Hyperkinetic Dysarthria Module 8 Quiz

62 Questions

What do hyperkinetic disorders consist of?

Excessive involuntary movements

How are hyperkinetic movements described based on?

Induction, complexity, suppressibility

Which body parts should be identified in the description of a hyperkinetic movement disorder?

The body parts involved in the movement

What type of movements are considered automatic?

Learned motor behaviors performed without conscious effort

What best describes involuntary movements?

Not intentional and rarely suppressible

Which category of movement is induced by an inner sensory stimulus or unwanted feeling?

Semivoluntary

What type of movement disorder is characterized by relatively quick, unpredictable, and dance-like movements of various body parts?

Chorea

Which movement disorder is characterized by sudden brief contractions of a single muscle or body part?

Myoclonus

What movement disorder is described as sustained, involuntary contractions of antagonist muscles in one or more body parts?

Dystonia

Which type of tremor can affect the hands, arms, or head and is usually benign?

Essential tremor

What characteristic distinguishes hyperkinetic dysarthria from other dysarthrias?

Changes speech patterns

Which factor contributes to all hyperkinetic movement disorders interfering with speech production?

Dysfunction in the cerebellar control circuit

What is a common characteristic of hyperkinetic dysarthria?

Involuntary speaking normal at one moment and abnormally the next moment

Which movement disorders can lead to hyperkinetic dysarthria?

Chorea and dystonia

What neurotransmitter imbalance can result in hyperkinesia?

Inhibitory dopamine vs excitatory ACh

What can lesions in the cerebellar structure cause?

Abnormal thalamocortical discharge patterns

What is a characteristic of chorea?

Random, rapid, purposeless movements

What is Huntington's Disease characterized by?

Expansion of CAG repeats in IT 15 gene

What movement patterns are associated with hyperkinetic dysarthria?

Either subtle movements or large obvious movements

What might cause abnormal motor cortex discharges in hyperkinetic dysarthria?

Decrease in dopaminergic activity within the circuit

What is a characteristic feature of Huntington's Disease?

Inherited degenerative CNS disorder

How do individuals with severe chorea try to modify their movements?

By making movements appear intentional to cover them up

In hyperkinetic disorders, the movements are typically characterized by a lack of movement and stiffness.

False

Chorea is a common hyperkinetic disorder characterized by sustained contractions of antagonist muscles in various body parts.

False

Voluntary movements are intentional, planned, or self-initiated.

True

Hyperkinetic movements can be suppressed by volitional attention or sensory tricks.

True

Involuntary movements in hyperkinetic disorders are always fully intentional and suppressible.

False

Dystonia is a common hyperkinetic disorder characterized by sustained contractions of antagonist muscles in one or more body parts.

True

Chorea movements are slow and can be consciously controlled.

False

Myoclonus involves sustained contractions of antagonist muscles in the body parts affected.

False

Tics, such as eye blinks and head jerks, cannot be controlled voluntarily.

False

Dystonia movements are generally faster and more abrupt than choreic movements.

False

Restless leg syndrome causes a crawling sensation that is most prominent during ambulation.

False

Hyperkinetic dysarthria can lead to normal speech execution without any interference from involuntary movements.

False

Hyperkinetic dysarthria is characterized by consistent articulatory precision.

False

Hyperkinetic dysarthria may make functional daily living skills such as walking, eating, and talking nearly impossible.

True

Dyskinesias always result from an imbalance between inhibitory acetylcholine (ACh) and excitatory dopamine.

False

Lesions in the cerebellar structure cannot cause hyperkinetic dysarthria.

False

Chorea is characterized by slow, purposeful, and intentional movements.

False

Huntington's Disease affects the peripheral nervous system.

False

Involuntary movements associated with hyperkinetic dysarthria can interfere with speech production.

True

Hyperkinetic dysarthria may involve subtle movements like large movements of many parts of the body.

True

Individuals with severe chorea can easily suppress their involuntary movements.

False

Dyskinesias in hyperkinetic dysarthria are solely caused by an imbalance in serotonin levels.

False

Match the neurotransmitter with its function in hyperkinesia:

Dopamine = Inhibitory - downer Acetylcholine (ACh) = Excitatory Serotonin = May result in hyperkinesia if imbalanced Norepinephrine = Involved in BG control but role not well understood

Match the characteristic with its description in hyperkinetic dysarthria:

Harshness = One of the vocal characteristics of hyperkinetic dysarthria Variable articulatory imprecision = Speaking normal at one moment and abnormally the next moment Prosodic abnormalities = Include myloklonus then interfere diaphragm and intercostal muscles changing ability to communicate Breathing coordination issues = Resulting from distorted subsystems due to physical movement distortions

Match the movement pattern with its associated disorder:

Purposeless movements interfering with discrete actions = Chorea Volitional modification to cover up movements = Characteristic of severe cases of Chorea Expansion of CAG repeats within IT 15 gene = Huntington's Disease Gradual degeneration of neurons in BG and cerebral cortex = Etiology of Huntington's Disease

Match the type of tremor with its description:

Essential tremor = Action tremor affecting hands, arms, or head; usually benign in nature Resting tremor = Tremor occurring when the affected body part is at rest Postural/sustention tremor = Tremor during maintaining a position against gravity Action/intention tremor = Tremor during voluntary movement towards a target

Match the movement disorder with its associated body parts involved:

Chorea = Limbs, head, face, mouth, and neck Myoclonus = Single muscle or body part affected by sudden contractions Tics = Eye blinks, shoulder shrugs, and head jerks Dystonia = Antagonist muscles in one or more body parts

Match the movement disorder with its characteristic muscle tone fluctuation:

Chorea = Muscle tone fluctuates between hypotonic and hypertonic during one utterance Myoclonus = Sudden contractions cannot be consciously suppressed like hiccups Tics = Motor or vocal behaviors that can be controlled voluntarily Dystonia = Sustained contractions of antagonist muscles come and go in a waxing and waning pattern

Match the hyperkinetic movement disorder with its sensory experience:

Restless leg syndrome = Unpleasant crawling sensation in legs or arms; prominent during relaxation Hyperkinetic Dysarthria = Perceptually distinguishable from other dysarthrias affecting speech production Huntington's Disease = Affects peripheral nervous system causing involuntary movements interfering with speech production Essential Tremor = Action tremor affecting hands, arms, or head; usually benign in nature

Match the following hyperkinetic disorders with their common characteristics:

Restless Leg Syndrome = Causes a crawling sensation most prominent during ambulation Huntington's Disease = Characterized by relatively quick, unpredictable, dance-like movements Dyskinesias = Result from an imbalance between inhibitory acetylcholine (ACh) and excitatory dopamine Tremors = Affect hands, arms, or head and are usually benign

Match the involuntary movement Pattern with its description

Chorea = relatively quick, unpredictable, coordinate movements of the limbs, head, face, mouth, and neck; can have a dance like quality Myoclonus = sudden brief contractions of a single muscle or body part. Tics = motor or vocal behaviors that can be controlled voluntarily Dystonia = sustained, involuntary contractions of antagonist muscles in one or more body parts

Match the involuntary movement pattern with its description.

Restless leg syndrome = an unpleasant, crawling sensation in the legs or arms particularly during sitting and relaxation, it is most prominent in the evening; disappears during ambulation Tremor = an oscillatory, rhythmic movement of one or more body parts Dystonia = sustained, involuntary contractions of antagonist muscles in one or more body parts Tics = motor or vocal behaviors that can be controlled voluntarily

Match the type of movement disorder to its description

Chorea = Characterized by rapid, involuntary, random, purposeless movements of a body part Huntington's disease = Inherited autosomal dominant degenerative CNS disorder Myoclonus = nvoluntary and brief contractions of part of a muscle, a whole muscle, or a group of muscles in the same area of the body. Tics = Throat clearing, grunts, barking, Repetitive eye blinks, facial twitches, grimaces

Match the type of movement disorder to its description

Spasmodic Torticollis = Intermittent dystonic contractions of the neck, resulting in involuntary turning of the head, which is tilted upward Essential Tremor = Benign hyperkinetic movement that causes tremulous movements in affected body parts; an action tremor that disappears at rest Dystonia = sustained, involuntary contractions of antagonist muscles in one or more body parts Spasmodic Dysphonia = Involuntary vocal fold movements during phonation

Match the categorization of dystonia according to body part

Focal = present in only one part of the body Segmental = includes two or more parts of the body Generalized = affects all four limbs and the torso or neck Hemidystonia = affects two or more body parts on the same side of the body

Myoclonus contractions can occur with muscles on the opposite side of the body.

False

Chorea is nearly impossible to suppress.

True

Myoclonus contractions can be consciously suppressed.

False

Tics can be controlled voluntarily.

True

Movements associated with dystonia are typically slower and more prolonged than choreic movements.

True

Study Notes

Hyperkinetic Disorders

Characterized by excessive involuntary movements
Too much movement, too little dopamine
Common disorders include: Restless Leg Syndrome, dystonia, chorea, tics, myoclonus, and tremors

Hyperkinetic Movement Disorders

Can be described based on:
- How they are induced (stimuli, action, exercise)
- Complexity of the movements (complex or simple)
- Suppressibility (by volitional attention or sensory tricks)
Description should identify which body parts are involved

Movement Categories Based on Volition

Automatic: learned motor behaviors without conscious effort
Involuntary: not intentional, rarely suppressible but can be partially suppressed
Semivoluntary: movements induced by inner sensory stimulus or unwanted feeling/compulsion
Voluntary: intentional, planned, or self-initiated

Characteristics of Hyperkinetic Disorders

Any of the following five involuntary movement patterns can interfere with speech/communication:
- Chorea
- Myoclonus
- Tics
- Dystonia
- Tremor
Interfere with speech production, resulting in hyperkinetic dysarthria

Chorea

Relatively quick, unpredictable, coordinate movements of the limbs, head, face, mouth, and neck
Dance-like quality
Involuntary, irregular, purposeless, and nonrhythmic
Movements seem to flow randomly from one body part to another

Myoclonus

Sudden brief contractions of a single muscle or body part
"Myo" = single, "Clonus" = contraction
Contractions can occur singly in a repeating irregular pattern or rhythmically
Cannot be consciously suppressed
Examples: hiccups (myoclonus of the diaphragm), jerking as you are falling asleep (myoclonus)

Tics

Motor or vocal behaviors that can be controlled voluntarily
Desire to move becomes difficult to suppress
When the tic occurs, it gives pts momentarily relief
Examples: motor tics (eye blinks, shoulder shrugs, head jerks), vocal tics (grunting, humming, barking)

Dystonia

Sustained, involuntary contractions of antagonist muscles in one or more body parts
Contractions come and go in a waxing and waning pattern
Two opposite muscle groups = groups fighting, leading to twisted posture
Very painful, high suicide rate among this patient population

Tremor

Oscillatory, rhythmic movement of one or more body parts
Essential tremor: action tremor affecting hands, arms, or head (usually benign)
Can also result in a voice tremor when the vocal folds are affected
Types: resting tremor, postural/sustention tremor, action/intention tremor

Restless Leg Syndrome

Unpleasant, crawling sensation in the legs or arms
Particularly prominent in the evening, disappears during ambulation

Hyperkinetic Dysarthria

Perceptually distinguishable from other dysarthrias
Clinician can make an accurate diagnosis just by observing the individual's movements
No one underlying symptom, so speech is different in each individual
Any of the 6 movement disorders can cause a disruption to the 5 subsystems for speech
Accounts for 6% of all dysarthrias and 5.5% of all motor speech disorders
Accompanied by hypokinesia disorder
Definition: difficult to define because it can be caused by many hyperkinetic movement disorders
Shared factors: caused by dysfunction in the Basal ganglia, portions of the extrapyramidal system, and atypical cerebellar control circuit
Commonality: all produce involuntary movements that interfere with speech production
Muscle tone can range from hypotonic to hypertonic, and even fluctuate between the two during one utterance
Speech gives the impression that normal speech is being executed, but then it is interfered with by regular or unpredictable involuntary movements that distort, slow, or interrupt communication.### Perceptual Characteristics of Hyperkinetic Dysarthria
Characterized by vocal variability, articulatory imprecision, harshness, and prosodic abnormalities
Speaking style can change suddenly from normal to abnormal
Myoclonus can interfere with diaphragm and intercostal muscles, affecting communication

Etiologies of Hyperkinetic Dysarthria

Several hyperkinetic movement disorders can lead to hyperkinetic dysarthria
Involuntary movements can vary in severity and type, ranging from barely noticeable to severely impaired daily living skills

Neurological Basis of Dyskinesias

Dyskinesias can result from an imbalance between excitatory ACh and inhibitory dopamine
Relative increase in dopaminergic activity or decrease in cholinergic activity within the circuit may result in hyperkinesia
Other neurotransmitters are involved in basal ganglia (BG) control, but their roles are not well understood

Hyperkinetic Dysarthria and Movement

Movements can range from subtle (e.g., just lips, hands, or vocal folds) to obvious (e.g., large movements of many body parts)
Each hyperkinetic disorder has its own unique characteristic movement pattern

Associated Movement Disorders and Diseases

Chorea

Characterized by rapid, involuntary, random, purposeless movements of a body part
Can range from mild (appearing restless or jittery) to severe (interfering with walking, swallowing, speech, and other discrete movements)

Huntington's Disease

Inherited autosomal dominant degenerative CNS disorder
Caused by gradual degeneration of neurons in the BG and cerebral cortex
Characterized by expansion of the number of CAG repeats within the IT15 gene, resulting in the enlargement of the Huntingtin protein
A normal person has a CAG repeat number between 10-28, while those affected by Huntington's have 36 or more

Test your knowledge on hyperkinetic disorders which are characterized by excessive involuntary movements, including conditions like Restless Leg Syndrome and dystonia. Learn about the common hyperkinetic movements and how they are induced.

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