81 Questions
What are the two main categories of movement disorders discussed in the text?
Hyperkinesia and Hypokinesia
Which of the following is NOT a cardinal motor feature of Parkinsonism?
Ataxia
What term is used to describe a paucity or lack of voluntary and automatic movements unrelated to weakness or spasticity?
Hypokinesia
Which neurological syndrome is characterized by an excess of movement?
Hyperkinesia
What accounts for about half of all hypokinetic movement disorders?
Parkinsonism
In what condition are patients observed to have a paucity of symptoms, especially when they are unaware that their examination has already begun?
Hypokinetic disorders
What is the primary benefit of Levodopa in the treatment of Parkinson's disease?
Reduces tremor, bradykinesia, akinesia, and rigidity
What is a serious side effect associated with Levodopa treatment?
Hallucinations
Which therapeutic approach involves an electrode implanted in the brain to provide continuous stimulation?
Deep Brain Stimulation (DBS) therapy
What role does the Thalamus play in Deep Brain Stimulation (DBS) therapy?
Serves as a relay between sensory and motor systems
What symptom is hypokinetic dysarthria most commonly associated with?
Parkinson's Disease (PD)
How does delayed auditory feedback impact speech in patients?
Slows down the rate of speech
What is the main symptom that must be present for a diagnosis of Parkinsonism?
Bradykinesia
Which form of parkinsonism is characterized as a progressive, neurodegenerative disorder of unclear etiology?
Primary parkinsonism
What are the two age-based subgroups identified in Parkinson’s Disease research?
Early Onset PD and Late Onset PD
Which characteristics are associated with Bradykinesia?
Shuffling walk and lack of facial expression
What symptom is described as a result of increased muscle tone and affects the neck, trunk, and limbs?
Muscular rigidity
Which symptom is characterized by a delay in the initiation of movements?
Akinesia
Which impairment is commonly associated with Parkinson’s Disease, affecting high-level language abilities?
Deterioration of executive functioning
What perceptual characteristic may be present in Hypokinetic Dysarthria?
Rapid rate of speech
What common side effect of dopamine medication can occur in Parkinson’s Disease patients?
Excessive saliva due to decreased spontaneous swallowing events
What problem can arise due to ‘wearing-off spells’ in Parkinson’s Disease patients?
Return of tremors, stiff and slow movements
What is the role of the basal ganglia in motor learning?
Assist in learning new movements
Which nuclei make up the intermediary nuclei group in the basal ganglia?
Globus Pallidus Externa, Nigra substance, Subthalamic Nucleus
Which neurotransmitter is considered inhibitory in the functioning of the basal ganglia?
Dopamine
Damage to the basal ganglia circuit can result in:
Reduction in movement or inability to inhibit involuntary movement
What is the role of the substantia nigra in the basal ganglia?
Supply dopamine to the basal ganglia
What is the impact of reduced dopamine levels in the striatum in terms of neurotransmitter balance?
Increased excitatory acetylcholine levels
What is the most prominent prosodic error associated with hypokinetic dysarthria?
Monopitch and reduced stress
Which characteristic of articulation is commonly observed in individuals with hypokinetic dysarthria?
Imprecise consonants
What is a common cause of breathy voice quality in hypokinetic dysarthria?
Bowed vocal fold with incomplete adduction
Which evaluation task is particularly useful for assessing vowel quality in hypokinetic dysarthria?
Vowel prolongations
What deviant physical characteristic is associated with hypokinetic movement disorders?
Slow speech movements
What neurological structure is primarily responsible for motor control in the brain?
Basal ganglia
What physiological consequence does incomplete vocal fold closure have on speech production?
Gives rise to harsh voice quality
What effect does compromised basal ganglia function have on voluntary movement?
Impedes initiation and stopping of movement
What is a unique feature associated with palilalia in Parkinson's disease speech?
Increasing rate with phrase repetitions
Which of the following is the most common type of movement disorder?
Restless leg syndrome
Which of the following is the most common cause of hypokinesia?
Parkinson's
Hypokinetic disorders are characterized by an excess of movement.
False
Parkinsonism is the most common cause of hypokinesia.
True
Bradykinesia is a motor feature commonly associated with Parkinsonism.
True
Drop attacks are a common cause of hypokinesia.
False
Hyperkinesia is a neurological syndrome characterized by a lack of movement.
False
Rigidity is a common symptom associated with hypokinetic disorders.
True
Hypokinetic dysarthria is primarily characterized by hyperkinetic movements.
False
Breathy voice quality in hypokinetic dysarthria is caused by complete vocal fold closure during phonation.
False
Imprecise consonants in hypokinetic dysarthria are caused by excessive range of motion in laryngeal muscles.
False
Patients with hypokinetic dysarthria may experience moments of aphonia, which is the complete loss of phonation.
True
In hypokinetic dysarthria, shallow breath support can lead to poorly controlled inhalations.
False
The basal ganglia control circuit includes the substantia nigra and nucleus accumbens.
True
Reduced dopamine levels in the striatum can improve neurotransmitter balance.
False
Palilalia in Parkinson's disease speech involves a decrease in loudness and a slower rate of repetition.
False
Short rushes of speech are common in hypokinetic dysarthria due to difficulties in stopping voluntary movement quickly.
True
The basal ganglia primarily play a role in cognition and motivation, rather than motor control.
False
Resting tremors in Parkinson's disease typically occur at a frequency of 4 to 6 oscillations per second.
True
Postural instability and gait difficulties are more common in Early Onset Parkinson's Disease.
False
Bradykinesia is primarily caused by muscle weakness in Parkinson's disease.
False
Excessive saliva production is a common symptom of Parkinson's disease due to increased swallowing events.
False
Hypokinetic dysarthria is the most common type of motor speech disorder.
False
Dopamine medication in Parkinson's disease can lead to hallucinations as a side effect.
True
Akinesia is characterized by a delay in the initiation of movements.
True
Parkinson's disease primarily affects the voluntary muscle movements but not the automatic ones.
False
Primary parkinsonism is another term for idiopathic Parkinson's disease.
True
Wearing-off spells in Parkinson's disease happen when the medication loses its long-lasting effect, resulting in the return of symptoms like tremors and slow movements.
True
Deep Brain Stimulation therapy targets the cerebellum to correct malfunctions in Parkinson's patients.
False
Levodopa can effectively reduce the severity of speech symptoms in patients with Parkinson's disease.
False
Hypokinetic Dysarthria is commonly associated with fast movements and tense muscles.
False
The Thalamus serves as a relay between the sensory and motor systems, but does not play a role in consciousness and arousal.
False
Delayed auditory feedback causes patients to speed up their rate of speech due to increased proprioceptive feedback.
False
Parkinson's Disease primarily affects non-verbal communication, such as gestures and facial expressions.
False
Globus Pallidus consists of the globus pallidus internus and globus pallidus externus.
True
Acetylcholine is an inhibitory neurotransmitter in the basal ganglia functioning.
False
The substantia nigra supplies the basal ganglia with serotonin, contributing to Parkinson's disease symptoms.
False
Damage to the basal ganglia circuit often results in increased movement due to an abundance of dopamine.
False
Hypokinetic dysarthria is directly related to symptoms associated with hyperkinesia.
False
The basal ganglia control circuit transmits information about planned upcoming movements from the BG to the cortex.
False
Globus Pallidus Externa is considered one of the output nuclei in the basal ganglia.
False
A reduction of dopamine in the striatum can lead to an imbalance with too much inhibitory acetylcholine.
True
The basal ganglia includes four nuclei: the corpus striatum, the claustrum, the amygdala, and the substantia nigra.
False
The basal ganglia play a role in regulating emotional behaviors but not motor learning.
False
Study Notes
Movement Disorders
- Movement is controlled by a highly evolved and sophisticated system of interacting circuits in the nervous system.
- Disorders affecting movement control can manifest in various ways.
- The treatment of movement disorders is a subspecialty of neurology, concerned with patients who move either "too much" or "too little".
Hypokinesia and Hyperkinesia
- Hypokinesia: a paucity/lack of voluntary and automatic movements, unrelated to weakness or spasticity.
- Hyperkinesia: an excess of movement.
Hypokinetic Disorders
- Patients with hypokinetic disorders present with a lack of symptoms, often best observed when unaware of the examination.
- Examples: observing patients while entering the room, reaching the chair or table.
- Parkinsonism is the most common cause of hypokinesia, but there are other less common causes:
- Drop attacks
- Catatonia
- Hypothyroid slowness
- Rigidity
- Stiff muscles
Parkinsonism
- The most recognized form of hypokinesia, accounting for about half of all hypokinetic movement disorders.
- Manifests as any combination of its four cardinal motor features:
- Resting tremor
- Bradykinesia (slowness in movement)
- Rigidity (stiffness)
- Gait/postural instability
Hypokinetic Dysarthria
- A motor speech disorder associated with dysfunction in the basal ganglia control circuit.
- Accounts for approximately 8.3% of motor speech disorders and 9.1% of all dysarthrias.
- The only dysarthria in which the perceptual characteristic of rapid rate of speech may be present.
Parkinson's Disease (PD)
- A progressive, neurodegenerative disorder of unclear etiology.
- Research has revealed two age-based subgroups:
- Early Onset PD (EOPD)
- Late Onset PD (LOPD)
- Characteristics:
- Bradykinesia: slowing of movement
- Hypokinesia: decreased amplitude of movement
- Akinesia: lack of movement
- Resting tremors
- Muscular rigidity
- Disturbance of Postural Reflexes
- Associated impairments:
- Early deterioration of executive functioning
- Subtle, high-level language abilities compromised
- Depression (40-60%)
- Tendency to sway backwards when standing or turning
- Hallucinations as a side effect of dopamine medication
- Excessive saliva
- Sleep disturbances
- Addictive and compulsive behaviors
Basal Ganglia (BG)
-
A group of subcortical nuclei within the brain responsible for motor control, cognition, learning, motivation, and other functions.
-
Includes:
- Caudate nucleus
- Putamen
- Globus pallidus
- Subthalamic nucleus
- Nucleus accumbens
-
Functions:
- Regulating muscle tone
- Regulating movements that support goal-directed movements
- Controlling postural adjustments during skilled movements
- Adjusting movements to the environment
- Assisting in learning new movements
-
Basal ganglia control circuit:
- Descends from the cortex
- Smooths and refines planned movements
- Sends refined neural impulses to the motor cortex
- Transmits through the pyramidal system to the lower motor neurons
-
Damage to the BG/circuit results in:
- Reduced movement or inability to inhibit involuntary movement
- Abundance of ACh and lack of dopamine### PD Treatment Strategies
-
L-dop replacement is a dopamine replacement agent for treating bradykinetic symptoms secondary to Parkinson's disease.
-
L-dopa is a chemical that can reach the striatum and convert into dopamine, compensating for the dopamine not produced by the substantia nigra.
-
Benefits: significantly reduces tremor, bradykinesia, akinesia, and rigidity.
-
Side-effects: minor (gastrointestinal disturbance, poor control of blood pressure, insomnia, and agitation), serious (hallucinations, severe agitation, decreased social inhibitions, and paranoid delusions).
Neuro Patch
- A dopamine agonist delivered through a silicone-based patch for early symptoms of PD.
Exercise/Dance/Movement Therapy
- Strengthens muscles, increases flexibility, and promotes heightened proprioceptive awareness.
Deep Brain Stimulation (DBS) Therapy
- An electrode implanted in the brain continuously provides stimulation to the target area (thalamus).
- Uses electrical currents to target abnormal brain activity, triggering blood flow and a series of chemical reactions that lead to the release of neurotransmitters.
- Helps correct malfunctions in the brain.
HYPOKINETIC DYSARTHRIA
- Characterized by rigid and stiff muscles, slow and reduced movements, and associated with tremors.
- Rigidity results from opposing muscles contracting simultaneously.
- Most commonly seen in Parkinson's disease (PD) due to reduced dopamine availability.
PARKINSON'S DISEASE (PD)
- Symptoms: tremors at rest, difficulty in initiating movements, and speech characteristics.
- Speech characteristics: breathy voice, fast rate, difficulty in initiation, and voice and swallowing changes.
- Lesion: Basal ganglion, which plays a role in motor learning, executive functions, emotional behaviors, and reward and reinforcement.
BASAL GANGLIA
- A subcortical structure that serves as a relay between sensory and motor systems and the cerebral cortex.
- Regulates muscle tone, movements, and postural adjustments during skilled movements.
- Includes 5 nuclei: corpus striatum, claustrum, amygdala, substantia nigra, and subthalamic nucleus.
BASAL GANGLIA FUNCTIONS
- Regulates muscle tone and movements that support goal-directed movements.
- Controls postural adjustments during skilled movements.
- Assists in learning new movements.
BASAL GANGLIA CONTROL CIRCUIT
- First part: cortical fibers transmit information about planned movements to the basal ganglia.
- Second part: basal ganglia smooth and refine planned movements, especially for slow and continuous movements.
- Third part: refined neural impulses are sent back to the motor cortex and transmitted through the pyramidal system to the lower motor neurons.
BASAL GANGLIA CONTROL CIRCUIT DAMAGE
- Results in reduced movement or inability to inhibit involuntary movement due to imbalance of neurotransmitters.
- Hypokinetic dysarthria characteristics are mostly associated with reduction in movement.
- Rigidity, reduced ROM, and slowed movement are common symptoms.
SPEECH CHARACTERISTICS OF HYPOKINETIC DYSARTHRIA
- Voice: harsh-hoarse voice quality, reduced vocal volume.
- Articulation: reduced ROM, imprecise consonants, and repeated phonemes.
- Respiration: reduced VC and phonation time, breathing rates faster than normal.
- Prosody: reduced and monoloudness, low rate with intermittent rapid bursts.
KEY EVALUATION TASKS FOR HYPOKINETIC DYSARTHRIA
- Conversation speech: evoking prosodic errors and detecting short rushes of speech.
- Speech alternate motion rates (AMRS): highlighting articulation errors, variable rates of articulation, and blurring syllables.
- Vowel prolongations: assessing VQ.
NEUROLOGICAL BASIS OF HYPOKINETIC DYSARTHRIA
- Associated with dysfunction of the basal ganglia (BG) control circuit.
- BG control circuit consists of the BG and its associated connections.
- The BG is a collection of subcortical gray matter, responsible for motor control, cognition, learning, motivation, and other functions.
This quiz covers topics related to movement disorders, focusing on the treatment and manifestations of disorders affecting movement control. It also discusses the subspecialty of neurology concerned with patients who have excessive or reduced movement. Explore the neurological syndromes of hyperkinesia and hypokinesia in this module.
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