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Motor > Hypokinetic Dysarthria > Flashcards

Hypokinetic Dysarthria Flashcards

1
Q

Definitions of Hypokinetic Dysarthria

A

Caused by any process that damages basal ganglia (extrapyramidal system)

Speech characteristics: harsh vocal quality, reduced stress, monoloudness, imprecise consonants

May manifest in any or all levels of speech
Most evident in voice, articulation, and prosody
Reflects effects of rigidity, reduced force and range of movement, and slow but sometimes fast repetitive movements

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2
Q

Neurologic Basis of Hypokinetic Dysarthria

A

Unique, as only dysarthria with:
-Increased rate as symptom
-Mainly one causative factor (parkinsonism)
Symptoms affect muscles of speech

Symptoms caused by dysfunction to basal ganglia or to basal ganglia’s neural connections to other parts of CNS

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3
Q

Hypokinetic

A

less motion

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4
Q

Characteristics of Parkinsonism

A

Distinctive collection of symptoms
-Resting tremor
-Bradykinesia: slow, reduced range of movement
-Rigidity
-Akinesia: delay in initiation of movements
Postural reflexes

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5
Q

Causes of Parkinsonism

A

Caused by dysfunction in basal ganglia
Depends on balanced interaction of several neurotransmitters, including dopamine (inhibitory) and acetylcholine (excitatory)

Reduction of dopamine in striatum
Causes too much acetylcholine
-Thought to be primary cause of rigidity, bradykinesia, and other symptoms of parkinsonism

Varied causes of reduced dopamine

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6
Q

Causes of Hypokinetic Dysarthria

A

Parkinsonism: collective term for different disorders sharing many similar symptoms

Major causes of hypokinetic dysarthria

  • Idiopathic Parkinson’s disease
  • Neuroleptic-induced parkinsonism
  • Postencephalitic parkinsonism
  • Traumatic head injury
  • Toxic metal poisoning
  • Stroke
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7
Q

Speech Characteristics of Hypokinetic Dysarthria

A

Quite distinctive
Most noticeable errors: prosody and articulation
Most errors result of bradykinesia, akinesia, and muscle rigidity
In severe cases tremors cause tremulous phonations

There are significant individual differences

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8
Q

Prosody

A

Monopitch, reduced stress, and monoloudness most common

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9
Q

Articulation

A

Imprecise consonants, repeated phonemes, palilalia

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10
Q

Phonation

A

Harsh/breathy quality, aphonia, low pitch

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11
Q

Respiration

A

Sometimes noted

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12
Q

Resonance

A

If present, mild hypernasality

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13
Q

Key Evaluation Tasks for Hypokinetic Dysarthria

A

Conversational speech and reading

  • Evoke many errors of prosody
  • Detect short rushes

Speech alternate motion rates (AMRs)
-Highlight articulation errors

Vowel prolongations
-Assess vocal quality

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14
Q

Treatment of Hypokinetic Dysarthria

A

Divided into three categories
Pharmacologic
-Most widely used
-L-Dopa

Surgical

  • Ablation procedures (making lesion in basal ganglia)
  • Deep brain stimulation

Behavioral: speech-language therapy

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15
Q

Pharmacologic Treatments for Parkinsonism

A

Replacing dopamine in striatum

  • Problem: direct dosages of dopamine unable to reach striatum
  • Precursor of dopamine, L-dopa used to reach striatum and then converted to dopamine

Correct neurotransmitter imbalance by decreasing acetylcholine activity in striatum

  • Anticholinergic drugs
  • Sometimes combined with L-dopa treatment
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16
Q

Surgical Treatments for Parkinsonism

A

Complicated and invasive
Used when patient incapacitated and medications ineffective

Two general types

  • Ablative surgery (thalamotomy and pallidotomy)
  • Deep brain stimulation
17
Q

Ablative procedures

A

Lesions are purposefully produced in small amounts of brain tissue in order to reduce neuron activity in a specific area of the brain.

18
Q

Pallidotomy

A

A hole is drilled into the skull, and a small electrical probe is inserted into the globus pallidus of the basal ganglia. The tip of the probe is then heated for a short time to destroy nearby neurons.

The loss of these neurons reduces brain activity in that part of the basal ganglia, and consequently, a patient’s muscle rigidity, tremor, and bradykinesia may be reduced to some degree.

19
Q

Deep brain stimulation

A

More effective. It does not result in permanent lesions, and can be reversed.

In this treatment, a small electrode is inserted into either the globus pallidus or subthalamic nucleus. When turned on, the electrode sends a low-level electrical current to the surrounding neurons, which interrupts neural activity in that part of the brain. The electrode is controlled and powered by a small pulse generator near the collar bone (under the skin).

20
Q

Stem-Cell Implantation

A

Stem cells unique as can transform themselves into different types of cells
Found naturally in embryos, in adult tissues, and can be grown in labs
Significant amount of research concentrated on using stem cells to treat parkinsonism
Results preliminary but encouraging
Few human trials conducted

21
Q

Behavioral Treatments for Parkinsonism

A

Behavior- and instrumentation-based tasks important part of clinical treatment plan

Articulation

  • Most common deficit: imprecise consonants due to reduced range of motion in articulators
  • Compounded by increased rate

Treatment types
Rate reduction, stretching, traditional articulation tasks

22
Q

Rate reduction

A

slowing the rate of speech can improve articulation because it allows the articulators more time to reach the target positions and also gives listener more time to process what is being spoken. There are a different rate control procedures, and are as follows:

23
Q

There are a different rate control procedures, and are as follows:

A

Pacing Boards

Hand or finger tapping

Alphabet boards

Delayed Auditory Feedback

Reciting syllables to a metronome

24
Q

Pacing Boards

A

Devices with finger-width slots. Patient is instructed to place a finger in the first slot and begin reading or repeating a short sentence; each time a word is spoken the patient moves the finger to the next slot.
Drawback: reluctance to use in public

25
Q

Hand or finger tapping

A

The clinician sets the pace for repeating or reading sentences by tapping his or her hand or finger. The patient attempts to speak one syllable for each of the clinician’s taps.

Once this rate is established, the patient does the tapping to control the rate of speech.

26
Q

Alphabet boards

A

This is simply a piece of paper with all of the letters of the alphabet printed in large, dark paint. The numbers 1 to 10 also may be printed on it.
The patient is told to use the board by pointing to the first letter of every word as it being spoken. Two benefits, slows the speech rate and provides listener a visual cue.

27
Q

Delayed Auditory Feedback

A

Using an electronic device, the patient’s own voice is fed in after a short delay (usually 50 to 150 msec).

28
Q

Reciting syllables to a metronome

A

Producing one syllable for every beat of the metronome.

29
Q

Traditional Articulation Treatment:

A

Intelligibility drills
Phonetic Placement
Exaggerating Consonants
Minimal contrast drills

30
Q

Phonation Treatment

A

Adduct vocal folds only partially or have harsh or breathy vocal quality

Combined with poor respiratory support; results in significantly reduced loudness

Activities to more fully adducted position

Pushing and pulling procedure
Hard glottal attack
Voice amplifiers
Instrumental biofeedback
Lee Silverman Voice Treatment
31
Q

Lee Silverman Voice Treatment

A

Concentrates strictly on increasing vocal loudness
Requires multiple repetitions of high-effort phonations from the patient.
Treatment sessions must be completed daily
Patients must be calibrated for what is normal loudness
Progress must be quantified

32
Q

Respiration Treatment

A 
Shallow breath support can cause shortened phrases and decreased loudness
Respiratory treatments
Speaking immediately on exhalation
Cueing for complete inhalation
Slow and controlled exhalation
Stop phonation early
Optimal breath group
33
Q

Prosody Treatment

A

Improved by slowing rate
Intonation profiles
Contrastive stress drills
Chunking utterances into syntactic units

34
Q

Hypokinetic dysarthria

Caused by

A

Any process that damages basal ganglia or it’s neural connections

35
Q

Closely associated with

A

Parkinsonism

36
Q

Most common cause

A

Idiopathic Parkinson’s disease

37
Q

Speech characteristics

A

Vary widely among individuals

38
Q

Treatment involves targeting

A

Articulatory precision, phonatory effort, and natural prosody

Motor (5 decks)

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