What is Mutism? - University of Massachusetts Amherst

14 Pages·2008·0.06 MB·English

by  Audri Cid

Mutism
by:
Audri Cid
Christine Walsh
What is Mutism?
(cid:122)Patients are unable to speak, but are
conscious and alert.
(cid:122)Can exist with or without:
(cid:123)Cognitive deficits
(cid:123)Motor deficits
(cid:123)Hearing loss/laryngectomy
(cid:123)Locked-in syndrome
Types of Mutism
Neurogenic –neurologically based Psychogenic –psychologically based
(cid:123) Anarthria (cid:123) Anxiety
(cid:123) Locked-in syndrome (cid:123) Stress
(cid:123) Cerebellar mutism (cid:123) Social phobia
(cid:123) Apraxia of speech (cid:123) Trauma
(cid:123) Aphasia (cid:123) Major life changes
(cid:123) Disorders of arousal
(cid:123) Akinetic
(cid:123) Corpus callosotomy
(cid:123) Drug induced
(cid:123) Apallic
Cerebellar Mutism
(cid:122) Occurs after surgery in the vermis of the cerebellum.
(cid:122) Language and speech abilities are normal immediately
post surgery, with mutism developing anywhere from 1
to 2 days later.
(cid:122) Patients are cognitively alert but experience difficulty
initiating oral movements and performing complex oral
motor tasks.
(cid:122) Mutism lasts on average 4-8 weeks and 80% of patients
are left with an ataxic dysarthria.
(cid:122) Primarily occurs in children due to posterior fossa
tumors, but occasionally affects adults.
(cid:122) Treatment involves speech therapy after mutism
resolves.
Akinetic Mutism
Akinetic Mutism caused by tumors, TBI, anoxia, encephalitis, etc.:
• Total absence of spontaneous behavior and speech, however can visually track
objects
Abulia:
• Lack of initiative in thought, speech, physical action and affective emotion
• Reluctance to perform simple motor activities, however has ability to do so
• Decreased speech output
• Speech characteristics are brief, aphonic, whispered, reduced in loudness,
monotone
Apathy:
• Diminished motivation, however normal consciousness, attention, cognitive
capacity and mood
• Able to initiate and sustain behavior, describe goals, interests and react
emotionally
Location of lesion: Usually ACA, PCA, SMA and the anterior cingulated gyrus
(cid:123) Reduces drive to speak drive for movements and activation of motor responses
(frontal lobes)
(Duffy, 2005)
Drug-Induced Mutism
Akinetic mutism or anarthria resulting from
neurotoxicity, usually as a result of
immunosuppressive therapy
-Cyclosporin-A
Location of lesion: Cingulated gyrus
-Imaging studies reveal decreased density of
cerebral white matter, most commonly affecting
the occipital cortex, cerebellum, periventricular
matter and brainstem
(Tague, S., Peudenier, S., Gie, S., Rambeau, M., Gandemer, V., Bridoux, L., Betremieux,
P., De Parscau, L., & Gall, E., 2004)
Case Study #1
(cid:122) 35-year-old woman admitted to hospital
(cid:122) On Day 5 displayed agitation, choreoathetotic involuntary
stereotypical movements of the upper and lower extremities and
trunk
(cid:122) Tendon reflexes were brisk
(cid:122) Plantar reflexes were positive
(cid:122) By the 3rd week displayed akinetic mutism
(cid:122) Decreased strength in the arms and legs resembling generalized
dystonia
(cid:122) Markedly dysarthric
(cid:122) Initially able to swallow
(cid:122) Severely impaired articulation
(cid:122) Speech limited to one-syllable utterances
(Zaknun, J., Stieglbauer, K., Trenkler, J. & Alchner, F., 2005)
Making a Differential Diagnosis
It’s important to consider several factors:
(cid:122) Previous health history
(cid:122) Current status and symptoms
(cid:122) Imaging studies (MRI, CT, PET)
(cid:122) CSF analysis
What to Assess…
(cid:122) Due to damage of the frontal lobes, all
aspects of executive function may be
assessed, including:
(cid:123)Arousal (EEG’s)
(cid:123)Cognitive processing
(cid:123)Affect and drive
(cid:123)Motor initiation, planning, programming and
coordination
(cid:123)Execution of movement
Treatment for Neurogenic Mutism
(cid:122) Trial of dopaminergic therapy
-Use of levadopa or carbidopa and
bromocriptine
• Surgical intervention
• Optimize medical condition with physical and
cognitive rehabilitation
• Modify environment
• Use of adaptive devices
• Behavioral intervention