1
Q
hyperkinetic dysarthria is what level of motor organization
A
extrapyramidal
2
Q
t/f abnormal involuntary movement are often called hyperkinesia
A
true
3
Q
what are the 3 main cerebral structures of extrapyramidal level
A
basal ganglia
subthalamic nucleus
substantia nigra
4
Q
hyperkinetic dysarthria symptoms
A
- involuntary, unprogrammed, extra movements
- occurs in any muscles or group of muscles
- the inhibitory nature of extrapyramidal level is inhibited
- result from a failure of extrapyramidal level to inhibit the extra impulses from the cortex
5
Q
3 general classifications of hyperkinetic dysarthria
A
quick, slow, tremor
6
Q
what is QUICK hyperkinetic dysarthria
A
- quick, unsustained, involuntary movements
- myoclonus: FASTEST
- tourette’s (tics): FAST
- chorea: SLOWER than tics and clonus
7
Q
myoclonus (quick hyper)
A
- FASTEST hyperkinetic disorder
- characterized by involuntary single or repetitive brief jerks of a body part
- sudden large transient “shock like” contraction –> can be momentarily postponed/reduced
- involuntary, irregular jerks in chest, larynx, VP, lips, tongue and jaw
- irretractable hiccups
- idiopathic or brain/spinal injury; meds reaction
8
Q
myoclonus: essential assessment
A
conversational speech is usually unaffected
respiration, phonation and vowels are unprogrammed
palatal myoclonus (resonance) –> tends to go away during sleep
AMR/SMR: fleeting interruptions
9
Q
Tourette’s (tics) (quick hyper)
A
- involuntary, compulsive, rapid, nonrhythmic movement –> can be postponed but not suppressed
- postponing can make worst
- rapid and arrhythmic tic movements
- odd vocalizations
- facial grimaces
- slower palatal myoclonus (resonance)
- etiology is unknown
10
Q
Tourette’s (tics): essential assessment
A
Type of quick hyperdysartheira
- simple phonic tics (noises) –> like sniffing, throat clearing, barking
- complex phonic tics (linguistically meaningful) –> coprolalia (profanity), echolalia, palilialia, loud talking
11
Q
Chorea (quick hyper)
A
- quick rapid involuntary, irregular, fleeting, unpredictable, non stereotyped movement
- contraction than release = smoother dance-like movement
- can occur at rest but increases with voluntary movement
12
Q
t/f Sydenham’s chorea is not progressive
A
true
13
Q
two common type of chorea
A
- sydenham’s –> childhood fever
- huntington’s chorea –> progressive genetic with dementia
14
Q
Chorea essential assessment
A
- **every aspect of speech is affected
- highly variable, can not predict
- respiration –> bursts of loudness
- phonation –> roughness, strain-strangled, low pitch
- articulation –> irregular breakdown, variable rate, prolonged phonemes
- AMR/SMR –> slow, unpredictable
- vowel –> short, irregular pitch
15
Q
Slow hyperkinetic dysarthria
A
- Athetosis –> slow
- Dystonia –> slowest
16
Q
Athetosis - slow hyperkinetic dysarthria
A
- involuntary, irregular, unpredictable, non-stereotyped movements interfering with all skilled movement –> slightly slower than chorea
- stiff, high muscle tone, hypercontraction
- fluctuating b/w flaccid spastic tone, distal movement, tremors increase with stress
- shallow noisy stridor breathing
- facial grimacing
- etiology –> early onset from birth trauma and anoxia OR later onset –> stroke; tumor in basal ganglia
17
Q
Athetosis - slow hyperkinetic dysarthria –> essential asessment
A
conversational speech
- bursts of loudness
- groaning voice, explosive, phonation arrest
- lack of coordination of voicing and articulation
- amr/smr –> unpredictable
- vowel –> reduced duration, irregular pitch
18
Q
Dystonia - slow hyperkinetic dysarthria
A
- involuntary, random movements interfere with all skilled movements; action-induced (not seen at rest); contractions build up slowly; reduced strength
- primary dystonia is hereditary; secondary is brain trauma or inflammation (encephalitis)
19
Q
3 types of dystonia
A
- generalized
- segmental
- isolated/focal
20
Q
generalized dystonia
A
generalized –> whole body; starts in childhood with foot turning in
- symptoms improve with sensory tricks such as touching chin,face or pencil b/w teeth during speech (more of a sensory feedback issue than psychological)
- breathing irregular, abnormal posture
- larynx - indirect exam –> VFs appear normal; endoscopy –> reveals involuntary hyperadd/abduction during speech
- involuntary movements in velopharynx and lips, tongue jaw
21
Q
segmental dystonia
A
- segmental –> 2+ structures; starts as adult; clenching in eyes+lips/jaw = meige; clenching in jaw+tongue = oromandibular meige
22
Q
isolated/focal dystonia
A
- isolated/focal –> one area, starts as adult
types: spasmodic dysphonia (laryngeal dystonia; most common); blepharospasm (difficult to open eyes); torticollis (humped to one side); limb dystonia (writers cramps) - females are more affected
- action induced –> speaking; symptoms emerge during connected speech
- improves with laugh, singing, whisper, etc.
23
Q
generalized dystonia - essential assessment
A
- bursts of loudness
- rough, strangled voice
- breathy
- irregular articulatory breakdown with prolonged phonemes
- amr/smr: reduced duration
- vowels are reduced, variability in pitch
24
Q
two types of spasmodic dystonia
A
adductor ->
- 80-90% of cases
- larynx stiffens and forcefully adducts the VFs
- hyperadduction including glottic closure increases subglottic pressure
- spasms occur on voiced sounds
- strained strangled voice
- effortful phonation
abductor –>
- spasms in posterior cricoarytenoid muscles
- involuntary abduct VFs
- occurs on voiceless speech sounds
- prolonged voiceless sounds (prolonged H—-arry)
- breathy voice
25
differential diagnosis for adductor vs abductor spasmodic dysphonia
adductor --> spasms occur on voiced speech sounds (difficult to say aunt annie's alligator)
abductor --> prolonged voiceless sounds (difficult to say H----ary; h-----at)
26
hyperkinetic dysarthria - tardive dyskinesia and tremors
results from exposure to neuroleptic drugs --> usually goes away after stopping meds
preventable
types:
tardive dyskinesia --> akathisia, difficulty not moving; occurs during sleep and rest; smacking of lips, tongue protrusion, rapid, involuntary jerking/slow movements
27
what is akathisia
restlessness; quivering
seen in tardive dyskinesia
28
slow hyperkinetic dysarthria - tremors - types
29
tremors affecting speech or motor control
rest tremor --> no
action/kinetic --> yes; connected speech
postural --> yes; sustained sounds
isometric --> yes; motor strength
physiological tremor --> yes; connected speech and sustained sounds
30
what is an essential tremor
stand alone tremor with no other issues
mild = change in F0 and loudness; rhythmic changes in pitch and loudness
moderate to severe = connected speech
severe = voice arrests
31
what is a tremor as a symptoms
tremors are symptoms of PD, CP, ALS, MS, etc
32
what is anarthria
absence of speech due to loss of movement supporting speech production
occurs with brainstem stroke
33
what is mutism
absence of speech that is not anarthria
2 types akinetic and cerebellar
akinetic = happens due to diminished motivation
cerebellar = post brain surgery to remove tumor
34
locked-in syndrome
occurs due to brainstem stroke
anarthria is accompanied by total immobility of the body except eye movement and blinking
35
apraxia - cortical level
insert screenshot
- breakdown in programming motor movement
- individual muscles are good
- affect any type of learned motor function
36
apraxia - cortical level - etiology
- stroke or acquired brain injuries
- dementia
- PD and HD
37
ideomotor apraxia
incorrect initiation of gestures and motor planning, sequencing, planning, groping
38
ideational apraxia
incorrect use of items; seen in dementia
39
t/f apraxia of speech can be motor component of aphasia
true -->
aphasia may be primary disorder - usually Broca's
important to assess language as well
40
apraxia - larynx assessment
perseverate, groping errors at adduction (onset of phonation)
41
apraxia - essential assessment
- type of errors is relatively consistent
- usually more difficult when they repeat the model
- altered prosody; aphonic
- articulation - struggles initiating speech; errors increase with longer words (thick, thicken, thickening), intrusive "schwa"
- SMR: irregular articulatory breakdowns; MORE impaired than AMR
- AMR: more difficult on complex sequence and repeat words of increasing length
- *deterioration of accuracy with repeating words of increasing length
42
nonverbal oral movement apraxia assessment
disorder of planning and executing nonspeech oral motor movements
- cough, smile, blow, puffy cheeks, protrude tongue
- assess spontaneous and volitional speech
43
automatic speech movements assessment for apraxia
automatic speech movements
- count 1-30
- days of week
- sing HBD (singing is usually easier)
44
volitional speech in apraxia
The problem lies with the inability to plan the movements of articulators for the purposes of volitional (on command) speech, thus it is often referred to as a “motor planning disorder.” The term volitional in the context of Apraxia means that the child has difficulty making speech movements when he/she is consciously aware of trying to do so or in instances
45
differential diagnosis of dysarthria and apraxia
46
t/f when apraxia co-occurs with dysarthria there is diffuclty with sequencing and intiaiting movement; concominant motor weakness
true
47
why assess apraxia at SW level, multisyllabic, sentence level
increased complexity = greater breakdown
pot --> potter --> pottery
48
t/f initiating motor planning is difficult in apraxia
true
49
framework for therapy
motor learning theory --> work on meaningful linguistic units; feedback; self-correction; random practice
cognitive load --> give one stimulus at a time; work on several areas in one session; may motivate, might be too hard, must monitor performance to determine
50
t/f chunking (phrase modiciation) is important for breath support
true
51
t/f to facilitate respiration like increase/reduce loudness patient is prompted to take deeper breaths and then start phonation after inhale
true
52
t/f to facilitate phonation semi-occluded vocal tract exercises generate back pressure and efficient VF vibration
true
53
t/f to facilitate resonance by increasing resonance focusing on oral resonance; bark like a seal or blowing exercises
true
54
t/f apraxia is more a language based treatment than dysarthria
true
55
management of apraxia of speech guidelines
56
apraxia programs
eight step continuum -> watch, listen, say it with me
PROMPTS
Motor Speech
flashcards
Decks in class (3)
# Cards
