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Hypokinetic dysarthria & Parkinson's disease: A resource man

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Lauren Campbell

on 5 December 2014

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Transcript of Hypokinetic dysarthria & Parkinson's disease: A resource man

Overview of motor speech control and Parkinson's disease
In Parkinson’s disease, cells in the substantia nigra (part of basal ganglia control circuit) are damaged and don’t produce a crucial neurotransmitter called dopamine.
Medical & physiological aspects of Parkinson's disease
SLP assessment and treatment issues
What is it like living with Parkinson's disease?
Additional SLP Resources
Hypokinetic dysarthria & Parkinson's disease: A resource manual

Medications available
Surgical treatment
Parkinson's disease causes stiffness and slowness of movement. Symptoms include
slowed movement
rigid muscles
impaired posture
loss of automatic movements
Deep Brain Stimulation
DBS is thought to reduce activity in overactive brain structures by inhibiting firing of neurons (reducing unwanted movements) or helping of inhibitory neurons (increasing wanted movements).
Individuals who have undergone DBS still need to take medication, but after DBS many individuals with PD experience reduction of unwanted movements.
Pallidotomy is the permanent destuction of the globus pallidus, which is important in regulating movement.
A pallidotomy can enhance the effect of medication in people with and advanced form of PD.
Dopamine Replacement therapy
In most individuals with PD, Levodopa signficantly improved mobility in the early stages of the disease.
During the course of PD, individuals who are taking Levodopa can develop dyskinesias.
Despite these unwanted movements, clinical data suggests that Levodopa can slow the progression of PD or has a prolonged effect on the symptoms of PD.
Studies show that some individuals with PD demonstrated alleviated speech prosody deficits after the administration of levodopa-based medication.
Medications cont.
Dopamine Agonists
Unlike dopamine replacement therapies, dopamine agonists are not converted to dopamine. A dopamine agonist is a medication that mimics the effect of dopamine on the brain.
Some dopamine agonist medications include:

What is hypokinetic dysarthria?

Hypokinetic dysarthria is a a motor speech disorder characterized by:

a decrease in range of movement
an increase in tone causing rigidity and variability in movement of the articulators
a decreased amplitude

Parkinson's disease is a movement disorder that affects the basal ganglia circuit of the brain.
Parkinson's disease results from a loss of nerve cells producing dopamine.

Early- Tremor on one side of the body is usually the first symptom of PD.
Moderate- Individuals may begin to walk with a shuffling gait due to problems with balance.
Advanced-After several years with PD, individuals progress to the advanced stage. Stiffness in the muscles and tremors increase.
(National Institution of Neurological Disorders and Stroke, 2014; Duffy, 2013)
National Institution of Neurological Disorders and Stroke, 2014; Duffy, 2013
Lozano, et al, 1995
National Parkinson Foundation, 2014; Duffy, 2013
Alternative Treatments to PD
Vitamin E has been investigated as a treatment to PD because some investigators believe that late onset PD can be caused by unknown environmental toxicants that can cause damage to the substantia nigra
Vitamin E is thought to serve as a successful strategy for the prevention or treatment of PD by enriching the substantia nigra. However, more research is needed in this area.
(Farris & Zhang, 2003)
Overview of speech motor control
Orange: IAP
Blue=BG Control Circuits

Referred by neurologists, insurance companies, or patients in support group request services.
Generally when the patient requests services, or they indicate difficulties with speech, voice, or swallowing.
Neurologists now beginning to refer much earlier in disease progress.
LSVT assessment protocol
Oral/motor examination
Bedside swallow study if indicated
Frenchay Dysarthria Assessment
Roberston Dysarthria Profile
Assessment of Intelligibility in Dysarthric Speech
Treat the symptoms

The motor plan is accessed and info from the control circuits and IAP is integrated into the program. The program is then sent down the DAP and to the LMN!
Mayo Clinic
National Parkinson's Association

Be on the lookout for biases, reliable sources, and be able to back up your methods.
Web Resources
Have sources on hand for the population you work with.
Is the purpose...
personal support?
local resources?
The type of source depends on your clients needs.
......how do you find out what they are looking for?
Stages of Parkinson's disease
(Coelho, 2005)
Coelho, C. (2005). Prosodic characteristics of Parkinsonian speech: The effect of levadopa-based medication. Journal of Speech Language Pathology, 3(13), 51-68.

DeLong, M. (2014). The Basal Ganglia. Retrieved November 5, 2014, from http://fisica.cab.cnea.gov.ar/escuelaib2014-neurociencias/restricted/BOOKS/Principles of Neural Science - Kandel/gateway.ut.ovid.com/gw2/ovidweb.cgisidnjhkoalgmeho00dbookimagebookdb_7c_2fc~50.htm

Duffy, J. (2013). Managing the Dysarthria s. In Motor Speech Disorders: Substrates, Differential Diagnosis, and Management (3rd ed., pp. 425-427). St Louis: Elsevier Moby.

Duffy, J. (2005). Motor speech disorders: Substrates, differential diagnosis, and management (2nd ed.). St. Louis, Mo.: Elsevier Mosby.

Fahn, S., Shoulson, I., Rudolph, A., Lang, A., Tanner, C., Jonathan, D., Mare, K., (2004). Levodopa and the Progresson of Parkinson's Disease (K. Kieburtz, Ed.). The New England Journal of Medicine, 351 (42), 2498-2508

Fox, C., Ebersbach, G., Ramig, L., & Sapir, S. (2012). LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinson's Disease (20420080), 1-12. doi:10.1155/2012/391946

Farris, M., & Zhang, J. (2003). Vitamin E Therapy in Parkinson's Disease. Toxicoloty, 189, 129-146.

Halpern, H., & Goldfarb, R. (2013). Language and motor speech disorders in adults (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Miller, N., Deane, K. O., Jones, D., Noble, E., & Gibb, C. (2011). National survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: therapists' practices. International Journal Of Language & Communication Disorders, 46(2), 189-201. doi:10.3109/13682822.2010.484849

St. Clair, R., Rodriguez, W., & Joshua, I. (2014). The Basal Ganglia and the Serial Order of Communicative Signs. Retrieved November 5, 2014, from http://www.structural-communication.com/Articles/basal-ganglia-serial-order-rodgrizues-stclair-joshua.html

"Parkinson Disease is more than tremors. It affects every muscle in your body-from your limbs to your intestines to your throat, to your facial muscles, to your lungs, your heart, and your mind. There is not a muscle left untouched by Parkinson’s disease."
"It means not knowing what the future holds and not being able to do anything about it. It means when I go to bed at night I have no idea how I will be when I wake up in the morning."
"There are 1.5 million Americans with Parkinson's disease. Every case is different. Only Micheal J. Fox is Micheal J. Fox."

“I have tried not to let Parkinson’s disease define who I am. I have lived with
this disease for 8 years now. Each year more symptoms are added on and I
am beginning to realize what Parkinson’s can do. I have found that having
Parkinson’s disease has changed my bucket list. Instead of having trips or destinations that I would like to do I focus on developing good friendships.”

Hypokinetic Dysarthria
University of Michigan-Movement Disorders Program

-Cortical Basal Ganglionic Degeneration
-Lewy Body Disease
-Multiple system Atrophy
-Drug-induced Parkinsonism
-Parkinson's Disease
-Parkinsonism/Parkinson-Plus Syndromes
-Progressive Supranuclear Palsy
Parkinson's Disease
Parkinson's Resource Center
-Support Group
Sing! Sing Out Loud-
"Tremble Clefs"
-Dance For Parkinson's
Support Group:
-Parkinson's TeleHealth Program
(Miller et al., 2011, p. 193)
"Think Loud!"
Treatment Goals
Short Term Goals:
Produce vowels with average 75 dB for 20 seconds.
Average 70 dB during sentence reading and paragraph reading tasks.
Utilize diaphragm breathing, phrasing, and pitch variation in sentence reading with moderate assistance, 80% success.
Long Term Goals:
Increase average speaking loudness to 74 dB.
Increase speech prosody and facial expression to match words and situations.
(K. Hayes, personal communication, November 21, 2014)
(K. Hayes, personal communication, November 21, 2014)
(K. Hayes, personal communication, November 21, 2014)
(Clair, Rodriguez & Joshua, 2014)
(DeLong, 2014; Halpern & Goldfarb, 2013))
(Duffy, 2005)
-Hypokinetic dysarthria resources for SLPs
-Parkinsons's disease resources for SLPs
Possible causes of hypokinetic dysarthria

Parkinson’s disease
Vascular diseases
Toxic-metabolic diseases
Inflammatory diseases
Degenerative diseases
Infectious diseases

By: Kiera Giffin, Lauren Lytle, Taylro O'Grandy, Jan Rodriguez, Julia Terrell, Lauren Van Orden
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