Hypokinetic Dysarthria Flashcards
What is hypokinetic dysarthria?
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.
Parkinsonism
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
Etiologies of Hypokinetic Dysarthria
Parkinson’s Disease - 90%
- idiopathic form of Parkinsonism
- Most common form of Parkinsonism and HD
- high prevalence of speech deficits
- 60-80%
James Parkinson
- 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
Neurons in Substantia Nigra
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
Medical treatment of Parkinson’s Disease
- 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
Idiopathic
don’t know the cause; can’t be identified
Difference between PD and parkinsonism
- 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.
Neuroleptic-Induced Parkinsonism
- 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
Postencephalic Parkinsonism
- caused by viral encephalitis
- can also affect children
** itis: information
Traumatic Brain Injury
- cerebral anoxia (if it affected the BG)
- “punch drunk” encephalopathy
CVA
When it affects
- basal ganglia
- substantia nigra
- BG control circuit
The most common speech production errors in people with HD
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
Speech errors - Prosody/articulation
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
Speech errors - phonation
- harsh voice quality
- breathy
- reduced vocal loudness
Speech errors - respiration
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
Key evaluation tasks
- conversational speech/reading
- rate problems
- intelligibility - AMRs:
- imprecise consonants
- variable rate
- “blurring” of syllables - can’t count it - vowel prolongation:
- breathy voice quality: extremely quiet, short maximum phonation time
Treatment of HD - Rate Reduction
- can improve articulation
- give articulators more time to reach target positions
- give listener more processing time
Treatment of HD - DAF (Delayed auditory feedback)
- 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
DAF and normal speakers
- 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
DAF sidenotes
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
Types of DAF
- DAF units
- Wireless DAF
- Casa Futura Technologies “Small Talk”
- DAF apps
Treatment - FAF
- 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
Treatment - Phonation
Pushing/pulling
- effortful closure
- medical compression
HGA-Hard glottal attack (VP protocol)
Instrumental biofeedback
- Visi-Pitch or CSL
LSVT
SpeakOut!
LSVT
- 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
Speak Out! basic information
- Parkinson’s Voice Project
- Invented in Richardson, TX
- NFP organization
- Samatha Elandary, the Founder and CEO
- Private donation and “pay it forward”
Speak Out! General information
- 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
Speak out components
- warm up: MAY ME MY MOE MOO
- activate hand motor system - sustained “ah”
- glide: start at “home base”
- getting a stretch closure - counting tasks
- reading activities
- cognitive activities
MAF - masking auditory feedback
- 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
Other sensory feedback
- 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
