hypokinetic

Question 1

what subsystems does hypokinetic dys affect?

Answer 1

all subsystems

Question 2

what is hypokinetic dysarthria related to?

Answer 2

basal ganglia control (extrapyramidal problems)

Question 3

what are the parts of the basal ganglia

Answer 3

caudate nucleus, putamen, globus pallidus

Question 4

what are the parts of the extrapyramidal system that if they are messed up they can cause hypokinetic dys?

Answer 4

basal ganglia (caudate nucleus, putamen, globus pallidus), subthalmic nuclei and the substantia nigra

Question 5

What is the most common dz seen in hypokinetic dysarthria?

Answer 5

Parkinson’s dz

Question 6

In hypokinetic dysarthria speech reflects characteristics due to?

Answer 6

rigidity
reduced ROM
reduced force and movement

Question 7

what may you see in speech with hypokinetic dys?

Answer 7

quick movements in speech

Question 8

why do they call it hypo?

Answer 8

reduced ROM and mobility

Question 9

what is the functions of the basal ganglia?

Answer 9

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

Question 10

This control circuit acts to influence the cortex in what way?

Answer 10

inhibitory

Question 11

How does this control circuit influence the cortex in and inhibitory way?

Answer 11

it inhibits unnecessary movement and it does this by controlling cortical output or messages that might be excessive

Question 12

Where does the initiation of motor movement start?

Answer 12

in the cortex

Question 13

What modulated and regulates motor movements?

Answer 13

the basal ganglia and cerebellum

Question 14

Where are motor movements modulated and regulated?

Answer 14

in the basal ganglia and cerebellum

Question 15

damage to the basal ganglia and control circuit can result in two types of problems?

Answer 15

Reduced movement

problems in inhibiting involuntary movements

Question 16

basal ganglia control circuit problems are commonly caused by what?

Answer 16

neurotransmitters being out of balance

Question 17

t or f. normal function of the basal ganglia depends on the integrity of connections and proper balance of crucial neurotransmitters.

Answer 17

True

Question 18

where is Dopamine produced.

Answer 18

substantia nigra

Question 19

Dopamine is produced in the substantia nigra and then is sent where?

Answer 19

striatum (caudate nucleus and putamen)

Question 20

what is the striatum?

Answer 20

Caudate nucleus and putamen

Question 21

is dopamine inhibitory or excitatory?

Answer 21

inhibitory

Question 22

What happens if substantia nigra neurons are destroyed?

Answer 22

the dopamine supply is reduced or lost.

Question 23

Defficiancy in dopamine causes?

Answer 23

hypokinesia

Question 24

defficiancy in ACH causes?

Answer 24

hyperkinesia

Question 25

hypokinetic dysarthria occurs in at least what % of Parkinson's ptnts?

Answer 25

50%

Question 26

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

Answer 26

True

Question 27

what is melanin?

Answer 27

dark pigment found in certain cells it is referred to as depigmentation of the substantia nigra when this degeneration occurs.

Question 28

where do you find melanin?

Answer 28

in the pars compacta of the substantia nigra

Question 29

what are the non-speech signs of Parkinson's?

Answer 29

``` Tremor at rest pill rolling rigidity bradykinesia hypokinesia ```

Question 30

what may hypokinesia result in?

Answer 30

- 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

Question 31

what is pill rolling?

Answer 31

a tremor most often btwn the thumb and index finger

Question 32

rigidity is?

Answer 32

associated with feelings of stiffness, characterized by slow movements

Question 33

What is a type of rigidity that Parkinson's ptnts might have?

Answer 33

cogwheel rigidity

Question 34

what is cogwheel rigidity?

Answer 34

when you see jerky movements typically in elbow

Question 35

what is bradykinesia?

Answer 35

delays and false starts initiating movements and also in stopping movements once started people feel stuck or frozen in position.

Question 36

what is akinesia?

Answer 36

absence of movement

Question 37

why in Parkinson's dz is there posture problems?

Answer 37

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

Question 38

Etiologies of Hypokinetic?

Answer 38

anything that damages the basal ganglia (degenerative, vascular etcc.) Parkinson's most common

Question 39

With Parkinson's dz the ptnt can also have hyperkinetic dysarthri/a?

Answer 39

yes bc of the meds from the PD

Question 40

What are the degenerative dz that can cause hypokinetic dys?

Answer 40

Parkinson's dz Alzheimer's dz picks dz

Question 41

What is PD?

Answer 41

slowly progressing idiopathic usually occurs mid-late in lie some may have dementia and depression

Question 42

What meds do pd ptnts respond well to?

Answer 42

1-dopa increases the dopamine in the straitum

Question 43

some cases of PD were noted after what?

Answer 43

viral encephalitis this is called postencephalitic parkinsonism

Question 44

parkinsonism

Answer 44

usually refers to general clinical signs similar to what you see in PD

Question 45

Alzheimers and picks are similar to dementia

Answer 45

yes

Question 46

Multiple strokes affecting the basal ganaglia may result in a condition called?

Answer 46

vascular parkinsonism

Question 47

what is cerebral hypoxia?

Answer 47

it is a disorder that is related to the lack of oxygen to cerebrum due to various causes including carbon monoxide poisoning.

Question 48

what are the etiologies of hypokinetic dys?

Answer 48

``` degenerative toxic-metabolic Trauma Infectious Vascular ```

Question 49

What is the toxic metabolic condition that may cause hypokinetic dys?

Answer 49

antipsychotic drugs (neuroleptic) may block dopamine receptors and lead to hypokinetic dysarthria symp.

Question 50

boxers with repeated head trauma can cause damage to what?

Answer 50

substantia nigra

Question 51

if the substantia nigra is damaged what type of symptoms will you get?

Answer 51

pd like symptoms

Question 52

what is it called when the boxers get repeated head trauma?

Answer 52

punch drunk encephalopathy (can have ataxic issues too)

Question 53

what medical treatment for PD can actually worsen hypokinetic dys?

Answer 53

stereotactic ventrolateral thalamotomy (done to stop severe tremors)

Question 54

what happens during a stereotactic ventrolateral thalamotomy?

Answer 54

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

Question 55

What can result from things like measles, mumps, mononucleosis and rabies?

Answer 55

viral encephalitis

Question 56

What does the ptnt complain about with hypokinetic dys?

Answer 56

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

Question 57

What are some non-speech clinical findings of hypokinetic dys?

Answer 57

- 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

Question 58

What are the speech clinical findings

Answer 58

``` 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) ```

Question 59

What is palilalia?

Answer 59

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)

Question 60

what are the best speech distinguishing features of hypokinetic?

Answer 60

``` fast rate short rushes of speech reduced stress monopitch/ monoloudness inappropriate silences breathiness ```

Question 61

T or F the most prominent speech features of hypokinetic dys are related to prosody.

Answer 61

True

Question 62

Flaccid has the most breathiness out of all the dysarthrias

Answer 62

true

Question 63

flaccid is rougher sounding and is usually

Answer 63

LOUDER than hypokinetic

Question 64

people with hypokinetic dys can produce AMR's for a long time

Answer 64

people with flaccid cannot