Hyperkinetic dysarthria is a type of motor speech disorder associated with involuntary movements that affect the muscles involved in speech production. These movements are due to abnormalities in the basal ganglia or related neural pathways, which are involved in regulating motor control and ensuring smooth, coordinated movements. Here are some key aspects of hyperkinetic dysarthria: Causes Hyperkinetic dysarthria can arise from various neurological conditions that affect the basal ganglia or its connections. Some common causes include: Huntington's disease: A genetic disorder that causes the progressive breakdown of nerve cells in the brain. Tourette syndrome: A condition characterized by repetitive, involuntary movements and vocalizations (tics). Dystonia: A movement disorder causing involuntary muscle contractions leading to twisting and repetitive movements or abnormal postures. Chorea: Involuntary, rapid, and irregular movements, often seen in conditions like Sydenham's chorea or as a side effect of certain medications. Medications: Certain drugs, such as antipsychotics, can cause tardive dyskinesia, which includes involuntary movements and can affect speech. Wilson's disease: A rare genetic disorder leading to copper accumulation in the brain, liver, and other tissues. Symptoms The symptoms of hyperkinetic dysarthria are characterized by various involuntary movements that can disrupt normal speech patterns. These symptoms may include: Irregular articulatory breakdowns: Inconsistent and unpredictable speech errors. Variable speech rate: Fluctuations in the speed of speech, with sudden accelerations or decelerations. Voice tremor: Rhythmic fluctuations in pitch and loudness. Sudden changes in loudness or pitch: Abrupt shifts that are involuntary. Involuntary movements: These may include tics, dystonic movements, chorea, or myoclonus affecting the face, jaw, tongue, or respiratory muscles. Diagnosis Diagnosis of hyperkinetic dysarthria involves several steps: Clinical evaluation: A neurologist or speech-language pathologist will assess the patient's speech characteristics, medical history, and neurological status. Observation of involuntary movements: Identifying the type, frequency, and pattern of movements can help determine the underlying cause. Neuroimaging: MRI or CT scans to look for structural abnormalities in the brain. Genetic testing: Especially if conditions like Huntington's disease or Wilson's disease are suspected. Treatment Treatment for hyperkinetic dysarthria focuses on managing the underlying condition and improving speech function. Approaches may include: Medications: Drugs to manage the underlying neurological condition or reduce involuntary movements. For example, anticholinergic medications, muscle relaxants, or medications specific to the disorder (like tetrabenazine for Huntington's disease). Speech therapy: Techniques to improve speech clarity and communication, such as: Rate control: Strategies to slow down speec

1. HYPERKINETIC DYSARTHRIA

2. Hyperkinetic Dysarthria
 Associated with diseases or damage to
basal ganglia control circuit.
 Can manifest in all speech sub system but
has prominent effects on prosody.
 This type of dysarthria is caused due to
abnormal movements that can occur to
different parts of body. Deviant speech
characteristics are product of abnormal
involuntary movements that disturb rhythm
and rate of motor activities

3. Causes of Hyperkinetic
movement
 An imbalance of either dopamine or
acetylcholine in the basal ganglia

4. Cont’d
 In hyper kinetic ,movements are extra/excess and always
involuntry.These movement disorder disappear during
sleep and increase with stimulation.
Some major type of hyperkinesias are;
 Chorea
 Dyskinesia
 Tics disorder
 Ballism
 Myoclonus
 Athetosis
 Dystonia

5. CHOREA
 It is characterized by rapid, random,
purposeless, involuntary, irregular movement of
a body part i.e. hand, head, face, tongue, legs
diaphragm etc.
 It may be present at rest, during sustained
posture and voluntary movement.
 Chorea can be cause by inflammatory for
example (sydenham’s chorea) or degenerative
(Huntington chorea or toxic conditions wilson’s
disease, dopaminergic medications ,strokes
and during pregnancy etc.

6.  Chorea: As dancelike, because the
movements appear to be smooth and
coordinated, but they are actually
unpredictable and purposeless

7. Speech Characteristic in
Chorea
 Voluntary movement of all muscles are susceptible to interference
from involuntary movements so all of processes of speech are
affected.
Phonation/
respiration
Sudden forced inspiration expiration.voice stoppage,strained harsh voice
quality, loudness variation, transient breathiness
Resonance Hyper nasality (intermittent)
Articulation Distortion ,slow and irregular AMRs
Prosody Prolonged intervals and phonemes, variable rate, inappropriate silences,
variable pattern of stress
Physical Quick, unpattrened involuntary head/neck, jaw, face, tongue, palate,
pharyngeal, laryngeal, thoracic-abdominal movements at rest, during
sustained postures and movement .Dysphagia
Patient’s
complaint
inability to “get speech out,” involuntary orofacial movements Chewing
and swallowing problems

8. DYSKINESIA
 It is a general term used to refer to abnormal
,involuntary movements. It sometimes refer to
abnormal movements that are restricted to certain
body parts.
Oro facial dyskinesia
 Involuntary movements of mouth, face, tongue and
jaw that can occur without hyperkinesias elsewhere
in the body. This can occur due to prolonged use of
psychotic medicine (Tardive dyskinesia ) or can be
hereditary .

9.  Tardive dyskinesia
a. Means late appearing involuntary
movements
b. Can cause choreic movement to the
face, mouth, and neck; lip smacking,
tongue protrusions, chewing motions and
grimacing

10.  Akathisia
 A subjective sense of motor
restlessness and is often confused with
psychotic agitation. It may be
characterized by overt restlessness like
shifting position, rubbing scalp or limbs.

11. Myoclonus
a. Involuntary and brief contractions of a part
of a muscle, a whole muscle or a group of
muscles in the same area of the body. The
contractions may occur singly, or in a
repeating irregular pattern or rhythmically
b. It can be found in cases of many medical
conditions: kidney failure, epilepsy, anoxia,
strokes, TBI, Alzheimer

12. Focal myoclonus (specific muscles or body
parts affected)
a. Hemifacial spasm (spasms around the
eye then spread to the entire face). It is a
common disorder and is painless but
causes embarrassment

13. b. Palatopharyngolaryngeal myoclonus:
 Rare; the contractions are fairly
rhythmic and occur about 1-3 times
a second
 Typical causes : brainstem strokes,
cerebellar lesions, encephalitis, and
tumors

14. Tic disorder
a. A tic is a rapid movement that can be
controlled voluntarily for a certain period
of time but is eventually performed
because of compulsive desire to do so
b. There are motor (eye blinking and
complex hand gestures and body
movements: jumping, kicking) and vocal
tics (throat clearing, shouting)

15. c. Stress increases frequency of tic
d. Etiology: mild brain damage, toxic
reactions, but no identifiable CNS
disorder in most cases
e. Idiopathic tics occur in about 10-12% of
the children in the form of excessive
eyeblinks for less than a month to
about one year, after which most
disappear

16. Gilles de la Tourette syndrome
a. The development of symptoms before
age 14
b. The slow appearance and
disappearance of symptoms
c. Tic behaviors that change and evolve
over time

17. e. Minor neurological abnormalities.
f. Causes: supersensitive dopamine
receptors in the striatum
g. Genetic link; all show symptoms by
age 10; prevalence 3/100,000; boys
more affected
h. Vocal tics include

18. Essential tremor (organic tremor)
sometimes called familial tremor
a. Most common hyperkinetic movement
disorder (300/100,000)
b. Benign movement disorder that begins
as a tremulous movement; action
tremor affected by stress and fatigue;
progression is slow

19. c. Appears to be idiopathic; beginning at
age 40-50; genetic
d. Mostly affects hands, arms, or head;
e. has been associated with Hemifacial
spasm and focal dystonia

20. BALLISM
 Rare hyperkinetic disorder characterized by involuntary , wide-
amplitude, vigorous & flailing movement of limbs ,when
unilateral known as hemiballism
 Hemiballism usually remit spontaneously after a period of
days—months and can be treated successfully with meds
 Facial muscles may be affected
 Least important hyperkinetic disorder with regard to occurrence
of hyperkinetic dysarthria
 Lesion in subthalmic nucleus

21. ATHETOSIS
 Rare disorder, mostly seen with putamen
involvement characterized by an inability to maintain
a body part in a single position due to Slow
hyperkinetic disorder characterized by continuous,
purposeless , slow movements that tend to flow one
into another
 Muscles of face , neck & tongue leading to facial
grimacing , writhing of tongue & problems with
speaking & swallowing
 Athetotic and choreicform movements sometimes
combine with one another and known as
choreoathetosis

22. Dystonia
a. Abnormal muscle tone causing
involuntary, prolonged muscle contractions
that interfere with normal movement or
posture; may affect a single group of
muscles or multiple groups
b. Movement is more sustained and slower
than chorea

23. c. Dystonia is not necessarily
constant and may appear/disappear
during a movement (waxing and
waning). Severe cases: contractions
can be constant resulting in painful,
fixed contractions of affected body
part

24. Types of dystonia
 Focal dystonia:
 Involves only one body part: hand, tongue, etc
 Segmental dystonia
 Affects two or more parts of body: face and jaw
 Hemidystonia:
 Two or more body parts on same side of body
 Generalized dystonia:
 involve all four limbs

25. Etiologies of Conditions where
dystonia is the primary symptom
a. Spasmodic torticollis: characterized by
intermittent (sometimes no contraction is
evident) dystonic contractions of the neck
muscles which result in an involuntary
turning of the head; the head also usually
tilts upward as a result of the
contractions; stress and anxiety affects
frequency; speech is slow in rate, mildly
reduced in intelligibility and lower in pitch
for females

26. c. Meige’s syndrome: Rare idiopathic
disease; characterized by repetitive eye
blinking and abnormal facial movement
that are often dystonic in nature; appears
in early middle age and gets progressively
worse such that functional vision is
impossible.
When the jaw, tongue, mouth and neck are
sufficiently strong they cause
hyperkinetic. D

27. d. Spasmodic dysphonia: Not always classified
as a dystonia (sometime essential tremor);
characterized by involuntary vocal fold
movements during phonation. Unlike focal
dystonia SD does not have a gradual waxing and
waning but are vigorous and active
Expressed as adductor (vocal folds either
constantly adducted giving a strained quality or
intermittently giving a jerky tight quality or a
shaky quality) or abductor vocal folds are
involuntarily abducted resulting in moments of
breathiness or aphonia

28. Speech characteristics
Phonation/respiration Strained-harsh voice quality, voice stoppages, audible
inspiration, excess loudness variations, alternation
loudness, voice tremor
Resonance hypernasality
Articulation Distorted vowels, irregular articulatory breakdowns, slow
irregular AMRs
Prosody Inappropriate silences, excess loudness variations,
excessive-inefficient-variable patters of stress
Physical Relatively slow, waxing and waning head-neck, jaw,
face, tongue, palate, pharyngeal, laryngeal, thoracic-
abdominal movements Present at rest, during sustained
postures and movement, but sometimes only during
speech, dysphagia
Patient’s complaints Effortful speech, inability to “get speech out, “involuntary
orofacial movements Chewing and swallowing problems
(food “sticks” in throat)

29. How can we distinguish speech
characteristics of dystonia from
chorea?
 More errors of
articulation in
dystonia than in
chorea
 Imprecise
consonants,
distorted vowels
and irregular
articulatory
breakdown
 Chorea displayed
more prosodic
errors than those
with dystonia
 Generally dystonia
had more
articulatory
problems and
chorea has more
prosodic errors

30. Management
Mostly medication that suppress the
involuntary movements
Choreic and tic: Haloperidol
Myoclonic jerks clonazepam or valproic
SD and spasmodic torticollis: Botox (most
effective)

31.  Behavioral treatment on trial period for those
not too severely affected:
a. Locate sensory tricks
 Neck dystonia (Cervical dystonia or spasmodic
torticollis)
Touching the chin, back of the head, neck. cheek
or upper face gently can help with neck dystonia
(torticollis)
 The touch is usually (but not always) more effective
on the side of the head with the dystonia.
 Reclining or sitting with head support.
 Resting the head against a wall..
 Looking at a fixed point or into a mirror

32. Eye dystonia
 Use a tight baseball cap, hair band around the forehead.
 Put your head back – close your eyes, or look down.
 Go in a dark place and try to relax.
 Gum chewing, whistling, humming, talking, sucking on a
straw or singing sometimes keep the eyes open in order
to do activities.
 Reading aloud.
 Looking down (some people find gardening or cooking
helpful because they involve looking down).

33. Voice dystonia (Laryngeal
dystonia or spasmodic dysphonia)
 Vocal exercise (humming, speaking slowly, reciting
nursery rhymes)
 Volume control (talking softly or loudly)
 Feeling relaxed
 Breathing deeper breaths, exhaling before
speaking, not holding onto the breath
 Environmental control (talking one-on-one, not
being interrupted)
 Using voice early in the morning
 Physical exercise (need to check exercise is
appropriate with doctor before trying)

34.  Mouth or jaw (Oromandibular) dystonia
 Activities like speaking and chewing
reduce symptoms (for others they can
make it worse)
 For jaw spasms – a toothpick, chewing
gum, or sucking a boiled sweet has helped
some people.
 Bite blocks (focal dystonic jaw movements
to stabilize the jaw during speech (seems
to suppress dystonic jaw movements)
 If the mouth is dry, saliva replacement
gel use. This is available on prescription
either via the doctor or dentist.

35.  Relaxation therapy and related
treatment
1. Mental imagery
2. Habit reversal
d. Easy onset of phonation for
laryngeal involuntary movements