Advanced Articulation Disorders Chapt 8

  1. Hyperkinetic dysarthria may be manifestation in what speech systems?
    Respiration, phonation, resonance, articulation, prosody. (ALL)
  2. What does hyperkinetic dysarthria have prominent effects on?
  3. Why is it called hyperkinetic dysarthria?
    • Because it is characterized by increased involuntary movement.
    • - Jerky, inappropriate movement
  4. 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
  5. What is the most often result of hyperkinesias?
    Diseases of the basil ganglia control circuit.
  6. Many hyperkinesias result from a failure of pathways to ___________ cortical motor discharges.
  7. Hyperkinesias can also result from a disruption of the normal equilibrium between __________ and ____________ neurotransmitters.
    Excitatory and inhibitory (too much dopamine)
  8. Abnormal or excessive involuntary movements is called
  9. Hyperkinesias occur where ____________ steadiness is expected.
  10. Hyperkinesias can occur at ____________, during __________ postures, and during __________ movement.
    Rest, static, voluntary
  11. Hyperkinesias is usually abolished by _____________ and exacerbated by _________ and __________ emotions.
    Sleep, anxiety, heightened
  12. In some cases with hyperkinesias only specific movement trigger them? T or
  13. In some cases with hyperkinesias adopting specific ___________ can inhibit them.
  14. What do the term hyperkinesias indicate?
    It indicated the presence of extra on involuntary movements that can range in rate from slow to fast.
  15. In fact _____________ movements are generally slowed in body parts affected by hyperkinesias.
  16. 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
  17. A general term used to refer to abnormal, involuntary movements, regardless of etiology.
  18. Involuntary orofacial movements that can occur without hyperkinesias elsewhere in the body.
    Orofacial dyskinesias
  19. A term that refers to orofacial dyskinesias caused by prolonged use of antipsychotic drugs.
    Tardive dyskinesia
  20. What is the most common Tardive dyskinesia is ___________ ____________- __________ ____________.
    Oro-buccal-lingual dyskinesia.
  21. Tardive dyskinesia can also affect ___________ function, with subsequent effects on __________.
    Respiratory, speech
  22. 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)
  23. Akathisia can occur in ____________ and ____________ disease.
    Parkinsonism, Parkinson�s
  24. Involuntary single or repetitive brief jerks of a body part.
  25. With Myoclonus if jerks are repetitive the can be ___________ or __________.
    rhythmic, nonrhythmic
  26. Can Myoclonus be inhibited willfully?
  27. Myoclonus can be confined to a ____________ muscle or can be ____________.
    single, multifocal
  28. Myoclonus may occur spontaneously or can be induced by __________, __________, or _________ stimuli and sometimes __________ movements.
    visual, tactile, auditory, voluntary
  29. When Myoclonus is brought on by movement it is called?
    Action Myoclonus
  30. Myoclonus can be associated with lesions anywhere from the ___________ to the _______ ______.
    Cortex, spinal cord
  31. Myoclonus can occur in ___________ where it is considered a component of a seizure.
    Epilepsy (Myoclonus epilepsy)
  32. __________ are a form of complex Myoclonus produced by a brief spasm of the diaphragm with subsequent _________ of the vocal fold.
    Hiccups, adduction
  33. ________ are rapid, stereotyped, coordinated or patterned movements that are under partial voluntary control.
  34. __________ is characterized by involuntary, rapid, nonsterotypical, random, purposeless movement of the body part.
  35. Chorea may be present at __________ and during ___________ postures and ___________ movement.
    rest, sustained, voluntary
  36. Chorea can be ______________ or ________________ or ____________ in origin.
    Degenerative, inflammatory, infectious.
  37. Chorea can be degenerative as in _____________ or infectious as in _____________ or ____________.
    Huntington�s chorea, Sydenham's chorea, encephalitis.
  38. Involves gross, abrupt contractions of muscles of the extremities that can produce wild flailing movements.
  39. When Ballismus is unilateral the condition is called?
  40. What is the most common cause of Ballismus?
  41. ____________ is characterized by slow, writhing, purposeless movements that tend to flow into one another.
  42. __________ is considered a major category of cerebral palsy?
  43. When Athetosis is acquired it may be caused by _____________ conditions.
  44. ___________ is a relatively slow hyperkinesias characterized by involuntary abnormal postures resulting from excessive cocontraction of antagonistic muscles.
  45. With _____________ the primary abnormal movements tend to be slow and sustained, but there may be superimposed quick movements.
  46. The abnormal posture with dystonia may involve _____________ of a body part.
  47. Dystonia may involve only ______ segment of the body or ____________ regions.
    One, contiguous (segmental)
  48. _____________ is segmental dystonia characterized by tonic or clonic spasms of the neck muscles.
    Torticollis (cervical dystonia)
  49. Another name for Torticollis is __________ ___________.
    Cervical dystonia
  50. Spasms of the neck muscles in Torticollis cause deviation of the head to the side, backward, or forward. T or F
  51. Torticollis is considered a ________ ________ disease and is most often ____________.
    Basal ganglia, idiopathic
  52. ______________ is characterized by a forceful, spasmodic, relatively sustained closure of the eyes.
  53. Blepharospasm can occur __________ or with other dystonic disorders, particularly those involving ________ muscles.
    Alone, orofacial
  54. ____________ is a general descriptive tem that designates various muscular contractions.
  55. ________ Spasms are prolonged or continuous?
  56. ________ spasms are repetitive, rapid in onset, and brief in duration?
  57. Spasms usually are ______, even when they result from fear, anxiety and conversion disorders.
  58. Spasms often result in movement, but sometimes they __________ motion.
  59. _____________ is the most common involuntary movement?
  60. Tremor involves the ______ movement of a body part.
  61. Tremor can be characterized as __________, ___________, __________, or ____________.
    resting, postural, action, or terminal
  62. ________ tremor occurs when the body part is in repose?
  63. _____________ tremor occurs when the body part is maintained against gravity.
    postural tremor
  64. ___________ tremor occurs during movement.
  65. ________ tremor occurs as the body part nears a target.
  66. _____________ 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
  67. What are the most common etiologies of hyperkinetic dysarthrias?
    Idiopathic, toxic-metabolic, degenerative causes.
  68. What is the most frequent cause of hyperkinetic dysarthria?
    degenerative causes
  69. 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?
    toxic-metabolic conditions
  70. ______________ means that which takes on the neuron?
  71. What is the most frequent culprit for toxic-metabolic conditions?
    Neuroleptic or antipsychotic drugs, whose actions block dopamine receptors, are the most frequent culprits.
  72. ___________ and ______________ can be caused by anitiparkinsonian drugs and usually occur at the time of peak levodopa effect.
    Chorea and dystonia
  73. ____________ ______________ is an inherited autosomal dominant degenerative CNS disorder.
    Huntington's disease
  74. __________ of the offspring of individuals with the gene are affected when talking about Huntington's disease.
  75. Huntington's disease usually begins ____________ by the ________ or __________ decade, with progression to death within __ to ___ years.
    insidiously, fourth or fifth, 10 to 20 years
  76. What is Huntington's disease most characteristic clinical feature?
  77. __________, _______________, ______________, and _____________also are characteristic with Huntington's, and ______ and ______ are common.
    depression, dementia, personality changes, and attention deficits. dysphagia and dysarthria.
  78. ___________ ____________ __________ usually results form autosomal dominant inheritance?
    Primary Generalized Dystonia
  79. Primary Generalized Dystonia usually begins in ___________ as a __________ dystonia, spreading over months or years to affect other body parts.
    childhood. focal
  80. Primary Generalized Dystonia is often associated with ___________ abnormalities and ________ deformities in the neck, trunk, and extremities.
    gait, postural
  81. Sydenham's Chorea is a ____________ process.
  82. Sydenham's Chorea is associated with ______________ infection or __________ ________.
    Streptococcal infection, rheumatic fever
  83. Sydenham's Chorea occurs in ____________ of patients with rheumatic fever.
  84. Other infectious causes of chorea include ____________, _______, __________, ___________, and __________.
    diphtheria, rubella, systemic lupus, erythematosus, and AIDS
  85. __________ lesions are NOT a common cause of hyperkinesias?
  86. ___________ or other vascular disturbance in the basal ganglia control circuit and sometimes the cerebellar control circuit, can lead to movement disorders of hyperkinetic dysarthria.
  87. _____________ tumors of the basal ganglia and the thalamus have been associated with chorea and dystonia?
  88. Primary dystonia can be ________ or ________.
    generalized or focal
  89. _____ % of the cases were of undetermined etiology with toxic or metabolic causes accounting for an additional ________ % of cases, talking about hyperkinetic dysarthria.
    67%, 12%
  90. The percentages of hyperkinetic dysarthria in regards to a cause suggest that the cause often lies in ____________ abnormalities rather than _________ lesions.
    neurochemical, structural
  91. What is the most frequent known cause of hyperkinetic dysarthrias?
  92. What is the most frequent degenerative disease that causes hyperkinetic dysarthrias?
    Huntington's Chorea
  93. Patient�s complaints with hyperkinetic dysarthria are ________, __________, __________, hard- to- get out speech.
    slow, slurred, halting
  94. ________ and __________ complaints are common in chorea and dystonia?
    chewing and swallowing
  95. Patients complaints with hyperkinetic dysarthria their voice is __________, __________, closes off, doesn't want to come out.
    tight, shaky
  96. Some patients with hyperkinetic dysarthria use _________ ________ to reduce or eliminated orofacial dystonic posturing.
    sensory tricks
  97. Dysarthria of Chorea nonspeech oral mechanism: __________ is occasionally observed.
  98. Dysarthria of Chorea nonspeech oral mechanism - ________ and _______ difficulties are NOT uncommon.
    chewing and swallowing
  99. The most striking abnormality in dysarthria of Chorea is ____________ unsteadiness.
  100. Some movement disorders may become clinically evident only during ___________. When this is the case the problems often is diagnosed as ________.
    Speech, psychogenic
  101. 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
  102. What % of cases in patients with dysarthria of Chorea had reduced intelligibility?
  103. _______% of cases in patients with dysarthria of Chorea had some impairment of cognitive ability?
  104. In patients with dysarthria of Chorea what were the patient�s complaints or perceptions?
    Slurred, Slow, Halting, hard-to-get-it-out speech.
  105. ________ and __________ complaints are common in Chorea and dystonia?
    chewing and swallowing
  106. In Dysarthria of Chorea: At rest during attempts to maintain steady orofacial postures, _______, _______, ________ movements may occur.
    quick, unpredictable, involuntary
  107. When talking about Dysarthria of Chorea and the speech of it; nearly ______ aspects of movement may be disturbed.
  108. In patients with dysarthria of Chorea involuntary movements may alter the direction and rhythm of movement and they generally ________ rate.
  109. In patients with dysarthria of Chorea, force and range of an individuals and repetitive movements may vary from _________ to __________ to ___________.
    reduced, normal, excessive
  110. ____________ tone may be excessive in the category of speech in patients with Dysarthria of Chorea .
  111. How can respiration be affected in patients with in patients with dysarthria of chorea?
    It can be sudden, forced, involuntary inspiration or expiration
  112. 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.
  113. How is resonance affected in patients with in patients with dysarthria of chorea?
    Chorea may lead to hypernasality in some patients
  114. 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.
  115. Imprecise articulation in patients with dysarthria of chorea tends to occur simultaneously with ____________ vowels and ___________.
    distorted, hypernasality
  116. How is Prosody affected in patients with dysarthria of chorea?
    Prosodic disturbances are prominent, including prolonged phonemes, and excess and equal stress (monotone)
  117. 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.
  118. 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.
  119. In patients with Dystonia ________ may occur and _______ and ____________ complaints are common.
    drooling, chewing and swallowing
  120. _____________ movements are slower than those of chorea, and they have a waxing and waning character.
  121. _____________________ and _________ _____________ may be present, as may intermittent relatively sustained spasms that lead to mouth opening and closing.
    Blepharospasm, facial grimacing
  122. Patients may use __________ _____________ to inhibit dystonic movements.
    sensory tricks
  123. In patients with Dystonia nearly all aspects of _____________ may be disturbed.
  124. Dystonic movements may alter __________ and __________ of movement, and ________ generally is slow.
    direction, rhythm, rate
  125. 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.)
  126. How is Phonation affected in Dystonic speech?
    It is harsh, strained-strangled voice, excess loudness and voice stoppages due to HYPERADDUCTION of vocal folds.
  127. Some patients with Dystonia exhibit ____________ inspiration.
  128. ___________ ___________ was more evident is speakers with dystonic speech than any other dysarthric group studied.
    Voice Tremor ***Good Test Question****
  129. ____________ is not a pervasive characteristic in dystonic speech.
    Hypernasality (resonance)
  130. How is articulation in dystonic speech characterized?
    imprecise consonants, distorted vowels, and irregular articulatory breakdowns.
  131. What causes the articulation problems with dystonic speech?
    involuntary jaw, face, lip, or tongue movements.
  132. How is prosody affected in dystonic speech?
    Prosodic disturbances are prominent and are similar to those encountered in Chorea.
  133. How is dysarthria of dystonia identified and distinguished from other MSD?
    - MOST apparent is the variable nature of the deviant speech characteristic
  134. 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.
  135. What is a major subcategory of cerebral palsy?
  136. The speech characteristics of ___________ probably are captured within the descriptions of dysarthria associated with dystonia and perhaps Chorea
  137. _________ _______ affects the cervical neck muscles and not the cranial nerve- innervated speech muscles.
    Spasmodic Torticollis (Cervical Dystonia)
  138. Another name for Spasmodic Torticollis is _______ ________.
    Cervical Dystonia
  139. Spasmodic Torticollis is usually ______________ to the effects of neck postural deviations on primary speech muscle activity.
  140. 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
    • - Dysphonic
    • - reduced in rate (These deficits, when present, usually are mild and intelligibility is maintained.
  141. ___________ ___________ 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
  142. Palatopharyngolarngeal Myoclonus usually is caused by a ____________ and __________ _____________ event and can also be ________.
    brainstem or cerebellar vascular; idiopathic
  143. PM is present at ________, during __________ postures and movement, and during ________.
    rest, sustained, sleep (all the time)
  144. The most common finding in PM is ________, _________ beating like elevation of the soft palate at a rate of 60-240 per minute.
    abrupt, rhythmic
  145. ____________ 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.
  146. ___________ are a frequent complaint when PM is idiopathic but uncommon when PM is symptomatic.
  147. ____________ 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.
  148. 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.
    brief, low
  149. The effects of PM usually can be heard during _____________ prolongation as momentary rhythmic arrest or tremor like variations.
  150. The dysarthria of PM probably is ___________ as an isolated speech disturbance.
  151. PM probably most often occurs as one part of a speech disturbance that may include?
    • -Spastic
    • - Ataxic
    • - Flaccid
    • - Unilateral Upper Motor Neuron Dysarthria
  152. Action Myoclonus has a ___________ impact on speech than PM?
  153. 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
  154. 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.
    Action Myoclonus.
  155. With _____ ______ patients have slow and slightly slurred speech.
    Action Myoclonus
  156. The MOST common etiology of AM is ______ ___________.
    anoxic encephalopathy (due to cardiorespiratory arrest)
  157. Other causes of AM include:
    • - epilepsy
    • - encephalitis
    • - Stoke
  158. The dysarthria of AM appears to have its primary perceptual effects on _____________ (_______) and ________.
    articulation (labial), phonation
  159. _____________ fluctuations of phonation and ___________ voice arrests are characteristic.
    Repetitive, adductor
  160. With AM __________ speech rate is characteristic and the Myoclonic movement�s ____________ with increased speech rate.
    slow, worsen
  161. 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)
  162. _______ are brief involuntary movements or sounds that occur over normal background motor activity.
  163. Tics may occur as an __________ , __________ disorder but _________ ______ is the prototypic disorder.
    isolated, nonspecific: Tourette's Syndrome
  164. Tics can be brief and isolated; tics include
    • - eye blinks
    • - head twitch
    • - facial grimace
    • - touching
    • - Jumping
    • - obscene gestures
  165. Tics often are bizarre appearing and frequently misinterpreted as signs of ___________ disease.
  166. 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
  167. In most cases of Tourette's syndrome it is generally thought that most cases are ___________ determined and that the cause involves ________ receptor sensitivity.
    genetically, dopamine
  168. The motor and behavior features of Tourette's syndrome _______ in severity.
  169. Tourette's Syndrome frequently co-occurs with ___________-____________ disorder.
  170. What issues are more common than Tourette's syndrome?
    • - Stuttering
    • - Dyslexia
    • - conduct disorder
    • - Panic attacks
    • - multiple phobias
    • - depression
    • - Mania
  171. Tourette's is characterized by vocal tics that can be isolated or embedded within voluntary verbal utterances. T or F
  172. ________ tics are unique because they represent the only dysarthria in which specific sounds or spoken works represent the disorder.
  173. Simple vocal tics include:
    - noises and sounds that are made repetitively and sometimes can be suppressed temporarily.
  174. The most common vocal tics made are:
    • - throat clearing and grunting
    • - yelling- screaming
    • - sniffing
    • - barking
    • - snorting
    • - coughing
    • - spitting
    • - squeaking
    • - humming
  175. More complex vocal tics include:
    • - echolalia
    • - palilalia
    • - coprolalia
  176. involuntary, compulsive swearing is called?
    Coprolalia *** Good Test Question***
  177. _________ tremor is the most common movement disorder?
    Essential tremor
  178. A family history of tremor is present in ____% - _____% of affected people.
    17, 96
  179. Essential Tremor can begin at _____ age, often before _____ and incidence _________ with age?
    any, 50, increases
  180. Essential Tremor occurs most frequently in the ____________., but can also be present in the __________.
    hands, voice
  181. Essential tremor is generally __________, it usually slowly _____________ in severity.
    benign, increases (gets worse with age)
  182. A focal presentation Essential tremor sometimes spreads to include ________ body parts
  183. The onset of essential voice tremor usually is ___________.
  184. Essential Tremor worsens with ___________ and ___________ stress and improves with ____________ intake.
    fatigue and psychological, alcoholic
  185. 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.)
  186. _____ tremor may be apparent at rest or on protrusion when talking about essential tremor.
  187. In patients with Essential tremor _______ movements of the jaw and lips often are apparent at ______, during sustained postures and during _________ prolongation.
    tremulous, rest, vowel
  188. ___________ and __________ tremor often are obvious during sustained "ah" synchronous with the perceived voice tremor.
    Palatal and Pharyngeal
  189. 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.
  190. Voice tremor may not be apparent during ________ speech, especially when mild
  191. ET is most easily perceived during?
    vowel prolongation
  192. How do you rule out respiratory contribution to the voice tremor the patient should do what?
    - prolong /s/ and /z/
  193. 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 __________.
  194. 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.
    Phonatory, secondary
Card Set
Advanced Articulation Disorders Chapt 8
Advanced Articulation Disorders Chapt 8