Dysarthria PDF

Dysarthria By Dr.Elham Moamen Lecturer of Phoniatrics Faculty of medicine, Suez canal university Objectives Definition Aetiology Clinical picture Diagnosis Treatment  Definition It is a group of neurogenic speech disorders characterized b...

Dysarthria By Dr.Elham Moamen Lecturer of Phoniatrics Faculty of medicine, Suez canal university Objectives Definition Aetiology Clinical picture Diagnosis Treatment  Definition It is a group of neurogenic speech disorders characterized by “abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production”. Neurogenic Impaired speech production  Types The primary types of dysarthria identified by perceptual attributes and the associated localization of pathophysiology (Duffy, 2020) are as follows: Flaccid—associated with disorders affecting the lower motor neuron pathways and motor units. Spastic—associated with bilateral disorders of the upper motor neuron system. Ataxic—associated with disorders of the cerebellar control circuit. Hypokinetic—associated with disorders of the basal ganglia control circuit. Hyperkinetic—associated with disorders of the basal ganglia control circuit. Unilateral upper motor neuron—associated with unilateral disorders of the upper motor neuron system. Mixed—various combinations of dysarthria types (e.g., spastic–ataxic, flaccid– spastic). Undetermined—Perceptual features are consistent with a dysarthria but do not clearly fit into any of the identified dysarthria types.  Aetiology (Causes) Congenital—Cerebral palsy, Chiari malformation, congenital suprabulbar palsy, syringomyelia, syringobulbia Degenerative diseases—Amyotrophic lateral sclerosis, Parkinson’s disease, progressive supranuclear palsy, cerebellar degeneration, corticobasal degeneration, multiple system atrophy. Demyelinating and inflammatory diseases—Multiple sclerosis, Guillain-Barré and associated autoimmune syndromes. Infectious diseases—COVID-19, acquired immune deficiency syndrome (AIDS), infectious encephalopathy, central nervous system tuberculosis, poliomyelitis. Neoplastic diseases—Central and peripheral nervous system tumors; cerebral, cerebellar, or brainstem tumors.  Aetiology (Causes) Toxic/metabolic diseases—Botulism, carbon monoxide poisoning, hypothyroidism & Wilson’s disease Trauma—Traumatic brain injury, neck trauma, neurosurgical/postoperative trauma. Vascular diseases—Stroke (hemorrhagic or nonhemorrhagic) & arteriovenous malformations Other neurologic conditions—Hydrocephalus, Meige syndrome, myoclonic epilepsy & Tourette syndrome.  Affected Speech parameters Resonance Articulation Prosody + Respiration Phonation  Clinical picture People who have dysarthria produce sounds that approximate what they mean and that are in the correct order. BUT Atypical vocal quality (e.g., breathy, harsh, strained) and difficulty changing loudness and pitch due to the neuromotor damage to the phonatory system. Speech may be jerky, staccato, breathy, irregular, imprecise, or monotonous, depending on where the damage is.  Clinical picture Because the ability to understand and use language is not usually affected, most people with dysarthria can read and write normally. In addition, there could be a difficulty chewing and swallowing.  Diagnosis Case History Aetiology of dysarthria, if known. Associated deficits (e.g., language, cognitive communication, swallowing). Medical procedures, hospitalizations, and prior treatments /rehabilitaions and their outcomes. Medications and potential side effects/symptoms. Person-specific communication needs. The impact of the presenting problem on activities, participation, and overall quality of life.  Physical Examination Assessment of overall body posture and breathing pattern. Complete cranial nerve examination to assess facial, oral, velopharyngeal, and laryngeal function. Assessment of sustained vowel prolongation—to determine if there is adequate pulmonary support and proper phonation.  Physical examination Articulatory structures (e.g., head, jaw, lip, tongue) Muscle state (wasting) Muscle tone (Abnormal muscle tone at rest) Muscle power (Weakness) Muscle range of motion (Decreased) Presence of abnormalities {Fasciculations, Tremors, Involuntary movements Abnormal reflexes (e.G., Hypo- or hyperactive gag reflex, jaw jerk..)}  Physical examination A) Non speech tasks B) Speech tasks Judge speed and regularity of jaw, lip, and tongue movement and articulatory precision. Single-words, phrases, sentences and connected speech (reading and/or spontaneous speech). Speech intelligibility—the degree to which the listener (familiar or unfamiliar) understands the individual’s speech signal. Intelligibility and comprehensibility are typically reported as a percentage of words correctly identified by a listener.  Additional areas of assessment Language—Assess receptive and expressive language skills in oral and written modalities to help distinguish between dysarthria and aphasia. Cognitive-abilities—Attention, memory, organization, executive function, level of alertness. Swallowing—Assess swallowing function.  Treatment Dysarthria treatment focuses on facilitating efficient, effective, and natural communication between the patients and their listeners. Speech therapy  Treatment Restorative interventions Maximize intelligibility by improving the function of the speech production subsystems (respiration, phonation, resonance, articulation & prosody). Restorative approaches focus on improving speech intelligibility, Compensatory interventions Maximize a person’s participation in activities by improving functional communication. Compensatory approaches focus on Improving: The speaker’s use of communication strategies, The listener skills and capacity, and Effective use of AAC strategies (e.g., speech-generating devices, letter board). Good luck