lecture dysarthria

1. Hyperkinetic
Dysarthria
PRESENTED BY:
HAFIZA SHABNUM NOOR
SENIOR LECTURER (RCRAHS, RIU, LAHORE )
MS-SLP (RIU), BS-SLP (UHS)
EX-CONSULTANT SPEECH AND LANGUAGE PATHOLOGIST , CHILDREN HOSPITAL
FAISALABAD
EX. LECTURER MULTAN MEDICAL AND DENTAL COLLEGE
MULTAN

2. Hyperkinetic
dysarthrias
 Hyperkinetic dysarthria implies
pathologies in the basal ganglia, related
portion of the extrapyramidal system,
or sometimes the cerebellar control
circuit

3. Cont.
 The diversity of lesion associated with
hyperkinetic dysarthria (and movement
disorder in general) reflects the
diversity of abnormal movements that
may occur in CNS disease and our
limited understanding of their anatomy
and pathophysiology.

4. Cause of
hyperkinetic
movement
 An imbalance of either dopamine or
acetylcholine in the basal ganglia
 Read page: 192 &193
 Table: 8.1

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

6. Disorders
that cause
chorea
Sydenham’s chorea/ chorea minor
Stroke
Tardive dyskinesia
Anoxia
Carbon monoxide

7. Characteristic
s of
Sydenham’s
Chorea
Rare disorder that affects children between the age
of 5-15
Called St. Vitrus Dance
Associated with rheumatic fever
May be caused by hypersensitive dopamine
receptors or too much dopamine.
40% of children exhibit hyperkinetic
Usually disappears in 3-4 month. w/oTX

8. Chorea in stroke
 A. Hemichorea because the involuntary movements occur only on the contralateral
side of the body to the site of the lesion (If damage is restricted to only one side of
the brain usually affecting the basal ganglia or thalamus.
 B. Hemiballism (caused by damage to the subthalamic nucleus near the substantia
nigra) characterized by wild and violent involuntary movements of the limbs
contralateral to the lesion; usually remit spontaneously after a period of days –
months; can be treated successfully with meds

9. Dyskinesias
 Dyskinesia is a general term used to refer to abnormal,
involuntary movements, regardless of etiology.
 Orofacial dyskinesias are involuntary orofacial movements that
can occur without hyperkinesias elsewhere in the body. Most
hereditary and acquired conditions that cause orofacial
dyskinesias are associated with basal ganglia abnormalities.
 Orofacial dyskinesias are a common side effect of prolonged
use of antipsychotic drugs, a condition known as tardive
dyskinesia (TD)

10. Tardive
dyskinesia
Means late appearing involuntary movements
Can cause choreic movement to the face,
mouth, and neck; lip smacking, tongue
protrusions, chewing motions and grimacing
Caused by taking antipsychotic
Women and elderly are more susceptible

11. Factors
affecting
speech in
chorea
Chorea can affect many muscle groups
The voluntary movement of all the muscles are
susceptible to interference from the involuntary
movements so all of the processes of speech are
affected. (This is in contrast to other dysarthria
where one or two processes are primarily affected

12. Cont.
The movements are predictable and
variable. For instance one minute the
muscles of the lips and tongue may be
affected, the next, the respiratory muscles
may be affected or all could be affected at
once or little interference from choreic
movements
The movements are unpredictable and
variable. For instance one minute the
muscles of the lips and tongue may be
affected, the next, the respiratory muscles
may be affected.

13. Speech errors
Prolonged intervals between syllables and words
Variable rate of speech
Inappropriate silences
Excessive loudness variations
Prolonged phonemes
Rapid, brief inhalations or exhalations of air
Voice stoppages
Intermittent breathy voice quality

14. Cont.
Prosody ( may be primarily compensatory
in nature)
Prolonged intervals between syllables
(waiting for the choreic movements to
end)
Variable rate of speech (hurrying before
the next choreic movement begins)
Others; mono-pitch, inappropriate
silences and mono-loudness

15. Articulation
errors
distorted vowels
Imprecise consonants (result of
involuntary choreic movements on
voluntary movements of articulation
Prolonged phonemes: choreic
movements that force the holding of
an articulatory position longer than
normal required

16. Phonation
problems
Harsh vocal quality
Breathy
Excess loudness variations
Stratined- strangled vocal quality
Voice stoppages
May be caused by intermittent vf adduction or
intermittent vf abductions (variability of the movements)

17. Respiratory
diificulties
 Unexpected inhalations and exhalations
of air caused by involuntary movements
of the chest or diaphragm
 They can cause
 Extraneous phonations, halting
utterances, and short phrases and
excessive loudness variations (caused
by sudden increases in subglottic air
pressure and involuntary exhalations
during phonation)

18. Resonance
difficulties
 Involuntary movements that alter the
timing of velar elevation

19. Myoclonus
 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 patterns
rhythmically.
 It can be found in cases of many
medical conditions: kidney failure,
epilepsy, anoxia, strokes, TBI, Alzheimer.

20. Focal
Myoclonus
 Specific muscles or body parts affected
 Hemifacial spasm ( spasms around the
eye then spread to the entire face)
 It is a common disorder and is painless
but causes embarrassment
 Palatopharyngeal myoclonus:
 Rare; the contractions are fairly
rhythmic and occur about 1-3 times a
second; 1-3 Hz
 Typical causes: brain strokes, cerebellar
lesions, encephalitis and tumors

21. Tic disorder
 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
 There are motor (eye blinking and
complex hand gestures and body
movements: jumping, kicking)
 And vocal tics (throat clearing,
shouting)

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

23. Gilles de la
Tourette
syndrome
 The development of symptoms before
the age of 14
 The slow appearance and
disappearance of symptoms
 Tic behaviours that change and evolve
over time

24. Cont.
 Minor neurological abnormalities
 Causes: supersensitive dopamine
receptors in the striatum
 Genetic link: all show symptoms by age
10; prevalence 3/100,000; boys more
affected
 Vocal tics included

25. Essential tremor
 Essential tremor (organic tremor) sometimes called familial tremor is a neurological
disorder of which the most recognizable feature is a tremor of the arms or hands
that is apparent during voluntary movements such as eating and writing

26. Essential tremor
 Most common hyperkinetic movement disorder 300/100,000
 Benign movement disorders that begins as a tremulous movement; action tremor
affected by stress and fatigue; progression is slow
 Appears to be idiopathic; beginning at 40-50; genetic
 Mostly affects hands, arms, or head
 Has been associated with hemifacial spasm and focal dystonia

27. Essential voice tremor
Occurs in about 20% of the individuals with essential tremor
Characterized by tremulous shaky vocal quality caused by
rhythmic, involuntary contractions of the vf (6Hz) along with
vertical laryngeal movements
Primarily evident with vowel prolongation
Tremor of the lips, tongue or neck may accompany the
tremor; may slow down speech in severe cases

28. Dystonia
Abnormal muscle tone causing involuntary,
prolonged muscle contractions that interfere
with normal movement or posture; may affect a
single group of muscle or multiple groups
Movement in more sustained and slower than
chorea.
Dystonia is not necessarily constant and may
appear during a movement ( waxing and
waning). Severe cases: contractions can be
constant resulting in painful, fixed contractions
of affected body part

29. Etiologies (dystonia is primary)
 Spasmodic torticollis: intermittent dystonic contractions of the neck muscles:
involuntary turning of head, head tilts upward as a result of contractions.
 Stress and anxiety affects frequency; speech is slow in rate, mildly reduced in
intelligibility and lower pitch for females
 Drug induced dystonia (tardive dystonia) ( neuroleptic) ( withdrawal of the drug may
stop dystonia and contractions appear near mouth and face; grimacing, tongue
protrusion; sometimes generalizing to other body parts)

30. Cont.
 Meige’s syndrome: rare idiopathic disease: repetitive eye blinking and abnormal
facial movement that are often dystonic in nature
 It 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
 Spasmodic dysphonia; not always classified as a dystonia (sometimes essential
tremors), characterized by involuntary vocal fold movements during phonation

31. Types of dystonia
 Focal
 Segmental; affects two or more body parts
 Generalized affects all four limbs and torso or neck
 Hemi-dystonia affects two or more body parts on the same side of the body

32. Speech characteristics
dystonia
 More errors of articulation
 Imprecise consonants, distorted vowels and
irregular articulatory breakdown
 Prosody, mono-loudness, inappropriate silences
and short phrases, reduced stress in normally
stressed words and syllables
 Phonation: harsh vocal quality, strained
strangled voice, increased muscle tone, excessive
loudness variation
 Respiration: excessive loudness might be a
result of affected muscles of respiration
 Resonance; may be present , but if present it is
very mild
chorea
 More Prosodic errors
 Generally chorea has more prosodic
and dystonia has more articulatory
errors

33. Treatment
medication
 Medications to suppress the
involuntary movements
 Botox in spasmodic dysphonia
Management
 Behavioral treatment
 Locate sensory tricks
 Relaxation therapies
 Mental imagery
 Habits reversal
 Bite blocks
 Easy onset of phonation for laryngeal
involuntary movements

34. Please watch
 https://www.youtube.com/watch?v=3TWl6NEDSkk

35. Jazak Allah !!
 .