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: Motor Speech Disorder

Overview

Dysarthria is a motor speech disorder caused by a neurological deficit resulting in weakening or paralysis of the muscles responsible for speech formation.

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

  • Dysarthria may be classified according to presentation of symptoms into the following:[4] [5]
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

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

Epidemiology and Demographics

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

Diagnostic Study of Choice

  • There is no established criteria for the diagnosis of dysarthria.
  • Detailed history and examination is important to identify the cause and to classify dysarthria.
  • Speech assessment should be conducted by a speech language pathologist to identify perceptual speech and subsystem involvement.

History and Symptoms

  • Signs and symptoms of dysarthria vary, depending on the underlying cause and the type of dysarthria.[14]
  • Patient may present with slow or rapid speech, nasal speech, uneven or monotone, slurred speech and/or abnormal speech volume or rhythm.[15]

Physical Examination

  • Physical examination varies depending on the underlying cause of dysarthria.

Laboratory Findings

  • There are no diagnostic laboratory findings associated with dysarthria. Laboratory findings defer on the basis of underlying cause.

Electrocardiogram

  • There are no ECG findings associated with dysarthria.

X-ray

  • There are no x-ray findings associated with dysarthria.

Echocardiography or Ultrasound

CT scan

  • There are no CT scan findings associated with dysarthria. However, it provides a detailed image of CNS to help identify the underlying cause of speech problem.

MRI

  • There are no MRI findings associated with dysarthria. However, it provides a detailed image of CNS to help identify the underlying cause of speech problem.

Other Imaging Findings

  • There are no other imaging findings associated with dysarthria.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with dysarthria.

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

  1. "Definition of DYSARTHRIA". www.merriam-webster.com. Retrieved 2020-03-07.
  2. 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.
  3. Darley, F. L., Aronson, A. E., & Brown, J. R. (1975). Motor speech disorders. Philadelphia, PA: W.B. Saunders.
  4. 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.
  5. 1459-Blanchet%20(1).pdf
  6. O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company
  7. 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.
  8. Duffy, J. R. (2013). Motor speech disorders (3rd ed.)St. Louis, MO: Elsevier Mosby.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. Cochrane Database of Systematic Reviews. doi:10.1002/14651858. ISSN 1465-1858. Missing or empty |title= (help)
  14. O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company
  15. Mackenzie, Catherine (2011). "Dysarthria in stroke: A narrative review of its description and the outcome of intervention". International Journal of Speech-Language Pathology. 13 (2): 125–136. doi:10.3109/17549507.2011.524940. ISSN 1754-9507.
  16. "Dysarthria". PubMed Health.
  17. e National Collaborating Centre for Chronic Conditions, ed. (2006). "Other key interventions". Parkinson's Disease. London: Royal College of Physicians. pp. 135–146.
  18. de Swart, B. J.M.; Willemse, S. C.; Maassen, B.A.M.; Horstink, M. W.I.M. (2003). "Improvement of voicing in patients with Parkinson's disease by speech therapy". Neurology. 60 (3): 498–500. doi:10.1212/01.WNL.0000044480.95458.56. ISSN 0028-3878.

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