Hyperkintetic Dysarthria Flashcards
Speech difficulties are due to what?
Excessive movement
Prominent effects on…
Prosody (especially rhythm) and rate
Movements are…
Irregular and unpredictable
Specific symptomology depend on the etiology and location, but primarily due to damage in the basal ganglia
One word for Hyperkinetic?
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
Dyskinesias
General term for abnormal involuntary movements
Orofacial dyskinesias (e.g., tardive dyskinesia)
Myoclonus
Single or repetitive brief, lightning-like involuntary jerks of a body part
Tics
Rapid movements under partial voluntary control
Can be speech or non-speech motor actions
Chorea
Involuntary rapid, random movements during sustained posture or rest
**Associated with Huntingtons
Ballismus
Abrupt contractions of the extremities; wild flailing movements
Athetosis
Slow, writhing movements that flow into one another
Dystonia
Abnormal postures from excessive contraction of agonist and antagonist muscles
Torticollis, orofacial dystonia, blepharospasm
Spasm
Abnormal muscular contraction; tonic- prolonged or continuous; clonic- repetitive, rapid in onset and brief
Tremor
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
Effects on the Speech Mechanism- Respiratory
Excessive loudness variations due to sudden inhalation/exhalation
Reduced phrase length
Phonatory
Harsh or strained vocal quality (adduction) or breathiness (abduction)
Sudden voice stoppage (severe hyperadduction)
Resonance
Mild, intermittent hypernasality
Articulation
Irregular articulatory breakdowns, prolonged phonemes, variable rate
Prosody
Equal and excess stress or reduced prosodic contour
Etiologies
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
Tourette’s Syndrome
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)
Chorea
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
Dystonia
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
Spasmodic Dysphonia
“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
Spasmodic Dysphonia Cont.
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
Essential Vocal Tremor
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
SLP Treatments
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
**Non-Speech Treatments * *
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
HYPERKINETIC CHART
—–>
RESPIRATION
- Affect loudness phrase and length
- Excessive bursts (explosive loudness)
PHONATION
- 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.
RESONANCE
- Hypernasality
ARTICULATION
- Irregular arctic breakdowns/disruptions
- Irregular AMRs and SMRs
- Prolonged vowels (compensatory)
PROSODY
- Sometimes seen equal and excess stress
NON SPEECH
- Tourettes (TICS)
- Chorea (Huntington’s Disease),
- Spasmodic Dysphonia (laryngeal dystonia)
- Unilateral tremor,
- Benign essential vocal tremor
- Athetosis
- Dystonia
NEUROANATOMY
Basal Ganglia
