dysarthria

What is dysarthria

Dysarthria is difficulty speaking or speech disorder caused by brain damage or nerves damage that resulted in speech muscles weakness or paralysis. Dysarthria is a motor speech disorder and can be mild or severe. Dysarthria often is characterized by slurred or slow speech that can be difficult to understand.

You use many muscles to talk. These include muscles in our face, lips, tongue, and throat, as well as muscles for breathing. It is harder to talk when these muscles are weak.

Symptoms of dysarthria:

A child or adult with dysarthria may have:

  • slurred, nasal-sounding or breathy speech
  • a strained and hoarse voice
  • excessively loud or quiet speech
  • problems speaking in a regular rhythm, with frequent hesitations
  • “gurgly” or monotone speech
  • difficulty with tongue and lip movements
  • difficulty swallowing (dysphagia), which may lead to constant drooling

As a result of these problems, a person with dysarthria may be difficult to understand. In some cases, they may only be able to produce short phrases, single words or no intelligible speech at all.

Dysarthria doesn’t affect intelligence or understanding, but a person with the condition may also have problems in these areas. Speech problems can also affect social interaction, employment and education.

Common causes of dysarthria include nervous system (neurological) disorders such as stroke, brain injury, brain tumors, and conditions that cause facial paralysis or tongue or throat muscle weakness. Certain medications also can cause dysarthria.

Dysarthria treatment is directed at treating the underlying cause of your condition when possible, which may improve your speech. You may have speech therapy to help improve speech. For dysarthria caused by prescription medications, changing or discontinuing the medications may help.

If you or your child has dysarthria, you may find it helpful to see a speech and language pathologist. Ask your doctor about your nearest speech and language therapy clinic.

Dysarthria can happen with other speech and language problems. You might have trouble getting messages from your brain to your muscles to make them move, called apraxia. You could also have trouble understanding what others say or telling others about your thoughts, called aphasia.

Speech-related conditions

  • Dysarthria – difficulty speaking caused by brain damage, which results in an inability to control the muscles used in speech
  • Dysphagia – difficulty swallowing, which can be a symptom of dysarthria
  • Dysphasia or aphasia – language difficulties, which could be difficulty understanding language (receptive dysphasia) or expressing yourself (expressive dysphasia)
  • Dyspraxia and ataxia – problems with physical co-ordination, which can also sometimes affect the movements needed for speech.

Dysarthria types

  • Ataxic dysarthria which affects respiration, phonation, resonance, and articulation tend to place the same excessive stress on all syllables 1). Ataxic dysarthria is usually associated with cerebellar disorders with articulation and prosody most impaired. Patients present with decreased motor coordination for accurate articulation with slow and deliberate articulation, imprecise consonant production, distorted vowel production, and prolonged phonemes. Equal and excessive stress is placed on all syllables. Ataxic dysarthria is caused by damage to the cerebellum, or cerebellar connections to other parts of the brain. Isolated cerebellar dysarthria has also been reported with small infarcts in the left paravermian zone of the ventral cerebellum (lobulus simplex and semilunaris superior).
  • Spastic dysarthria is characterized by the harshness of the vocal quality and long duration in phoneme to phoneme transitions and syllables. Pitch break can be seen 2)
  • Hypokinetic dysarthria seen in parkinsons disease is characterized by hoarse speech with low volume and compulsive repetition of syllables with on monopitch and monoloudness 3).Hypokinetic dysarthria, most typically seen in parkinsonism, is associated with hypophonia or reduced vocal loudness. Furthermore, there is monotonous speech with a slow and flat rhythm. Initiation of speech is difficult, resulting in inappropriate silences intermixed with short rushes of speech. The rate is variable with wide fluctuations in pitch.
  • Hyperkinetic dysarthria seen in Huntingtons disease is associated with harsh sounding, hypernasality, and frequent pauses. There is associated dystonia with lack of intelligibility 4). Hyperkinetic dysarthria also results from secondary to damage to the basal ganglia and is typified by Huntington’s disease. Damage to this system causes involuntary movements such as tremors, dyskinesia, athetosis, and dystonia. Vocal quality may be described as harsh, strained, or strangled and is often associated with spasmodic dysphonia.
  • Flaccid dysarthria due to lower motor neuron (LMN) paralysis of vocal cord shows harsh voice, low volume with inspirational stridency.
  • Mixed dysarthria is characterized by harshness of voice in case of upper motor neuron (UMN) involvement and breathy voice in case of lower motor neuron (LMN) involvement 5). Mixed dysarthria is caused by simultaneous damage to two or more primary motor components of the nervous system, involving both UMNs and LMNs. This form of dysarthria is common in patients with MS (multiple sclerosis), ALS, or severe traumatic brain injury. The patients may speak very slowly and with great effort. Articulation is markedly impaired with imprecise articulation and hypernasality. Vocal pitch is low with harsh and/or strained, or strangled vocal quality. Prosody is disrupted with intonation errors and inappropriately shortened phrases/sentences. Bulbar involvement in ALS often presents in this fashion with dysarthria, hypophonia, drooling of saliva, and progressive swallowing difficulties.

Acoustic analysis of the speech can be done by fast Fourier transformation 6).

Dysarthria vs Aphasia

Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is a language disorder that happens when you have brain damage. Your brain has two halves. Language skills are in the left half of the brain in most people. Damage on that left half of your brain may lead to language problems. Damage on the right side of your brain may cause other problems, like poor attention or memory.

Aphasia may make it hard for you to understand, speak, read, or write. It does not make you less smart or cause problems with the way you think. Brain damage can also cause other problems along with aphasia.

Causes of Aphasia

Aphasia is most often caused by stroke. However, any type of brain damage can cause aphasia. This includes brain tumors, traumatic brain injury, and brain disorders that get worse over time.

Signs of Aphasia

Aphasia can lead to a number of different problems. You may have trouble talking, understanding, reading, and writing.

Talking

You may find that you:

  • Can’t think of the words you want to say.
  • Say the wrong word. Sometimes, you may say something related, like “fish” instead of “chicken.” Or you might say a word that does not make much sense, like “radio” for “ball.”
  • Switch sounds in words. For example, you might say “wish dasher” for “dishwasher.”
  • Use made-up words.
  • Have a hard time saying sentences. Single words may be easier.
  • Put made-up words and real words together into sentences that do not make sense.

Understanding

You may:

  • Not understand what others say. This may happen more when they speak fast, such as on the news. You might have more trouble with longer sentences, too.
  • Find it hard to understand what others say when it is noisy or you are in a group.
  • Have trouble understanding jokes.

Reading and Writing

You may have trouble with the following things:

  • Reading forms, books, and computer screens.
  • Spelling and putting words together to write sentences.
  • Using numbers or doing math. For example, it may be hard to tell time, count money, or add and subtract.

Testing for Aphasia

You should see a doctor if you have trouble speaking or understanding what people say. A doctor will determine if there is a medical cause for your problem. A speech-language pathologist, or speech language pathologist, will test your speech and language skills. The speech language pathologist will ask you about the problems you have and what you want to work on.

The speech language pathologist will test how well you:

  • Understand words, questions, directions, and stories.
  • Say words and sentences. The speech language pathologist will ask you to name objects, describe pictures, and answer questions.
  • Read and write. The speech language pathologist will have you write letters, words, and sentences. You will also read short stories and answer questions about them.
  • Find other ways to share your ideas when you have trouble talking. This may include pointing or using other gestures and drawing pictures.

Treatments for Aphasia

There are many ways to work on your language. The type of treatment you get depends on what you want and need. You may work with an speech language pathologist on your own or in a small group. You may want your family to be a part of your treatment. They can help you use the skills you learn with the speech language pathologist at home. You may also join a support group or Stroke Club for social activities.

Do you speak more than one language? You may talk better in one language and have more trouble in the other. Or, you may have trouble in both. You should work with an speech language pathologist who speaks both languages if you can.

In severe cases, you may need to find other ways to answer questions or tell people what you want. These may include simple hand gestures, writing, pointing to letters or pictures, or using a computer. This is augmentative and alternative communication.

Tips for Communicating With a Person Who Has Aphasia

These tips may make it easier for you to understand and talk with others. Share these tips with your family and friends.

To help me talk with you:

  • Get my attention before you start speaking.
  • Keep eye contact with me. Watch my body language and the gestures I use.
  • Talk to me in a quiet place. Turn off the TV or radio.
  • Keep your voice at a normal level. You do not need to talk louder unless I ask you to.
  • Keep the words you use simple but adult. Don’t “talk down” to me.
  • Use shorter sentences. Repeat key words that you want me to understand.
  • Slow down your speech.
  • Give me time to speak. It may take me longer. Try not to finish my sentences for me.
  • Try using drawings, gestures, writing, and facial expressions. I may understand those better than words sometimes.
  • Ask me to draw, write, or point when I am having trouble talking.
  • Ask me “yes” and “no” questions. Those are easier than questions that I have to answer in words or sentences.
  • Let me make mistakes sometimes. I may not be able to say everything perfectly all the time.
  • Let me try to do things for myself. I may need to try a few times. Help me when I ask for it.

Dysarthria vs Apraxia

Apraxia is a motor speech disorder that makes it hard to speak. Apraxia (called “dyspraxia” if mild) is a neurological disorder characterized by loss of the ability to execute or carry out skilled movements and gestures, despite having the desire and the physical ability to perform them. Apraxia is a neurological disorder that affects the brain pathways involved in planning the sequence of movements involved in producing speech. The brain knows what it wants to say, but cannot properly plan and sequence the required speech sound movements. Apraxia results from dysfunction of the cerebral hemispheres of the brain, especially the parietal lobe, and can arise from many diseases or damage to the brain.

To speak, messages must go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. When you have apraxia of speech, the messages do not get through correctly, due to brain damage. You might not be able to move your lips or tongue the right way to say sounds. Sometimes, you might not be able to speak at all.

Apraxia of speech is sometimes called acquired apraxia of speech, verbal apraxia, or dyspraxia. It is a motor speech disorder. You can also have apraxia in other parts of your body, like in your arms or legs. This is called limb apraxia.

Children can also have apraxia. This is called childhood apraxia of speech.

How severe your apraxia is depends on what type of brain damage you have. Apraxia can happen at the same time as other speech or language problems.

Causes of Apraxia of Speech

Damage to the parts of the brain that control how your muscles move causes apraxia of speech. Any type of brain damage can cause apraxia. This includes stroke, traumatic brain injury, dementia, brain tumors, and brain diseases that get worse over time.

Signs of Apraxia of Speech

If you have apraxia of speech, you will have problems saying sounds correctly. This may cause you to say something very different than what you meant. You may even make up words. For example, you may say “chicken” for “kitchen.” Or, you may say something that might not make sense, like “bipem.” You may know that what you say is wrong and try to fix it. Sometimes you will get it right, but sometimes you will still say something else. This can be very frustrating.

If you have apraxia, you may:

  • Have trouble imitating and saying sounds on your own. You may add new sounds, leave sounds out, or say sounds the wrong way.
  • Be able to say something the right way one time but the wrong way the next time.
  • Move your tongue and lips to get them into the right place as you try to say sounds. This is called groping.
  • Speak more slowly.
  • Be able to say things that you say all the time—like “Hello” or “How are you?”—without much trouble. This is called automatic speech.
  • Not be able to say any sounds at all. This may happen in severe cases.

Testing for Apraxia of Speech

If you have trouble speaking, you should see a doctor right away. It is important to find out why and make sure it does not get worse. A speech-language pathologist can test your speech and language. This will help the speech language pathologist decide if you have apraxia or some other problem. The speech language pathologist will look at how well you can move your mouth, lips, and tongue. She will listen to how your speech sounds in single words, sentences, and conversation. The speech language pathologist will test how you understand what others say and how you use words to tell others about your thoughts.

Treatment for Apraxia of Speech

The speech language pathologist can work with you to improve how you say sounds and put sounds into words. Treatment will focus on getting your muscles to move correctly. You may need to retrain your muscles to make sounds. Repeating sounds over and over and practicing correct mouth movements can help. You may need to slow down or pace your speech so that you can say the sounds you need to say. In severe cases, you may need to find other ways to answer questions or tell people what you want. These may include simple hand gestures, writing, pointing to letters or pictures, or using a computer. This is called augmentative and alternative communication.

Dysarthria causes

The muscles used for speech are controlled by the brain and nervous system. Dysarthria can develop if either of these is damaged in some way.

Dysarthria can either be:

  • Developmental – when it occurs as a result of brain damage before or during birth, such as in cerebral palsy
  • Acquired – when it occurs as the result of brain changes later in life, such as damage caused by a stroke, head injury or brain tumor, or a progressive condition such as Parkinson’s disease or motor neurone disease

Dysarthria in children is usually developmental, while dysarthria in adults is often acquired, although both types can affect people of any age.

Whether dysarthria will improve with speech and language therapy depends on the cause and the extent of the brain damage or dysfunction. Some causes remain stable, while others may worsen over time.

In dysarthria, you may have difficulty moving the muscles in your mouth, face or upper respiratory system that control speech.

Conditions that may result in dysarthria include:

  • Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
  • Brain injury
  • Brain tumor
  • Cerebral palsy
  • Guillain-Barre syndrome
  • Head injury
  • Huntington’s disease
  • Lyme disease
  • Multiple sclerosis
  • Muscular dystrophy
  • Myasthenia gravis
  • Parkinson’s disease
  • Stroke
  • Wilson’s disease

Some medications, such as narcotics or sedatives, also can cause dysarthria.

Dysarthria complications

Because of the communication problems dysarthria causes, complications can include:

  • Social difficulty. Communication problems may affect your relationships with family and friends and make social situations challenging.
  • Depression. In some people, dysarthria may lead to social isolation and depression.

Dysarthria signs and symptoms

Signs and symptoms of dysarthria vary, depending on the underlying cause and the type of dysarthria, and may include:

  • Slurred speech
  • Slow speech
  • Inability to speak louder than a whisper or speaking too loudly
  • Rapid speech that is difficult to understand
  • Nasal, raspy or strained voice
  • Uneven or abnormal speech rhythm
  • Uneven speech volume
  • Monotone speech
  • Difficulty moving your tongue or facial muscles

Dysarthria diagnosis

A speech-language pathologist might evaluate your speech to help determine the type of dysarthria you have. This can be helpful to the neurologist, who will look for the underlying cause.

Speech and language therapists can carry out an assessment to determine the extent of the speech problem. They may ask you or your child to:

  • make different sounds
  • talk about a familiar topic
  • count numbers or recite days of the week
  • read a passage aloud

The therapist may also want to examine the movement of the muscles in the mouth and voice box (larynx), and may wish to make a recording.

Besides conducting a physical exam, your doctor might order tests, including:

  • Imaging tests. Imaging tests, such as an MRI or CT scan, create detailed images of your brain, head and neck that may help identify the cause of your speech problem.
  • Brain and nerve studies. These can help pinpoint the source of your symptoms. An electroencephalogram measures electrical activity in your brain. An electromyogram evaluates electrical activity in your nerves as they transmit messages to your muscles. Nerve conduction studies measure the strength and speed of the electrical signals as they travel through your nerves to your muscles.
  • Blood and urine tests. These can help determine if an infectious or inflammatory disease is causing your symptoms.
  • Lumbar puncture (spinal tap). In this procedure, a doctor or nurse inserts a needle in your lower back to remove a small sample of cerebrospinal fluid for laboratory testing. A lumbar puncture can help diagnose serious infections, disorders of the central nervous system, and cancers of the brain or spinal cord.
  • Brain biopsy. If a brain tumor is suspected, your doctor may remove a small sample of your brain tissue to test.
  • Neuropsychological tests. These measure your thinking (cognitive) skills, your ability to understand speech, your ability to understand reading and writing, and other skills. Dysarthria doesn’t affect your cognitive skills and understanding of speech and writing, but an underlying condition can.

Dysarthria treatment

Your treatment will depend on the cause and severity of your symptoms and the type of dysarthria you have.

A speech and language therapist will work as part of a team of healthcare professionals that includes people from the health, social and voluntary sector.

Your doctor will treat the cause of your dysarthria when possible, which may improve your speech. If your dysarthria is caused by prescription medications, talk to your doctor about changing or discontinuing such medications.

Speech and language therapy

You may have speech and language therapy to help you regain normal speech and improve communication. Your speech therapy goals might include adjusting speech rate, strengthening muscles, increasing breath support, improving articulation and helping family members communicate with you.

Your speech-language pathologist may recommend other communication methods (augmentative and alternative communication systems) to help you communicate, if speech and language therapy isn’t effective. These communication methods could include visual cues, gestures, an alphabet board or computer-based technology.

They may recommend:

  • strategies to improve speech, such as slowing speech down
  • exercises to improve the volume or clarity of speech
  • assistive devices, such as a simple alphabet board, an amplifier, or a computerized voice output system

Some speech and language therapists may be able to carry out or refer you for a specialist assessment of communication aids, including computerised voice output systems. For some people, these devices can be used alongside or instead of speech to help them communicate.

See your local speech and language therapist if you’re interested in having an assessment. They’ll be able to provide further information and advice about arranging an assessment and trial of a communication aid.

There’s no guarantee that speech and language therapy can improve the speech of everyone with dysarthria. Whether treatment is successful will depend on the extent and location of the brain damage or dysfunction, the underlying condition causing it, and the individual’s personal circumstances.

Communication tips

The following advice may help you communicate more effectively if you’ve got dysarthria or if you’re communicating with someone with the condition.

Tips for people with dysarthria

Simple changes in the way you talk with a person who has dysarthria can make a difference.

  • Turn off the radio or TV.
  • Move to a quieter room if needed.
  • Make sure lighting in the room is good.
  • Sit close enough so that you and the person who has dysarthria can use visual cues.
  • Make eye contact with each other.

If you have dysarthria, you may find it helpful to:

  • take a good breath before you start speaking
  • put extra effort into stressing key words
  • speak slowly, saying one word at a time if necessary
  • leave a clear space between each word
  • make sure you’re in the same room as the person you’re talking to and face them
  • attract the listener’s attention – for example, by touch or calling their name before you begin talking to them
  • keep sentences short and avoid long conversations if you’re feeling tired
  • reduce background noise – for example, switch off the TV or radio
  • repeat yourself if needed

Tips for family, friends and carers

If you’re speaking to a person with dysarthria, you may find the following advice helpful:

  • Using hand gestures
  • Writing by hand what you are saying
  • Using a computer to type out the conversation
  • Using alphabet boards, if muscles used for writing and typing are also affected
  • Ask questions in a way that they can answer you with yes or no.
  • Reduce distractions and background noise when you’re having a conversation
  • Look at the person as they talk
  • After speaking, allow them plenty of time to respond – if they feel rushed or pressured to speak, they may become anxious, which can affect their ability to communicate
  • Be careful about finishing their sentences or correcting any errors in their language as this may cause resentment and frustration
  • If you don’t understand what they’re trying to communicate, don’t pretend you understand as they may find this patronizing and upsetting – it’s always best to be honest about your lack of understanding
  • If necessary, seek clarification by asking yes/no questions or paraphrasing – for example, say: “Did you ask me if I’d done the shopping?”

Coping and support

If you have significant dysarthria that makes your speech difficult to understand, these suggestions may help you communicate more effectively:

  • Speak slowly. Listeners may understand you better with additional time to think about what they’re hearing.
  • Start small. Introduce your topic with one word or a short phrase before speaking in longer sentences.
  • Gauge understanding. Ask listeners to confirm that they know what you’re saying.
  • If you’re tired, keep it short. Fatigue can make your speech more difficult to understand.
  • Have a backup. Writing messages can be helpful. Type messages on a cellphone or hand-held device, or carry a pencil and small pad of paper with you.
  • Use shortcuts. Create drawings and diagrams or use photos during conversations, so you don’t have to say everything. Gesturing or pointing to an object also can help convey your message.

Family and friends

If you have a family member or friend with dysarthria, the following suggestions may help you better communicate with that person:

  • Allow the person time to talk.
  • Don’t finish sentences or correct errors.
  • Look at the person when he or she is speaking.
  • Reduce distracting noises in the environment.
  • Tell the person if you’re having trouble understanding.
  • Keep paper and pencils or pens readily available.
  • Help the person with dysarthria create a book of words, pictures and photos to assist with conversations.
  • Involve the person with dysarthria in conversations as much as possible.
  • Talk normally. Many people with dysarthria understand others without difficulty, so there’s no need to slow down or speak loudly when you talk.

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