Slurred speach resident survival guide

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Slurred speach resident survival guide
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Usman Ali Akbar, M.B.B.S.[2]

Synonyms and Keywords: Approach to dysarthria, Approach to slurred speech, Approach to difficulty in speaking,Approach to motor speech disorders.

Overview

Slurred Speech or Dysarthria is usually defined as difficulty in speech and is a motor speech disorder caused by a neurological deficit resulting in weakening or paralysis of the muscles responsible for speech formation. The causes of dysarthria are vast and depend upon the location of the lesion. The treatment of dysarthria depends upon the etiology. Treatment usually focuses on achieving independent daily living for the patients. These include Augmentative and alternative communication, Lee Silverman voice treatment and Pitch Limiting Voice Treatment.

Causes

The causes of slurred speech and dysarthria are vast and can be classified as follows.[1] [2]

Types of Dysarthria
Flaccid Dysarthria Spastic Dyasarthria Mixed Dysarthria (Flaccid/Spastic) Ataxic Dysarthria Hypokinetic Dysarthria Hyperkinetic Dysarthria
Site of Lesion LMN neurons  Upper motor neurons Upper and Lower motor neuron Cerebellum   Substantia nigra, Medication induced   Extrapyramidal tract, specifically the basal ganglia; may be unilateral or bilateral
Causes Viral infection, Tumor, CVA, Congenital conditions, disease, palsies and trauma. CVA, Tumor, Infection, Trauma, Congenital Conditions ALS, Trauma, CVA CVA, Tumor, Trauma, Congenital Condition, Infection, Toxic effects Parkinsonism, Drug-induced Chorea, Infection, Gilles de la Tourette Syndrome, Ballism, Athetosis, CVA, Tumor, Dystonia, Drug induced, Dyskinesia.
Speech Characteristics Hypernasality, imprecise consonants, breathiness, mono-pitch, nasal emission. Imprecise consonants, mono-pitch, reduced stress, harsh vocal quality, mono loudness, low pitch, slow rate, hypernasality, strained-strangled voice, short phrases. Imprecise consonants, hypernasality, harsh vocal quality, slow rate, mono-pitch, short phrases, distorted vowels, low pitch, mono loudness, excess and equal stress, prolonged intervals. Imprecise consonants, excess and equal stress, irregular articulatory breakdowns, distorted vowels, harsh voice, loudness control problems, variable nasality. Monopitch, reduced stress, mono loudness, imprecise consonants, inappropriate silences, short rushes of speech, harsh voice, breathy voice. Imprecise consonants, distorted vowels, harsh voice quality, irregular articulatory breakdowns, strained-strangled voice, mono-pitch, mono loudness.

Diagnosis

Shown below is an algorithm summarizing the diagnosis of dysarthria or slurred speech according the the The American Speech-Language-Hearing Association (ASHA) guidelines.[3]
 
 
 
 
 
 
Patient with slurred speech
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-Speech Examination
  • To assess the speed, strength, range, and accuracy of movements not related to the speech by doing clinical>
  • Cranial nerve examination
  • Facial and neck muscle tones examination
  • To observe sustained vowel prolongation in order to assess adequate pulmonary and laryngeal support
  • Judging the speed and regularity of jaw, lip and tongue movement
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Speech Production
  • Vocal quality and change in pitch production
  • Stress Testing- 2-4 minutes of reading or speaking is given and an assessment of deterioration is done over time
  • Motor speech planning or programming is done.
  • To observe sustained vowel prolongation in order to assess adequate pulmonary and laryngeal support
  • Judging the speed and regularity of jaw, lip, and tongue movement
  • Assessment of Prosody
  • Assessment of speech intelligibility
  • Assessment of Comprehension and Efficiency of Speech
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wasted and weak tongue, weak voice nasal emission of air, dysphonia, poor or absent palatal deviation, absent gag and jaw jerk reflex
 
Non-wasted tongue, poor tongue movements, slurred speech, poor palatal elevation, brisk gag reflex, brisk jaw reflex
 
Scanning speech, irregular articulation, and poor voice volume and breathing control
 
Hypophonia, monopitch voice, slurring and fast rate speech
 
Poor coordination with breathing, harsh, superimposed bulbar involuntary movements, poorly modulated.
 
Combination of flaccid and spastic dysarthria symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lower Motor Neuron Lesion
 
Upper motor Neuron Lesion
 
Cerebellum/Outflow pathways lesion
 
Sustantia Nigra Lesion
 
Caudate/Putamen Lesion
 
Both upper and lower motor neuron Lesion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Flaccid Dysarthria
 
Spastic Dysarthria
 
Ataxic Dysarthria
 
Hypokinetic
 
Hyperkinetic
 
Mixed Flaccid-Spastic Lesion

Treatment

Shown below is an algorithm summarizing the treatment of dysarthria or slurred speech according the the The American Speech-Language-Hearing Association (ASHA) guidelines. [3]
 
 
 
 
 
 
 
Treatment of Dysarthria/Slurred Speech
Treatment is based on etiology and type of dysarthria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
General Recommendations include

Implementation of Speech Viewer III

Do's

  • Communication strategies should employed by the patient with dysarthria.[3]
  • Eye contact should be maintained with the communication partner.
  • Repair strategies such as restating message in different words and using gestures to help convey messages should be used.
  • Environmental modification such as reducing background noise and ensuring that good lighting is present.
  • Face to face seating for conversations should be employed.

Don'ts

  • Don't speak too fast. Speak slowly so that listeners may understand you better.[7]
  • Don't go for long topics. Ask the patient to start small and introduce the topic of conversation with one word or short phrase.
  • Fatigue can make it difficult for patients to speak clearly.
  • Background noise should be reduced.

References

  1. Enderby, Pam (2013). "Disorders of communication". Neurological Rehabilitation. Elsevier. pp. 273–281. doi:10.1016/b978-0-444-52901-5.00022-8. ISBN 978-0-444-52901-5. ISSN 0072-9752.
  2. Ozsancak, C; Auzou, P (2003). "[Dysarthria?]". Revue neurologique (in français). 159 (4): 466–9. ISSN 0035-3787. PMID 12773881.
  3. 3.0 3.1 3.2 "Dysarthria". American Speech-Language-Hearing Association. Retrieved 2020-11-30.
  4. "Dysarthria". PubMed Health.
  5. e National Collaborating Centre for Chronic Conditions, ed. (2006). "Other key interventions". Parkinson's Disease. London: Royal College of Physicians. pp. 135–146.
  6. 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.
  7. "Dysarthria (difficulty speaking)". nhs.uk. 2019-11-10. Retrieved 2020-11-30.
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