Ataxic, hyper, hypo, mixed

Clinical signs of cerebellar damage

Ataxia: incoordinated, clumsy, high fall risk

Dysmetria: X stop mvm, mvt under or overshoot

Dyssnergia: decomposition of mvm (errors in timing, speed)

Hypotonia

Asthenia: muscle easily tired

Tremor: intention tremor only seen during mvm, OK at rest

Disturbance of posture, gait (incoordination, loss of balance=falls)

Rebound phenomenon (neurologists ask pts to put hands out, tap on arm): exaggerated reflex of mvm, positive rebound means that they have cerebellum damage, possibly have ataxic dysarthria

Nystagmnus-involuntary eye mvms, eye will dart around

Ataxic dysarthria

Causes of cerebellar damage

Trauma

Vascular disease

Infections

Tumours

Toxic, metabolic, endocrine disorders

Demyelinating, hereditary

Extra-pyramidal system disorders

Extra-pyramidal system-multi-synaptic pathways indirectly connecting motor areas of cerebral cortex with LMN

Major components: basal ganglia, substantia nigra, red nuclei, subthalamic nuclei

Controls muscle tone for maintenance of posture, for supporting mvms

Pyramidal

Straight from motor cortex to LMN

Clinical signs

Hypokinesia

Hyperkinesia

slowness, poverty spontaneous mvm

Types: akinesia- X mvm at all, most disabling symptom

Characteristics: slowness in intiation, execution of vol mvms, slow shuffling gait-dev festinating gait

Bradykinesia

Affects speed that muscles are activated

Slow mvm, delayed or false starts-reattempt a mvm multiple times

Slowness once mvt begun, may be difficult to stop

Intermittent freezing/immobility

Loss of postural reflex, stooped look-rounding of shoulders, loss of muscular contraction to support body-core strength impacted.

Tremor at rest: most evident at rest (limbs, head), pill rolling- thumb-fingers rubbing tgt

Rigidity: increased muscle tone, slowness of mvt, feeling of stiffness, cogwheel rigidity

Aetiology

Parkinson's disease as most freq cause. Hypokinetic dysarthria occurs in approx 70-90% of all cases. Increase in prevalence, severity as disease progresses. Degeneration nerve cells, also possible if someone has vascular lesion in extra pyramidal systemtracts in corpus striatum, substantia nigra-deficiency of neurotransmitter dopamine

Any process that damages extrapyramidal system-stroke, cerebral hypoxia, TBI, toxic-metabolic conditions (neuroleptic, anti-emetic drugs)

abnormal excessive involuntary mvm

2 Types

Quick

Slow

Myoclonic jerks: abrupt, sudden, unsustained, irregular, muscles of limbs, face, oral cavity, soft palate, larynx, diaphragm-affects speech

Tics: Brief, unsustained, recurrent, compulsive moments of small part of body eg. Tourette syndrome with multiple tics, uncontrolled vocalisations (grunting, coughing, barking), coprolalia (involuntary swearing)

Chorea: single, unsustained, muscle action --> short, rapid, uncoordinated jerks of trunk, limb, face, tongue or diaphragm, irregular, unpredictable patterns. 2 major diseases: Huntington's chorea, Syndenham's chorea

Ballismus (hemiballismus): wild flailing mvms on one side of body, marked in arm, facial muscle

Athetosis

Dyskinesia

Dystonia

Huntington's chorea

What is it: chronic degenerative neurological disorder, progressive chorea, intellectual deterioration, decreased cognitive functioning.

Inherited condition: begins in adult life, fatal 10-20y post onset.

Lesions: loss of neurons w/i caudate nucleus, putamen, cerebral cortex, white matter

Features: facial grimacing, head jerks, weaving mvm of arms and shoulders, twists, jerks of body, increased muscle tone, problems w coordination

Continuous, arrythmic, slow writhing-type mvms

Irregular respiratory cycling: unable to regularly inhale, exhale. Decreased vital capacity, difficulty controlling prolonged exhalation, laryngeal spasm, incoodination of phonation, articulation, monopitch, artic errors

Lingual, facial, buccal, peri-oral areas

Repetitive, slow, writhing, flexing, extending voluntary mvm with tremor

Tardive dyskinesia, levodopa-induced kinesia (effect of dopamine medications to replenish dopamine BUT this medication then causes excessive involuntary mvm)

Slow, sustained for prolonged periods

Speech muscles-facial spasms, prolonged lip pursing, invl twisting, protrusion of tongue

Essential tremors

Tremors-involuntary mvms resulting from contraction of opposing muscle groups

Absent at rest-appears when muscles act to move or support body part

Slowly progressive-hands, heads commonly affected

May affect laryngeal muscles-organic voice tremor-excess low pitch, monopitch, strained, strangled quality, pitch breaks, harsh

Mixed dysarthria

What is it?

3 neurological conditions

1 level of nervous system damaged

Aetiology: CVA, TBI (most common), inflammatory disease, degenerative conditions

ALS

Multiple sclerosis

TBI

What is it: form of MND, selective, progressive degeneration of corticospinal, corticobulbar pathways, severe weakness of bulbar musculature, both UMN, LMN lesions , dev b/w 60-70 y/o, die usually 1-5 years from onset

Aetiology: variety of hereditary, traumatic, toxic, viral, but mostly unknown

Problems: swallowing, aspiration, saliva control, speech

Types of dysarthrias: Flaccid-spastic dysarthria. BUT overall: more spastic > flaccid. Flaccid-phon and reson, spastic-prosodic excess, insufficiency, artic, reson incompetence, phon stenosis (at lvl of VF)

What is it: most common demyelinating disease, is a major cause of neurological disability in young adults (peak onset 20-40y/o females slightly more affected than males),

Caseload: 2/3 cases periods where symptom get worse, remission (period of hiatus where things return to near normal), 1/3 cases progressive without remission. Majority: significant disability wrt motor, cognitive function

Aetiology: unknown-metabolic, immunological, inflammatory, viral. Most common in temperate climates. Lesions- white matter CNS-demyelination causes scarring (sclerosis) of brain tissue- seen as plaques in white matter, may affect a number of diff parts in CNS

Symptoms: optic neuritis, motor difficulties, incontinence, dysarthria, dysphagia, seizures, mood affected, cognitive and memory problems

Dysarthria-Approx 1/3 problems with commn in TBI Population. Wide range of severity-can be from mild artic imprecision to total unintelligibility. Long term outcome-persistent disorder

Aetiology: falls, MVAs

Prognosis: poor BUT functional speech has been recovered long after acceptable period of neurological recovery