Dysarthria: Difference between revisions
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*The term dysarthria is derived from New Latin. | *The term dysarthria is derived from New Latin. | ||
*'Dys' means dysfunctional/impaired and 'arthr' means joint/vocal articulation.<ref> "Definition of DYSARTHRIA". www.merriam-webster.com. Retrieved 2020-03-07. </ref> | *'Dys' means dysfunctional/impaired and 'arthr' means joint/vocal articulation.<ref> "Definition of DYSARTHRIA". www.merriam-webster.com. Retrieved 2020-03-07. </ref> | ||
*Tradiationally dysarthria has been defined as disorders of oral speech resulting from lesions within the nervous system | |||
*Recently dysarthria includes speech disorders resulting from problem in muscular control of speech formation.<ref>Darley, F. L., Aronson, A. E., & Brown, J. R. (1975). Motor speech disorders. Philadelphia, PA: W.B. Saunders.</ref> | |||
==Classification== | ==Classification== | ||
Revision as of 14:31, 8 September 2020
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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
- Recently dysarthria includes speech disorders resulting from problem in muscular control of speech formation.[2]
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.[5]
- 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:[6]
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.[7]
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.[8]
- Parkinson's disease: Approximately 70%–100% of individuals develop dysarthria.[9]
- Multiple sclerosis: 25% and 50% of individuals with multiple sclerosis present with dysarthria at some point.[10]
- Amyotrophic lateral sclerosis: Approximately 30%-100% depending on the stage of the disease.[11]
- Traumatic brain injury: Approximately 10%–65% of individuals with traumatic brain injury develop dysarthria.[12]
- 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
Diagnosis
Treatment
Medical Therapy
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.
- ↑ 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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