Signs and symtoms for hyperkinetic dysarthria

Question 1

Dystonia

• Slow or quick?
• what happens alot?
• during movement or rest?
• treatment/compensation?

Answer 1

-Slower than chorea,

– tongue coming out while talking or jaw opening off and on while speaking – exacerbated by the action of speech. Botox is sometimes used to inject in tongue. The speech problem is caused by these involuntary movements.

• Primarily are movement problems at rest, but sometimes occur in speech.
• May improve with sensory tricks. In speech exam look for/ask about sensory tricks. (Hold pipe in mouth to inhibit dystonia, etc.)

Question 2

dystonia

• phonation
• resonance
• articulation

Answer 2

Phonation –voice stoppages, strained-harsh voice, audible inspiration, excess loudness variation, alternating loudness, tremor-like voice.
Resonance-intermittent hypernasality
Articulation – distortions & irregular breakdown, distorted vowels, slow & irregular AMRs.

Question 3

Spasmodic torticollis (cervical dystonia)

Answer 3

affects cervical neck muscles and not muscles innervated by cranial nerves. Can also have facial spasms. Speech deviances are related to deviancies in neck postures. Effects are usually mild on speech and are primarily at laryngeal level – pitch variability

Question 4

Palatopharyngolaryngeal myoclonus

Answer 4

abrupt movements of soft palate, pharyngeal walls and laryngeal muscles. Effects on speech are not great. Can be mild intermittent hypernasality. Patient often complains of “earclicks” which is the opening and closing of the Eustachian tube because of pharyngeal contractions.

Question 5

Spasmodic dysphonia

Answer 5

Caused by spasms of the laryngeal adductor or abductor muscles due to different causes. There are different kinds of spasmodic dysphonia depending on whether the cause may be related to neurogenic, psychogenic or unknown reasons. Duffy says the ones that aren’t neurogenic are not MSD. alchol helps

Question 6

Organic voice tremor

Answer 6

the voice tremor is usually with gradual onset, and worsens with fatigue and stress, may improve with alcohol and is often accompanied by head or jaw or extremity tremor. Do vowel prolongation in speech exam to really hear tremor. Not much effective treatment. BOTOX helps some. Meds for limb tremors bay help but meds don’t usually help with voice tremor.

Question 7

action myoclonus

Answer 7

– not often seen for SLPs. It is different from other myoclonic disorders because it is induced by action and is more rhythmic.

Question 8

• Tourette’s syndrome-

Answer 8

most are genetically related. Typically you see facial grimaces, eyeblinks, twitches of head. Can also include larger movements, spinning, jumping, etc. May appear to be bizarre. There are also vocal tics – which can include odd noises such as grunting, yelling, whistling, squeaking, etc. Can include echolalaia, palilalia and coprolalia – swearing compulsively. Most cases are male – by 4 to 1. Can be accompanied by OCD.