What does hyperkinetic dysarthria have prominent effects on?
Why is it called hyperkinetic dysarthria?
Because it is characterized by increased involuntary movement.
- Jerky, inappropriate movement
Hyperkinetic speech can often give the impression that normal speech is being executed but then is interfered with by regular or unpredictable involuntary movements that _______________, ___________, or _____________ it.
Distort, slow or interrupt
What is the most often result of hyperkinesias?
Diseases of the basil ganglia control circuit.
Many hyperkinesias result from a failure of pathways to ___________ cortical motor discharges.
Hyperkinesias can also result from a disruption of the normal equilibrium between __________ and ____________ neurotransmitters.
Excitatory and inhibitory (too much dopamine)
Abnormal or excessive involuntary movements is called
Hyperkinesias occur where ____________ steadiness is expected.
Hyperkinesias can occur at ____________, during __________ postures, and during __________ movement.
Rest, static, voluntary
Hyperkinesias is usually abolished by _____________ and exacerbated by _________ and __________ emotions.
Sleep, anxiety, heightened
In some cases with hyperkinesias only specific movement trigger them? T or
In some cases with hyperkinesias adopting specific ___________ can inhibit them.
What do the term hyperkinesias indicate?
It indicated the presence of extra on involuntary movements that can range in rate from slow to fast.
In fact _____________ movements are generally slowed in body parts affected by hyperkinesias.
Some hyperkinesias are rapid, unsustained and unpatterend, whereas other are _______ to develop, may be __________ for seconds or longer or may be_____________ to a degree that distorts posture in a constant or waxing and waning manner.
Slow, sustained, prolonged
A general term used to refer to abnormal, involuntary movements, regardless of etiology.
Involuntary orofacial movements that can occur without hyperkinesias elsewhere in the body.
A term that refers to orofacial dyskinesias caused by prolonged use of antipsychotic drugs.
What is the most common Tardive dyskinesia is ___________ ____________- __________ ____________.
Tardive dyskinesia can also affect ___________ function, with subsequent effects on __________.
A condition characterized by an inner sense of motor restlessness, which can be manifest by overt motor restlessness.
Akathisia (weight shifting, pacing to relieve the sensation)
Akathisia can occur in ____________ and ____________ disease.
Involuntary single or repetitive brief jerks of a body part.
With Myoclonus if jerks are repetitive the can be ___________ or __________.
Can Myoclonus be inhibited willfully?
Myoclonus can be confined to a ____________ muscle or can be ____________.
Myoclonus may occur spontaneously or can be induced by __________, __________, or _________ stimuli and sometimes __________ movements.
visual, tactile, auditory, voluntary
When Myoclonus is brought on by movement it is called?
Myoclonus can be associated with lesions anywhere from the ___________ to the _______ ______.
Cortex, spinal cord
Myoclonus can occur in ___________ where it is considered a component of a seizure.
Epilepsy (Myoclonus epilepsy)
__________ are a form of complex Myoclonus produced by a brief spasm of the diaphragm with subsequent _________ of the vocal fold.
________ are rapid, stereotyped, coordinated or patterned movements that are under partial voluntary control.
__________ is characterized by involuntary, rapid, nonsterotypical, random, purposeless movement of the body part.
Chorea may be present at __________ and during ___________ postures and ___________ movement.
rest, sustained, voluntary
Chorea can be ______________ or ________________ or ____________ in origin.
Degenerative, inflammatory, infectious.
Chorea can be degenerative as in _____________ or infectious as in _____________ or ____________.
Involves gross, abrupt contractions of muscles of the extremities that can produce wild flailing movements.
When Ballismus is unilateral the condition is called?
What is the most common cause of Ballismus?
____________ is characterized by slow, writhing, purposeless movements that tend to flow into one another.
__________ is considered a major category of cerebral palsy?
When Athetosis is acquired it may be caused by _____________ conditions.
___________ is a relatively slow hyperkinesias characterized by involuntary abnormal postures resulting from excessive cocontraction of antagonistic muscles.
With _____________ the primary abnormal movements tend to be slow and sustained, but there may be superimposed quick movements.
The abnormal posture with dystonia may involve _____________ of a body part.
Dystonia may involve only ______ segment of the body or ____________ regions.
One, contiguous (segmental)
_____________ is segmental dystonia characterized by tonic or clonic spasms of the neck muscles.
Torticollis (cervical dystonia)
Another name for Torticollis is __________ ___________.
Spasms of the neck muscles in Torticollis cause deviation of the head to the side, backward, or forward. T or F
Torticollis is considered a ________ ________ disease and is most often ____________.
Basal ganglia, idiopathic
______________ is characterized by a forceful, spasmodic, relatively sustained closure of the eyes.
Blepharospasm can occur __________ or with other dystonic disorders, particularly those involving ________ muscles.
____________ is a general descriptive tem that designates various muscular contractions.
________ Spasms are prolonged or continuous?
________ spasms are repetitive, rapid in onset, and brief in duration?
Spasms usually are ______, even when they result from fear, anxiety and conversion disorders.
Spasms often result in movement, but sometimes they __________ motion.
_____________ is the most common involuntary movement?
Tremor involves the ______ movement of a body part.
Tremor can be characterized as __________, ___________, __________, or ____________.
resting, postural, action, or terminal
________ tremor occurs when the body part is in repose?
_____________ tremor occurs when the body part is maintained against gravity.
___________ tremor occurs during movement.
________ tremor occurs as the body part nears a target.
_____________ dysarthrias can be caused by any process that damages the _______ _______ control circuit or portions of the ___________ control circuit or indirect activation pathways that can lead to hyperkinesias.
Hyperkinetic, basal ganglia, cerebellar
What are the most common etiologies of hyperkinetic dysarthrias?
Idiopathic, toxic-metabolic, degenerative causes.
What is the most frequent cause of hyperkinetic dysarthria?
Drugs that affect the balance of neurotransmitter in the basal ganglia are a common cause of acute or delayed-onset involuntary movements these are called?
______________ means that which takes on the neuron?
What is the most frequent culprit for toxic-metabolic conditions?
Neuroleptic or antipsychotic drugs, whose actions block dopamine receptors, are the most frequent culprits.
___________ and ______________ can be caused by anitiparkinsonian drugs and usually occur at the time of peak levodopa effect.
Chorea and dystonia
____________ ______________ is an inherited autosomal dominant degenerative CNS disorder.
__________ of the offspring of individuals with the gene are affected when talking about Huntington's disease.
Huntington's disease usually begins ____________ by the ________ or __________ decade, with progression to death within __ to ___ years.
insidiously, fourth or fifth, 10 to 20 years
What is Huntington's disease most characteristic clinical feature?
__________, _______________, ______________, and _____________also are characteristic with Huntington's, and ______ and ______ are common.
depression, dementia, personality changes, and attention deficits. dysphagia and dysarthria.
___________ ____________ __________ usually results form autosomal dominant inheritance?
Primary Generalized Dystonia
Primary Generalized Dystonia usually begins in ___________ as a __________ dystonia, spreading over months or years to affect other body parts.
Primary Generalized Dystonia is often associated with ___________ abnormalities and ________ deformities in the neck, trunk, and extremities.
Sydenham's Chorea is a ____________ process.
Sydenham's Chorea is associated with ______________ infection or __________ ________.
Streptococcal infection, rheumatic fever
Sydenham's Chorea occurs in ____________ of patients with rheumatic fever.
Other infectious causes of chorea include ____________, _______, __________, ___________, and __________.
diphtheria, rubella, systemic lupus, erythematosus, and AIDS
__________ lesions are NOT a common cause of hyperkinesias?
___________ or other vascular disturbance in the basal ganglia control circuit and sometimes the cerebellar control circuit, can lead to movement disorders of hyperkinetic dysarthria.
_____________ tumors of the basal ganglia and the thalamus have been associated with chorea and dystonia?
Primary dystonia can be ________ or ________.
generalized or focal
_____ % of the cases were of undetermined etiology with toxic or metabolic causes accounting for an additional ________ % of cases, talking about hyperkinetic dysarthria.
The percentages of hyperkinetic dysarthria in regards to a cause suggest that the cause often lies in ____________ abnormalities rather than _________ lesions.
What is the most frequent known cause of hyperkinetic dysarthrias?
What is the most frequent degenerative disease that causes hyperkinetic dysarthrias?
Patient�s complaints with hyperkinetic dysarthria are ________, __________, __________, hard- to- get out speech.
slow, slurred, halting
________ and __________ complaints are common in chorea and dystonia?
chewing and swallowing
Patients complaints with hyperkinetic dysarthria their voice is __________, __________, closes off, doesn't want to come out.
Some patients with hyperkinetic dysarthria use _________ ________ to reduce or eliminated orofacial dystonic posturing.
Dysarthria of Chorea nonspeech oral mechanism: __________ is occasionally observed.
Dysarthria of Chorea nonspeech oral mechanism - ________ and _______ difficulties are NOT uncommon.
chewing and swallowing
The most striking abnormality in dysarthria of Chorea is ____________ unsteadiness.
Some movement disorders may become clinically evident only during ___________. When this is the case the problems often is diagnosed as ________.
What is the most frequently recognized combination of involved structures when dealing with dysarthria of Chorea? But in some cases only a ______ speech structure may be involved?
(Jaw, Face, and Tongue), single
What % of cases in patients with dysarthria of Chorea had reduced intelligibility?
_______% of cases in patients with dysarthria of Chorea had some impairment of cognitive ability?
In patients with dysarthria of Chorea what were the patient�s complaints or perceptions?
________ and __________ complaints are common in Chorea and dystonia?
chewing and swallowing
In Dysarthria of Chorea: At rest during attempts to maintain steady orofacial postures, _______, _______, ________ movements may occur.
quick, unpredictable, involuntary
When talking about Dysarthria of Chorea and the speech of it; nearly ______ aspects of movement may be disturbed.
In patients with dysarthria of Chorea involuntary movements may alter the direction and rhythm of movement and they generally ________ rate.
In patients with dysarthria of Chorea, force and range of an individuals and repetitive movements may vary from _________ to __________ to ___________.
reduced, normal, excessive
____________ tone may be excessive in the category of speech in patients with Dysarthria of Chorea .
How can respiration be affected in patients with in patients with dysarthria of chorea?
It can be sudden, forced, involuntary inspiration or expiration
How is phonation effected in patients with in patients with dysarthria of chorea?
harsh voice quality, excess loudness variations, and strained-strangled voice quality because of HYPERADDUCTION OF THE VOCAL FOLDS.
How is resonance affected in patients with in patients with dysarthria of chorea?
Chorea may lead to hypernasality in some patients
What is the MOST PROMINENT feature of articulation in patients with dysarthria of chorea but not the most DISTINGUISHING feature in patients with dysarthria of chorea?
Imprecise articulation in patients with dysarthria of chorea tends to occur simultaneously with ____________ vowels and ___________.
How is Prosody affected in patients with dysarthria of chorea?
Prosodic disturbances are prominent, including prolonged phonemes, and excess and equal stress (monotone)
Patients with dysarthria of chorea also exhibited prosody insufficiency, characterized by__________, ______________, ____________ and ____________.
monopitch, monoloudness, reduced stress and short phrases. Patients also had a variable rate.
What features of dysarthria of chorea help identify and distinguish it from other MSD's?
- Most apparent is the transient and unpredictable nature of the deviant
-Most Obvious is hypernasality, strained-harshness, transient breathiness, articulatory distortions and irregular articulatory breakdowns, loudness variations and sudden forced inspiration and expiration.
- can lead to prolonged intervals and phonemes, variable rate, inappropriate silences, voice stoppages, and excessive or insufficient stress patterns.
In patients with Dystonia ________ may occur and _______ and ____________ complaints are common.
drooling, chewing and swallowing
_____________ movements are slower than those of chorea, and they have a waxing and waning character.
_____________________ and _________ _____________ may be present, as may intermittent relatively sustained spasms that lead to mouth opening and closing.
Blepharospasm, facial grimacing
Patients may use __________ _____________ to inhibit dystonic movements.
In patients with Dystonia nearly all aspects of _____________ may be disturbed.
Dystonic movements may alter __________ and __________ of movement, and ________ generally is slow.
direction, rhythm, rate
How is respiration affected in Dystonic speech?
Dystonic speakers did not exhibit speech characteristics that clearly reflected respiratory dystonia. (some had excess loudness variation, and a small had mild alternating loudness which could reflect abnormal respiratory movements.)
How is Phonation affected in Dystonic speech?
It is harsh, strained-strangled voice, excess loudness and voice stoppages due to HYPERADDUCTION of vocal folds.
Some patients with Dystonia exhibit ____________ inspiration.
___________ ___________ was more evident is speakers with dystonic speech than any other dysarthric group studied.
Voice Tremor ***Good Test Question****
____________ is not a pervasive characteristic in dystonic speech.
How is articulation in dystonic speech characterized?
imprecise consonants, distorted vowels, and irregular articulatory breakdowns.
What causes the articulation problems with dystonic speech?
involuntary jaw, face, lip, or tongue movements.
How is prosody affected in dystonic speech?
Prosodic disturbances are prominent and are similar to those encountered in Chorea.
How is dysarthria of dystonia identified and distinguished from other MSD?
- MOST apparent is the variable nature of the deviant speech characteristic
What is the most PREVALENT speech characteristic of dystonic speech?
-Imprecise and irregular breakdowns of articulation
- inappropriate variability of loudness and rate
- strained harness
- transient breathiness
- audible inspiration.
What is a major subcategory of cerebral palsy?
The speech characteristics of ___________ probably are captured within the descriptions of dysarthria associated with dystonia and perhaps Chorea
_________ _______ affects the cervical neck muscles and not the cranial nerve- innervated speech muscles.
Spasmodic Torticollis (Cervical Dystonia)
Another name for Spasmodic Torticollis is _______ ________.
Spasmodic Torticollis is usually ______________ to the effects of neck postural deviations on primary speech muscle activity.
The speech of some speakers with Spasmodic Torticollis is perceived as?
- Slowly initiated
- reduced in maximum duration of utterances
- reduced in pitch and pitch variability
- reduced in rate (These deficits, when present, usually are mild and intelligibility is maintained.
___________ ___________ is a rare disorder characterized by relatively abrupt rhythmic or semirhythmic unilateral or bilateral movements of the soft palate, pharyngeal walls and laryngeal muscles.
Palatopharyngolarngeal Myoclonus usually is caused by a ____________ and __________ _____________ event and can also be ________.
brainstem or cerebellar vascular; idiopathic
PM is present at ________, during __________ postures and movement, and during ________.
rest, sustained, sleep (all the time)
The most common finding in PM is ________, _________ beating like elevation of the soft palate at a rate of 60-240 per minute.
____________ contractions also may be apparent and may produce opening and closing of the Eustachian tube with an associated clicking sound that sometimes can be heard by others.
___________ are a frequent complaint when PM is idiopathic but uncommon when PM is symptomatic.
____________ movements of the larynx sometimes can be seen on the external surface of the neck, and patients may complain of a clicking sensation in the larynx or a sensation of laryngeal spasm.
The effects of PM on speech, even when it affects the jaw, lips, tongue, palate, pharynx and larynx are not apparent under most circumstances because they are so _______ and _______ in amplitude.
The effects of PM usually can be heard during _____________ prolongation as momentary rhythmic arrest or tremor like variations.
The dysarthria of PM probably is ___________ as an isolated speech disturbance.
PM probably most often occurs as one part of a speech disturbance that may include?
- Unilateral Upper Motor Neuron Dysarthria
Action Myoclonus has a ___________ impact on speech than PM?
AM is distinguished from other Myoclonic conditions because it is induced by ________ _______ activity and is less _____________ and __________ then other forms.
VOLITIONAL muscle, generalized and rhythmic
An arrhythmic fine or course jerking of a muscle or group of muscles in disorderly fashion, excited manly by muscular activity when a conscious attempt at precision is required, worsened by emotional arousal, suppressed by barbiturates.
With _____ ______ patients have slow and slightly slurred speech.
The MOST common etiology of AM is ______ ___________.
anoxic encephalopathy (due to cardiorespiratory arrest)
Other causes of AM include:
The dysarthria of AM appears to have its primary perceptual effects on _____________ (_______) and ________.
articulation (labial), phonation
_____________ fluctuations of phonation and ___________ voice arrests are characteristic.
With AM __________ speech rate is characteristic and the Myoclonic movement�s ____________ with increased speech rate.
What can help confirm the diagnosis of dysarthria of AM?
- deterioration of voice quality or articulatory adequacy with increased rate
- the emergence of Myoclonic facial movements with increased rate (because other dysarthrias are not triggered by increases in rate)
_______ are brief involuntary movements or sounds that occur over normal background motor activity.
Tics may occur as an __________ , __________ disorder but _________ ______ is the prototypic disorder.
isolated, nonspecific: Tourette's Syndrome
Tics can be brief and isolated; tics include
- eye blinks
- head twitch
- facial grimace
- obscene gestures
Tics often are bizarre appearing and frequently misinterpreted as signs of ___________ disease.
Characteristics of TS include:
- multiple motor and one or more vocal tics
- tic free periods not exceeding 3 months
- Marked distress or impairment in daily functioning
- onset before 18 years of age
- No due to physiologic effects of substance or other medical condition
In most cases of Tourette's syndrome it is generally thought that most cases are ___________ determined and that the cause involves ________ receptor sensitivity.
The motor and behavior features of Tourette's syndrome _______ in severity.
Tourette's Syndrome frequently co-occurs with ___________-____________ disorder.
What issues are more common than Tourette's syndrome?
- conduct disorder
- Panic attacks
- multiple phobias
Tourette's is characterized by vocal tics that can be isolated or embedded within voluntary verbal utterances. T or F
________ tics are unique because they represent the only dysarthria in which specific sounds or spoken works represent the disorder.
Simple vocal tics include:
- noises and sounds that are made repetitively and sometimes can be suppressed temporarily.
The most common vocal tics made are:
- throat clearing and grunting
- yelling- screaming
More complex vocal tics include:
involuntary, compulsive swearing is called?
Coprolalia *** Good Test Question***
_________ tremor is the most common movement disorder?
A family history of tremor is present in ____% - _____% of affected people.
Essential Tremor can begin at _____ age, often before _____ and incidence _________ with age?
any, 50, increases
Essential Tremor occurs most frequently in the ____________., but can also be present in the __________.
Essential tremor is generally __________, it usually slowly _____________ in severity.
benign, increases (gets worse with age)
A focal presentation Essential tremor sometimes spreads to include ________ body parts
The onset of essential voice tremor usually is ___________.
Essential Tremor worsens with ___________ and ___________ stress and improves with ____________ intake.
fatigue and psychological, alcoholic
The voice tremor can be an isolated problem, but more often is accompanied by ________ or ___________ tremor.
head or extremity (when isolated it is sometimes misdiagnosed as a psychogenic disorder.)
_____ tremor may be apparent at rest or on protrusion when talking about essential tremor.
In patients with Essential tremor _______ movements of the jaw and lips often are apparent at ______, during sustained postures and during _________ prolongation.
tremulous, rest, vowel
___________ and __________ tremor often are obvious during sustained "ah" synchronous with the perceived voice tremor.
Palatal and Pharyngeal
3 effects of ET on Voice
- a typical essential voice tremor when the adductor and abductor vocal fold tremor components are relatively equal
- an adductor spasmodic dysphonia when the adductor component is predominant.
- and abductor spasmodic dysphonia when the abductor component is predominant.
Voice tremor may not be apparent during ________ speech, especially when mild
ET is most easily perceived during?
How do you rule out respiratory contribution to the voice tremor the patient should do what?
- prolong /s/ and /z/
When doing the /s/ and /z/ test for respiration; if the /s/ is steady and the /z/ or vowels contains tremor then respiratory contribution to the voice tremor is __________.
Patients with severe essential tremor may have reduced speech rate secondary to ___________ interruptions. Speech rate also may be reduced __________ to jaw lip and tongue tremor.