic dysarthria:

A
  • Huntington’s chorea or Huntington’s Dz is probably most well known
46
Q

Toxic-metabolic conditions that cause hyperkinetic dysarthria:

A
  • due to antipsychotic drugs because they affect the neurotransmitters
  • Tardive dyskinesia- often seen in patients with schizophrenia who have taken antipsychotic drugs
47
Q

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

A
  • because if the drugs are withdrawn early enough, speech can go back to normal
  • if not, there may be permanent dysarthria
48
Q

Vascular disorders causing hyperkinetic dysarthria:

A

– usually don’t see many of these causing hyperkinetic dysarthria unless there are strokes that affect basal ganglia or cerebellum

49
Q

Infectious processes causing hyperkinetic dysarthria:

A
  • inflammation can cause a disorder called Sydenham’s chorea- seen in young people and may be associated with strep throat. Typically it is temporary
50
Q

Neoplasm causing hyperkinetic dysarthria:

A
  • tumors of basal ganglia and thalamus may result in hyperkinetic dysarthria
51
Q

Tourette’s and hyperkinetic dysarthria:

A
  • causes both verbal and motor tics. Cause probably related to problems with dopamine receptor
52
Q

Nonspeech Patient Complaints with Hyperkinetic Dysarthria:

A

Nonspeech-depends on the specific disorder

Many report can’t keep jaw, face, tongue still

Problems with swallowing or chewing

Some may be aware of abnormal movements, whereas others may not

Some have learned sensory tricks to hold back movement, i.e. holding or touching body part that is moving

53
Q

Specific diseases with nonspeech and speech signs (8):

A
  1. Chorea
  2. Dystonia
  3. Spasmodic torticollis (cervical dystonia)
  4. Palatopharyngolaryngeal myoclonus
  5. Action myoclonus
  6. Tourette’s syndrome
  7. Organic voice tremor
  8. Spasmodic dysphonia (adductor and abductor)
54
Q

Non-speech characteristics of Chorea with hyperkinetic dysarthria:

A

Nonspeech findings-usually 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, unpatterned movements

Can sometimes be difficult to distinguish from normal unsteadiness. See page 227, Fig. 8.2.

55
Q

Speech Characteristics of Chorea with hyperkinetic dyarthria:

A

Speech assessed through reading, conversation, AMRs, and vowel prolongation.

Look for unpredictable movements and breakdown in rate and prosody.

Phonation-respiration: sudden forced inspiration or expiration, excess loudness variations, strained-strangled voice, voice stoppages, transient breathiness.

Resonance – intermittent hypernasality and weak pressure consonants.

Artic - irregular breakdown, distortions, distorted vowels. Slow & irregular AMRs.

Prosody - prolonged intervals & phonemes, inappropriate silences, variable rate, variable stress patterns. Prosodic components are prominent.

56
Q

Non-speech signs of dystonia and hyperkinetic dysarthria:

A

Slower than chorea, waxing & waning or near constant character

Oral mech normal size, strength etc. as in chorea.

May have problems with drooling, swallowing, may be problems with facial grimacing.

Primarily are movement problems at rest, but sometimes occur in speech.

Example of dystonia – 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 in tongue. The speech problem is caused by these involuntary movements.
See page 233.

May improve with sensory tricks. In speech exam look for/ask about sensory tricks. (Hold pipe in mouth to inhibit dystonia, etc.) Michael Fox - held book in hand to prevent tremors – but he had Parkinson’s DZ

57
Q

Speech findings with Dystonia and hyperkinetic dysarthria:

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

58
Q

Non-speech characteristics of Spasmodic torticollis (cervical dystonia) and hyperkinetic dysarthria:

A
  • affects cervical neck muscles and not muscles innervated by cranial nerves
  • Can also have facial spasms
  • Speech deviances are related to deviancies in neck postures
59
Q

Speech charcteristics of Spasmodic torticollis (cervical dystonia) and hyperkinetic dysarthria:

A
  • Effects are usually mild on speech and are primarily at laryngeal level – pitch variability
  • Articulation/Prosody level - may have reduced rate and delayed speech initiation, slow AMRs.

Page 235, figure 8.7

60
Q

Non-speech characteristics of Palatopharyngolaryngeal myoclonus and hyperkinetic dysarthria:

A
  • abrupt movements of soft palate, pharyngeal walls and laryngeal muscles
  • Effects on speech are not great
  • Can be mild intermittent hypernasality
  • Patient often complains of “earclicks” which is the opening and closing of the Eustachian tube because of pharyngeal contractions
61
Q

Speech characteristics of Palatopharyngolaryngeal myoclonus and hyperkinetic dysarthria:

A
  • Effects on speech are not great
  • Can be mild intermittent hypernasality
  • Patient often complains of “earclicks” which is the opening and closing of the Eustachian tube because of pharyngeal contractions
62
Q

Action myoclonus and hyperkinetic dysarthria:

A
  • not often seen for SLPs

- It is different from other myoclonic disorders because it is induced by action and is more rhythmic

63
Q

Tourette’s syndrome and hyperkinetic dysarthria:

A
  • Most are genetically related
  • Typically you see facial grimaces, eyeblinks, twitches of head
  • Can also include larger movements, spinning, jumping, etc.
  • May appear to be bizarre
  • There are also vocal tics – which can include odd noises such as grunting, yelling, whistling, squeaking, etc.
  • Can include echolalaia, palilalia and coprolalia – swearing compulsively
  • Most cases are male – by 4 to 1
  • Can be accompanied by OCD
64
Q

Organic voice tremor and hyperkinetic dysarthria:

A
  • the voice tremor is usually with gradual onset, and worsens with fatigue and stress, may improve with alcohol and is often accompanied by head or jaw or extremity tremor
  • Do vowel prolongation in speech exam to really hear tremor
  • Not much effective treatment. BOTOX helps some.
  • Meds for limb tremors bay help but meds don’t usually help with voice tremor
65
Q

Spasmodic dysphonia and hyperkinetic dysarthria:

A
  • (may also be called spastic dysphonia but is somewhat different because there are no articulation or rate problems with spasmodic dysphonia.)
  • Caused by spasms of the laryngeal adductor or abductor muscles due to different causes
  • There are different kinds of spasmodic dysphonia depending on whether the cause may be related to neurogenic, psychogenic or unknown reasons
  • Duffy says the ones that aren’t neurogenic are not MSD.
  • It is characterized by strained or breathy voice quality
  • onset is 45-50 years
  • Can be exacerbated by stress and fatigue.
66
Q

Adductor spasmodic dyphonia complaints:

A

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

67
Q

Abductor spasmodic dysphonia complaints:

A
  • increased effort & fatigue with speaking, may improve with alcohol if tremor based, runs out of air
68
Q

What helps to distinguish hyperkinetic dysarthria from other MSDs?

A

variable nature of the speech deviances

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