Flashcards in Hypokinetic Dysarthria Deck (56):
Which subsystems does Hypokinetic Dysarthria affect?
Hypokinetic dysarthria is related to the pyramidal or extrapyramidal system?
Extrapyramidal: basal ganglia control problems
Primary components affected with Hypokinetic Dysarthria:
-Basal ganglia (caudate nucleus, putamen & globus pallidus)
*All of these structures are located deep in the brain
Which disease do we most likey see Hypokinetic Dysarthria ?
Parkinsons’s Dz is the disease in which we most often see this dysarthria.
As flaccid dysarthria speech reflects characteristics due to weakness, hypokinetic dysarthria reflects characteristics due to (3):
- Reduced ROM
- Reduced force of movement
It is call hypo because of:
reduced ROM and mobility
The function of the basal ganglia and its control circuit is to (7):
o facilitate movement
o regulate muscle tone
o regulate movements that support goal-directed movements (swinging arms while walking)
o control postural adjustment in skilled movements (stabilize shoulder in writing)
o adjust movements to the environment
o assist in the learning of new movements
o This control circuit also 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
If you have too much movement or too little in speech you get a______
The initiation of the motor movements starts in the cortex but it is modulated and regulated in:
Damage to basal ganglia control circuit can result in two types of problems:
o Reduced movement
o Problems in inhibiting involuntary movement
Basal ganglia control circuit problems are often due to what being out of balance?
Normal function of basal ganglia depends on the (2):
- integrity of connections
- proper balance of crucial neurotransmitters
What is the crucial neurotransmitter for proper basal ganglia functioning?
Dopamine is a neurotransmitter produced in the:
substantia nigra (a structure in the mid-brain)
After Dopamine is produced in the substantia nigra, it is sent to the:
striatum (caudate nucleus and putamen)
The striatum (part of the basal ganglia) is made up of (2):
- Caudate nucleus
Is the substantia nigra strictly a part of the basal ganglia?
No, but is located close to it and is similar in its function
Dopamaine is an inhibitory or excititory mechanism?
If substantia nigra neurons are destroyed,
dopamine supply is reduced or lost
Deficiency in dopamine causes_____
Deficiency in Ach causes______
One of the most consistent pathological findings in patients with Parkinsons is:
-Degeneration of the melanin-containing cells in the pars compacta of the substantia nigra.
- This is referred to as “depigmentation” in the substantia nigra
What is Melanin?
Is a dark pigment found in certain cells
How does “depigmentation” in the substantia nigra affect speech?
because of the basal ganglia connections with the motor areas of the cerebral cortex
Hypokinetic dysarthria occurs in at least __% of Parkinson’s patients
Classic nonspeech signs of PD (6):
1. Tremor at rest (resting tremor), most often in limbs and head
2. Pill rolling movement between thumb and index finger.
6. Posture Problems
Rigidity and Hypokinetic Dysarthria:
- Associated with feeling of stiffness,
- Characterized by slow movements
- Cogwheel rigidity is when you see jerky movement typically in elbow
Bradykinesia and Hypokinetic Dysarthria:
- Delays and false starts initiating movements and also in stopping movements once started
- People feel stuck or frozen in a position.
*not being able to move upon request
In Hypokinetic Dysarthria you there may be ____ movement, but you may also see very _____ movements in speech.
quick movements in speech
Hypokinesia and Akinesia with Hypkinetic Dysarthria:
Hypokinesia = Reduced movement
Akinesia = absence of movement
Is strength always noticeably affected in PD?
Hypokinesia may result in (4):
o Masked expression of face with unblinking eyes
o Reduced arm swing in walking
o Micrographic (small) writing
o Festination - when pt starts walking slowly then speeds up with quick, shuffling steps.
Ataxic dysarthria has ____ tremor where Hypokinesic Dysarthria has _____ tremor.
Posture problems and Hypokinetic Dysarthria:
- Due to impaired postural reflexes
- Pts tend to be stooped with flexed head and trunk
- Problems turning in bed, and going from sitting to standing
- Feel like they’re falling
What is Festination?
When a pt starts walking slowly then speeds up with quick, shuffling steps
Etiologies of Hypokinetic Dysarhria (9):
**Hypokinetic dysarthria can be caused by anything that damages basal ganglia: degenerative, vascular, etc.
1. PD is most common cause.
2. You can also have hyperkinetic dysarthria with PD, related to medication.
3. Degenerative diseases
4. Vascular conditions
5. Toxic-metabolic conditions
What is the most common cause of Hypokinetic Dysarthria?
Characteristics of PD:
- usually is slow progressing
- idiopathic (unknown cause)
- Usually occurs mid to late in life
- Some may have dementia and depression
- Responds well to drug, l-dopa. It increases the dopamine in the striatum. There are side effects- confusion is one.
What is postencephalitic parkinsonism?
- Some cases of PD were noted following viral encephalitis
- Parkinsonism usually refers to general clinical signs similar to what you see in PD
Degenerative diseases that cause Hypokinetic Dysarthria (2):
- Alzheimer’s Dz: may show some signs similar to PD.
- Pick’s Dz: dementia disease which may show PD symptoms
Vascular conditions that can cause Hypokinetic Dysarthria (2):
o Multiple strokes affecting basal ganglia may result in condition called “vascular parkinsonism”.
o Disorder called “cerebral hypoxia” related to lack of oxygen to cerebrum, due to various causes including carbon monoxide poisoning.
Toxic-metabolic conditions that can cause Hypokinetic Dysarthria:
- Antipsychotic drugs (neuroleptic) may block dopamine receptors and lead to hypokinetic dysarthric symptoms. - - This drug induced Parkinsonism symptoms usually disappear after the drug is removed.
*Always ask these patients if they are on any medications
Trauma that can cause Hypokinetic Dysarthria (3):
o Boxers with repeated head trauma can damage substania nigra – (Remember that it can also damage cerebellum and thus demonstrate ataxic problems.) If the substantia nigra is damaged you may get PD similarities. This is often called “punch drunk” encephalopathy. (Encephalopathy means any disease of the brain.)
o TBI – can result in PD like symptoms and hypokinetic dysarthria.
o A medical treatment for PD can actually worsen hypokinetic dysarthria - it is called stereotactic ventrolateral thalamotomy
What is a stereotactic ventrolateral thalamotomy?
- 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 dysarthria, aphasia and cognitive deficits
Infectious Diseases that can cause Hypokinetic Dysarthria:
Viral encephalitis resulting from such things as:
Patient Complaints (9):
1. Weak or quiet voice-difficulty being heard in noisy place
2. Too fast speech rate
3. Words are imprecise and flat in emotional tone
4. Hard to get speech started (Bradykinesia)
5. Some stuttering or repetitions (may be due to anxiety of speech problems)
6. Fatigue brings negative effect on speech (see this at night often after a day of talking).
7. Meds may help speech it if helps other PD symptoms
8. Swallowing, drooling problems
9. Stiff upper lip-due to rigidity problems
Nonspeech Clinical findings of Hypokinetic Dysarthria (7):
1. Look for mask like face, unsmiling, unblinking especially at rest, although facial movement during speech may also be lessened.
2. Reduced movements of chest and abdomen during breathing
3. Patient may not swallow enough and thus cause drooling due to too much saliva accumulating.
4. Head turn may not accompany eye movement to look for something on the periphery.
5. Tremor of jaw and lips at rest or in opening and retracting lips. Tongue may have tremors on protrusion or at rest in mouth.
6. May have normal size, strength and symmetry of jaw, face and tongue.
7. Flat affect – restricted, unemotional facial affect (no facial expression) which may not reflect patient’s emotional state
Speech Clinical Findings with hypokinetic dysarthria (2):
• Assess through conversation, reading, AMRs and vowel prolongation.
• AMRs may be slow to start and throughout or they can be slow to start and become very rapid even to the point of blurring
Speech characteristics with hypokinetic dysarthria (12):
o Monopitch & monoloudness
o Reduced loudness
o Reduced stress (due to difficulty in making it loud)
o **Short rushes of speech
o Overall increased rate of speech – not the same as short rushes of speech
o Harsh/breathy voice quality
o Imprecise consonants
o Difficulty initiating speech (Bradykinesia)
o Rapid or blurred AMRs
o Inappropriate silences (b/c of Bradykinesia)
o Occasional tremor on vowel prolongation
What is Palilalia?
*pathological reiterative utterances (type of studdering)
- hypokinetic dysarthria is the only dysarthia which has palilalia, but it is seen in other neurological diseases.
- pathological repetition of words or utterances getting quicker as they go – a compulsive not controllable repetition.
- Example, “what’s that, what’s that, etc.”
- different from perseveration, because in perseveration there is an intervening stimulus (stimulous changes) and in palilalia there is not
Best distinguishing speech features (6):
o Fast rate
o Short rushes of speech
o Reduced stress
o Monopoitch & monoloudness
o Inappropriate silences
Which dysarthria(s) can rapid rate be heard?
* but not all hypokinetic dysarthrias demonstrate fast speech
what is the most prominent speech features of hypokinetic dysarthria?
What are some differentiating characteristics of hypokinetic dysarthria & flaccid dysarthria (3):
1 Breathiness heard in both but is worse in flaccid dysarthria, Breathiness is not the others dysarthrias
2 Flaccid dysarthria is rougher sounding and is usually louder than hypokinetic dysarthria
3 People with hypokinetic dysarthia can produce AMRs for a long time and people with FD cannot.
Do ppl with Parkinson's tend to speak soft of loudly?
Soft. And when we they are talking at a normal amplitude, they feel like they are shouting