Dysarthria
Dysarthria | |
---|---|
Other names | Speech sound disorder, Developmental speech sound disorder |
Specialty | Neurology, neuropsychology, speech–language pathology |
Symptoms | Slurred speech, weak execution of oral muscular movements |
Dysarthria is a
Neurological injury due to damage in the central or peripheral nervous system may result in weakness, paralysis, or a lack of coordination of the motor–speech system, producing dysarthria.[1] These effects in turn hinder control over the tongue, throat, lips or lungs; for example, swallowing problems (dysphagia) are also often present in those with dysarthria. Cranial nerves that control the muscles relevant to dysarthria include the trigeminal nerve's motor branch (V), the facial nerve (VII), the glossopharyngeal nerve (IX), the vagus nerve (X), and the hypoglossal nerve (XII).
Dysarthria does not include speech disorders from structural abnormalities, such as
Causes
Various neurological and motor disorders can give rise to dysarthria. The main causes can be classified as genetic, infectious, toxic, traumatic, vascular, neoplastic, demyelinating, degenerative, or other.[7][8]
- Genetic: Wilson's disease, Tay–Sachs disease, and Sensory ataxic neuropathy, dysarthria, and ophthalmoparesis (SANDO syndrome)
- Infectious: Lyme disease (borreliosis) and Creutzfeldt–Jakob disease (CJD)
- Toxic: Heavy metal poisoning and Alcohol
- Traumatic: Cerebral palsy (CP), Traumatic brain injury (TBI), Chronic traumatic encephalopathy (CTE)
- Vascular: Stroke and Transient ischemic attack (TIA)
- Neoplastic: Brain tumors
- Demyelinating: Multiple sclerosis (MS) and Guillain–Barré syndrome (GBS)
- Degenerative: Niemann-Pick disease (NP disease), and Friedreich's ataxia(FRDA or FA)
- Other: Hypoxic encephalopathy, Central pontine myelinolysis, and Idiopathic intracranial hypertension(IIH)
These result in lesions to key areas of the brain involved in planning, executing, or regulating motor operations in
Diagnosis
Classification
Dysarthrias are classified in multiple ways based on the presentation of symptoms. Specific dysarthrias include
Ataxic dysarthria is an acquired neurological and sensorimotor speech deficit. It is a common diagnosis among the clinical spectrum of
Common clinical features of ataxic dysarthria include abnormalities in speech modulation, rate of speech, explosive or
Ataxic dysarthria is associated with damage to the left cerebellar hemisphere in right-handed patients.[15]
Dysarthria may affect a single system; however, it is more commonly reflected in multiple motor–speech systems. The etiology, degree of neuropathy, existence of co-morbidities, and the individual's response all play a role in the effect the disorder has on the individual's quality of life. Severity ranges from occasional articulation difficulties to verbal speech that is completely unintelligible.[1]
Individuals with dysarthria may experience challenges in the following:
Examples of specific observations include a continuous breathy voice, irregular breakdown of articulation, monopitch, distorted vowels, word flow without pauses, and hypernasality.[4]
Treatment
Articulation problems resulting from dysarthria are treated by speech language pathologists, using a variety of techniques. Techniques used depend on the effect the dysarthria has on control of the articulators. Traditional treatments target the correction of deficits in rate (of articulation), prosody (appropriate emphasis and inflection, affected e.g. by apraxia of speech, right hemisphere brain damage, etc.), intensity (loudness of the voice, affected e.g. in hypokinetic dysarthrias such as in Parkinson's), resonance (ability to alter the vocal tract and resonating spaces for correct speech sounds) and phonation (control of the vocal folds for appropriate voice quality and valving of the airway). These treatments have usually involved exercises to increase strength and control over articulator muscles (which may be flaccid and weak, or overly tight and difficult to move), and using alternate speaking techniques to increase speaker intelligibility (how well someone's speech is understood by peers). With the speech–language pathologist, there are several skills that are important to learn; safe chewing and swallowing techniques, avoiding conversations when feeling tired, repeat words and syllables over and over in order to learn the proper mouth movements, and techniques to deal with the frustration while speaking. Depending on the severity of the dysarthria, another possibility includes learning how to use a computer or flip cards in order to communicate more effectively.[3]
More recent techniques based on the principles of motor learning (PML), such as LSVT (Lee Silverman voice treatment)[16] speech therapy and specifically LSVT may improve voice and speech function in PD.[17] For Parkinson's, aim to retrain speech skills through building new generalised motor programs, and attach great importance to regular practice, through peer/partner support and self-management. Regularity of practice, and when to practice, are the main issues in PML treatments, as they may determine the likelihood of generalization of new motor skills, and therefore how effective a treatment is.[citation needed]
See also
- Lists of language disorders
References
- ^ a b c d O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company.[page needed]
- ISBN 0323024521.
- ^ a b "Dysarthria". PubMed Health.
- ^ S2CID 39377646.
- ^ "Definition of DYSARTHRIA". www.merriam-webster.com. Retrieved 2020-03-07.
- ^ Company, Houghton Mifflin Harcourt Publishing. "The American Heritage Dictionary entry: dysarthria". www.ahdictionary.com. Retrieved 2020-03-07.
- PMID 37279355, retrieved 2024-04-19
- ISBN 9780323024525.
- S2CID 24242242.
- PMID 21827886.
- S2CID 19196473.
- PMID 502519. Archived from the originalon 2012-07-16.
- PMID 20453409.
- PMID 19088478.
- S2CID 16595062.
- PMID 17117354.
- ISBN 1-86016-283-5. Archived from the originalon 2010-09-24. Retrieved 2011-01-23.
Further reading
- Duffy, Joseph R (2005). Motor Speech Disorders: Substrates, Differential Diagnosis, And Management (2nd ed.). Saint Louis: C.V. Mosby. ISBN 0-323-02452-1.
- Gatokowska, Izbela. Diagnosing Dysarthria in Adults: A New Speech Assessment Method for Polish, English, and Spanish. AE Academic Publishing, 2020.
- Haines, Duane (2004). Neuroanatomy: an atlas of structures, sections, and systems. Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4677-9.
- Hustad, KC; Lee, J (2008). "Changes in Speech Production Associated with Alphabet Supplementation". Journal of Speech, Language, and Hearing Research. 51 (6): 1438–50. PMID 18664687.
- Hustad, KC (2006). "Estimating the Intelligibility of Speakers with Dysarthria". Folia Phoniatrica et Logopaedica. 58 (3): 217–28. S2CID 19302344.
- Hustad, KC (2006). "A Closer Look at Transcription Intelligibility for Speakers with Dysarthria: Evaluation of Scoring Paradigms and Linguistic Errors Made by Listeners". American Journal of Speech-Language Pathology. 15 (3): 268–77. PMID 16896176.