hypokinetic Flashcards
what subsystems does hypokinetic dys affect?
all subsystems
what is hypokinetic dysarthria related to?
basal ganglia control (extrapyramidal problems)
what are the parts of the basal ganglia
caudate nucleus, putamen, globus pallidus
what are the parts of the extrapyramidal system that if they are messed up they can cause hypokinetic dys?
basal ganglia (caudate nucleus, putamen, globus pallidus), subthalmic nuclei and the substantia nigra
What is the most common dz seen in hypokinetic dysarthria?
Parkinson’s dz
In hypokinetic dysarthria speech reflects characteristics due to?
rigidity
reduced ROM
reduced force and movement
what may you see in speech with hypokinetic dys?
quick movements in speech
why do they call it hypo?
reduced ROM and mobility
what is the functions of the basal ganglia?
facilitate movement
regulate muscle tone
regulate movements that support goal-directed movments (swinging arms while walking)
control postural adjustments in skilled movements (stabilizes shoulder in writing)
adjust movements to the environment
assist in the learning of new movements
This control circuit acts to influence the cortex in what way?
inhibitory
How does this control circuit influence the cortex in and inhibitory way?
it inhibits unnecessary movement and it does this by controlling cortical output or messages that might be excessive
Where does the initiation of motor movement start?
in the cortex
What modulated and regulates motor movements?
the basal ganglia and cerebellum
Where are motor movements modulated and regulated?
in the basal ganglia and cerebellum
damage to the basal ganglia and control circuit can result in two types of problems?
Reduced movement
problems in inhibiting involuntary movements
basal ganglia control circuit problems are commonly caused by what?
neurotransmitters being out of balance
t or f. normal function of the basal ganglia depends on the integrity of connections and proper balance of crucial neurotransmitters.
True
where is Dopamine produced.
substantia nigra
Dopamine is produced in the substantia nigra and then is sent where?
striatum (caudate nucleus and putamen)
what is the striatum?
Caudate nucleus and putamen
is dopamine inhibitory or excitatory?
inhibitory
What happens if substantia nigra neurons are destroyed?
the dopamine supply is reduced or lost.
Defficiancy in dopamine causes?
hypokinesia
defficiancy in ACH causes?
hyperkinesia
hypokinetic dysarthria occurs in at least what % of Parkinson’s ptnts?
50%
T or F. The most consistent finding in ptnts with Parkinsons is the degeneration of the melanin-containing cells in the pars compacta of the substantia nigra
True
what is melanin?
dark pigment found in certain cells it is referred to as depigmentation of the substantia nigra when this degeneration occurs.
where do you find melanin?
in the pars compacta of the substantia nigra
what are the non-speech signs of Parkinson’s?
Tremor at rest pill rolling rigidity bradykinesia hypokinesia
what may hypokinesia result in?
- masked expression of the face and unblinking eyes
- reduced arm swing in walking
- micrographic (small) writing
- festination (when pt starts walking slowly then speeds up with quick, shuffling steps)
-posture problems
what is pill rolling?
a tremor most often btwn the thumb and index finger
rigidity is?
associated with feelings of stiffness, characterized by slow movements
What is a type of rigidity that Parkinson’s ptnts might have?
cogwheel rigidity
what is cogwheel rigidity?
when you see jerky movements typically in elbow
what is bradykinesia?
delays and false starts initiating movements and also in stopping movements once started people feel stuck or frozen in position.
what is akinesia?
absence of movement
why in Parkinson’s dz is there posture problems?
it is due to impaired postural reflexes
pts tend to be stooped with felxed head and trunk
problems turning in bed, and going from sitting to standing
may feel like falling
Etiologies of Hypokinetic?
anything that damages the basal ganglia (degenerative, vascular etcc.)
Parkinson’s most common
With Parkinson’s dz the ptnt can also have hyperkinetic dysarthri/a?
yes bc of the meds from the PD
What are the degenerative dz that can cause hypokinetic dys?
Parkinson’s dz
Alzheimer’s dz
picks dz
What is PD?
slowly progressing
idiopathic
usually occurs mid-late in lie
some may have dementia and depression
What meds do pd ptnts respond well to?
1-dopa increases the dopamine in the straitum
some cases of PD were noted after what?
viral encephalitis this is called postencephalitic parkinsonism
parkinsonism
usually refers to general clinical signs similar to what you see in PD
Alzheimers and picks are similar to dementia
yes
Multiple strokes affecting the basal ganaglia may result in a condition called?
vascular parkinsonism
what is cerebral hypoxia?
it is a disorder that is related to the lack of oxygen to cerebrum due to various causes including carbon monoxide poisoning.
what are the etiologies of hypokinetic dys?
degenerative toxic-metabolic Trauma Infectious Vascular
What is the toxic metabolic condition that may cause hypokinetic dys?
antipsychotic drugs (neuroleptic) may block dopamine receptors and lead to hypokinetic dysarthria symp.
boxers with repeated head trauma can cause damage to what?
substantia nigra
if the substantia nigra is damaged what type of symptoms will you get?
pd like symptoms
what is it called when the boxers get repeated head trauma?
punch drunk encephalopathy (can have ataxic issues too)
what medical treatment for PD can actually worsen hypokinetic dys?
stereotactic ventrolateral thalamotomy (done to stop severe tremors)
what happens during a stereotactic ventrolateral thalamotomy?
a surgical lesion is intentionally made in the thalamus to interrupt the control circuit from which the tremor comes. Tremors are stopped but side affects may occur including dys or worsening of existing dys, aphasia and cognitive defects
What can result from things like measles, mumps, mononucleosis and rabies?
viral encephalitis
What does the ptnt complain about with hypokinetic dys?
weak or quiet-voice (diff being heard in noisy places)
too fast rate of speech
words are imprecise and flat in emotional tone
hard to get speech started
some stuttering or repetitions
fatigue brings negative effects on spch
meds may help speech if it helps other PD symptoms
swallowing/drooling problems
stiff upper lip due to rigidity
What are some non-speech clinical findings of hypokinetic dys?
- look for mask like-face unsmiling, unblinking
- reduced movements of chest and abdomen during breathing
- ptnt may not swallow eough and thus cause drooling
- head turn may not accompany eye movement to look for something on the periphery
- tremor of jaw and lips at rest or in opening and retracting lips. Tongue may have tremors or protrude out of mout
- may have normal size, strength, symmetry of jaw face and tongue
- flat affect: restricted, unemotional facial affect which may not reflect ptnts emotional state
What are the speech clinical findings
assess through conversation, AMR's, reading and vowel prolongation -AMR's may be slow to start and throughout or they can be slow to start and become very rapid even to the point of blurring -monopitch and monoloudness reduced loudness reduced stress short rushes of speech overall increased rate of speech harsh/breathy voice imprecise consonants diff. initiating speech rapid or blurred AMR's inappropriate silences occasional tremor on vowel prolongation palilalia (pathological reiterative utternaces)
What is palilalia?
pathological reiterative utterances
hypokinetic is the only dysarthria that has this but some other neurological disorders can
repetition of words or utterances getting quicker as they go. (compulsive not controllable repetition)
what are the best speech distinguishing features of hypokinetic?
fast rate short rushes of speech reduced stress monopitch/ monoloudness inappropriate silences breathiness
T or F the most prominent speech features of hypokinetic dys are related to prosody.
True
Flaccid has the most breathiness out of all the dysarthrias
true
flaccid is rougher sounding and is usually
LOUDER than hypokinetic
people with hypokinetic dys can produce AMR’s for a long time
people with flaccid cannot
