Brief overview
- When to see a doctor? In case of sudden or gradual speech disorders
- Causes: stroke, craniocerebral trauma, early brain damage, encephalitis, meningitis, brain tumor, multiple sclerosis, Parkinson’s disease, amyotrophic lateral sclerosis, Huntington’s chorea
- Therapy: Treatment of the underlying disease, individual speech therapy, if necessary aids like soft palate prosthesis or electronic voice amplifier
What is dysarthria?
By definition, dysarthria is a disorder of the speech motor system. The affected person knows exactly what and how he or she wants to say something. However, the nerve and muscle structures responsible for speech are unable to correctly execute the corresponding commands from the cerebral cortex.
Difference from speech disorder
Speech disorders (aphasias) are to be distinguished from speech disorders (dysarthrias): In these, affected individuals are unable to understand and process speech correctly. They also have problems finding the right words and forming correct, meaningful sentences. In dysarthria, on the other hand, these higher brain functions are not impaired.
How does dysarthria manifest itself?
Spastic (hypertonic) dysarthria
Characterized by increased muscle tension (hypertonia) of the speech muscles, which therefore can only be moved to a limited extent. This affects breathing, voice production and articulation. A compressed, raspy voice is typical. The affected person also articulates only intermittently and unclearly.
Hypotonic dysarthria
Hyperkinetic dysarthria
Exaggerated, explosive speech movements are typical. Volume, pitch and articulation vary greatly. Sometimes the affected person also involuntarily grimaces, wriggles or clicks his tongue.
(Rigid-)Hypokinetic Dysarthria
Ataxic dysarthria
People with ataxic dysarthria speak very unevenly, meaning that volume, pitch, and accuracy of articulation vary widely; all speech is characterized by involuntary, inappropriate changes in breathing, voice, and articulation.
Mixed dysarthria
Dysarthria: causes and risk factors
There are many causes of dysarthria. The most common are:
- Stroke (apoplexy): In a stroke, the brain is suddenly no longer supplied with sufficient blood and thus oxygen. This is usually caused by a clot in the blood vessels, more rarely by a cerebral hemorrhage. Strokes very often cause speech disorders. Stroke patients often also develop aphasia.
- Early childhood brain damage: If the child’s brain is damaged between the sixth month of pregnancy and the end of the first year of life, this may also lead to dysarthria.
- Brain inflammation (encephalitis): usually viruses trigger infectious inflammation of the brain, rarely bacteria. Dysarthria is one of the possible symptoms of encephalitis.
- Brain tumor: brain tumors are possible triggers for different forms of dysarthria depending on their location and size.
- Multiple sclerosis (MS): In this chronic inflammatory disease of the nervous system (spinal cord and brain), the immune system destroys the protective layer around the nerve fibers (myelin sheaths) so that nerve impulses are no longer transmitted without interference. Dysarthria is a possible consequence.
- Amyotrophic lateral sclerosis (ALS): this rare chronic disease of the nervous system affects motor function, breathing, communication skills, and food intake. Speech disorders are among the common early symptoms of ALS.
- Huntington’s disease: In adults with hyperkinetic dysarthria, the cause is usually Huntington’s disease – a rare inherited disorder that is associated with involuntary, sudden, irregular movements, among other symptoms.
- Poisoning (intoxications): Intoxications, for example, due to alcohol abuse or drug use, are also among the possible causes of dysarthria.
Dysarthria: When to see a doctor?
Dysarthria: examinations and diagnosis
In the case of sudden onset of dysarthria as a result of a stroke or traumatic brain injury, the cause is clear. Here, the focus is on the initial medical care of the patient.
This is followed by a neurological examination with the aim of determining the disease underlying the dysarthria and the exact location of the brain damage.
Further examinations are possible, for example, measurement of electrical brain activity (EEG), imaging procedures such as computer tomography (CT) and magnetic resonance imaging (MRI), as well as taking and analyzing a sample of cerebrospinal fluid (CSF diagnostics).
Dysarthria: Treatment
The first step is to treat the underlying condition that led to the dysarthria (such as stroke, encephalitis, Parkinson’s disease).
The dysarthria itself is primarily treated by means of speech therapy. The most important goal is to maintain or restore the patient’s ability to communicate independently.
Building blocks of speech therapy
In speech therapy, patients learn how to speak more intelligibly with conscious head and body posture. Using special exercises, the therapist promotes the harmonious interaction of breathing, voice and articulation. If body tension is too high (spastic dysarthria), relaxation exercises help; if body tension is too low (hypotonic dysarthria), tension-building training sessions are useful.
Patients who have particular problems speaking in certain situations are best advised to discuss this specifically with the therapist. How to deal with such critical situations can then be practiced, for example, in role plays.
In very severe cases of dysarthria, patients work out alternative forms of communication together with the therapist. For example, instead of speaking, facial expressions, gestures and written language can be used to make oneself understood.
Communication aids
Electronic amplifiers support the voice of very softly speaking dysarthria patients. Alternative communication systems such as portable electronic typewriters are designed for dysarthria patients who are barely able to articulate or speak intelligibly (for example, in the late stages of amyotrophic lateral sclerosis).
Disease management
What you can do yourself
Both dysarthria patients themselves and their conversation partners potentially contribute a lot to successful communication. Important points are:
- Avoid stress and excitement: Have conversations without rushing and in a calm environment. Both sides – dysarthria patient and conversation partner – best take enough time to speak and understand. Noise sources in the immediate vicinity (radio, TV, machines, etc.) remain switched off in the meantime.
- Maintain eye contact: During the conversation, it is recommended that the dysarthria patient and the other person maintain eye contact. This is because supportive facial expressions and gestures make it easier for the patient to make himself understood.
- Asking questions: If you do not understand a dysarthria patient correctly, ask. Reproachful comments (“Speak more clearly!” or “Speak louder!”) should be avoided!
- Show respect: A speech disorder is not an intellectual disability. For people with dysarthria, it is important that they are not made to feel mentally inferior or immature.
