Hyperkinetic Dysarthria

  1. Hyperkinetic Dysarthria
    • -associated with basal ganglia control circuit pathology
    • -Can be at one or all levels of speech
    • -most prominent at prosody
    • -abnormal rhythmic or irregular speech
    • -involuntary movements occur when stasis is expected
  2. Hyperkinesia
    • the thalamus has mainly an excitatory influence on the cortex. This affect is inhibited by the Basal ganglia. Hyperkinesia results from an interruption in this inhibitory affect. This disruption is caused by a lack of equilibrium between acetocholyn and dopamine.
    • -cerebellar control can also be implicated
  3. Huntington's disease (chorea)
    complex, non coordinated big movements, brief sudden purposeless jerks. Exhausting, dietary intake a problem, degenerative
  4. Dystonia
    • involuntary muscle contractions
    • - can be repetitive, twisting
  5. Hyperkinetic etiology
    • -Toxic Metabolic (more so for this MSD)-drugs from psychotics, anti parkinson drugs, alcohol withdrawal, thyroid conditions, oral contraceptives
    • -vascular lesions
    • -tumors
    • -infectious processes
    • -tourette's syndrome
    • Unknown causes
  6. Patient perspectives
    • -Speech slurred, hard to get out
    • -depends on the type of movement disorder(chorea, dystonia etc)
    • -may not be aware of abnormal movements
    • -sensory tricks to help interrupt the uncontrolled movements
  7. Clinical Characteristics of Hyperkinetic: Dyskinesias
    • involuntary abnormal hyperkinetic movements
    • -orofacial, tardive, orobuccal-
  8. Clinical Characteristics of Hyperkinetic: Akathesia
    Sense of restlessness in the whole body or part of the body. May be moving or sitting still but they feel it moving.
  9. Clinical Characteristics of Hyperkinetic: Myoclonus
    • involuntary, single or repetitive jerk that involves an entire muscle and displaces a whole part of the body.
    • -can be spontaneous or induced
    • -can not be inhibited
    • -can disrupt articulation and phonation
  10. Myoclonus vs Fasciculations
    • Myo is caused by an UMN deficit and Fasc is a LMN deficit. 
    • -Myoclonus is on a greater scale, involves the CNS and can be action or stimulus induced
    • -Fasciculations are completely spontaneous
  11. Clinical Characteristics of Hyperkinetic: Athetosis
    slow writhing purposeless movements that flow from one to the other. a relatively slow hyperkinesia
  12. Clinical Characteristics of Hyperkinetic: dystonia
    • implies an abnormal posture with an inappropriate sustained contraction of the muscles
    • -can be phasic (temporary) rotation of neck to one side
    • -may only be apparent during some activities
    • -sensory tricks may be helpful
    • -cervical dystonia affects the neck muscles
  13. Clinical Characteristics of Hyperkinetic: Tics
    • rapid non rhythmic coordinated movements or patterns of movements under partial voluntary control
    • -vocal tics: simple sounds or words that may be repeated
    • =Tourette's syndrome
  14. Clinical Characteristics of Hyperkinetic: Ballism
    Gross abrupt contractions of the axial and proximal muscles of the extremities resulting in flailing limbs
  15. Clinical Characteristics of Hyperkinetic: Chorea
    can't sit still, restlessness, rapid involuntary random purposeless movements
  16. Chroea speech assessments
    • conversations, AMRs and vowel prolongations, 
    • -unpredictable breakdowns of artic, rate and prosody
    • -unplanned jaw, tongue, face and palate movements can be perceived
    • -visual observations during speech are important
  17. Clinical Characteristics of Hyperkinetic: Tremor
    • rhythmic periodic movements
    • -terminal, resting, postural or action tremors
    • -voice tremor
    • usually gradual onset and is most easily perceived during vowel prolongation or going to a higher pitch.  It is also called vibrato behaviour
  18. Clinical Characteristics of Hyperkinetic:spasm
    • Descriptive term for a muscle contraction
    • -can be tonic- prolonged or continuous
    • -can clonic - repetitive, rapid onset and brief durations
    • -not all spasms are due to lesions in the CNS
  19. Clinical Characteristics of Hyperkinetic:Bruxism
    • Teeth grinding or clenching or movement
    • -TMJ soarness
  20. Spasmodic dysphonia of essential voice tremor
    • -results from laryngospasm
    • -adductor or abductor or mixed
    • -insidious onset
    • -not present during breathing, swallowing, or at rest
    • -action induced
    • -sound breathy
    • -can begin with a flu-like illness or a period of acute stress
Card Set
Hyperkinetic Dysarthria
Hyperkinetic Dysarthria