Dysarthria: The Struggle of Stroke Patients against Motor-Speech Dysfunction - Research Paper Example

?DYSARTHRIA IN STROKE PATIENTS Dysarthria: The struggle of Stroke Patients against Motor-Speech Dysfunction Dysarthria usually occurs after damage to the central or peripheral nervous system transpired following brain injury, or commonly a post-stroke feature. It is often confused with dysphasia, which is a disorder involving the process of formulating ideas to be spoken. Dysarthria, on the contrary, causes a stroke patient to have difficulties in conversing fluently due to the inability to fully control the muscles used in speaking hence, producing slurring of speech, changes in rate, volume and quality of voice, and sometimes, excessive salivation. The impact of this disorder to the stroke patient may vary uniquely depending on the extent and severity of the condition along with the modes of rehabilitation and treatment. Dysarthria: The struggle of Stroke Patients against Motor-Speech Dysfunction Dysarthria is a motor-speech disorder. Barnes, Dobkin & Bogousslavsky (2005) defined this as a condition resulting from impairments of any one or more of the speech subsystems of phonation, articulation, resonance and prosody. Brain injury specifically due to CVA (Cerebrovascular Accident) or popularly known as stroke may cause the muscles of the face, mouth and respiratory system to weaken or even impede its movement, therefore, causing the individual to exert further effort just to speak. The common causes of dysarthria according to the American Speech-Language-Hearing Association (2011) include stroke, head injury, cerebral palsy, and muscular dystrophy. Both children and adults can have dysarthria. This paper will give emphasis to dysarthria experienced by stroke patients; its signs and symptoms, classification, diagnosis, therapy and rehabilitation along with the goals of treatment and social support that can be provided for those suffering from this disorder. Signs and Symptoms of Dysarthria The American Speech-Language-Hearing Association (2011) mentioned several symptoms of dysarthria depending on the scope and site of damage to the nervous system. These include slurred speech, speaking quietly or hardly capable to murmur, sluggish speed of speech, brisk rate of speech with a faltering feature, restricted tongue, lip and jaw movement, atypical accent when talking, variation in vocal quality, huskiness, breathiness, drooling or poor control of saliva, chewing and swallowing problems. Classifications of Dysarthria Tanner (2008), along with Barnes, Dobkin & Bogousslavsky (2005) and McNeil (2009) cited several types of dysarthria. These include Spastic, Flaccid, Hypokinetic, Hyperkinetic, Ataxic, Pure or Isolated, Unilateral Upper Motor Neuron and Mixed Dysarthria. Barnes, Dobkin & Bogousslavsky (2005) differentiated the mentioned categories based on speech features and common lesion location. Spastic Dysarthria In this kind of dysarthria, the speech characteristics observed in the patient include vague consonants, monopitch, reduced stress, and harsh vocal quality. Mcneil (2009) also adds that the voice could be weak and unsteady in this type of dysarthria. The usual lesion site illustrates bilateral upper motor neuron pyramidal tract lesions. Flaccid Dysarthria The salient feature of this kind of dysarthria according to Godefroy & Bogousslavsky (2007) is evident hypernasality with nasal emission of air, continuous breathiness during phonation and perceptible inspiration. Lower motor neuron lesions are evident in the brainstem in flaccid dysarthria. Kirshner (2007) mentioned that this type of dysarthria is apparent in any disorders with bilateral lesions involving the corticobulbar tracts; frequently, seen in bilateral stroke. Hypokinetic Dysarthria This variety is typically seen in patients with Parkinson’s disease; however, strokes affecting the basal ganglia may emulate this type. McNeil (2009) stressed that due to imprecise consonant articulation; intelligibility deficits may occur or may be present in this dysarthria type. In addition, Godefroy and Bogousslavsky (2007) mentioned that there is also stiffness or diminished range of movement; wherein the basal ganglia control circuit is primarily affected thereby, producing extrapyramidal symptoms. Hyperkinetic Dysarthria McNeil (2009) described this as dysarthria with unnecessary impulsive or as Godefroy and Bogousslavsky (2007) illustrated it as involuntary movements. These movements are the ones individuals have no control of somewhat like one’s reflexes. The area affected also localizes on the basal ganglia control circuit, hence, like hypokinesia, it may produce extrapyramidal symptoms such as the quick forms: chorea (jerky, irregular muscle movements specifically of the face or the extremities); myoclonus (abrupt, epigrammatic, shock-like movements), tics (recurring, pointless motions), and ballismus (uninhibited, vicious, flinging or actions of the proximal limbs); and the slow forms: athetosis (involuntary, comparatively slow, writhing movements that notably emanate from one another), tardive dyskinesia (unconscious, periodic moements of the face, jaw, mouth and tongue, for instance, lip pursing, gnawing movements and protuberance of the tongue), dystonia (sustained muscle contractions, commonly creating twisting or recurring movements or bizarre postures or positions) and tremors (unprompted, regular, oscillatory movements for the upper extremities particularly the hands, limbs, head or articulators). Ataxic Dysarthria This category highlights the use of inaccurate consonants, additional or equal stress, and unusual articulatory breakdown with vague vowels. It also features incoordination, mainly because the cerebellum or its connections is the one targeted by stroke. Pure or Isolated Dysarthria Like with the other types it features imprecise consonants; however, lacunar infarcts will be present in the corona radiate or internal capsule. Unilateral Upper Motor Neuron Dysarthria This dysarthria variety is distinguished by unclear consonants accompanied with deliberate irregular motor rates and phonatory idiosyncrasies, resembling the spastic type, but less rigorous. In an imaging scan, lesions can be seen on the on the unilateral pyramidal tract, more inclined to the left than to the right or known as unilateral hemisphere stroke; thus the name. Mixed Dysarthria Kirshner (2007) portrayed this subcategory which can presume quite a few forms. A common example is the spastic-flaccid dysarthria which affects both the upper and lower motor neuron systems. It is characterized by hypernasality, liquid sounding voice quality, often heard as babbling when speaking, tremendously unhurried rate, and severe consonant elusiveness. It is manifested usually in multiple strokes. Diagnosis Dysarthria can be diagnosed with the help of a Speech-Language Pathologist (SLP) who will then assess and evaluate the etiology and severity of the problem. The SLP will examine the movements of an individual’s face, lip, tongue as well as breaths support for speech and more. Therapy and Rehabilitation Treatment varies on the severity of the condition. In a journal article by Dickson (2008), she gave emphasis that social participation of those afflicted with this disorder should be taken into full consideration. She also added that speech and language interventions should go beyond the speech impairment to uphold psychosocial well being, lessen the likelihood of feelings of stigmatization and disgrace, and changes in self-identity, regardless of the austerity of the condition. Goals of Treatment The American Speech-Language-Hearing Association (2011) enumerated the possible aims of treatment which, consists of reducing the rate of speech, enhancing the breath support so that the affected individual may speak clearer and louder, boosting muscle strength, augmenting tongue, mouth and lip movement, articulation enhancement so that speech is more apparent and understandable, instructing caregivers, family members and teachers tactics to better correspond with a person with dysarthria. Lastly, in severe cases, it is essential to learn and utilize alternative means of communication such as simple gestures, alphabet boards or electronic or computer-based apparatus. References American Speech-Language-Hearing Association (2011). Dysarthria. Retrieved September 25, 2011, from http://www.asha.org/public/speech/disorders/dysarthria.htm Barnes, M. P., Dobkin, B. H., & Bogousslavsky, J. (2005). Aphasia and Dysarthria after stroke. Recovery after stroke (pp. 482-485). New York: Cambridge University Press. Dickinson, S. (2008). Patients’ experiences of disruptions associated with post-stroke dysarthria. International Journal of Language and Communication Disorders, Volume 43, Issue 2, pp. 135-153. Godefroy, O. & Bogousslavsky, J. (2007). Dysarthria. The Behavioral and Cognitive Neurology of Stroke (pp. 86-96). New York: Cambridge University Press. Kirshner, H. (2007). Dysarthria. First Exposure to Neurology (pp. 122-125). United States of America: McGraw-Hill Companies, Inc. McNeil, M.R. (2009). Dysarthria. Clinical Management of Sensorimotor Speech Disorders (Chapters 8-12, pp. 116-201). New York: Thieme Medical Publishers, Inc. Tanner, D. C. (2008). Dysarthria: The Paralyzed Tongue. The Family Guide to Surviving Stroke and Communication Disorders (Chapter 3, pp. 52-56). Ontario, Canada: Jones and Bartlett Publishers, Inc. Read More