Slurred speech resident survival guide
|Slurred speach resident survival guide|
Synonyms and Keywords: Approach to dysarthria, Approach to slurred speech, Approach to difficulty in speaking,Approach to motor speech disorders.
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.
|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.|
DiagnosisShown below is an algorithm summarizing the diagnosis of dysarthria or slurred speech according the the The American Speech-Language-Hearing Association (ASHA) guidelines.
|Patient with slurred 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|
TreatmentShown below is an algorithm summarizing the treatment of dysarthria or slurred speech according the the The American Speech-Language-Hearing Association (ASHA) guidelines. 
|Treatment of Dysarthria/Slurred Speech |
Treatment is based on etiology and type of dysarthria
|General Recommendations include |
Implementation of Speech Viewer III
- Communication strategies should employed by the patient with dysarthria.
- 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't speak too fast. Speak slowly so that listeners may understand you better.
- 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.
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- "Dysarthria (difficulty speaking)". nhs.uk. 2019-11-10. Retrieved 2020-11-30.