Hypokinetic Dysarthria

  1. Hypokinetic Dysarthria
    • associated with basal ganglia control circuit pathology, mainly damage to the substantia nigra
    • characteristics: ridgidity, reduced force and ROM, slow individual or sometimes fast repetitive movements and speech. Most evident in voice artic and prosody
  2. Basal ganglia control ciruit
    • Part of the IAP, it regulates tone,
    • -postural adjustments during skilled movements,
    • -assists in the learning of new movements
    • -scales the force amplitude and duration of movement
  3. Damage to the Basal ganglia control circuit
    • -failure to inhibit involuntary movements
    • -usually caused by lack of neurotransmitters: dopamine
    • -reduces movements
  4. etiologies: all affect Basal ganglia
    • -Parkinson's disease
    • -drug induced:symptoms usually abate when drug is removeed
    • -Progressive Supra-nuclear Palsy (PSP)
    • -olivopontocerebellar atrophy
    • -Alzhiemer's disease
    • -Picks disease
  5. Parkinson's symptoms: Tremors
    • Parkinism of unknown cause but is responsive to LevoDopa treatment
    • -Tremors-mostly at rest (seen mostly in limbs and head), decreases with voluntary movement, pill rolling behaviour between fingers, appears restless or fidgety
  6. Parkinson's symptoms: Rigidity
    • slowness of movement, stiffness or tightness
    • -resistance in all directions
    • -jerky on and off rigidity called cogwheel
    • -transitions are hard
  7. Hypokinetic Clinical characteristics
    • -Akensia-brady kinesia: repetitive movements, delays or false starts at the beginning of movement and slowness once movement begins
    • -masked Facies:lack of emotional expression
    • -writing may become micrographic
    • -freezing gate
    • -festination- shuffling
    • -postural instability
    • -difficulty making adjustments
    • -doesn't respond well to medication
  8. Patient perspectives
    • -weak speech
    • -hard to get speech started then too fast and indistinct
    • -affected by fatigue
    • -drooling and swallowing complaints common
  9. OME findings
    • -expressionless
    • -infrequent swallow
    • -tremor in jaw lips or tongue
    • -lips may be rigid
    • -normal size shape and symmetry
    • -non speech AMRs slowly initiated and then fast
  10. Hypokinetic hallmarks
    • Dysphonia= difficulty making voiced sounds
    • Blurred AMRs=rapid accelerated
    • Short rushes of speech
    • Reduced ROM
  11. Speech characteristics
    • imprecise consonants
    • inappropriate silences
    • breathiness,harshness, and reduced loudness
    • monopitch, reduced stress, varied rate, repeated phonemes
  12. Treatment
    • -better breath support
    • -increasing loudness
    • -exaggerated prosody
    • -exaggerated ROM
    • -Singing
    • -self monitoring
    • -voice therapy
  13. Parkinsonism
    refers to etiologies or pathophysiology that are different from PD or when symptoms are not responsive to medications used to manage PD
  14. Parkinson's plus syndrome
    degenerative neurologic diseasea that include but go beyond signs and symptoms of parkinsonism. A mixed dysarthria is common
Card Set
Hypokinetic Dysarthria
Hypokinetic Dysarthria