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Questions and Answers
What are the two main categories of movement disorders discussed in the text?
What are the two main categories of movement disorders discussed in the text?
Which of the following is NOT a cardinal motor feature of Parkinsonism?
Which of the following is NOT a cardinal motor feature of Parkinsonism?
What term is used to describe a paucity or lack of voluntary and automatic movements unrelated to weakness or spasticity?
What term is used to describe a paucity or lack of voluntary and automatic movements unrelated to weakness or spasticity?
Which neurological syndrome is characterized by an excess of movement?
Which neurological syndrome is characterized by an excess of movement?
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What accounts for about half of all hypokinetic movement disorders?
What accounts for about half of all hypokinetic movement disorders?
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In what condition are patients observed to have a paucity of symptoms, especially when they are unaware that their examination has already begun?
In what condition are patients observed to have a paucity of symptoms, especially when they are unaware that their examination has already begun?
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What is the primary benefit of Levodopa in the treatment of Parkinson's disease?
What is the primary benefit of Levodopa in the treatment of Parkinson's disease?
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What is a serious side effect associated with Levodopa treatment?
What is a serious side effect associated with Levodopa treatment?
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Which therapeutic approach involves an electrode implanted in the brain to provide continuous stimulation?
Which therapeutic approach involves an electrode implanted in the brain to provide continuous stimulation?
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What role does the Thalamus play in Deep Brain Stimulation (DBS) therapy?
What role does the Thalamus play in Deep Brain Stimulation (DBS) therapy?
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What symptom is hypokinetic dysarthria most commonly associated with?
What symptom is hypokinetic dysarthria most commonly associated with?
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How does delayed auditory feedback impact speech in patients?
How does delayed auditory feedback impact speech in patients?
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What is the main symptom that must be present for a diagnosis of Parkinsonism?
What is the main symptom that must be present for a diagnosis of Parkinsonism?
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Which form of parkinsonism is characterized as a progressive, neurodegenerative disorder of unclear etiology?
Which form of parkinsonism is characterized as a progressive, neurodegenerative disorder of unclear etiology?
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What are the two age-based subgroups identified in Parkinson’s Disease research?
What are the two age-based subgroups identified in Parkinson’s Disease research?
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Which characteristics are associated with Bradykinesia?
Which characteristics are associated with Bradykinesia?
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What symptom is described as a result of increased muscle tone and affects the neck, trunk, and limbs?
What symptom is described as a result of increased muscle tone and affects the neck, trunk, and limbs?
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Which symptom is characterized by a delay in the initiation of movements?
Which symptom is characterized by a delay in the initiation of movements?
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Which impairment is commonly associated with Parkinson’s Disease, affecting high-level language abilities?
Which impairment is commonly associated with Parkinson’s Disease, affecting high-level language abilities?
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What perceptual characteristic may be present in Hypokinetic Dysarthria?
What perceptual characteristic may be present in Hypokinetic Dysarthria?
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What common side effect of dopamine medication can occur in Parkinson’s Disease patients?
What common side effect of dopamine medication can occur in Parkinson’s Disease patients?
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What problem can arise due to ‘wearing-off spells’ in Parkinson’s Disease patients?
What problem can arise due to ‘wearing-off spells’ in Parkinson’s Disease patients?
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What is the role of the basal ganglia in motor learning?
What is the role of the basal ganglia in motor learning?
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Which nuclei make up the intermediary nuclei group in the basal ganglia?
Which nuclei make up the intermediary nuclei group in the basal ganglia?
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Which neurotransmitter is considered inhibitory in the functioning of the basal ganglia?
Which neurotransmitter is considered inhibitory in the functioning of the basal ganglia?
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Damage to the basal ganglia circuit can result in:
Damage to the basal ganglia circuit can result in:
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What is the role of the substantia nigra in the basal ganglia?
What is the role of the substantia nigra in the basal ganglia?
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What is the impact of reduced dopamine levels in the striatum in terms of neurotransmitter balance?
What is the impact of reduced dopamine levels in the striatum in terms of neurotransmitter balance?
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What is the most prominent prosodic error associated with hypokinetic dysarthria?
What is the most prominent prosodic error associated with hypokinetic dysarthria?
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Which characteristic of articulation is commonly observed in individuals with hypokinetic dysarthria?
Which characteristic of articulation is commonly observed in individuals with hypokinetic dysarthria?
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What is a common cause of breathy voice quality in hypokinetic dysarthria?
What is a common cause of breathy voice quality in hypokinetic dysarthria?
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Which evaluation task is particularly useful for assessing vowel quality in hypokinetic dysarthria?
Which evaluation task is particularly useful for assessing vowel quality in hypokinetic dysarthria?
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What deviant physical characteristic is associated with hypokinetic movement disorders?
What deviant physical characteristic is associated with hypokinetic movement disorders?
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What neurological structure is primarily responsible for motor control in the brain?
What neurological structure is primarily responsible for motor control in the brain?
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What physiological consequence does incomplete vocal fold closure have on speech production?
What physiological consequence does incomplete vocal fold closure have on speech production?
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What effect does compromised basal ganglia function have on voluntary movement?
What effect does compromised basal ganglia function have on voluntary movement?
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What is a unique feature associated with palilalia in Parkinson's disease speech?
What is a unique feature associated with palilalia in Parkinson's disease speech?
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Which of the following is the most common type of movement disorder?
Which of the following is the most common type of movement disorder?
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Which of the following is the most common cause of hypokinesia?
Which of the following is the most common cause of hypokinesia?
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Hypokinetic disorders are characterized by an excess of movement.
Hypokinetic disorders are characterized by an excess of movement.
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Parkinsonism is the most common cause of hypokinesia.
Parkinsonism is the most common cause of hypokinesia.
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Bradykinesia is a motor feature commonly associated with Parkinsonism.
Bradykinesia is a motor feature commonly associated with Parkinsonism.
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Drop attacks are a common cause of hypokinesia.
Drop attacks are a common cause of hypokinesia.
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Hyperkinesia is a neurological syndrome characterized by a lack of movement.
Hyperkinesia is a neurological syndrome characterized by a lack of movement.
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Rigidity is a common symptom associated with hypokinetic disorders.
Rigidity is a common symptom associated with hypokinetic disorders.
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Hypokinetic dysarthria is primarily characterized by hyperkinetic movements.
Hypokinetic dysarthria is primarily characterized by hyperkinetic movements.
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Breathy voice quality in hypokinetic dysarthria is caused by complete vocal fold closure during phonation.
Breathy voice quality in hypokinetic dysarthria is caused by complete vocal fold closure during phonation.
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Imprecise consonants in hypokinetic dysarthria are caused by excessive range of motion in laryngeal muscles.
Imprecise consonants in hypokinetic dysarthria are caused by excessive range of motion in laryngeal muscles.
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Patients with hypokinetic dysarthria may experience moments of aphonia, which is the complete loss of phonation.
Patients with hypokinetic dysarthria may experience moments of aphonia, which is the complete loss of phonation.
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In hypokinetic dysarthria, shallow breath support can lead to poorly controlled inhalations.
In hypokinetic dysarthria, shallow breath support can lead to poorly controlled inhalations.
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The basal ganglia control circuit includes the substantia nigra and nucleus accumbens.
The basal ganglia control circuit includes the substantia nigra and nucleus accumbens.
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Reduced dopamine levels in the striatum can improve neurotransmitter balance.
Reduced dopamine levels in the striatum can improve neurotransmitter balance.
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Palilalia in Parkinson's disease speech involves a decrease in loudness and a slower rate of repetition.
Palilalia in Parkinson's disease speech involves a decrease in loudness and a slower rate of repetition.
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Short rushes of speech are common in hypokinetic dysarthria due to difficulties in stopping voluntary movement quickly.
Short rushes of speech are common in hypokinetic dysarthria due to difficulties in stopping voluntary movement quickly.
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The basal ganglia primarily play a role in cognition and motivation, rather than motor control.
The basal ganglia primarily play a role in cognition and motivation, rather than motor control.
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Resting tremors in Parkinson's disease typically occur at a frequency of 4 to 6 oscillations per second.
Resting tremors in Parkinson's disease typically occur at a frequency of 4 to 6 oscillations per second.
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Postural instability and gait difficulties are more common in Early Onset Parkinson's Disease.
Postural instability and gait difficulties are more common in Early Onset Parkinson's Disease.
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Bradykinesia is primarily caused by muscle weakness in Parkinson's disease.
Bradykinesia is primarily caused by muscle weakness in Parkinson's disease.
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Excessive saliva production is a common symptom of Parkinson's disease due to increased swallowing events.
Excessive saliva production is a common symptom of Parkinson's disease due to increased swallowing events.
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Hypokinetic dysarthria is the most common type of motor speech disorder.
Hypokinetic dysarthria is the most common type of motor speech disorder.
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Dopamine medication in Parkinson's disease can lead to hallucinations as a side effect.
Dopamine medication in Parkinson's disease can lead to hallucinations as a side effect.
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Akinesia is characterized by a delay in the initiation of movements.
Akinesia is characterized by a delay in the initiation of movements.
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Parkinson's disease primarily affects the voluntary muscle movements but not the automatic ones.
Parkinson's disease primarily affects the voluntary muscle movements but not the automatic ones.
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Primary parkinsonism is another term for idiopathic Parkinson's disease.
Primary parkinsonism is another term for idiopathic Parkinson's disease.
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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.
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.
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Deep Brain Stimulation therapy targets the cerebellum to correct malfunctions in Parkinson's patients.
Deep Brain Stimulation therapy targets the cerebellum to correct malfunctions in Parkinson's patients.
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Levodopa can effectively reduce the severity of speech symptoms in patients with Parkinson's disease.
Levodopa can effectively reduce the severity of speech symptoms in patients with Parkinson's disease.
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Hypokinetic Dysarthria is commonly associated with fast movements and tense muscles.
Hypokinetic Dysarthria is commonly associated with fast movements and tense muscles.
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The Thalamus serves as a relay between the sensory and motor systems, but does not play a role in consciousness and arousal.
The Thalamus serves as a relay between the sensory and motor systems, but does not play a role in consciousness and arousal.
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Delayed auditory feedback causes patients to speed up their rate of speech due to increased proprioceptive feedback.
Delayed auditory feedback causes patients to speed up their rate of speech due to increased proprioceptive feedback.
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Parkinson's Disease primarily affects non-verbal communication, such as gestures and facial expressions.
Parkinson's Disease primarily affects non-verbal communication, such as gestures and facial expressions.
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Globus Pallidus consists of the globus pallidus internus and globus pallidus externus.
Globus Pallidus consists of the globus pallidus internus and globus pallidus externus.
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Acetylcholine is an inhibitory neurotransmitter in the basal ganglia functioning.
Acetylcholine is an inhibitory neurotransmitter in the basal ganglia functioning.
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The substantia nigra supplies the basal ganglia with serotonin, contributing to Parkinson's disease symptoms.
The substantia nigra supplies the basal ganglia with serotonin, contributing to Parkinson's disease symptoms.
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Damage to the basal ganglia circuit often results in increased movement due to an abundance of dopamine.
Damage to the basal ganglia circuit often results in increased movement due to an abundance of dopamine.
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Hypokinetic dysarthria is directly related to symptoms associated with hyperkinesia.
Hypokinetic dysarthria is directly related to symptoms associated with hyperkinesia.
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The basal ganglia control circuit transmits information about planned upcoming movements from the BG to the cortex.
The basal ganglia control circuit transmits information about planned upcoming movements from the BG to the cortex.
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Globus Pallidus Externa is considered one of the output nuclei in the basal ganglia.
Globus Pallidus Externa is considered one of the output nuclei in the basal ganglia.
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A reduction of dopamine in the striatum can lead to an imbalance with too much inhibitory acetylcholine.
A reduction of dopamine in the striatum can lead to an imbalance with too much inhibitory acetylcholine.
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The basal ganglia includes four nuclei: the corpus striatum, the claustrum, the amygdala, and the substantia nigra.
The basal ganglia includes four nuclei: the corpus striatum, the claustrum, the amygdala, and the substantia nigra.
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The basal ganglia play a role in regulating emotional behaviors but not motor learning.
The basal ganglia play a role in regulating emotional behaviors but not motor learning.
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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.
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L-dopa is a chemical that can reach the striatum and convert into dopamine, compensating for the dopamine not produced by the substantia nigra.
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Benefits: significantly reduces tremor, bradykinesia, akinesia, and rigidity.
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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.
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Description
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.
