dysarthria

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7 types of dysarthria

flaccid, spastic, ataxic, hyperkinetic, hypokintetic, unilateral upper motor nueron, mixed

Characteristic common to all forms

impaired muscular control of the speech much and peripheral or central nervous system pathology

5 areas of speech it affects

articulation, phonation, prosody, resonance, respiration

etiological factors

degenerative nuerologic diseases (parkinsons, ALS, MS, myasthenia gravis), nonprogressive neurological conditions (stroke, infections, TBI, surgical trauma, toxic effects from drugs/alcohol)

Common sites of lesion

LMN, unilateral/bilateral UMN, cerebellum and basal ganglia (extrapyramidal system)

nueromuscular problems

muscle weakness, spasticity, incoordination, and rigidity

movement disorders

reduced or variable range and speed, involuntary movements, reduced strength ofmovement, unsteady or inaccurat movement, and abnormal tone

respiratory problems

forced inspirations/expirations, audible or breathy inspirations

Phonatory disorders

pitch, loudness and vocal quality

pitch disorders

abnormal pitch, pitch breaks, abrupt variations ofpitch, monopitch , diplophonia, shaky tremulous voice

loudness disorders

too loud/too soft, monoloudness, alternating changes in loudness, progressive loudness etc

vocal quality problems

harsh, rough gravelly voice, hoarse voice, breathy voice, strained or stangeld, effortful phonation, uncontrolled cessation of voice

articulation disorders

imprecise articulation, prolongations and repetitions of phonemes, irregular breakdowns in ariculation, distortionof vowels,

prosodic disorders

slower, excessively faster, variable rate of speech, inappropriate pauses, short rushes of speech

resonance disorders

hypernasality, hyponasality, nasal emissions

ataxic dysarthria (site of lesion)

cerebellar systerm

ataxic MAIN characteristics

articulatory and prosodic issues
DRUNKEN SPEECH (SLURRED WORDS)

ataxic characteristics (others)

gait disturbances (instability of trunk and head)
movement disorders (uncoordinated jerky, inaccruate, slow movements
articulation disorders (imprecise production of consonants, distortions of vowels)
prosodic disorders (excesssive and even stress, proloned phonemes, slow rate of speech)
phonatory disorders: monopitch, monoloudness and harhness
speech quality: impression of drunken speech

flaccid dysarthria (site of lesion)

lower motor nuerons

flaccid (cranial nerves)

trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X) and hypoglossal (XII)

Flaccid major charateristics

muscular disorders (weakness, hypotonia, atrophy)
fasiculations(twitches of resting muscles) or fibrillations (contractions of individual muscles)
rapid/progressive weakness
repiratory weakness
phonatory disorders: breathy voice, audible inspiratioin, short phrases
reonance disorders: hyper nasality, imprecise consonants, nasal emissions
phonatory-prosodic disorders: harsh voice, monopitch, and mono loudness
ariculation disorders more pronounced with lesions in V, VII and XII

hyperinetic dysarthria (site of lesion)

basal ganglia

hyperkinetic MAIN characterisitics

incluntary movements and variable muscle tone, prosodic istrubances are dominant

hyperkinetic characteristics - other

movement disorders, myoclonus (involuntary jerks of body parts), tics of the face, termors, spasms
dystonia
voice tremors, intermittently strained voice, voice stoppage, harsh voice
intermittent hypernasality
slower rate, excess loudness variations
audible inspiration, forced and sudden inspiration of expiration
inconsistent articulation problems

Hypokinetic dysarthria (site of lesion)

damage to basal ganglia, usually found in parkinsons

hypokinetic characteristics

tremors in the resting facial, mouth and limb muscles
mask-like face
small print
short rapid shuffling steps
postural disturbances
decreased swallowing
monopitch, low pitch, monoloudness, harsh continuous breathy voice
reduced stress, inappropriate silen intervals, short rushes of speech, short phraes, increased rate in segments
imprecise consonants, repeated phonemes, resonance disorders, mild hypernasality
reduced vital capacity, irregular breathing and faster respiration

spastic dysarthria (site of lesion)

bilateral damage to the upper motor neurons
lesions in multiple areas, cortical areas, basal ganglia, internal capsule, pons and medulla

spastic dysarthria characteristics

SPASTICITY AND WEAKNESS (bilateral facial weakness)
reduced range and slowness, loss of fine skilled movements
hyperactive gag reflex
hyperadduction of vocal folds and inadequate closure of the velopharyngeal port
excess and equal stress, slow rate, monopitch, monoloudness, reduced stress, and short phrases
imprecise production of consonants and distorted vowels
breathy voice, harshness, low pitch, pitch breaks, strained-strangled voice, short phrases and slow rate
hypernasality

Mixed dysarthria

combination of two or more pure syarthrias

mixed flaccid-spastic dysarthria

ALS - imprecise production of consonants, hypernasality, harsh voice, slow rate, monopitch, short phrases, istorted vowels, lowpitch, monolouness, excess and equal stres or reduced stress, proloned intervals, prolonged phonemes, strained voice, breathiness, audible inspiration, nasal emissions

mixed ataxic-spastic dysarthria

MS - impaired loudness, harsh voice quality, imprecise articulation, impaired emphasis, hypernasality, inappropriate pitch levels, sudden articulatory breakdowns

Unilateral upper motor neuron

damage to the upper motor neurons involved in speech production
may coexist with aphasia/apraxia

UUMN dysarthria is characterized by

unilateral lower face weakness, unilateral tongue weakness, unilateral palatal weakness and hemiplegia/hemiparesis
articulation disorders, imrecise production of consonants and irregular articulatory breakdowns,
harsh voice, reduced loudness, strained harshness
slow rate, increased rate in segments, excess and equal stress, monopitch, monoloudness, low pitch and short phrases
hypernasality
dysphagia, aphasia, apraxia and RHD

Assessment of dysarthria

record extended conversational speech sample
complete various speech tasks
diadochokinetic rate
oral mech
assess respiratory problems through observation
assess phonatory disorders by having them hold out /ah/ (pat attentionto pitch , tremors, diplaphonia, quality of voice)
assess articulation
assess prosodic disorders
assess reonance disorders
assess speech intelligibility

treatment of dysarthria

focus of 5 areas of speech (respiratory, prosody, resonance, articulation, phonation)
also teach slef-correction, self-evaluation, self-monitoring skills
procedure focus on intensive, systemiatic, and extensive drill, instruction, demonstration , modeling, shaping , prompting , fading , differential reinforcement, and other behavioral management

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