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Motor Speech Exam 3 > Hypokinetic Dysarthria > Flashcards

Hypokinetic Dysarthria Flashcards

1
Q

What is hypokinetic dysarthria?

A

hypokinesis, but not hypotonia
- kinesis: movement
- less movement, but more muscle tone

**Vast majority of cases due to Parkinsonism
**Remember, Parkinsonism and HD are not the same things.

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2
Q

Parkinsonism

A

collective term for a group of disorders with many of the same symptoms
- neurologist’s diagnosis based on TRAP:
T: resting tremors
R: rigidity
A: akinesia
P: postural instability

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3
Q

Etiologies of Hypokinetic Dysarthria

A

Parkinson’s Disease - 90%
- idiopathic form of Parkinsonism
- Most common form of Parkinsonism and HD
- high prevalence of speech deficits
- 60-80%

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4
Q

James Parkinson

A
  • wrote an account of his patients in 1817
  • described a “shaking palsy”
  • not all PD patients have tremor: tremor dominant or rigidity dominant
  • speech symptoms clearly resembled what is known as hypokinetic dysarthria
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5
Q

Neurons in Substantia Nigra

A

The pars compacts region of the substantia nigra in the normal brain appears dark because dopamine-producing neurons are highly-pigmented; as neurons die from Parkinson’s disease the color fades

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6
Q

Medical treatment of Parkinson’s Disease

A
  • Usually treated pharmacologically (e.g. L-dopa), but doesn’t really transfer to the speech
  • DBS: deep brain stimulation (pacemaker of the brain)
  • surgeries: thalamotomy (where signals from the BG get through), pallidotomy (little cut in the lesions)

** otomy: cut it

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7
Q

Idiopathic

A

don’t know the cause; can’t be identified

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8
Q

Difference between PD and parkinsonism

A
  • PD is idiopathic: they don’t know the cause, but they have the symptoms
  • It’s not PD if there is an etiology.
  • it’s consequential distinction.
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9
Q

Neuroleptic-Induced Parkinsonism

A
  • 2nd most common form of Parkinsonism
  • side effect of antipsychotic drugs:
    ** e.g., chlorpromazine
    ** schizophrenia: often associated with excess dopamine; block dopamine that causes too little dopamine
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10
Q

Postencephalic Parkinsonism

A
  • caused by viral encephalitis
  • can also affect children

** itis: information

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11
Q

Traumatic Brain Injury

A
  • cerebral anoxia (if it affected the BG)
  • “punch drunk” encephalopathy
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12
Q

CVA

A

When it affects
- basal ganglia
- substantia nigra
- BG control circuit

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13
Q

The most common speech production errors in people with HD

A

monopitch
reduced stress
monoloudness
imprecise consonants
inappropriate silences
short rushes
harsh voice quality
breathy voice (continuous)
pitch level
variable rate - variable, speed up and stop

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14
Q

Speech errors - Prosody/articulation

A

monopitch
reduced stress
monoloudness
inappropriate silences
short rushed of speech: stop and go quality
variable speech rate

imprecise consonants:
- reduced ROM
- distortions
- spirantization: sounds more like a fricative
- articulatory undershoot: they are not going all the way

reduced phonemes
palilalia: delayed repetition of words or phrases

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15
Q

Speech errors - phonation

A
  • harsh voice quality
  • breathy
  • reduced vocal loudness
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16
Q

Speech errors - respiration

A

Faster breathing rates
Paradoxical movements - contradiction; opposers
Reduced ROM
May result in:
- shallow breath support
- poorly controlled exhalation
- short breathing cycles
- short rushes
- breathy, soft phonation

17
Q

Key evaluation tasks

A
  1. conversational speech/reading
    - rate problems
    - intelligibility
  2. AMRs:
    - imprecise consonants
    - variable rate
    - “blurring” of syllables - can’t count it
  3. vowel prolongation:
    - breathy voice quality: extremely quiet, short maximum phonation time
18
Q

Treatment of HD - Rate Reduction

A
  • can improve articulation
  • give articulators more time to reach target positions
  • give listener more processing time
19
Q

Treatment of HD - DAF (Delayed auditory feedback)

A
  • speech is amplified, delayed, then “fed back” to the speaker’s ears
  • speaker prolongs syllable until the delayed signal is perceived, then begins next syllable
  • slow, fluent speech with prolonged vowels, connected syllables (it’s important)

** anything that can help them initiate vocal fold activity is good

20
Q

DAF and normal speakers

A
  • delayed indicates that the speech sound has not been completed
  • repetition or prolongation of syllables
  • “artificial stuttering”
  • responses vary with attention paid to delayed signal
  • helps explain variability in responding
21
Q

DAF sidenotes

A

Clinicians need to use instructions, modeling, and feedback

Multiple delay intervals:
- rate vs. intelligibility
** want to get a balance; slow enough to increase intelligibility
- progression of disease/disorder
- personal preference

22
Q

Types of DAF

A
  • DAF units
  • Wireless DAF
  • Casa Futura Technologies “Small Talk”
  • DAF apps
23
Q

Treatment - FAF

A
  • Frequency-altered feedback
  • shifts pitch up or down
  • might increase activity in L auditory cortex
  • alter pitch > change VF tension
  • UP > increase VF tension
  • Down > decrease VF tension
    ** PWS versus PD
    ** Down is good for PWS
    ** Up is good for PD
24
Q

Treatment - Phonation

A

Pushing/pulling
- effortful closure
- medical compression

HGA-Hard glottal attack (VP protocol)

Instrumental biofeedback
- Visi-Pitch or CSL

LSVT
SpeakOut!

25
Q

LSVT

A
  • Think Loud!!!
  • Rationale: lack of respiratory effort
  • Schedule: 1 hour a day, 4 days a week for 4 weeks, total of 16 sessions, with homework
  • SLP training: two-day courses
  • Procedures
    1. Daily “ahs” - duration and amplitude
    2. “ah voice”: is the voice that you remember doing first thing in the morning
26
Q

Speak Out! basic information

A
  • Parkinson’s Voice Project
  • Invented in Richardson, TX
  • NFP organization
  • Samatha Elandary, the Founder and CEO
  • Private donation and “pay it forward”
27
Q

Speak Out! General information

A
  • Total of 12 sessions
  • Schedule: 1 hour a day, 3 days a week for 4 weeks, with homework
  • say it with “intent”
    ** say like you mean it
    ** qualitative
  • “throw the sound over my head”
  • after they finish training, they get to pick between these two: loud crowd and choir
  • SLP training: workshop
  • counting backward versus forwards
  • pyramidal system instead of extrapyramidal
  • not dopamine-dependent
  • amplitude in dB SPL; you also time some tasks
28
Q

Speak out components

A
  1. warm up: MAY ME MY MOE MOO
    - activate hand motor system
  2. sustained “ah”
  3. glide: start at “home base”
    - getting a stretch closure
  4. counting tasks
  5. reading activities
  6. cognitive activities
29
Q

MAF - masking auditory feedback

A
  • applies Lombard Effect
    (raise noise in the presence of voice)
  • patient wears earphones, masking noise introduced
  • Kay PENTAX facilitator
  • SpeechVive: multi-talker babble noise, like a party
30
Q

Other sensory feedback

A
  • voice monitoring in patients with PD
  • example: vibrotactile biofeedback
  • voice monitor by Griffin Labs
  • VocaLog
  • FB given when they fall below “threshold”
  • collects data that can be dumped onto computer and grasped

Motor Speech Exam 3 (3 decks)

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