Hypokinetic dysarthria Flashcards
1
Q
Hypokinetic dysarthria may be demonstrated in all sub-systems, but is more evident in ________ , ________, and _______.
A
voice
articulation
prosody
2
Q
What systems does hypokinetic dysarthria affects?
A
All sub-systems especially, voice, articulation, and prosody.
3
Q
Hypokinetic dysarthria is related to ____ ____ control problems. Also known as _________.
A
basal ganglia
extrapyramidal.
4
Q
What dysarthria is related to basal ganglia control problems?
A
Hypokinetic dysarthria
5
Q
What are the primary components of Hypokinetic dysarthria?
A
Basal ganglia: caudate nucleus, putamen & globus pallidus), subthalamic nuclei, & substantia nigra.
6
Q
Where are the basal ganglia, subthalamic nuclei, & substantia nigra located?
A
Deep in the brain.
7
Q
What is the disease that you see most often with hypokinetic dysarthria?
A
Parkinson’s disease
8
Q
Hypokinetic dysarthria reflects characteristics due to what?
A
Rigidity, reduced ROM, and reduced force of movement
9
Q
_______ ______ may be the most significant underlying neuromuscular deficit in hypokinesia (decreased bodily movement) as it affects speech in hypokinetic dysarthria.
A
Reduced ROM
10
Q
Reduced ROM may be the most significant underlying neuromuscular deficit in _________ (decreased bodily movement) as it affect speech in _______ dysarthria.
A
hypokinesia
hypokinetic
11
Q
What is hypokinesia?
A
Reduced bodily movement
12
Q
There may be _____ movement in hypokinetic dysarthria.
A
slow
13
Q
You may see _____ movements in ____ during hypokinetic dysarthria.
A
quick
speech
14
Q
You may see quick movements in speech during ______ dysarthria.
A
hypokinetic
15
Q
What does hypo mean in hypokinetic dysarthria?
A
reduced ROM and mobility
16
Q
What is the function of the basal ganglia and its control circuit?
A
- facilitates movement
- regulates muscle tone
- regulates movements that support goal-directed movements (swinging arms while walking)
- control postural adjustment in skilled movements (stabilize shoulder in writing)
- adjust movements to the environment
- assist in the learning of new movement
17
Q
The _____ _____ acts to influence the cortex in an inhibitory way (it helps to inhibit unnecessary movement). It does this by controlling cortical output or messages that might be excessive.
A
control circuit of basal ganglia
18
Q
What does the control circuit of basal ganglia do specifically?
A
It acts to influence the cortex in an inhibitory way (it helps to inhibit unnecessary movement). It does this by controlling cortical output or messages that might be excessive.
19
Q
The initiation of the motor movements starts in the _____ but it is modulated and regulated in the _____ _____ as well as the _______.
A
cortex
basal ganglia
cerebellum
20
Q
Damage to basal ganglia control circuit can result in what two types of problems?
A
- reduced movement
- problems in inhibiting involuntary movement
21
Q
Reduced movement and problems in inhibiting involuntary movement result from damage to the _____ _____ _____ _____.
A
basal ganglia control circuit
22
Q
What is the cause of basal ganglia control circuit problems?
A
neurotransmitter being out of balance
23
Q
Neurotransmitter being out of balance usually results in problems of:
A
basal ganglia control circuit
24
Q
Normal function of basal ganglia depends on the ______ of _______ & proper balance of crucial ________.
A
integrity of connections
neurotransmitters
25
What depends on the integrity of connections & proper balance of crucial neurotransmitters?
Normal function of basal ganglia
26
What is the crucial neurotransmitter for proper basal ganglia functioning?
Dopamine
27
Why is dopamine important?
It is the crucial neurotransmitter for proper basal ganglia functioning.
28
_______ is an inhibitory mechanism.
Dopamine
29
What happens if substantia nigra neurons are destroyed?
Dopamine supply is reduced or lost
30
Deficiencies in dopamine causes _______; deficiency in Ach causes _______.
hypokinesia
| hyperkinesias
31
What do deficiencies in dopamine cause?
hypokenisia
32
What do deficiencies in Ach causes?
hyperkinesias
33
Where is dopamine produced?
substantia nigra, a structure in mid-brain
34
The dopamine is produces in the substantia nigra, where is it sent afterwards?
striatum (caudate nucleus and putamen)
35
Is the substantia nigra strictly part of the basal ganglia?
NO, but it is located close to it and is similar in function.
36
One of the most consistent pathological findings in patients with Parkinson is degeneration of the melanin-containing cells in the ______ _______ of the substantia nigra.
Pars compacta
37
What is one of the most consistent pathological findings in patients with Parkinsons?
depigmentation in substantia nigra: degeneration of melanin-containing cells in the pars compacta
38
What is melanin?
A dark pigment found in certain cells
39
Degeneration of the melanin-containing cells in the pars compacta of the substantia nigra is one of the most consistent pathological findings in patients with what disorder?
Parkinsons
40
Why does degeneration of hte melanin-containing cells in the pars compacta of the substantia nigra affect speech?
Due to the basal ganglia connections with the motor areas of the cerebral cortex.
41
Hypokinetic dysarthira occurs in at least _____ of Parkinson's patients.
50%
42
What are the classic non-speech signs of Parkinson's disease?
-Tremor at rest
-Pill rolling
-RIgidity (cogwheel rigidity)
Bradykinesia or hypokinesia
-Akinesia
-posture problems
43
How is strength affected in Parkinson's disease, is it always affected?
Not always noticeably affected
44
Where do tremors at rest occur more often?
head and limbs
| It happens in Parkinson's disease
45
What is pill rolling?
movement between thumb and index finger. (related to resting tremor)
parkinson's disease
46
What is rigidity?
| What is Cogwheel rigidity?
Associated with feeling of stiffness, characterized by slow movements.
Cogwheel rigidity is when you see jerky movement typically in elbow.
Usually happens in Parkinson's disease
47
What is bradykinesia or hypokinesia?
| What disease does this happen?
Delays and false starts initiating movements and also in stopping movements once started. People feel stuck or frozen in position.
-Parkinson's disease
48
What is akinesia?
| When does this happen?
Absence of movement
- Micrographic (small writing)
- festinating gait-walking with short, shuffling steps then speeding up
- reduced arm swing, eye blinking, head movement and limb gestures, frequency of swallowing
- Masked face
- Parkinson's disease
49
How do posture problems look in Parkinson's disease due to impaired postural reflexes?
Patients tend to be stooped with flexed head and trunk. Problems turning in bed, and going from sitting to standing. Feel like they-re falling.
50
Hypokinetic dysarthria can be caused by anything that damages what?
basal ganglia
51
Parkinson's disease is the most common cause of what dysarthria?
Hypokinetic
52
Does Parkinson's disease occur only with hypokinetic dysarthria?
No, it can also happen with hyperkinetic dysarthria due to medication.
53
What are some degenerative diseases that may cause hypokinetic dysarthria?
Parkinson's disease
Alzheimer's disease
Pick's disease
54
Parkinson's disease responds well to what drug?
L-Dopa; it increases the dopamine in the striatum, however there are side effects-confusion is one.
55
What is the course of Parkinson's disease?
Usually slow progressing, idiopathic. Usually occurs mid to late in life. May have dementia and depression.
56
Some cases of PD were noted following _______ ______. This is also called _______ _______.
viral encephalitis -
| Postencephalitic parkinsonism
57
What does parkinsonism usually refers to?
General clinical signs similar to what you see in PD.
58
Alzheimer's disease may show some signs similar to _____.
Parkinson's disease
59
What is Pick's disease?
Dementia disease which may show PD symptoms.
60
What are some vascular conditions that may cause hypokinetic dysarthria?
- vascular parkinsonism
| - cerebral hypoxia
61
What is vascular parkinsonism?
Multiple strokes affecting basal ganglia that causes hypokinetic dysarthria.
62
What is cerebral hypoxia?
Related to lack of oxygen to cerebrum due to various causes including carbon monoxide poisoning. This can cause hypokinetic dysarthria.
63
What is a toxic metabolic condidtion that causes hypokinetic dysarthria?
Antipsychotic durgs (neuroleptic)
64
What is antipsychotic (neuroleptic)
A toxic metabolic condition that may block dopamine receptors and lead to hypokinetic dysarthric symptoms. This drug induced symptoms usually disappear after the drug is removed.
65
Boxers with repeated head trauma can damage _____ _____ and _________.
substantia nigra
| cerebellum
66
BOxers with repeated head trauma can either cause ______ or ______ dysarthria. Depending on what is damaged.
ataxic
| hypokinetic
67
If the substantia nigra is damaged during boxing you may get similarities to what disease?
Parkinson's disease
68
When the substantia nigra is damaged due to boxing it is called ____ _____ _______.
punch drunk encephalopathy
69
What does encephalopathy mean?
Any disease of the brain
70
A TBI can result in _____ like symptoms and ________ dysarthria.
PD
| hypokientic
71
What are two medical treatment for PD that can actually worsen hypokinetic dysarthria and its used to stop tremors?
stereotactic ventrolateral thalamotomy
| Deep brain stimulation
72
What is deep brain stimulation?
Treatment to decrease tremors in PD. Can worsen speech. Involves an implanted pulse generator so that stimulation can be sent to the brain to block tremors.
73
What is stereotactic ventrolateral thalamotomy?
A medical treatment for PD that can actually worsen hypokinetic dysarthria and is done to stop severe tremors.
A surgical lesion is intentionally made in the thalamus to interrupt the control circuit from which the tremor comes. Tremors are stopped but side effects may occur including dysarthria or worsening of existing dysarthira, aphasia and cognitive deficits.
74
A surgical lesion is intentionally made in the thalamus to interrupt the control circuit from which the tremor comes. Tremors are stopped but side effects may occur including dysarthria or worsening of existing dysarthira, aphasia and cognitive deficits.
Stereotactic ventrolateral thalamotomy
75
_____ ______ ______ is a medical treatment for PD that can actually worsen hypokinetic dysarthria and is done to stop severe tremors.
Stereotactic ventrolateral thalamotomy
76
_______ ____ ____ is a treatment to decrease tremors in Pd. Can worsen speech. Involves an implant pulse generator so that ________ can be sent to the brain to stop tremors.
Deep brain stimulation
| stimulation
77
Watch
PD videos
78
What are some of the patients complaints (8) with hypokinetic dysarthria?
- weak or quiet voice-difficulty being heard in noisy place (note that pt reports that others tell them this but the pt often denies that this is the case.
- too fast speech rate
- words are imprecise and flat in emotional tone
- hard to get speech started
- some stuttering repetitions
- fatigue brings negative effect on speech
- swallowing drooling problems
- stiff upper lip due to rigidity problems
79
What can help speech in patients with Parkinson's disease?
Meds might help if it helps other PD symptoms
80
Who has the following complaints:
- weak or quiet voice-difficulty being heard in noisy place (note that pt reports that others tell them this but the pt often denies that this is the case.
- too fast speech rate
- words are imprecise and flat in emotional tone
- hard to get speech started
- some stuttering repetitions
- fatigue brings negative effect on speech
- swallowing drooling problems
- stiff upper lip due to rigidity problems
These are some of the complaints from patients with hypokinetic dysarthria.
81
In hypokinetic dysarthria you may see a ____ like face, ______, ______ especially at rest, although ____ movement during speech may also be lessened.
mask
unsmiling
unblinking
facial
82
During hypokinetic dysarthria there are ______ movements of chest and abdomen during ________.
reduced
| breathing
83
During hypokinetic dysarthria patient may not ______ enough and thus cause ______ due to too much saliva accumulating.
swallow
| drooling
84
What happens in hypokinetic dysarthria due to too much saliva accumulating?
may not swallow enough causing drooling
85
What happens to your face in hypokinetic dysarthria?
- mask like face
- unsmiling
- unblinking at rest
- facial movement during speech may be lessened
86
What happens to your breathing in hypokinetic dysarthria?
reduced movements of chest and abdomen
87
When do tremors occur for people who have hypokinetic dysarthria?
tremor of jaw and lips at rest or in opening and retracting lips. Tongue may have tremors on protrusion or at rest in mouth.
88
How is the jaw, face, and tongue affected during hypokinetic dysarthria in terms of size, symmetry and and strength?
may be normal
89
People with hypokinetc dysarthria may have a ____ _____, restricted, unemotional facial affect which may not reflect patient's emotional state.
flat affect
90
How do you asses hypokinetic dysarthria for speech findings?
Assess through conversation, reading, AMRs, and vowel prolongation.
91
How are AMRs in hypokinetic dysarthria?
Slow to start and throughout or they can be slow to start and become very rapid even to the point of blurring.
92
What are some speech characteristics of hypokinetic dysarthria?
- monopitch & monloudness
- reduced loudness
- reduced stress
- short rushes of speech
- overall increased rate of speech - not the same as short rushes of speech
- harsh/breathy voice quality
- imprecise consonants
- difficulty initiating speech rapid or blurred AMRs
- inappropriate silences
- occasional tremor on vowel prolongation
- palilalia - pathological reiterative utterances-different from other stuttering
93
What is palilalia?
pathological reiterative utterances getting qucker as they go - a compulsive not controllable repetition. that is present in only hypokinetic dysarthria and other neurological conditions.
94
How is palilalia different from perseveration?
In perserveration there is an intervening stimulus and in palilalia there is not.
95
What are the best distinguishing speech features in hypokinetic dysarthria?
- fast rate
- short rushes of speech
- reduced stress
- monopitch & monoloudness
- inappropriate silences
- breathiness
96
______ is the only dysarthria in which a rapid rate may be heard but not all______ dysarthrias demonstrate fast speech.
Hypokinetic
| hypokinetic
97
Hypokinetic is the only dysarthria in which a ___ ___ may be heard but not all hypokinetic dysarthrias demonstrate fast speech.
rapid rate
98
The best distinguishing features of hypokinetic dysarthria are related to ______.
prosody
99
The breathiness heard in hypokinetic dysarthria is only worse in ______ dysarthria, not the other dysarthrias.
flaccid
100
________ dysarthria is rougher sounding and is usually louder than _______ dysarthria.
flaccid
| hypokinetic
101
Flaccid dysarthria is _____ sounding and is usually _______ than hypokinetic dysarthria.
rougher
| louder
102
People with hypokinetic dysarthria can produce ____ for a long time and people with flaccid dysarthria cannot.
AMRs
103
Read cases:
7.1, 7.4, 7.5
