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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
In addition to the above cardinal features, the following motor signs are frequently associated with parkinsonism: Gait abnormalities: freezing, festinating, short/shuffling steps, slower speed.Flexed posture of limbs, neck, and trunk.Masked facial features (hypomimia), decreased blink rate.Progressively smaller handwriting (micrographia).Softer speech (hypophonia).
Paralysis of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Patients with unilateral laryngeal paralysis typically experience hoarseness and hypophonia. These can range from subtle vocal fatigue to near-total aphonia, reflecting the degree of glottic insufficiency, which varies from affected individual to individual. Dysphagia with possible frank aspiration may also be reported, albeit less often than voice complaints. Dysphagia-related complaints are more frequent in cases of ‘high’ vagal injury, affecting both superior and recurrent laryngeal nerves, which adds hemi-laryngeal anaesthesia, pharyngeal constrictor atony and cricopharyngeal muscle hyperfunction to glottic insufficiency from the immobile vocal fold. Situations in which laryngeal anaesthesia exists alongside other cranial nerve deficits, as in jugular foramen syndromes, after stroke and after skull base surgery also carry increased dysphagia risk. Surgeries affecting pulmonary reserve, as do most thoracic procedures, appear to carry a higher risk of aspiration, and age may be an independent risk factor.23
Introduction to brain damage part two
Published in Barbara A. Wilson, Samira Kashinath Dhamapurkar, Anita Rose, Surviving Brain Damage After Assault, 2016
Barbara A. Wilson, Samira Kashinath Dhamapurkar, Anita Rose
Locked-in syndrome (LIS): This condition usually is the result of brainstem pathology, which disrupts the voluntary control of movement. However, the sustained damage does not disturb wakefulness or awareness. Individuals who are diagnosed as “locked in” usually experience significant if not full body paralysis, but they are fully conscious. Such individuals are able to communicate consistently and reliably using movements of the eyes or by movements of the eyelids. The American Congress of Rehabilitation Medicine (1995) said that the LIS had five characteristics, namely (i) sustained eye opening, (ii) preserved basic cognitive abilities, (iii) aphonia or severe hypophonia (loss of voice), (iv) quadriplegia or quadriparesis and (v) a vertical or lateral eye movement or blinking of the upper eyelid as the primary means of communication. In order to determine whether someone has LIS, one can ask a series of yes/no questions, ask the person to blink once for yes and twice for no (or eyes up for yes and down for no) and see if the responses are accurate.Laureys and colleagues (2005) published an excellent chapter on what it is like to have this syndrome.
Comparison of Parkinsonian speech ratings by individuals with Parkinson disease, communication partners, and a trained rater
Published in Speech, Language and Hearing, 2022
Sabiha Parveen, Alexander M. Goberman
Individuals with PD have demonstrated deficits in sensory and proprioceptive reception within the orofacial region, hands, and arms (Koller, 1984). These somatosensory deficits can range from pure perceptual deficits in auditory or visual modalities, or to a combination of auditory and visual deficits, to overall disturbed sensorimotor integration (Fearon et al., 2015). The term sensorimotor integration refers to the process of integrating the incoming sensory input from the central nervous system to facilitate the execution of motor programs. Basal ganglia are essential to an effective sensorimotor integration mechanism (Abbruzzese & Berardelli, 2002). Evidence suggests that the auditory and somatosensory loops of the sensorimotor integration system may be affected among individuals with PD due to basal ganglia dysfunction leading to deficits in motoric performance, including speech production and perception tasks requiring these sensory systems (Fearon et al., 2015). One of the distinctive speech characteristics of hypophonia in individuals with PD is related to deficits in sensorimotor integration such that there is an abnormal integration of self-perception of loudness during the motor output of the speech intensity among these individuals (Clark et al., 2014). Similarly, motor deficits, including bradykinesia and gait deficits among individuals with PD, are attributed to the underlying impaired sensorimotor integration functioning (Fearon et al., 2015).
Manganese concentration in patients with encephalopathy following ephedrone use: a narrative review and analysis of case reports
Published in Clinical Toxicology, 2022
Michal Ordak, Natalia Sloniewicz, Tadeusz Nasierowski, Elzbieta Muszynska, Magdalena Bujalska-Zadrozny
In 2008, Stepens et al. described 23 adult patients (20 men and three women) from Latvia who had used intravenous ephedrone for 1.5–12 years [10]. All of them suffered from hepatitis C, and 20 of them also suffered from HIV. The patients initially reported neurological symptoms such as hypophonia (three patients) and gait disturbance (20 patients). The first symptoms appeared on 1.3–10.3 years after the first use of ephedrone. Neurological examinations showed abnormal gait and difficulty walking backwards in all patients. Eleven patients regularly fell over, and one was required a wheelchair. In 21 patients, in addition to gait disturbances, the hypophonic speech was present, and one of them was mute. No patient reported a cognitive decline. Cessation of ephedrone used did not lead to improvements in neurological deficits. Three patients received levodopa without improvement in their movement disorders. In one patient who developed signs two months before treatment, chelation therapy with three parenteral diethylenetriaminepentaacetic acid administrations over six days resulted in a 28% reduction in blood manganese concentration, but with no change in movement disorders. The manganese concentration in whole blood was measured with graphite furnace–atomic absorption spectrometry. The samples were injected into a Zeeman spectrometer [10].
Sequential motion rate and oral reading rate: normative data for Greek and clinical implications
Published in Logopedics Phoniatrics Vocology, 2022
K. Konstantopoulos, P. Vogazianos, Y. Christou, M. Pisinou
A history form specialized for speech/voice and an oromotor clinical examination were performed by an experienced speech therapist to measure the severity of dysarthria. In the history form, the patients reported speech/voice abnormalities such as slow or fast rate along the course of the disease, hypophonia, imprecise articulation, breathiness, mumbling, shortness of breath, and harshness of voice. The oromotor clinical examination showed that the patients exhibited moderate dysarthria and dysphagia with reduced sustained phonation (20/20 patients, 100%), low volume for voice (18/20 patients, 90%), reduced tongue movement (18/20 patients, 90%), and reduced lip movement (13/20 patients, 65%). After the dysarthria assessment, a recording of speech took place.