Speech Characteristics of Dysarthria
Slurred speech, harsh vocal quality or tremor, prolonged phonemes and intervals btwn words/syllables, exaggerated or paradoxical respiration, excess/equal stress
What is ataxic dysarthria?
Lesion site: cerebellum
Neuromotor basis: incoordination
Common Etiologies: stroke, degenerative diseases, toxic conditions, trauma, demyelination (MS), tumors
Listen for rate at rest and during speech, both reading and conversation, look for rapid, shallow or effortful and irregularity of this subsystem and rate severity.
What is respiration?
Formal tool for quantifying single word & sentence intelligibility and speaking rate (test)
What is the Assessment of Intelligibility of Dysarthric Speech?
Treatment designed for hypokinetic dysarthria associated with Parkinson's.
Goals: Increase phonotory effort, vocal fold adduction, respiratory support
Simple instructions (Think loud)
What is LSVT?
good candidates:
mild-moderate PD
Phonatory: breathiness, short phrases, audible inspiration
Resonatory: Hypernasality, imprecise consonants, NAE, short phrases,
Phonatory-prosodic: harsh voice, monolooudness, monopitch
What is flaccid dysarthria?
Lesion: LMN pathways (cranial/spinal nerves)
Neuromotor basis: Weakness/paralysis, diminished/absent reflexes, loss of muscle mass (atrophy)
Common Etiology: Surgical trauma (severed spinal cord, RLN from heart surgery); degenerative (ALS); peripheral nerve disorder via trauma, genetic disease, metabolic disorder, toxins, nutritional, carcinoma, immunologic disorders (Guillan Barre)
Observe hyper or hyponasality, nasal emission of this subsystem.
What is resonance?
Speech sample
Oral reading sample
Diodochokinetic rate
Oral Mech
What are the components of informal assessment of dysarthria?
Watch and listen (integral stimulation)
Teach phonetic placement
Teach self-monitoring skills
Exaggerate consonants (clear speech)
Minimal contrasts
Intelligibility drills
What are intervention strategies to work on articulation?
Distorted vowels, monopitch, monoloudness, inappropriate silence, imprecise consonants.
What is hyperkinetic dysarthria?
Lesion: Basal Ganglia
Neuromotor basis: Excessive movement, slow (dystonia, athetosis, tardive dyskinesia), fast (no sustained postures: myoclonus, tics, chorea, balismus)
Etiology: Huntingtons, brainstem stroke, spasmodic dysphonia
Listen to sustained 'ah', take note of pitch and pitch breaks, diplophonia, variation in pitch and monotony of pitch, vocal tremors, vocal quality of this subsystem
What is phonation?
1. Respiration & Resonance
2. Phonation
3. Articulation and Prosody
(Note: prosody can go also with 1 & 2)
What is the treatment hierarchy to treat dysarthria we learned in class?
Modify pattern of speaking by increasing effort, using slow rate, overarticulating
Resistance treatement during speech
What are intervention strategies to address resonance?
Candidates: has VPI and can compensate
Excess muscle tone, slow tongue movement, drooling and swallowing difficulty, imprecise consonants, distorted vowels. Low pitch, harsh, pitch breaks, slow speaking
What is spastic dysarthria?
Bilateral damage to direct an dindirect activation pathways of CNS (UMN)
Weakness & spasticity
Progressive degenerative disease (MS/PLS) bilateral strokes, head injury, tumor, infection, CP
Screen with DDKs
For in-depth look use standardized tests and check stimulability as you go
What is articulation?
Intervention strategy that can be used to build respiratory support for speech.
Best candidates are those with low to midlevel stimulability (poor response to initial training)
What is biofeedback?
Pacing Devices
Metronome or finger tapping to reduce pauses
What are methods to alter speech rate?
Fast rushes of speech, quiet voice, monoloudness
What is hypokinetic dysarthria?
basal ganglia
Reduce ROM, rigid, reduced moves and tremor
Parkinson's
Note rate of speech, phrase length, stress patterns and short rushes of speech
What is prosody?
Pacing with metronome
sniffing, blowing panting
practicing effective breathing patterns (quick inspirations, slow controlled exhalations)
Biofeedback to increase control of inhale and exhale
Inspiratory checking without speech
What are non-speech tasks to coordinate respiration?
Used for ataxic or hyperkinetic dysarthria
What are methods to alter pitch?