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Motor Speech > Hyperkintetic Dysarthria > Flashcards

Hyperkintetic Dysarthria Flashcards

1
Q

Speech difficulties are due to what?

A

Excessive movement

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2
Q

Prominent effects on…

A

Prosody (especially rhythm) and rate

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3
Q

Movements are…

A

Irregular and unpredictable

Specific symptomology depend on the etiology and location, but primarily due to damage in the basal ganglia

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4
Q

One word for Hyperkinetic?

A

EXCESS

Vocal folds are fighting abduction/adduction with other muscles.

Hyper- constant movement. Not getting a signal all the time. Cant maintain the same position the way spastic is

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5
Q

Dyskinesias

A

General term for abnormal involuntary movements

Orofacial dyskinesias (e.g., tardive dyskinesia)

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6
Q

Myoclonus

A

Single or repetitive brief, lightning-like involuntary jerks of a body part

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7
Q

Tics

A

Rapid movements under partial voluntary control

Can be speech or non-speech motor actions

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8
Q

Chorea

A

Involuntary rapid, random movements during sustained posture or rest

**Associated with Huntingtons

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9
Q

Ballismus

A

Abrupt contractions of the extremities; wild flailing movements

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10
Q

Athetosis

A

Slow, writhing movements that flow into one another

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11
Q

Dystonia

A

Abnormal postures from excessive contraction of agonist and antagonist muscles

Torticollis, orofacial dystonia, blepharospasm

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12
Q

Spasm

A

Abnormal muscular contraction; tonic- prolonged or continuous; clonic- repetitive, rapid in onset and brief

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13
Q

Tremor

A

Most common involuntary movement

Rhythmic (periodic) movements
- Resting tremor
- Essential tremor – occurs with sustained posture & action; affects the upper limbs, head & speech mechanism
- Postural tremor – occurs when body part maintained against gravity
- Terminal tremor – occurs as body part nears target

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14
Q

Effects on the Speech Mechanism- Respiratory

A

Excessive loudness variations due to sudden inhalation/exhalation

Reduced phrase length

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15
Q

Phonatory

A

Harsh or strained vocal quality (adduction) or breathiness (abduction)

Sudden voice stoppage (severe hyperadduction)

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16
Q

Resonance

A

Mild, intermittent hypernasality

17
Q

Articulation

A

Irregular articulatory breakdowns, prolonged phonemes, variable rate

18
Q

Prosody

A

Equal and excess stress or reduced prosodic contour

19
Q

Etiologies

A

Toxic-Metabolic
- Antipsychotic drugs or Levadopa – Tardive Dyskinesia

Infections
Sydenham’s chorea – streptococcal infection – occurs in 1/3rd of kids with rheumatic fever
Diptheria, rubella, systemic lupus and AIDS

Tumors

Genetic disorders

20
Q

Tourette’s Syndrome

A

Mean onset – 6-7 yrs of age

Multiple motor and 1 or more vocal tics present for > 1 yr.

Strong genetic influences

Affects mostly males (3:1); frequently co-occurs with OCD or ADHD

Vocal tics isolated or embedded in verbal utterances

Throat clearing, grunting, echolalia, palilalia and coprolalia (involuntary, compulsive swearing)

21
Q

Chorea

A

Can be caused by Huntington’s Disease
- Autosomal dominant genetic disorder that appears in the 40s and 50s

Or Sidenham’s chorea which follows infections

Respiration – sudden forced, involuntary inspiration or expiration

Phonation – harsh vocal quality, excess loudness variations, strained-strangled voice

Resonance – hypernasality

Articulation – imprecision from excess movements

Prosody – prosodic excess, prolonged intervals, inappropriate silences, excess and equal stress

22
Q

Dystonia

A

Meige syndrome, Spasmodic Dysphonia

Most evident at rest or during attempts to maintain steady facial postures

Movements are slower than chorea

Clusters of deviant speech characteristics
Phonation – harsh, strained-strangled quality, excess loudness variations, voice stoppages

Articulation – imprecise consonants, distorted vowels, and irregular articulatory breakdowns

Prosody – monopitch, monoloudness, short phrases, reduced stress

23
Q

Spasmodic Dysphonia

A

“A group of voice disorders that most often reflect dystonic movements of laryngeal muscles that are triggered during speech.”

Defined as focal, speech-induced dystonia

Three types: adductor (~90%), abductor or mixed

Avg. age of onset ~ 45 – 50 yrs with more women than men

Emotional stress, anxiety, depression make it worse

24
Q

Spasmodic Dysphonia Cont.

A

Adductor*
- Hyperadduction of adductor laryngeal muscles

-Voice quality is strained, squeezed & effortful

-Part & whole word repetitions may be present

-Hypernasality

-Severe cases may be facial grimacing & neck contractions

Abductor
-Voice interrupted by brief, inappropriate breathy or aphonic speech easily triggered by voiceless consonants

-May have dysfluencies and hypernasality is sometimes apparent

Can be mixed as well

25
Q

Essential Vocal Tremor

A

Primarily viewed as voice disorder

Occurs in ~20% of patients with essential tremor elsewhere

Family history present in 17% to 96% of affected people

Can begin at any age & incidence increases with age

26
Q

SLP Treatments

A

Oromandibular dystonia – some patients benefit from use of a bite block or sensory tricks

Myoclonus – using slow speech rate may help with ease of speech

Vocal tremor – speech therapy to reduce perception of tremor
- Focus on shortening voice duration in connected speech

  • Adjusting pitch can also help mask tremor
27
Q

**Non-Speech Treatments * *

A

Deep brain stimulation for essential tremor, dystonia, dyskinesia, tics that have not responded to other pharmacological treatment

Botox Injections for dystonias, spasmodic dysphonia, palatal myoclonus

Pharmaceuticals
Tremor
- Propranolol (Inderal), Primidone (Mysoline)

Dystonias
- Artane, Clozapine, Xanax

Chorea
- Reserpine, Haldol

Tics
- Clonidine, Respiridone, Gabapentin

28
Q

HYPERKINETIC CHART

A

—–>

29
Q

RESPIRATION

A
  • Affect loudness phrase and length
  • Excessive bursts (explosive loudness)
30
Q

PHONATION

A
  • Sudden movements of the vocal folds open vocal folds

abduction (open) = breathy
adduction (closed) = strain

  • Pitch breaks (crack in voice and sudden pitch in voice) will disrupt pitch glide (sudden movement) in between.
31
Q

RESONANCE

A
  • Hypernasality
32
Q

ARTICULATION

A
  • Irregular arctic breakdowns/disruptions
  • Irregular AMRs and SMRs
  • Prolonged vowels (compensatory)
33
Q

PROSODY

A
  • Sometimes seen equal and excess stress
34
Q

NON SPEECH

A
  • Tourettes (TICS)
  • Chorea (Huntington’s Disease),
  • Spasmodic Dysphonia (laryngeal dystonia)
  • Unilateral tremor,
  • Benign essential vocal tremor
  • Athetosis
  • Dystonia
35
Q

NEUROANATOMY

A

Basal Ganglia

Motor Speech (9 decks)

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