Hyperkinetic dysarthria (dystonia)

symptoms: Spasmodic Torticollis

(contractions of the neck muscles), Tardive Dystonia (mouth and face resulting in grimacing and sustained tongue protrusions), and Meige Syndrome (repetitive eye blinking and abnormal facial movements; Involuntary movements can affects jaw, tongue, mouth, and neck).

symptoms: spasmodic dysphonia

Although not a primary dystonia, SD is characterized by involuntary contraction of the vocal folds during phonation. Unlike the primary dystonias where contractions are gradual, contractions in SD are described as active and vigorous.

speech characteristics

Articulation: Most salient speech deficit seen in those with Hyperkinetic Dysarthria of Dystonia ● Imprecise consonant production, Distorted vowels, Irregular articulatory breakdowns, Prolonged phonemes Prosody: Not as common as articulation errors, yet can still be frequent. This errors are caused by reduce range of motion and speed of the vocal tract ● Monopitch, Monoloudness, Inappropriate silences, Shortened phrases Phonation: Salient speech error in dystonia. Most with dystonia have a harsh vocal quality, and some may have a strained strangled quality. Excess loudness may also occur due to hyperadduction of the vocal folds. Respiration: Not as common, however, the excess loudness seen in phonation errors may also occur. This respiration errors are a result of abnormal contractions of the muscles for respiration. Resonance: Resonance deficits are rarely seen in hyperkinetic dysarthria of dystonia.

Medical tx

Botox (botulinum toxin) injections: Most successful drug based option, most commonly used, and most effective treatment for focal dystonias. The injection is placed into the muscle to reduce the contractions. Deep Brain Stimulation (DBS): This treatment has widened the spectrum of therapeutic options for patients with dystonia. It may be recommended for individuals with dystonic contractions, especially when medications cease to work sufficiently.

common etiologies

CVA of the basal ganglia, TBIs, Carbon Monoxide poisoning, Cerebral Anoxia, and Tumors

life expectancy

Individuals with dystonia are not at risk for a shorter life span.

Behavioral txs

Sensory tricks: It is recommended for clinicians to patients to find and use sensory tricks to suppress movements. The tricks can be as simple as touching the affected body part or even sucking on mint to help with articulation. However, they might not work for every patient and they might not work long term. Bite blocks: Used with focal dystonic jaw movements to stabilize the jaw during speech production. The bite block does not have to be visible and can be held between the back molars. Used to improve intelligibility by facilitating an open mouth productions and over articulation. Easy onset of phonation: This can lessen involuntary movements affecting the larynx.

symptoms: primary dystonias

Slow, sustained, involuntary muscle contractions in various parts of the the body depending on the etiology.

typical age of onset

There is no exact age of onset for dystonia. Dystonia can be present in children and adults. For children, symptoms of early onset generalized dystonia generally appear between the ages of 5 and 16 years old. Adults with Meige Syndrome typically start showing signs of dystonia at middle age.

assessment procedures

Vowel Prolongation: The purpose of asking a person to prolong a vowel is to better detect voice quality. Pitch and loudness can also be assessed. Alternate Motion Rates: The purpose of AMR is to detect irregular articulation breakdowns and speech rate variations. Conversation: Conversational speech and reading aloud evoke articulation and prosody errors. Observation: Observing the movements of the individual can help determine if dystonia is present.