Dysarthrias associated with hyperkinetic movement disorders

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Dysarthrias associated with hyperkinetic movement
disorders

• MSD
• 3/1/06
• Jill Fahy

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In-Class Project Friday 3/3/6

• 5 groups
• 5 video samples of dysarthrias
• 1-page QA to complete, based on your video
  sample
• Worth 20 points
• Bring all notes, sources, etc
• Work as a group to get best answers and most
  points possible.

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Exam 2 on Friday, Mar 10

• Spastic dysarthria
• Ataxic dysarthria
• Hypokinetic dysarthria
• Hyperkinetic dysarthrias
• Basal ganglia control circuit
• Cerebellar control circuit

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Basal ganglia structures, function

• Caudate nucleus
• Putamen
• Globus pallidus
• Smooth out, process, and refine the
• exaggerated mvmts initially planned by pre-motor
  cortex
• Send refined version to motor strip

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Basal ganglia control circuit

• From premotor cortex
• To basal ganglia
• Limbic system,
• Cerebellum
• Brainstem
• To thalamus
• To primary motor cortex
• To lower motor neuron
• To muscle

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Basal ganglia disorders

• Hypokinetic (less motion)
• Diminished dopamine production from substantia
  nigra leads to
• Dimished range frequency of mvmt (bradykinesia)
  
• Characteristics of muscle movements
• Rigidity
• Reduced force
• Reduced range of movement
• Slow, but sometimes fast repetitive mvmts.
• Only dysarthria with fast rate DSC

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Watch hypokinetic case

• Tim Conway ????
• On the Carol Burnett Show ????
• Shuffling old man
• Barely able to speak above whisper
• No facial expression, repetitive sounds
• Minimal labial movement
• Very funny ?

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Review of DSCs for Hypokinetic Dysarthria

• Reduced vocal loudness, monoloudness
• Harsh-hoarse voice, perhaps whispered
• Slow speaking rate, yet
• Intermittent bursts of rapid-fire articulation
• Excessive, overly-long pauses
• Prolonged syllables
• Reduced phonation time
• Palilalia (compulsive, increasingly rapid
  repetition of word or phrase, then fades out)
• Dysfluenciesrepeated phonemes

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Hyperkinetic BG Disorders

• Hyperkinetic (extra motion)
• Chemical imbalances and idiopathic etiologies
  more than specific lesions
• Basic release of excess cortically-planned
  movement
• Results in involuntary, excess, undesirable,
  disruptive movements
• Abnormal, variable, unpredictable, weird,
  bizarre, rapid or slow, rhythmic or not

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Hyperkinetic movementsSlow Fast

• Athetosis
• Dystonia
• Spasmodic dysphonia
• Spasmodic torticollis
• Spasm
• Myoclonus
• Palatopharyngo-laryngeal
• Essential Tremor
• Organic voice
• Spasmodic dysphonia
• Dyskinesias

• Tics
• Chorea
• Ballism
• Spasm
• Hemifacial spasm
• Myoclonus
• Action
• Essential Tremor
• Organic voice
• Dyskinesias

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Athetosis slow, irregular, writhing, flowing
cant maintain body part in single position CP
category called dystonia if acquired

• Spasmodic torticollis (ST) aka cervical
  dystoniacervical neck muscles involved, but NOT
  CNs of speech
• Dysarthria is 2 to deviations of neck posture
  changes in vocal tract
• Reduced phonation time, rate of speech, pitch,
  but functionally intelligible
• Constant pain, disfiguring

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Myoclonusbrief contractions, repeating pattern

• Palatopharyngolaryngeal myoclonusrare, abrupt
  contractions of palate, pharyngeal walls,
  laryngeal muscles
• Might see neck twitching
• Unilateral or bilateral, rhythmic beats
• May open E-tube, clicks heard
• Phonation/respiration normal
• Maybe occasional hypernasality
• Good artic, maybe silent interruptions

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Choreaslow or fast, dancelike purposeless
movements

• Size, strength, symmetry normal
• Direction, rhythm abnormal
• Force range vary from normal to excess
• Some drooling, swallowing issues
• Sudden forced inspiration, expiration
• Articulatory imprecision
• Harsh, strained, strangled, or breathy voice
• Variable loudness, rate, prosody
• Brief voice stoppages

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Huntingtons Chorea

• Degenerative
• Inherited
• Onset middle age, 15-year course
• Cognitive deficits, dementia
• Inattentive, withdrawn, angry outbursts, suicidal
  thoughts
• Lurching walk, FM trouble, dysphagia, dysarthria,
  bedridden, mute, akinetic

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Sydenhams chorea

• Rare, affects children 5-15
• Idiopathic, but associated with strep
• Dysarthria of chorea
• Muscle clumsiness, discoordination, rapid
  involuntary limb movement
• Disease clears in 3-6 weeks, sometimes months
• Aka St. Vitus Dance
• Penicillin, but no other treatment

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Tardive dyskenisia (chorea)

• Choreic movements of face, mouth, neck, maybe
  limbs
• Antipsychotic drugs over months, years
• Tardive, as in appear late in course of drug use
• Stopping meds cannot reverse condition
• Lip smacking, tongue protrusions, chewing,
  grimacing, jaw movements
• Interferes with attempts at voluntary articulation

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Dystonia slower than chorea, wax/wane

• Slow rate of speech
• Disrupted direction and rhythm
• Range may be disrupted by oncoming contraction of
  muscle needed for speech
• Some alternating, excess loudness
• Artic problems, consonants, vowels,
• Harsh vocal quality
• Resonance usually okay

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Final thoughts-hyperkinetic

• CTs often normal, perhaps idiopathic
• Mostly chemical, toxic, metabolic
• Can affect single muscles or isolated small
  groups of muscles
• DSCs vary w/rhythm, rate, severity of
  unpredictable, involuntary movements
• Slowed rate may be primary or secondary
• Voice tremors, spasmodic dysphonia fit here
• Jaw, face, tongue frequently affected