2. • Hyperkinetic dysarthria implies
pathologies in the basal ganglia, related
portion of the extrapyramidal system, or
sometimes the cerebellar control circuit.
3. • 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.
5. • Chorea: As dancelike, because the movements
appear to be smooth and coordinated, but they
are actually unpredictable and purposeless
6. Some of the known disorders that cause
of chorea
a. Sydenham’s Chorea / chorea minor
b. Stroke
c. Tardive Dyskinesia
d. Anoxia
e. Carbon Monoxide
7. • Characteristics of Sydenham’s Chorea
1. Rare disorder that affects children between
5 and 15
2. Called St. Vitus Dance
3. Associated with rheumatic fever
4. May be caused by hypersensitive dopamine
receptors or too much dopamine
5. 40% of children exhibit hyperkinetic.
6. Usually disappears in 3-4 mo. w/o TX
8. • Chorea in stroke
a. Hemichorea because the involuntary
movements occur only on the contralateral
side of the body to the site of lesion (if damage
is restricted to only one side of the brain
usually affecting the basal ganglia or
thalamus)
9. • Chorea in stroke
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
10. • 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
11. c. Caused by taking antipsychotic
d. Women and elderly are more susceptible
12. Factors causing speech errors in chorea
a. Chorea can affect many different 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)
14. Speech errors that are most evident in
individuals with chorea
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
15. Speech characteristics in chorea
Prosody (may be primarily compensatory in
nature)
a. Prolonged intervals between syllables
(waiting for choreic movement to end)
b. variable rate of speech (hurrying before
next choreic movement begins)
c. others: monopitch, inappropriate
silences and monoloudness
25. 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
26. 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
27. Essential tremor (organic tremor) sometimes
called familial tremor is
a progressive 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)
28. Essential 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
29. 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
30. Describe essential voice tremor
a. occurs in about 20% of the individuals with
essential tremor
b. characterized by a tremulous shaky vocal
quality caused by rhythmic, involuntary
contractions of the vf (6Hz), along with
vertical laryngeal movements
31. c. Primarily evident with vowel prolongation
d. Tremor of the lips, tongue or neck may
accompany the tremor; may slow down speech
in severe cases
32. 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
33. 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
34. 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
35.
36. b. Drug induced dystonia (tardive dystonia):
chronic drug-induced dystonia (neuroleptic).
Withdrawal of the drug may stop dystonia
and Contractions appear near mouth and
face: grimacing, tongue protrusions;
sometimes generalizing to other body parts
42. 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
43. speech errors in dystonia
a. Articulation: imprecise consonants,
distorted vowels, irregular articulatory
breakdowns and prolonged phonems due to
sustained dystonic contractions o the oral
muscles
Irregularity of the breakdowns due to the
intermittent nature of dystonia; when the
contractions are absent articulation will
appear normal
47. What is the TX for hyperkinetic
dysarthria
Mostly medication that suppress the
involuntary movements
Choreic and tic: Haloperidol
Myoclonic jerks clonazepam or valproic
SD and spasmodic torticollis: Botox (most
effective)