Motor Speech Disorders Final Exam

Exam #3: Chapters 9-11

Where is the site of lesion for hyperkinetic dysarthria?

basal ganglia control circuit

What does “hyperkinetic” mean?

too much movement

Why don’t we fully understand the basal ganglia?

the basal ganglia has a complex array of interconnections among themselves and many parts of the brain

Name some disorders that can cause hyperkinetic dysarthria.

Chorea, Myoclonus, Tics, Essential tremor, Dystonia, degenerative diseases, TBI, CVA, infection

What is Huntington’s Disease?

-a genetic disease characterized by involuntary twitching movements and eventual dementia.

-a progressive inherited disorder; children of an affected individual have 50% chance of inheriting the disorder

-onset of the disorder is typically middle age

Which components of speech will be affected by hyperkinetic movements?

phonation, respiration, resonance, articulation and prosody (ALL)

Why might you see unexpected inhalation and exhalations of air in chorea?

due to the unpredictable nature of muscle movements; chorea affects prosody

What is the most common hyperkinetic movement disorder?

essential tremor

How might we distinguish essential tremor from parkinsonism tremor?

essential tremor is:
- faster than a parkinsonism tremor
- an action tremor that disappears during movement
- not accompanied by other neurolgical symptoms, such as Bradykinesia or dementia

parkinsonism tremor:
- increases with movement
- slower
- accompanied by other neurological symptoms

Discuss dystonia.

hyperkinetic movement disorder of muscle tone
- causes involuntary, prolonged muscle contractions that interfere with normal movement or posture
- contractions are slower and demonstrate a more sustained quality
- contractions wax and wane during ongoing movement
- sensory tricks may provide some temporary relief

What are some disorders where dystonia might be a primary symptom?

- oromandibular dystonia: impacts the jaw, lips, and tongue; rare disorder

- spasmodic torticollis: contractions of the neck muscles that result in involuntary turning of the head

- drug-induced (tardive) dystonia: most of the contractions appear near the face and mouth, resulting in grimacing and sustained tongue protrusions

- meige syndrome: prominent symptoms include repetitive eye blinking and abnormal facial movements

- spasmodic dysphonia: involuntary vocal fold movements during phonation, muscle contractions are vigorous, majority of patients demonstrate contractions of the adductors that when sustained, contribute to strained-strangled vocal quality

What is the most prominent speech error in dystonia?

Articulation errors: imprecise consonants, distorted vowels, irregular articulatory breakdowns, prolonged phonemes

What are some key evaluation tasks for hyperkinetic dysarthria?

- vowel prolongation
- alternate motion rates (AMRs)
- conversational speech and reading
- careful observation of associated involuntary movements

What is the most common treatment for hyperkinetic dysarthria?

treatments are varied given the conditions are highly variable: medical (pharmacologic interventions and Deep brain stimulation DBS) and behavioral interventions

How does mixed dysarthria occur?

occurs when neurologic damage extends into two or more portions of the motor system
- damage may occur from one single incident or be a culmination of many events

Discuss mixed dysarthria

combination of two or more dysarthrias
- combination of characteristics found in the single (pure) dysarthrias
- mixed dysarthria is an extremely common diagnosis

Give some examples of combinations of neurological sites of lesion that might result in mixed dysarthria and name the dysarthria type.

Stroke, tumor, and TBI often cross topographical and structural neurologic boundaries
- crosses anatomical boundaries and thus affecting various components of the motor system

Discuss Multiple Sclerosis and its neurological site of lesion.

disease of the central nervous system characterized by the demyelination (deterioration of the myelin sheath) of nerve fibers, with episodes of neurologic dysfunction (exacerbation) followed by recovery (remission)

What is the most common type of mixed dysarthria in MS?

ataxic-spastic

What is Multisystems Atrophy?

collective term for a group of degenerative disorders. May include parkinsonism symptoms, shy-drager syndrome, progressive supranuclear palsy, olivopontocerebellar atrophy

What is Wilson’s Disease?

rare hereditary disease preventing the normal metabolism of dietary copper
- pharmacological treatments are successful in treatment
- dysarthria is one of the earliest diagnostic signs

What is the most common type of mixed dysarthria associated with Wilson’s Disease?

hypokinetic dysarthria symptoms are most prominent in conjunction with ataxic and spastic dysarthrias

What is Friedreich’s Ataxia?

a rare inherited disease that causes progressive damage to the nervous system resulting in symptoms ranging from muscle weakness and speech problems to heart disease
- neuron degeneration of the cerebellum, brain stem, and spinal cord
- untreatable within 10-15 years post diagnosis
- ataxic-spastic dysarthria is the most prevalent mixed dysarthria noted

What is amyotrophic lateral sclerosis (ALS)?

progressive degenerative disorder of motor neurons in the spinal cord and brainstem with rapid decline
- unknown etiology
- median survival rate is 2.2 years
- between 75-95% are unable to speak at the time of their death

How do you proceed with treating mixed dysarthria? Which dysarthria do you treat first?

• In general, treat the component that is most affecting speech production.
• When all elements are affecting speech production equally, sequence treatment based on how the different components of speech support each other.
• For example respiration would be addressed first because it is the foundation for all other speech components. Without adequate respiratory support, resonation, phonation, articulation, and prosody are all impaired, to some degree.

How do we sequence the speech components based on Dworkin’s (1991) work?

suggested that when elements of a mixed dysarthria affect speech production equally, the SLP should treat in following order:
respiration -> resonation -> phonation -> articulation -> prosody

rationale: prior speech components are the foundation for the other components
- if multiple issues, treat the most severe first