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Hypokinetic Dysarthria most common characteristics reduced vocal loudness harsh or breathy vocal quality and abnormal speaking rate (slow or rapid) increased speaking rate
What is the unique characteristic of Hypokinetic Dysarthria increased rate of speech may be one of the symptoms and the majority of cases share the same etiological factor.
What is the major etiological factor that causes Hypokinetic Dysarthria Parkinsonism
What are the Parkinsonism symptoms that affect speech? Muscle rigidity reduced ROM slowed movement
The symptoms of Parkinsonism that affect speech are caused by what? dysfunction in BG or damage to the BG control circuit.
A Parkinsonism characteristic known as Tremor Resting Tremor most commonly involves the hands and fingers but can also involve the limbs and face most noticeable when the body is NOT moving tends to decrease during voluntary movement
A Parkinsonism characteristic known as Bradykinesia Bradykinesia relates to slow and reduced ROM things like the shuffling walk or the masked face these are not related to muscle weakness but rather to a dysfunction of the Basal Ganglia
Is Bradykinesia related to muscle weakness? NO – it is not related to muscle weakness but rather to a dysfunction of the Basal Ganglia.
Atkinesia is a Parkinsonism characteristic Atkinesia is a delay in the initiation of movements
When a patient has the Parkinsonism characteristic known as Atkinesia the delay in the initiation of movements can cause them to become ‘stuck’ in a posture or have trouble stopping a movement once it is started.
Muscular rigidity is a Parkinsonism characteristic that happens as a result of increased muscle tone causes resistance to movement it can result in a slowness of movement and a feeling of stiffness or tightness
A Parkinsonism characteristic known as muscular rigidity can present with a person having a constant resistance to movement known as lead pipe resistance or an intermittent change in resistance known as cogwheel resistance
Another Parkinsonism characteristic is impaired… Impaired Postural Reflexes
Impaired Postural Reflexes are a characteristic of Parkinsonism where the patient may have difficulty maintaining their balance when walking difficulty rising from a chair
Additional Parkinsonism characteristics DDDH Depression Dysphagia Dementia Hypokinetic Dysarthria
Neurological Basis of Hypokinetic Dysarthria dysfunction in basal ganglia or damage to basal ganglia control circuit
A collection of subcortical gray matter that includes the caudate nucleus the putamen and the globus pallidus is the basal ganglia
Fibers from the cortex transmit info about PLANNED UPCOMING MOVEMENTS to WHERE? THE BASAL GANGLIA gets information about planned upcoming movements from fibers that transmit info from the cortex.
What does the Basal Ganglia do when it gets INFO ABOUT PLANNED UPCOMING MOVEMENTS from the fibers from the cortex? it SMOOOOTHS AND REFINES THEM AND THEN SENDS OUT THE NEWLY REFINED PLANNED MOVEMENT INFO back up to the motor cortex (but via the thalamus)
The smoooooothed and refined movements that went to the BG and then back up to the motor cortex via the thalamus are transmitted through what system? the pyramidal system (en route to the LMNs)
What are some functions of the Basal Ganglia? smooooths refines regulates muscle tone regulates movements that support goal directed movements control postural adjustments during skilled movements adjust movements to the environment assist in learning new movements
What are some functions of the Basal Ganglia? smoooooothing and refining regulating controlling adjusting and assisting
Proper BG function largely depends on the balanced interaction of neurotransmitters
What are the BG neurotransmitters? Dopamine = inhibitory. It slows neural activities within the striatum and also Acetylcholine = excitatory. It affects the BG by facilitating neural firing.
Where is Dopamine produced? it is produced by neurons in the Substantia Nigra
In Parkinsonism there is a reduction in what in the BG? In Parkinsonism there is a reduction of Dopamine in the Striatum this creates an imbalance…
The Dopamine producing neurons in the Substantia Nigra degenerate in Parkinsonism which results in production of LESS Dopamine for USE in the Striatum 
When there is LESS Dopamine for USE in the Straitum  there is too much what? TOO MUCH ACETYLCHOLINE…
TOO MUCH ACETYLCHOLINE may be what causes the muscle rigidity.
What is the goal of the medical / pharmacological treatment for Parkinsonism treat the neurotransmitter imbalance (ie: to replace the dopamine; to decrease the ACh activity via anticholinergics)
How can you decrease the Ach activity? anticholinergics
How do you treat Prosody concerns with hypokinetic dysarthria? I SEE SEE YOU....... Intonation profiles Contrastic Stress Drills Chunking Utterances into Syntactic Units
LSVT is used to treat what kind of dysarthia? Hypokinetic Dysarthria, Parkinson's Disease, Parkinsonisms and any other neurological disorders were there is decreased intelligibility and decreased vocal loudness.
Who developed LSVT? Ramig and Mead in 1987
What is the name of an intensive behavioral treatment that is given in sixteen sessions in one month? LSVT
What behavior treatment is done to increase intelligibility and vocal loudness? LSVT
80% of patients with Parkinson's disease exhibit these traits: reduced loudness, unclear speech, monotone, vocal tremor, hoarseness, and a rapid rate of speech
What are the five essential concepts for LSVT? Focus on VOICE Focus on HIGH EFFORT Focus on INTENSIVE TREATMENT Focus on CALIBRATION Focus on QUANTIFICATION
How does LSVT focus on VOICE? THINK LOUD! THINK SHOUT! This improves focal fold adduction! It has a maximum impact on intelligibility and has immediate reinforcement.
How does LSVT focus on HIGH EFFORT? HIGH EFFORT IS IN BOTH PHONATION AND PHYSICAL. It pushes the patien to new effort levels, trains on a new amplitude target and puts the LOAD on the LARYNX. It overrides rigidity and hypokinesia which helps deal wih progressive neurological diseases...
With regard to HIGH EFFORT and LSVT? Who is putting in the High Effort? Both the patient and th clinician! Helps with lack of affect and physical condition of patient...
How does LSVT focus on INTENSIVE TREATMENT? 16 SESSIONS PER MONTH! Daily opportunities to practice increase likelihood of 'building daily increments of vocal effort.' Maintain motivation and accountability... Maximize habituation and carry over/generalization...
What is a benefit of INTENSIVE TREATMENT in LSVT for the CLINICIAN? Intensive Treatment provides an opportunity for the clinician to see the patients daily fluctuations via 16 sessions per month...
How does LSVT focus on CALIBRATION? Through calibration, the patient 'knows' and 'accepts' the amount of effort needed to consistently increase vocal loudness to a level that is within normal limits.
Through the focus on CALIBRATION in LSVT, what is estabished? The relationship between increased vocal effort and vocal output is established through calibration.
When a patient is 'calibrated' in LSVT, he/she uses his/her louder voice... automatically in daily communication and is able to maintain this louder voice.
What is challenging at first with LSVT? Convincing the patient that their new LOUDER voice is within normal limits WNL, also you need to work toward habituation and carry over/generalization.
How does LSVT focus on QUANTIFICATION? Quantification is the KEY to motivating the patient! Must provide FEEDBACK! Use objective methods to document improvement. Document eficacy!
Overview of LSVT: Daily variables. Hierarchical speech loudness drills. Integration of the five essential components. Actual techniques are common voice treatment approaches but through administration and integration are specifically designed for Parkinson's Disease.



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