hyperkinetic dysarthria hyperkinetic not hypokinetic is not what many people think speaking too fast but it's actually too much movement so hyper meaning increased or excess and kinetic meaning movement so don't get it mixed up with hypokinetic and don't get it mixed up with talking quickly and it doesn't mean excess muscle tone either so hyper kinetic dysarthria is when you have excess movement of the speech apparatus and there can be a number of causes so possible causes probably the most iconic one would be Huntington's disease which is a horrible genetic disease hereditary disease tardive dyskinesia is another example and tardive dyskinesia occurs when you have certain neuroleptics drugs psychiatric drugs and we will have a look at a video of this but the newer elliptic drugs can cause completely involuntary oral and facial movements and lingual movements Tourette's is another one we'll also have a look at a video of this Tourette's is not just about cursing and swearing in fact that aspect of it is really exaggerated it's not the most common aspect and as a health professional you should you should know more about the real Tourette's than what the media portrays any sort of trauma is an excess unwanted movement so even though tremor is synonymous with Parkinson's as I explained in another video you don't actually get tremor of the speech apparatus all that often in Parkinson's and so Parkinson's is not typically hyperkinetic dysarthria however when people with Parkinson's are over medicated when they have too much levodopa that causes excess writhing sort of movements called dyskinesias that is technically hyperkinetic we saw through if it affects their speech so these are just some examples of causes obviously there are many more but what are the actual mechanisms of these excess movements and and therefore the mechanisms of hyperkinetic dysarthria as with hypokinetic dysarthria it's caused by the basal ganglia this group of quite deep structures in the brain now it's not fully understood how all these movement disorders occur from the basal ganglia but some of the circuits in this and it's very complicated but some of them suppress movement and some of them excite movement and when one of those things one of those pathways is not behaving correctly it can result in either not enough movement or excess movement so if it's excess movement and it affects speech then it's hyperkinetic dysarthria hyperkinetic bizarre three is not distinctive in its own right it's a group of lots of different disorders so it doesn't have a specific sound by itself the way you'll be able to diagnose it is just by looking at what is happening with someone's speech and is it caused by involuntary or compulsive movement and that's the way you know that it's hyperkinetic so the key thing with hyperkinetic is that speech is often normal so it's not necessarily I can't make these movements or can't produce normal speech it's that they have to deal with superimposed movement so it's just like the old TV trope you see on cartoons and that sort of thing and I'm by no means making a joke of this because it's not a fun thing to have at all but it's like the TV trope where someone has either a spell cast on them or magic dancing shoes and I can't stop moving it's not that that person can't walk it's that they have to deal with all these extra movement obviously it's very socially unacceptable to have these things and it can be very devastating for people most commonly affected is the jaw and the tongue the face as well facial movements grimacing and that sort of thing but also if someone has more whole body dyskinesia more whole body movements that they can't control that can affect the neck or maybe the trunk and even if the arms and shoulders are moving you can imagine the effect that has on controlling your respiration for breathing or controlling your phone ation which in turn affects sort of resonance so it can affect each system and it's not necessarily speech and atomy that has to be directly affected it can have an indirect hyper-connected r3 now there are a heap of different types of movement disorders well or should I say categories of distant disorders so these are the kind of different labels across the bottom here I'm not going to go into them in detail it's it's probably not a strength of mine but in any case it's we haven't got enough time but you can see depending on what the movement looks like and kind of the cause it has a different name and you start to get to know some of these and we'll just have a look at a couple of these so there's a table here that gives you basic definitions but let's have a look at a couple of examples first we're gonna look at its dystonia which is basically muscle contractions that hold for quite a while so dystonia can have a number of causes in the video we're going to watch the cause is inner elliptic medication so for schizophrenia resulting in dystonia so when did when did you start having trouble talking obviously this man's jaw is wide open or really the facial movements pretty good actually despite that but you can say his tongues also not moving it's just pretty much at rest in his mouth and actually it's probably quite tense oh really this morning and did you take any drugs other than your prescribed drugs I would say there's some neck flexion too because he's sort of in that Flex position oh no you don't do cocaine or anything like that oh no okay whether that movement just here was an actual dystonia or whether he was just kind of scrunching up one eye to try and express himself no okay count to 10 for me Wow cool for facial movement looks okay overall it's really jaw and tongue see just at the front day his tongue was just moving at the tip and that's as much as he can manage phonation his normal respiration appears to be normal and after they give him benadryl you've improved quite a bit [Music] Joel's pretty good tongue still not doing everything it should in articulations not quite there as the pupil on this eye has it been bigger than the people on your other eye for a while Oh okay so if someone pinned your tongue down to the bottom of your mouth and you tried to talk that's more or less what it sound like so that was dystonia and that was temporary in this case another type of dystonia which affects the laryngeal muscles specifically is spasmodic dysphonia and if you're someone who believes that dysphonia is a type of is a subset of dysarthria then that fits perfectly in any case listen to this lady she's got dystonia of the internal muscles of the larynx which makes her vocal folds snap open or remain open after she opens them for voiceless sounds I have the rare aversion the a B or the abductor version my vocal cords stay open rather than open and shut and I Sam breathy quite frequently he so I have a shape mystically cross hip T or 60 steps in front of his history at ease house so she's kind of fighting with her own vocal folds to keep them adducted enough to phone eight but they're trying to open and therefore she's got the breathy sort of voice I mean you wouldn't diagnose this is a hyperkinetic dysarthria because the more specific diagnosis is spasmodic dysphonia but just for interest sake that's there it is and then the other type adductor type spasmodic dysphonia is where the vocal folds want to close really tightly rather than closing enough to phone eight the AED for spasmodic dysphonia plus Traver compound and with it so you can either tremor in her voice on top of the adduction the vocal cords snapping shut early one morning a man and a woman were ambling along a one-lane running near rainy intermittent tightness that strain in the voice and I'm not a voice expert but I think the tremor is probably secondary to the spasmodic dysphonia in her trying to fight the dystonia in the vocal folds so the next one we'll look at is tardive dyskinesia as I said this also comes about from some psychiatric medications so see that jewel movement that is completely involuntary she's not doing it as a nervous twitch or anything like that it just happens and the tongue writhing as well a poking out of the mouth you can imagine what that feels like what that is like socially for her and we how would it affect speech remember this is a subtle version see her lips and which may actually be extreme normal lips and Moving's turn out to be extreme normal and should be school that's a lot more subtle but it is still a problem but the size of the lip smacking happening there the tardive dyskinesia nothing he can do to stop that here's someone trying to speak with tardive dyskinesia he's got a lot of strong facial dyskinesia on the left side and trying to eat his meal with jaw and facial movement that you can't control that's what I'm talking about when I say it's like the superimposed movement neck dystonia as well here I think okay next one is Coria which is rapid irregular involuntary movements and the key thing is that they are quite fast Coria means dancing in Greek so Sydenham score is one such disorder which is what the girl that we're about to see has and it comes from infection from a specific type of bacteria her tongue is making those movements while she's trying to speak and you can hear what that's doing to her slight facial movements as well I see movement on the right side that her right so that wasn't permanent and this is her later on after recovery so pleased to know she recovered quite well so that's Korea you can see that none of these necessarily sound the same but they've got that feature of excess movement last one is tics now tics are slightly different tics are slightly different because they're not completely involuntary rather than being involuntary they're voluntary but they are irresistible so if you want to get a feeling of what it's like to have turrets just try just try holding saliva in your mouth for 90 seconds without swallowing so you after a while maybe 20-30 seconds you'll get an urge to swallow just ignore that and see how the pressure kind of builds the longer you don't swallow for because swallowing is kind of the same it's it is voluntary but there's an urge to swallow after a while and that builds with a sort of pressure I'll Antonio Cardoso and 24 years of age was diagnosed with Treach when I was for pain people need to know that we're all one and we're all together were we're just the same as everyone else be as a player and so we just need to get so that's compulsive sort of movements and you can see it's affecting his speech if you would like more information about retch or tech disorders go to travel and style obviously the first problem is he's Irish so he's got a really strong accent there's no cure for that I'll Antonio Cardoso I'm 24 years of age it's a jaw and sort of lip movements for pain and tension in the neck there I'm we're all together we're just the same as everyone else PS a play and so we just need to get that word out there and if you could all just help us student support us so they are some examples of hyperkinetic dysarthria they're kind of self-evident you don't need us especially trained ear to pick them and really the shortcut is already here excess movement excess involuntary compulsive movement causes hyperkinetic dysarthria thanks for listening check out my other videos on the other subtypes of dasarha and maybe if you have topic requests leave them in the comments thanks you