The term dysarthria covers a range of disorders in speech. Writing, reading, grammar and language comprehension are not affected. Only the motor function of speech is disturbed due to impairment of cranial nerves or damage to the brain.
What is dysarthria?
Speaking is a highly complex interaction of more than a hundred muscles, the larynx, and breathing. During breathing, the diaphragm, as the main respiratory muscle, and other respiratory muscles ensure that the chest and abdomen are expanded and air can flow in. When we inhale, the diaphragm lowers to make room for the incoming air; when we exhale, it raises again, thus forcing the air out. The incoming and outgoing air is directed through the larynx. It consists of many muscles and cartilages and inside it are the vocal folds. To be able to produce sounds, the vocal folds close and the breathing air presses against them. They begin to vibrate and as a result, tones are produced. These sounds are articulated into words in the mouth and throat. The tongue, lips, jaw and soft palate are all involved in this process. In order for all of this to function unhindered, head and body posture are important. Only when the upper body is upright and the head is erect can the breath flow freely and the voice and articulation are not impaired. This performance is controlled in the brain. The cranial nerves transmit the movement impulses to the various muscles, thus creating the necessary fine-tuning to ensure that speaking succeeds flawlessly. Dysarthria can occur due to damage or disease of the brain or nervous system. The nerves and muscles involved in the speech process may either be paralyzed or have coordination problems. This can affect the tongue, soft palate, lips, jaw, throat, larynx, or respiratory muscles.
Causes
Dysarthria is a neurologically based disorder. There are several triggers for this speech disorder. It may exist from early childhood due to early brain damage or be caused later by strokes, brain hemorrhages or accidents involving severe head injuries, brain tumors, or progressive diseases of the nervous system such as Parkinson’s disease and multiple sclerosis. Similarly, stroke, traumatic brain injury, or Huntington’s disease may also be a cause of speech impairment.
Symptoms, complaints, and signs
A variety of speech impairments may be observed. Speech may sound washed out and slurred, somewhat as if alcoholic; it may be raspy and clenched, hoarse, and soft. Sometimes the speech is very monotonous or the speed is too slow or too fast.
Diagnosis and course
From the outward appearance, different types of dysarthria can be distinguished. Spastic or hypertonic dysarthria is caused by an increase in muscle tension in the muscles involved. As a result, the voice sounds rough and squeezed and speech is intermittent and slurred. Hypotonic dysarthria, on the other hand, is caused by a lack of muscle tension. As a result, articulation becomes unclear and volume and speech melody are disturbed. In addition, those suffering from it tire quickly when speaking. In hyperkinetic dysarthria, speech movements are often explosive and exaggerated. This is evidenced by severe fluctuations in volume and pitch and articulation. There may be additional grimacing and additional involuntary sounds, such as clicking. Hypokinetic dysarthria, on the other hand, shows a restriction and reduction in the mobility of the muscles involved. In this case, speech is monotonous and articulation is unclear. Facial muscle facial expressions may also be restricted and rigid. Ataxic dysarthria is characterized by coordination disorders. This affects volume, pitch, and accuracy of articulation. They vary constantly and uncontrollably. However, these individual forms often occur together as mixed dysarthria. Various methods are used to make a diagnosis. For example, the Aachen Materials for the Diagnosis of Neurogenic Speech Disorders (AMDNS), the Munich Intelligibility Profile (MVP), and the Frenchay dysarthria examination.
Complications
Dysarthria is a speech disorder in which speech motor performance is affected. Linguistic performance, on the other hand, is usually normal.In dysarthria, reading, writing, and comprehension function, but articulatory and speech rhythm problems are present. This leads to strained speech in which speech is chanted or slurred. In addition, dysarthrics sometimes have voice and breathing problems. If dysarthria is suspected, a specialist should be consulted to take further steps. Speech therapists or clinical linguists provide patients with information and perform speech therapy measures. Depending on the cause, different therapeutic successes can be expected. Possible causes include stroke, inflammatory processes in the brain, traumatic brain injury, degenerative diseases such as Parkinson’s disease and multiple sclerosis or ALS, alcohol abuse and other poisonings, and early childhood brain damage. The most clearly impaired is the formation of sounds. Voluntary control and programming of the organs of articulation are affected, which parallels the various aphasic disorders. With the help of speech tests, the speech disorders can be categorized more precisely in order to find out which linguistic sub-areas are affected and on which speech therapy is to be focused. In degenerative diseases such as MS, ALS or Parkinson’s disease, a more or less steady deterioration of the ability to speak is to be expected. Therefore, an emphasis should be placed on stabilizing the patient. In other dysarthric diseases, on the other hand, effective speech therapy can contribute to a significant improvement in the ability to speak.
When should you see a doctor?
If the child suffers from speech disorders from early childhood, the pediatrician should be consulted. The earlier dysarthria is clarified, the better the chances of recovery are, as a rule. Parents who notice slurred, rough, hoarse or monotonous speech in their child are therefore best advised to consult a medical professional directly. Dysarthria in adulthood usually occurs after an accident with severe head injuries, brain hemorrhages or strokes. Anyone who suddenly has problems speaking after such an illness should consult the doctor in charge. In most cases, however, the physician recognizes the dysarthria by himself anyway and will inform the patient about it. Whether the speech disorder needs to be treated depends on its type and severity as well as on the patient’s state of health. Sometimes the dysarthria is reversed by logopedic measures, in other cases complex interventions are necessary. If the speech disorder is perceived as a burden, it must be treated in any case. In early childhood dysarthria, therapy is routinely initiated after diagnosis.
Treatment and therapy
Treatment attempts to compensate for or, if possible, even eliminate the various confounding factors. For dysarthria caused by one-time events, strokes, or accidents involving brain injury, work will be done to restore the original condition. For progressive disorders, work is done to delay the progression of dysarthria as long as possible and to preserve speech. A therapy includes different approaches and approaches. First, work is done on posture. This can also be done in collaboration with a physiotherapist. Learning good head and body posture is very important here. If body tension is increased, relaxation techniques are taught; if body tension is too low, tension-building exercises are done. Breathing exercises are part of the program. Breath deepening and breath flow lengthening are practiced. The abdominal breathing is consciously performed and worked on so that it can be consciously used when speaking. This lengthens the breath stream and makes more air available for sound production. Vocal folds and other laryngeal muscles are trained through vocal exercises. The goal is to harmonize the vibrations of the vocal folds so that the voice becomes melodious and the volume is appropriate. This is achieved through the use of humming, buzzing, phonetic or syllabic exercises. In addition to the volume and the use of the voice, the duration of the tone and the pitch differentiation are practiced. Articulation is practiced passively and actively. Massages or vibrations on the speech tools often have a positive influence. They are additionally supplemented by oral motor gymnastics, such as different lip positions. This increases the functional ability and enables clearer speech.Spontaneous speaking is encouraged with speech exercises. In addition, problematic speech situations are examined and acted out. The improved speaking ability is additionally consolidated in role plays and practice situations in everyday life and thus increasingly integrated into everyday life.
Outlook and prognosis
Dysarthria does not result in self-healing. In any case, patients with this condition are dependent on medical treatment to alleviate the symptoms. If treatment does not occur for dysarthria, those affected suffer from speech difficulties. They are unable to form sentences correctly, with the speech itself sounding uncertain and slurred. Likewise, those affected sound as if they are alcoholic, which can also lead to social discomfort. Especially in children, this can lead to teasing or bullying, causing them to develop psychological upset and depression. Furthermore, dysarthria significantly delays the child’s development and for this reason should be treated early. In any case, early treatment has a very positive effect on the course of the disease and can prevent complaints in adulthood. As a rule, treatment is carried out through various therapies and exercises. It is not possible to predict how long the treatment will last and whether it will be successful. In most cases, however, the symptoms can be well alleviated. Dysarthria does not affect the patient’s life expectancy.
Prevention
Since neurological diseases can hardly be prevented, dysarthria as a secondary disease is equally difficult to treat preventively. Therefore, only a healthy lifestyle with moderate alcohol consumption and a balanced diet remains as a measure to prevent possible neurological damage.
Aftercare
In dysarthria, the affected person usually has few options for aftercare. In this case, the patient is solely dependent on intensive treatment by a physician to alleviate the symptoms and to continue to also enable an ordinary everyday life. Self-cure is not possible with this disease. Those affected are dependent on the help of other people in their everyday lives and, as a rule, in their entire lives. First and foremost, loving care and support from one’s own family and friends has a positive effect on the further course of dysarthria and can prevent other complaints. Should the patient with dysarthria wish to have children, genetic counseling may be advisable. This may prevent the syndrome from being passed on to descendants. In many cases, parents will need to engage in intensive therapy with the affected child. In this process, the parents should also familiarize themselves with the symptoms of the disorder, so that they can also understand the child correctly and respond to the child’s wishes. Whether there is a reduced life expectancy of the patient due to dysarthria, suffers can not be universally predicted.
Here’s what you can do yourself
Because existing dysarthria significantly reduces quality of life, affected individuals should seek professional treatment. However, speech and physical therapy builds on two pillars: first, treatment at the therapist’s office and second, daily exercises at home. Thus, patients can do a lot themselves to improve the restriction. In most cases, the body is under too much tension. Physiotherapy is used to try to correct the posture and relieve tension. Massages and other mindfulness exercises such as yoga or chi gong can also provide mental and physical relaxation. Other effective methods include autogenic training and progressive muscle relaxation according to Jacobsen. Both can be easily learned and applied at home. Conscious breathing is also an important aspect: The airflow should be used in a targeted and controlled manner not only for breathing but also for speaking. Furthermore, speech therapists perform voice exercises with the patients. These should also be repeated regularly at home. The psychological aspect should generally not be underestimated. In addition to supplementary psychotherapy or participation in a self-help group – depending on the ability to speak and the severity of the disease – the social environment of the affected person is of great importance.Acquaintances, family and friends should encourage and motivate the patient to do the exercises, even if success is slow.
