ch 5/6 hypo/hyper kinesia

Hypokinetic Movement Disorders

  • Definition of Hypokinesia:

    • Refers to too little voluntary movement.

  • Definition of Hyperkinesia:

    • Refers to too much involuntary movement.

  • Key Functions Benefiting from Non-English Movements:

    • Posture enhancement

    • Maintenance of normal tone

    • Initiation of volitional movement

    • Learning of new movements

Impact of Basal Ganglia Dysfunction

  • Symptoms Associated with Dysfunction:

    • Abnormal tone

    • Abnormal posture

    • Extraneous motor movements

  • Importance of Basal Ganglia:

    • Vital for regulating movement smoothly

    • Involvement in hypokinesia and hyperkinesia due to its regulatory role

    • Potential coexistence of both conditions

Parkison's Disease

  • Overview of Parkinson's Disease:

    • Most common disease affecting the basal ganglia

    • Related to the degeneration of substantia nigra which produces dopamine.

  • Consequences of Dopamine Deficiency:

    • Leads to basal ganglia dysfunction, manifesting as hypokinesia and possibly tremors.

  • Medication Treatment:

    • Use of Levodopa, commercial name Sinemet

    • Initial effectiveness, followed by reduced efficacy over time.

    • Patient presentation varies by medication cycle leading to changing symptoms between hypokinesia and hyperkinesia.

  • Visual Diagnosis:

    • Notable cases like Michael J. Fox showcase the on-off effects related to medication.

Clinical Presentation of Symptoms

  • Gait in Parkinson's Disease:

    • Reduced range of motion and stiff posture

    • Lack of arm movement when walking

  • Tremor at Rest:

    • Typical characteristic (4-6 Hz)

    • Quick tremors usually observed in hands, fingers, and potentially vocal cords.

  • Rigidity:

    • Cogwheel Rigidity:

    • Contrast with spasticity; people with rigidity don't resist movement as spastics do but are tight and stiff in motion.

  • Speech Implications:

    • Hypokinetic Dysarthria Characteristics:

    • Monopitch, monoloudness, reduced stress with appropriate silences

    • Short rushes of speech

    • Breathiness in voice

    • Symptoms lead to difficulty in:

    • Initiating speech (bradykinesia)

    • Achieving proper articulation and clarity.

    • Patients may describe their voice as weak or quiet.

Impact on Daily Life and Functioning

  • Social Interaction Effects:

    • Reduced facial affect known as masked facial affect

    • Lack of animation and reduced expressiveness can affect social dynamics.

  • Writing Changes:

    • Micrographia: progressively smaller handwriting as disease advances.

    • Deterioration in repetitive motor tasks with decreasing speed and amplitude.

  • Awareness and Perception:

    • Patients often lack insight about reduced animation or expressiveness.

    • Family members often observe changes first, noting they are less animated.

Diagnosis and Evaluation

  • Oral Motor Examination:

    • Visual assessment may not reveal hypokinesia until movement is elicited.

    • Connected speech assessments help reveal subtle deficits not apparent at rest.

  • Assessment Techniques:

    • Use of sustained vowel tasks to draw out vocal fold issues

    • Examination of repetition and elicitation of speech tasks to gauge ability.

Therapeutic Approaches

  • Working on Intent in Therapy:

    • Encouraging patients to speak with intent which can enhance strength, loudness, and clarity.

    • Involves altering motor plans to ensure that the basal ganglia's impact accommodates for motor planning.

  • Feedback and Adjustment:

    • Recording sessions to assist patients in understanding perceived loudness vs. actual loudness in their speech patterns.

Hyperkinetic Dysarthria

  • Definitions and Characteristics:

    • Hyperkinetic dysarthria arises from extra involuntary movements (hyperkinesias).

    • Observed through involuntary movements affecting speech.

  • Common Types of Hyperkinesia:

    • Tardive dyskinesia: long-term medication effects

    • Myoclonus: quick involuntary jerks in body parts

    • Chorea: significant and noticeable dance-like movements affecting speech

  • Description of Dysarthria due to Hyperkinesia:

    • Characterized by pauses and interruptions in speech as movements impact fluency.

Conclusion

  • Understanding basal ganglia functionality is crucial in recognizing and managing both hypokinetic and hyperkinetic dysarthrias. Observational assessments alongside therapeutic management are vital to improving patient outcomes.