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DYSARTHRIA

Dysarthria is a general term for a collection of neurological speech disorders characterized by weakness
and incoordination in the muscles that control respiration, phonation, resonation, and articulation. All of
these systems also are important for swallowing.

The weakness and incoordination may have an effect on all speech systems ranging from minimal to
profound, depending on the site and size of the lesion(s) in the brain, cerebellum, or brainstem. In
general, the range of motion (ROM), strength, coordination, and rate of muscle movement may be
affected in each of the speech systems, which then has an overall effect on the prosody of speech .
Dysarthria may have the same etiologies as aphasia and cognitive disorders (e.g., CVA, TBI, tumor, toxin,
degenerative disease). At other times, dysarthria has no clearly identifiable cause. Of the two motor
speech disorders (apraxia and dysarthria), dysarthria is the more prevalent, primarily because a variety
of areas in the central nervous system (CNS) and peripheral nervous system (PNS) may be damaged with
this condition

Characteristics of Dysarthria

Each of the speech systems contributes to the characteristics of dysarthria:

■ When the muscles of the respiratory system (diaphragm, chest, and abdominal muscles) are
weakened by damage to the CNS, patients have difficulty achieving adequate inspirations and having
controlled, steady, and prolonged expirations for normal speech. This weakness can result in low vocal
intensity and speech that is limited to short phrases.

■ When muscles of the phonatory system are weak, the vocal folds may have unilateral or bilateral
paresis or paralysis that prevents normal valving of the air stream from the lungs. This weakness results
in mild to severe breathiness of the voice.

■ When the muscles of the resonatory system are weak, unilateral or bilateral paresis of the soft palate
prevents it from making normal contact with the posterior pharyngeal wall, which can result in
hypernasality.

■ When the muscles of the mandible, lips, and tongue are weak, either unilaterally or bilaterally, there
can be decreased range of motion, strength, coordination, and rate of movement. This weakness results
in distorted, imprecise consonants that can have mild to severe effects on speech intelligibility
Types of Dysarthria

Six types of dysarthria have been described in the literature: spastic dysarthria, ataxic dysarthria, flaccid
dysarthria, hyperkinetic dysarthria, hypokinetic dysarthria, and mixed dysarthria. Each type has its own
primary speech characteristics

General Principles of Assessment of Dysarthria

A diagnosis of a motor speech disorder is made after a thorough evaluation of a patient’s motor speech
abilities. Sometimes evaluation results are unambiguous and a clear diagnosis can be made. More
commonly, several interpretations are possible, and the clinician has to rank these possibilities . The
process of narrowing down the list of possibilities and reaching conclusions about the nature of a deficit
is known as differential diagnosis ( the process of narrowing possibilities and reaching conclusions about
the nature of a deficit.)

When dysarthria is suspected, a thorough evaluation of the speech systems (respiratory, phonatory,
resonatory, and articulatory) is completed, with emphasis on the oral mechanism.

General Principles of Therapy for Dysarthria

The primary goal of speech therapy for dysarthria is to maximize the effectiveness, efficiency, and
naturalness of communication . Depending on the severity of the dysarthria, patients and clinicians
together may choose different approaches. For example, patients with mild dysarthria may focus on
efficient and natural-sounding speech; patients with moderate dysarthria may choose to work on speech
intelligibility and efficiency (i.e., manageable physical effort); and patients with severe dysarthria may
emphasize effective and efficient alternative means of communication .The restorative approach to
treatment of dysarthria attempts to restore lost motor abilities by reducing the underlying pathologic
neuromotor condition that is creating the dysarthria (e.g., weakness, incoordination, spasticity) .
Reduction of the underlying pathology thereby reduces the severity of the dysarthria. Speech
intelligibility is the focus of treatment.
Clinicians attempt to reduce patients’ impairments by increasing physiological support for speech—for
example, increasing range of motion, muscle tone, strength, and rate of movement of the articulators

However, because of the various types of dysarthria (spastic, ataxic, flaccid, hyperkinetic, hypokinetic,
mixed), what is appropriate treatment for one type may not be at all appropriate for another type. For
example, clinicians may attempt to strengthen weakened muscles of respiration, phonation, and
articulation for hypotonic or flaccid muscles, but use relaxation techniques for hypertonicity or
spasticity.

When speaking, individuals with dysarthria need to make speech very conscious so their focus is on
being heard and understood rather than on how quickly they can communicate their messages. Because
speaking needs to become very conscious, it is both physically and cognitively demanding—and
fatiguing