Dysarthria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Synonyms and keywords:
Overview
Historical Perspective
- The term dysarthria is derived from New Latin.
- 'Dys' means dysfunctional/impaired and 'arthr' means joint/vocal articulation.[1]
- Tradiationally, dysarthria has been defined as disorders of oral speech resulting from lesions within the nervous system.[2]
- Recently, dysarthria includes speech disorders resulting from problem in muscular control of speech formation.[3]
Classification
Type of Dysarthria | Area of Lesion | Main Feature |
Flaccid | Bilateral/unilateral lower motor neuron | Weakness, hyporeflexia, lack of normal muscle tone |
Spastic | Bilateral upper motor neuron(UMN) | Weakness, hyperreflexia, hypertonicity |
Unilateral UMN | Unilateral upper motor neuron | Weakness, reduced ROM, decreased fine motor control of tongue & lips |
Ataxic | Cerebellum | Poorly coordinated movements of speech mechanism, scanning/drunken speech |
Hyper-kinetic | Basal ganglia | Quick involuntary movements (hyperkinesis) |
Hypo-kinetic | Basal ganglia | Less movement (hypokinesis), increased muscle tone |
Mixed | More that one type of dysarthria co-exist | Mixed presentation |
Pathophysiology
- Dysarthria is a motor speech disorder, marked by poor articulation caused by neuromuscular impairment.[6]
- Neurological deficit in CNS and/or PNS causes weakness and/or paralysis of muscles responsible for speech.
- Following subsystems contribute to speech formation, impairment of these subsystems results into poor perceptual speech:[7]
Causes
Pathology | Disease |
Lower motor neuron | Myasthenia gravis, muscular dystrophy, cranial nerve VII, IX, X, XII, motor neuron disease |
Upper motor neuron(UMN) | Stroke, Multiple sclerosis, amyotrophic lateral sclerosis, brain tumor, brain injury, cerebral palsy |
Cerebellum | Spinal-Cerebellar Ataxia, multiple sclerosis, alcohol, tumor, paraneoplastic disorder |
Basal ganglia - Hyperkinetic | Huntington's disease |
Basal ganglia - Hypokinetic | Parkinsonism |
Toxic and metabolic | Wilson's disease, hypoxic encephalopathy, central pontine myelinolysis, botulism |
Differentiating Dysarthria from other Diseases
- Dysarthria must be differentiated from other motor speech disorders like apraxia and development verbal dyspraxia.
- Apraxia is a neurological disorder where there is ability and motivation to form speech but the patient cannot due to neurological deficit.
- Development verbal dyspraxia lacks muscle weakness and is characterized by developmental inability to motor plan volitional movement for the production of speech. Links to the FOXP2 gene have been identified.[8]
Epidemiology and Demographics
- Incidence and prevalence is not fully established.
- Disease based prevalence of dysarthria is as following:
- Stroke: Approximately 8%–60% of individuals with stroke present with dysarthria.[9]
- Parkinson's disease: Approximately 70%–100% of individuals develop dysarthria.[10]
- Multiple sclerosis: 25% and 50% of individuals with multiple sclerosis present with dysarthria at some point.[11]
- Amyotrophic lateral sclerosis: Approximately 30%-100% depending on the stage of the disease.[12]
- Traumatic brain injury: Approximately 10%–65% of individuals with traumatic brain injury develop dysarthria.[13]
- There is no racial predilection to dysarthria.
- Dysarthria affects men and women equally.
Risk Factors
- There are no established risk factors for dysarthria.
Screening
- There is insufficient evidence to recommend routine screening for dysarthria.
Natural History, Complications, and Prognosis
- Common complications of dysarthria include social distancing, irritability, and depression.
Diagnosis
Treatment
Medical Therapy
- Treatment is focused on achieving independent daily living for the patients.
- A speech language pathologist assist in improving articulation using various techniques.
- These treatments usually involve exercises to adjust speech rate, strengthen muscles of articulation, increase breath support, improve articulation and help family members communicate with the patient.
- Treat underlying cause and slowing progression of the disease causing motor speech dysfunction.
Surgery
- Surgical intervention is not recommended for the management of dysarthria.
Primary Prevention
- There are no established measures for the primary prevention of dysarthria.
Secondary Prevention
- There are no established measures for the secondary prevention of dysarthria.
References
- ↑ "Definition of DYSARTHRIA". www.merriam-webster.com. Retrieved 2020-03-07.
- ↑ Hirose, Hajime (1986). "Pathophysiology of Motor Speech Disorders (Dysarthria)". Folia Phoniatrica et Logopaedica. 38 (2–4): 61–88. doi:10.1159/000265824. ISSN 1421-9972.
- ↑ Darley, F. L., Aronson, A. E., & Brown, J. R. (1975). Motor speech disorders. Philadelphia, PA: W.B. Saunders.
- ↑ Duffy, Joseph R.; Josephs, Keith A. (2012). "The Diagnosis and Understanding of Apraxia of Speech: Why Including Neurodegenerative Etiologies May Be Important". Journal of Speech, Language, and Hearing Research. 55 (5). doi:10.1044/1092-4388(2012/11-0309). ISSN 1092-4388.
- ↑ 1459-Blanchet%20(1).pdf
- ↑ O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company
- ↑ Mackenzie C (April 2011). "Dysarthria in stroke: a narrative review of its description and the outcome of intervention". Int J Speech Lang Pathol. 13 (2): 125–36. doi:10.3109/17549507.2011.524940. PMID 21480809.
- ↑ Duffy, J. R. (2013). Motor speech disorders (3rd ed.)St. Louis, MO: Elsevier Mosby.
- ↑ Bogousslavsky, J; Van Melle, G; Regli, F (1988). "The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke". Stroke. 19 (9): 1083–1092. doi:10.1161/01.STR.19.9.1083. ISSN 0039-2499.
- ↑ Hartelius, L.; Svensson, P. (1994). "Speech and Swallowing Symptoms Associated with Parkinson's Disease and Multiple Sclerosis: A Survey". Folia Phoniatrica et Logopaedica. 46 (1): 9–17. doi:10.1159/000266286. ISSN 1421-9972.
- ↑ Darley, Frederic L.; Brown, Joe R.; Goldstein, Norman P. (1972). "Dysarthria in Multiple Sclerosis". Journal of Speech and Hearing Research. 15 (2): 229–245. doi:10.1044/jshr.1502.229. ISSN 0022-4685.
- ↑ Chen, Anton; Garrett, C. Gaelyn (2016). "Otolaryngologic presentations of amyotrophic lateral sclerosis". Otolaryngology–Head and Neck Surgery. 132 (3): 500–504. doi:10.1016/j.otohns.2004.09.092. ISSN 0194-5998.
- ↑ Cochrane Database of Systematic Reviews. doi:10.1002/14651858. ISSN 1465-1858. Missing or empty
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