Dysarthria Assessment and Treatment

Dysarthria Assessment and Treatment

• Dysarthria treatment approaches vary between clinicians.
• A combination of therapies is usually recommended.
• Treatments might focus on the damaged cranial nerve.
• Strengthening exercises are best for patients with significant weakness.

Damage to the Trigeminal Nerve

• Jaw muscle strengthening:
  • Three sets of opening and closing the mouth.
  • Focus on increasing bite strength.
  • Resistance exercises (opening, resisting closure).

Damage to the Facial Nerve

• Lip strengthening exercises:
  • Lip puckering (hold fully puckered for 10 seconds, then move side-to-side). Repeat 10 times.
  • Holding a wide smile for 5-10 seconds.
• Impacts bilabial and labiodental phonemes (sounds).

Damage to the Vagus Nerve

• Resonance deficit treatment:
  • Surgical/prosthetic:
    • Using a pharyngeal flap to ensure velopharyngeal closure.
    • Injecting Teflon into the pharynx where the soft palate makes contact.
    • Prosthetic palatal lift to push the velum upward (most successful).
  • Note: The effectiveness of surgical/prosthetic methods isn't consistent across all patients.

Modification of Speech

• Increase loudness: Masking nasal sounds with increased volume.
• Reducing speech rate: Increases intelligibility and reduces perceived hypernasality.

Phonation Deficit

• Pushing and pulling exercises: Patient uses upper body strength to aid vocal fold adduction.
• Holding breath to fully adduct vocal folds.
• Hard glottal attack: Rapid adduction with subglottic air pressure, followed by a "burst" of phonation.
• Head turning/sideways pressure: Helps with unilateral laryngeal weakness/paralysis.

Prosodic Deficit (Treatment)

• Pitch range variation:
  • Prolonging "ah" at low and high pitches.
  • Reading sentences with pitch arrows to demonstrate variation.

Damage to the Hypoglossal Nerve

• Tongue strengthening:
  • Resistance: Resist lateralization (clinician pushes toward the middle).
  • Elevation: Using a tongue depressor to elevate the tongue's back.
  • Mirror practice: Improves awareness and accuracy of tongue movement.
• Imprecise consonants are a common result.

Traditional Articulation Treatment

• Intelligibility drills: Patient reads words/sentences without clinician feedback.
  • If unintelligible, patient repeats, or clinician provides feedback.
• Phonetic placement: Instruct patient on correct articulator positions for improved speech.
• Minimal contrast drills: Emphasize phonetic differences (e.g., voicing, manner, place, vowels).
  • Example: 'park' vs. 'bark'.

Resonance Treatment

• Reduction of velar hypertonicity:
  • Stimulate tongue & velum with objects in mouth
  • Massage velum with depressor
  • Press velum upwards with depressor
• Increased loudness: Improve intelligibility by masking hypernasality.

Treatment of Spastic Dysarthria

• Phonation:
  • Head and neck relaxation (tilting, massage).
  • Yawn exercise: Promotes relaxation of the neck muscles.
• Articulation:
  • Tongue stretching.
  • Lip stretching (smiling, kissing, puffing cheeks).

Unilateral Upper Motor Neuron

• Definition: Damage to one side of the upper motor neurons causes weakness on the opposite side of the mouth, face, lips, tongue.
• Etiologies: Stroke, tumors, TBI.

Further Treatment Approaches

• Intelligibility drills, Phonetic placement, Minimal consonant drills, and Oral motor exercises are key aspects of speech therapy for dysarthria.
• Respiration techniques: Slow, controlled exhalation with subsequent speech.
• Pacing board for improved rate.
• Delayed auditory feedback (DAF) for practice and reinforcement.
• Treatment plan: Detailed, individualized treatment plan developed prior to therapy commencement. This plan should include factors from diagnostic reports as applicable.

Explore various approaches to assessing and treating dysarthria, including exercises targeting different cranial nerves. This quiz covers treatment methods such as jaw and lip strengthening, as well as strategies for addressing resonance deficits. Improve your understanding of dysarthria therapy techniques relevant for clinicians.