HYPOKINETIC DYSARTHRIA

Question 1

T/F All subsystems can be affected in Hypokinetic Dysarthria.

Answer 1

True.

Question 2

Which structure in the brain is mainly affected in Hypokinetic Dysarthria?

Answer 2

Basal Ganglia (EXTRAPYRAMIDAL).

Question 3

What are the parts of the BG and what other structures are related, located deep in the brain?

Answer 3

Parts of BG: Caudate nucleus, putamen, globus pallidus.

Other structures: Substantia Nigra, Subthalamic nuclei.

Question 4

Which dz is most often seen w/ Hypokinetic Dysarthria?

Answer 4

Parkinson’s dz (PD)

Question 5

Which characteristics are reflected in Hypokinetic Dysarthria?

Answer 5

1) Rigidity,
2) Reduced ROM,
3) Reduced Force of Mvmt.

Question 6

Which other characteristics are seen in Hypo Dysarthria?

Answer 6

Slow mvmt,BUT quick mvmts in speech.

Question 7

Why is it called HYPOkinetic?

Answer 7

Hypo= everything is LOW/LESS.

—>reduced ROM and mobility.

Question 8

What is the function of the BG and it’s control circuits? (7 functions)

Answer 8

1) facilitate mvmt.
2) regulate Muscle tone
3) regulate mvmts that support goal-directed mvmts.
4) control of postural adjustment
5) adjust mvmts to the environment
6) learning of new mvmts
7) Influences the cortex by inhibiting unnecessary mvmts.

Question 9

How does the BG control circuit inhibit unwanted mvmts?

Answer 9

By controlling cortical output or message that might be excessive.

Question 10

The initiation of motor movements starts in the ______________, but is modulated and regulated in the _______________ as well as the _____________.

Answer 10

Cortex (primary motor); BG; Cerebellum.

Question 11

What are the two main problems that arise from damage to the BG?

Answer 11

1) Reduced mvmt

2) Problems inhibiting involuntary mvmts.

Question 12

T/F BG control circuit problems are often due to neurotransmitters being out of balance.

Answer 12

True.

Question 13

Which is crucial neurotransmitter for proper BG functioning?

Answer 13

Dopamine.

Question 14

Which specific structure makes Dopamine and where is it sent? What does dopamine do?

Answer 14

Substancia Nigra; striatum.

It is an inhibitory mechanism.

Question 15

T/F The Substantia Nigra is part of the BG.

Answer 15

Not strictly part of the BG, but located close to it and is similar in function.

Question 16

Deficiency in dopamine causes _______________, deficiency in ACH causes __________________.

Answer 16

HYPOkinesia; HYPERkinesia

Question 17

What is melanin?

Answer 17

A dark pigment found in certain cells.

Question 18

In which structure is there a depigmentation of cells in pts with Parkinson’s?

Answer 18

Pars compacta (in the subtantia nigra).

Question 19

T/F Hypokinetic Dysarthria is seen in 30% of patients with PD?

Answer 19

False; 50%

Question 20

What are the Classic Non-speech signs of PD? (6)

Answer 20

1) Tremor @ rest
2) Pill rolling
3) Rigidity “cogwheel rigidity”
4) Bradykinesia
5) Hypokinesia
6) Posture problems

Question 21

What is bradykinesia?

Answer 21

Delays/false starts initiating mvmts and also in stopping mvmts once started. May get STUCK or FROZEN in a position.

Question 22

What is festination? Is this a result of HYPOkinesia or HYPERkinesia?

Answer 22

When pts starts walking slowly then speeds up w/ quick shuffling steps.
Result of HYPOkinesia.

Question 23

What are the etiologies? (6)

Answer 23

1) Degenerative dz (PD, Alzheimer’s, Pick’s)
2) Vascular conditions (stroke in the BG)
3) Cerebral hypoxia- lack of O2
4) Toxic/metabolic conditions -antipsychotic drugs, etc.
5) Trauma (TBI)
6) Infectious

Question 24

What is “punch drunk encephalopathy”?

Answer 24

PD-like symptoms caused by damage to substantia nigra. Encephalopathy refers to any dz of the brain.

Question 25

What is the medical tx for PD that can actually worsen Hypokinetic dysarthria?

Answer 25

stereotactic ventrolateral thalamotomy (done to stop severe tremors).

Question 26

What is deep brain stimulation?

Answer 26

Tx to decrease tremors in PD; it can worsen speech.

Question 27

What does a pt w/ Hypokinetic Dysarthria typically complain of?

Answer 27

Weak/quiet voice (can’t be heard in loud places), speaking too fast, imprecise artic, flat tone/affect, hard to initiate speech, some stuttering or repetitions, fatigue=worse speech, meds may help speech if it helps other PD symptoms, problems swallowing, drooling, stiff upper lip due to rigidity.

Question 28

How would you assess speech for a pt w/ hypokinetic dysarthria?

Answer 28

Conversation, reading, AMRs, vowel prolongation.

Question 29

What are the speech characteristics for a pt w/ hypokinetic dysarthria?

Answer 29

monopitch/monoloudness, reduced loudness, reduced stress, SHORT RUSHES OF SPEECH, overall increased rate, harsh/breathy voice, imprecise consonants, difficulty initiating speech, rapid/blurred AMRs, inappropriate silences, occasional tremor in vowel prolongation, palilalia.

Question 30

What do their (pts w/ hypokinetic dysarthria) AMRs sound like?

Answer 30

Rapid & blurred. At the beginning, they are slow and then rapid.

Question 31

What is palilalia?

Answer 31

Pathological reiterative utterances; Compulsive and not controllable repetitions. Ex: What’s that, What’s that, What’s that.

Question 32

Which are the BEST distinguishing speech features?

Answer 32

Fast rate, short rushes of speech, reduced stress, monopitch/monoloudness, inappropriate silences, breathiness.

Question 33

Why would pts with Hypokinetic Dysarthria have “inappropriate silences”?

Answer 33

B/c they have a hard time initiating speech.

Question 34

T/F The most prominent speech features in pts w/ hypokinetic dysarthria are related to LOUDNESS.

Answer 34

False; they are related to PROSODY.

Question 35

What are three ways you can distinguish Hypokinetic Dysarthria and Flaccid Dysarthria?

Answer 35

1) Flaccid dysarthria is MORE breathy than Hypokinetic.
2) Flaccid dysarthria has a rougher/louder vocal quality versus Hypokinetic.
3) People with Hypokinetic can produce AMRs for a long time and people w/ FD cannot.