Hypo+Hyperkinetic Dysarthria Profile

Hypokinetic Dysarthria

Damage to: Basal Ganglia

primary cause: parkinson’s

Increased rate of speech unique symptom!!

Hypokinetic: less motion: everything smalll!!

characteritics of parkinson’s

•Resting tremor

•Bradykinesia: slow, reduced range of movement

•Rigidity

•Spasticity

•Akinesia: delay in initiation of movements

•Postural reflexes

Motor symptoms of parkinson’s

•Tremor

•Bradykinesia (slow movement)

•Rigidity and freezing in place

•Stooped, shuffling gait

•Decreased arm swing when walking

•Difficulty arising from a chair

•Micrographia (small handwriting)

•Lack of facial expression (masked face)

•Slowed activities of daily living

•Postural instability

•Difficulty turning in bed

nonmotor symptoms:

•Diminished sense of smell

•Low voice volume

•Painful foot cramps

•Sleep disturbance

•Depression

•Constipation

•Drooling

•Increased sweating

•Urinary frequency/urgency

•Male erectile dysfunction

Speech characteristics of Hypokinetic Dysarthria

•Prosody: monopitch, reduced stress, and monoloudness most common

•Articulation: imprecise consonants, repeated phonemes, palilalia

•Phonation: harsh/breathy quality, aphonia, low pitch

•Respiration: sometimes noted

•Resonance: if present, mild hypernasality

•Significant individual differences

Key Evaluation Tasks for Hypokinetic Dysarthria

•Conversational speech and reading

—> Evoke many errors of prosody

—> Detect short rushes

•Speech alternate motion rates (AMRs)

—> Highlight articulation errors

•Vowel prolongations

—> Assess vocal quality

Most common deficit in parkinson’s:

Articulation: Imprecise consonants due to reduced range of motion in articulators; compunded by increased rate of speech

Treatment types: speech rate reduction, stretching, traditional articulation tasks

Phonation: parkinson’s

•Adduct vocal folds only partially or have harsh or breathy vocal quality

→ Combined with poor respiratory support; results in significantly reduced loudness

•Activities to more fully adducted position

—> Pushing and pulling procedure; hard glottal attack; voice amplifiers; instrumental biofeedback; Lee Silverman Voice Treatment

Respiration: parkinon’s

•.Shallow breath support can cause shortened phrases and decreased loudness

•Respiratory treatments

•. Speaking immediately on exhalation

•. Cueing for complete inhalation

•. Slow and controlled exhalation

•. Stop phonation early

•. Optimal breath group

Prosody

•Improved by slowing rate

•Intonation profiles

•Contrastive stress drills

•Chunking utterances into syntactic units

LVST LOUD

Summary: Hypokinetic Dysarthria

•Caused by processes that damage basal ganglia

•Closely associated with parkinsonism

•Idiopathic Parkinson’s disease most common cause

•Speech characteristics vary widely among individuals

•Treatment involves targeting articulatory precision, phonatory effort, and natural prosody

Hyperkinetic Dysarthria

DX: basal ganglia damage

•All produce involuntary movements that interfere with normal speech production

•“Hyperkinetic”: “too much movement”

•Each hyperkinetic movement disorder has its own involuntary motions

Causes of hyperkinetic Dysarthria

•movement disorders:

Chorea: Movement disorder distinguished by random involuntary movements of limbs, trunk, head, and neck. Choreic motions: Appear dancelike, smooth, and coordinated, but actually unpredictable, purposeless, and sometimes jerky or abrupt.

Huntington’s disease: progressive disorder

•Myoclonus: Hyperkinetic movement disorder distinguished by involuntary and brief contractions of part, whole, or group of muscles in same areaMuscle contractions may appear singly, in repeating irregular pattern, or rhythmically Can appear as part of many conditions: Kidney failure, epilepsy, cerebral anoxia, strokes, traumatic head injury, and progressive neurologic diseases

•Tics

•Essential tremor

•Dystonia

•Other causes: degenerative diseases, traumatic head injury, stroke, and infections

Speech Characteristics of Hyperkinetic Dysarthria of Chorea

•Degree of chorea influences how severely speech is affected

•Distinctive speech errors include:

•Prolonged intervals between syllables and words; variable speech rate; inappropriate silences; excess loudness variations; prolonged phonemes; rapid, brief inhalations or exhalations of air; voice stoppages; and intermittent breathy voice quality

Key Evaluation Tasks for Hyperkinetic Dysarthria

•Vowel prolongation

•Alternate motion rates (AMRs)

•Conversational speech and reading

•Careful observation of associated involuntary movements

behavioral treatment of huntington’s

•Early stages: maintain normal prosody and optimal rate

•Middle stages: rate of speech, rhythmic breathing and relaxation, speaking on exhalation

•Progressive dementia: work closely with caregivers

•Sensory tricks: idiosyncratic strategies that can suppress involuntary movement for a time

•Bite blocks: to stabilize jaw during speech

•Easy onset of phonation

Summary of hyperkinetic dysarthria

•Collection of separate dysarthrias, each associated with hyperkinetic movement disorder

•Caused by involuntary movements interfering with voluntary attempts at speech

•Effects of each disorder on speech production vary

•Many associated with damage to basal ganglia

•Most common treatment is drug-based