Dysarthria Symptoms Research Articles

Shorter Sentence Length Maximizes Intelligibility and Speech Motor Performance in Persons With Dysarthria Due to Amyotrophic Lateral Sclerosis.

Purpose The purpose of this study was to investigate the effect of sentence length on intelligibility and measures of speech motor performance in persons with amyotrophic lateral sclerosis (ALS) and to determine how these effects were influenced by dysarthria severity levels. Method One hundred thirty-one persons with ALS were included in this study, stratified into 4 dysarthria severity groups. All participants produced sentences from 5 to 15 words in length. Intelligibility, speaking rate, and measures of speech pausing behavior (i.e., total speech duration, total pause duration, and mean speech event duration) were measured for each sentence. Linear mixed-effects models were used to determine the effect of sentence length on speech measures for speakers at different dysarthria severity levels. Results Results showed that speech intelligibility significantly declined at longer sentence lengths only for the speakers with ALS who had more advanced dysarthria symptoms; however, speakers with mild-to-severe dysarthria showed significant declines in speaking rate and speech pausing behavior at longer sentence lengths. Conclusions Findings suggest that producing shorter sentences may help maximize intelligibility for speakers with moderate-to-severe dysarthria secondary to ALS and may be a beneficial compensatory strategy for preserving motor effort for all speakers with dysarthria secondary to ALS.

Relations between rhythmic impairment in speech and non-verbal domains in Parkinson's disease

Rhythmic disorders are common in patients with Parkinson's disease (PD), both in speech (i.e., dysarthria) and in non-verbal rhythmic tasks (e.g., tapping to a beat). However, it is still unknown whether rhythmic disorders in the speech and non-speech domains come from the same source (e.g., an impaired general system for beat perception and production). The goal of this study was to examine the relation between impaired speech rhythm in PD patients and non-speech rhythmic skills. Twenty-two PD patients (mean age: 69.3, SD: 5.5) performed (i) an oral diadochokinesis task, (ii) motor and perceptual non-verbal rhythmic tasks from the BAASTA battery. The patients were divided into two subgroups depending on their performance in the non-verbal rhythmic tasks: good beat-trackers ( n = 12) and poor beat-trackers ( n = 10). The two subgroup of patients were compared in terms of their speech performance. In addition, correlations were run to test the link between speech and non-verbal rhythmic skills. Good beat-trackers showed greater speech-related rhythmic abilities as compared to poor beat-trackers, such as lower variability in producing oral diadochokinesis ( Fig. 1 ), and greater articulatory skills. In addition, the ability to synchronize to a beat was generally correlated with the ability to perform diadochokinesis ( Fig. 2 ). Notably, this link was not confined to tasks involving rhythmic production, but was also apparent between speech production and rhythm perception with non-verbal material ( Fig. 3 ). Our results point to close relations between speech-related rhythmic skills and non-verbal rhythmic motor and perceptual abilities in PD. These findings are consistent with an impaired general system for beat perception and production in PD. This system can be the target of dedicated techniques for rhythmic training (e.g., using non-verbal material) for alleviating some dysarthric symptoms in PD.

Lambl’s excrescences and a review of therapeutic strategies

Background: Lambl’s excrescences (LEx) are thin, filiform structures that arise on the lines of closure of heart valves. Although rare, we have come across various case reports in the literature describing thromboembolic events associated with LEx. We report the case of a 63-year-old female who presented with TIA-like symptoms and was found to have a LEx on the aortic side of native aortic valve. We conducted a comprehensive literature review with emphasis on different therapeutic strategies utilized to provide insight for future encounters.Case presentation: A 63-year-old female with a past medical history significant for hypertension and hyperlipidemia presented to the emergency room with symptoms of dysarthria and unsteady gait. While in the hospital, the patient returned to her baseline gait and speech without intervention. Work-up for including computed tomography of the head, magnetic resonance imaging, and carotid doppler, as well as prolonged telemetry monitoring was negative. A transthoracic echocardiogram showed a 0.81 cm linear echodensity attached to the aortic side of the aortic valve, highly suggestive of LEx that was later confirmed on transesophageal echocardiogram. Patient was placed on clopidogrel alone for antiplatelet therapy due to an aspirin allergy and she was subsequently discharged home.Discussion: No standard management for LEx currently exists. We aim to add to the evidence of effective management and explore the literature of patients who have experienced TIA/CVA symptoms secondary to LEx.

Paroxysmal Ataxia and Dysarthria in a Patient with Demyelinating Disease

Paroxysmal dysarthria and ataxia is characterized by abrupt onset of dysarthria and ataxia of unilateral limbs for seconds. We present a 45-year-old female patient with paroxysmal symptoms of dysarthria, right-sided ataxia, and a persistent symptom of upbeating nystagmus. Her brain fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging indicated potential diagnosis of demyelinating disease. The paroxysmal and persistent symptoms have recovered after phenytoin administration. Sodium channel blocker may play a role in reducing the ephaptic transmission in a demyelinated or re-myelinated lesion. Key Words: Dysarthria, Ataxia, Demyelinating disease

Dualistic effect of pallidal deep brain stimulation on motor speech disorders in dystonia

BackgroundAlthough pallidal deep brain stimulation (GPi-DBS) is an effective treatment for dystonia, it may cause important stimulation-induced side-effects such as hypokinetic dysarthria or stuttering. However, the reasons behind the occurrence of these side-effects remain unknown. ObjectiveTo objectively investigate the impact of GPi-DBS on patients with dystonia on speech fluency, intelligibility, and key aspects of hyperkinetic and hypokinetic dysarthria. MethodsSpeech was systematically evaluated in 19 dystonic patients with GPi-DBS. Each patient was tested twice within one day in both the GPi-DBS ON and GPi-DBS OFF stimulation conditions. A control sample of 19 matched healthy speakers underwent the same speech assessment. ResultsWe observed an improvement of hyperkinetic dysarthria symptoms in 47% and an aggravation of hypokinetic dysarthria symptoms in 26% of patients with the GPi-DBS switched ON. A higher stimulus intensity was found in a group of patients in whom the hypokinetic dysarthria worsened with the GPi-DBS ON when compared to other dystonic patients (p = 0.02). Furthermore, we revealed a significant increase of dysfluent words in the GPi-DBS ON when compared to OFF condition (p = 0.001) associated with the shorter distance of the active contact localization along the medio-lateral direction (r = −0.70, p = 0.005). ConclusionThis study provides evidence of dualistic effects of GPi-DBS on speech in dystonia manifested as an improvement of hyperkinetic or a deterioration of hypokinetic dysarthria. Our findings suggest that lower stimulation parameters and placement of active contacts more laterally in the internal globus pallidus should be preferred to avoid the possible side effects of hypokinetic dysarthria and dysfluency.

Соматические дисфункции у детей с задержкой речи

Goal of research - the study aims to examine the osteopathic profi le of children with dysarthria and to develop recommendations for osteopathic correction of somatic dysfunctions in 2-3 year old children presenting this pathology.Materials and methods. 30 2-3 year old children with the symptoms of dysarthria took part in the research. All the children were divided into 2 groups: the control group of 15 children received standard treatment, and the experimental group of 15 children received both standard and osteopathic treatment. The dysarthria severity and the osteopathic profi le were evaluated with account of the number of somatic dysfunctions at global, regional, and local levels.Results. The osteopathic correction was shown to have a positive effect on dysarthria severity. The study established a correlation between the dysarthria severity in children and the number of somatic dysfunctions at the local level.Conclusion. The study suggests using osteopathic correction of somatic dysfunctions in the complex therapy of dysarthria in children.

Dysarthria in Adults With Cerebral Palsy: Clinical Presentation and Impacts on Communication.

Although dysarthria affects the large majority of individuals with cerebral palsy (CP) and can substantially complicate everyday communication, previous research has provided an incomplete picture of its clinical features. We aimed to comprehensively describe characteristics of dysarthria in adults with CP and to elucidate the impact of dysarthric symptoms on parameters relevant for communication. Forty-two adults with CP underwent speech assessment by means of standardized auditory rating scales. Listening experiments were conducted to obtain communication-related parameters-that is, intelligibility and naturalness-as well as age and gender estimates. The majority of adults with CP showed moderate to severe dysarthria with symptoms on all dimensions of speech, most prominently voice quality, respiration, and prosody. Regression analyses revealed that articulatory, respiratory, and prosodic features were the strongest predictors of intelligibility and naturalness of speech. Listeners' estimates of the speakers' age and gender were predominantly determined by voice parameters. This study provides an overview on the clinical presentation of dysarthria in a convenience sample of adults with CP. The complexity of the functional impairment described and the consequences on the individuals' communication call for a stronger consideration of dysarthria in CP both in clinical care and in research.

Childhood dysphasias in patients with late sequelae of perinatal central nervous system lesion

The aim of the study was to explore condition of the nervous system in different types of childhood dysphasia (CD), to compare the brain bio-electric activity to the level of cerebral blood flow, severity of neurological disorders, and neuropsychophysiological parameters, to identify the intact links of brain organization in children with minimal brain dysfunction (MBD), sensorineural hearing loss (SNHL), and spastic forms of infantile cerebral palsy (ICP). Patients and methods. 505 Children aged 4–8 years were examined: 218 with MBD, 73 with SNL, and 214 with spastic forms of ICP. The patients were divided into two groups: preschool age, 4–6 years (110 children with MBD, 29 with SNHL, and 116 with ICP) and early school age, 7–8 years (108 children with MBD, 44 with SNHL, and 98 with ICP). The group of preschool age children with spastic forms of ICP comprised 42 children with double hemiplegia (DHP), 36 with spastic hemiplegia (SHP), and 38 with spastic diplegia (SDP). The early school age group comprised 32 children with DHP, 37 with SHP, and 29 with SDP. All children underwent general clinical and neurological examination, computerized electroencephalography (EEG), neuropsychophysiological and speech testing, transcranial Doppler ultrasonography, and if required, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. To clarify the mechanisms of cerebral disintegration in children with signs of epileptiform activity, in the day-time EEG recording, extended video-EEG monitoring was performed for 12–14 h with mandatory recording of nocturnal sleep. Condition of the audio-verbal sphere in children with SNL was examined using an original computer program, Speech_Audiometry. Results and discussion. The rate of the motor type CD upon MBD was demonstrated to be 77.6%; the mixed type CD predominated in children with SNHL and ICP: 82.2 and 66.2%, respectively. Upon spastic forms of ICP, a combination of CD with symptoms of dysarthria and oral dyspraxia was detected in 84% of cases. A mutually aggravating effect of the main clinical manifestations on the nature and intensity of speech development disorders was revealed, especially when a child had two or more active pathological processes in the CNS. A number of clinical-neurophysiological and neuropsychological correlations with different types and versions of CD were found, which allows one to perform computerized support of rehabilitation of these children and to develop differentiated approaches to treatment.

An internal carotid artery aneurysm presenting with dysarthria

A 72-year-old woman presented to her general practitioner with a 4-week history of right neck swelling. Clinical examination elicited a pulsatile mass consistent with a carotid artery aneurysm. Five days later the patient noticed her tongue movements had become awkward with associated dysarthria. Computed tomography confirmed a 4cm internal carotid artery aneurysm arising just distally to the carotid bifurcation. She proceeded to transfemoral diagnostic carotid angiography. Balloon occlusion of the right internal carotid artery origin was performed for a ten-minute period without any neurological deficit. The decision was taken to proceed to surgical ligation of the origin of the internal carotid artery. Her symptoms of dysarthria have resolved.

Dysarthria induced by irinotecan in a patient with colorectal cancer

Successful management and subsequent prevention of a rare adverse drug reaction (ADR) associated with irinotecan chemotherapy are reported. A 49-year-old man with meta-static colon cancer undergoing treatment with i.v. irinotecan (180 mg/m(2) to be infused over 120 minutes) as part of a multidrug chemotherapy regimen developed dysarthria about 90 minutes into irinotecan infusions on two occasions. In both instances, the dysarthric symptoms (numbness of the tongue and difficult speech) resolved after the discontinuation of irinotecan and administration of hydration therapy. Brain imaging studies showed no functional or structural abnormalities; several concomitantly administered medications, including metoclopramide, palonosetron, and other components of the chemotherapy regimen, were deemed unlikely to have played a causal or contributory role in the episodes of dysarthria. Application of the ADR probability scale of Naranjo et al. in this case yielded a score of 9, indicating a definite ADR caused by irinotecan. For subsequently administered chemotherapy cycles, the duration of the patient's irinotecan infusions was increased (to 180 minutes for cycles 3-5 and to 240 minutes for cycles 6-12). Dysarthria did not recur and, with the exception of transient tongue twisting during two of the 180-minute infusions, he completed the full course of irinotecan therapy without a recurrence of dysarthric symptoms. Irinotecan-induced dysarthria in a man being treated for colon cancer resolved with the discontinuation of irinotecan. With increases in the duration of infusion, the man received additional irinotecan treatments with no recurrence of dysarthria.

Vertebral Artery Stenting With Flow Reversal

A 47-year-old man was admitted with recurrent symptoms of dysarthria, diplopia, vertigo, and drop attacks. Workup revealed >90% stenosis of the left vertebral artery at its origin with poststenotic dilatation (Fig 1). The vertebral artery was 4 mm in diameter. The plaque appeared to have significant embolic potential. The right common femoral artery was accessed with short 9F sheath, and patient was anticoagulated with intravenous heparin (100 U/kg body weight). The left subclavian artery was cannulated using headhunter catheter. The catheter was advanced over the wire to mid brachial artery. Wire exchanged to stiff wire. MoMa flow reversal guide catheter (Medtronic, Minneapolis, Minn) was advanced over the stiff wire until the trailing balloon was engaged in the left subclavian artery. The leading balloon was positioned in left subclavian artery and kept deflated. The trailing balloon in left subclavian artery was inflated after making sure that activated clotting time was >250 seconds. An angiogram was performed to ensure that there was no antegrade flow in left vertebral artery (Fig 2). Spartacore 0.014 wire (Abbott Labs, Abbot Park, Ill) was introduced through the working port of MoMa guide catheter and was used to cross the area of near occlusive stenosis in proximal part of left vertebral artery. The lesion was successfully stented open with 4- × 18-mm Herculink Elite (Abbott Labs) balloon-expandable stent (Fig 3). The stent was projected in the left subclavian artery for about 1 mm. The stented segment of vertebral artery was aspirated multiple times with Export catheter (Medtronic). A significant amount of atherosclerotic debris was aspirated (Fig 4). Antegrade blood flow was restored. The MoMa device balloon in subclavian artery was deflated. Completion arteriogram revealed brisk flow in left vertebral artery, without any residual stenosis. The patient remained stable, without any adverse neurologic events. Sheath and guiding catheter was removed and hemostasis secured. The 60-day follow-up revealed multiphasic flow in the left vertebral artery and patient remained symptom free. View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) Vertebral artery stenting with flow reversal as embolic protection is very safe and effective strategy for endovascular vertebral artery interventions in select group of patients.

Delayed Cerebral Metastases from Completely Resected Cardiac Myxoma: Case Report and Review of Literature

Cardiac myxoma is the most common benign tumor of the heart. However, low incidence of recurrence and metastasis has been reported. A 49-year-old female patient was admitted in the hospital due to sudden onset of left side weakness. Magnetic resonance imaging (MRI) of brain showed multifocal areas of diffusion restriction on diffusion weighted images. Echocardiography was performed to evaluate the cause of embolic brain infarction and cardiac myxoma was found in the left atrium. The patient underwent complete excision of the mass. One year later, the patient was readmitted with symptoms of dysarthria. Brain MRI showed newly developed multiple hemorrhagic metastatic lesions. The patient underwent radiotherapy of the metastatic lesions. Although rare, cardiac myxoma can cause delayed metastasis. We report a rare case of delayed multiple cerebral metastases from the completely resected cardiac myxoma.

Dysarthria in Friedreich’s Ataxia: A Perceptual Analysis

The aims of this study were to: (1) evaluate the perceptual speech dimensions, speech intelligibility and dysarthria severity of a group of individuals diagnosed with Friedreich’s ataxia (FRDA); (2) determine the presence of subgroups within FRDA dysarthria; (3) investigate the relationship between the speech outcome and the clinical factors of disease progression. The study included 38 individuals (21 female, 17 male) with a confirmed diagnosis of FRDA. A group of 20 non-neurologically impaired individuals served as controls. Perceptual analysis, investigating 30 different dimensions of speech, was conducted on a speech sample obtained from each participant. In addition, the Assessment of Intelligibility of Dysarthria Speech was administered. All FRDA participants presented with dysarthria with severities ranging from mild to moderate. Cluster analysis revealed 3 subgroups, the first presenting with mild dysarthric symptoms, the second with increased velopharyngeal involvement and the third characterized by increased laryngeal dysfunction. Dysarthria severity showed a significant correlation to disease duration but to no other clinical measure. The findings support the notion of subgroups in FRDA dysarthria, representing distinct impairments of the speech mechanism and perhaps reflective of differing evolutions beyond the cerebellum.

Dysphagia in children with infantile cerebral palsy

Dysphagia is a significant health problem in children with infantile cerebral palsy (ICP), but not frequently discussed in the literature. The study objective was to analyse dysphagia symptoms in children with a pyramidal form of ICP, including the oral and pharyngeal phases of deglutition and dysarthria severity. We searched for a correlation between dysphagia severity and ICP type, mental development and occurrence of epilepsy. A total of 67 children with a pyramidal form of infantile cerebral palsy were studied. Data were obtained based on case history elicited from the mothers, analysis of medical and psychological documentation, and logopaedic examination, including an examination of the action of swallowing. Dysphagia symptoms were found in 41 (61%) studied children, most frequently referring only to the oral phase (25 children), with concomitant mild and moderate dysarthria. Oral and pharyngeal dysfunctions were observed in 14 children and coexisted with more pronounced dysarthria symptoms. The most severe disorders were mainly found in the pharyngeal phase in 2 children. A statistically significant correlation was noted between the severity of dysphagia symptoms and the ICP type (p<0.044) and mental development (p<0.00002). Swallowing dysfunctions occur in the majority of children (>50%) with ICP. More serious disorders involving the oral and pharyngeal phases mainly affect children with tetraplegia and profound mental impairment. These disorders continue from early infancy through childhood and adolescence and improvement has been mainly observed when only the oral phase of swallowing is affected. These are always accompanied by dysarthria symptoms, which are especially severe when dysphagia involves the oral and pharyngeal phases. Early assessment and stimulation of the swallowing function should be a common element in the rehabilitation and care of children with ICP.

Incidence of dysarthria in children with cerebellar tumors: A prospective study

The present study investigated dysarthric symptoms in children with cerebellar tumors. Ten children with cerebellar tumors and 10 orthopedic control children were tested prior and one week after surgery. Clinical dysarthric symptoms were quantified in spontaneous speech. Syllable durations were analyzed in syllable repetition and sentence production tasks. Localization of the cerebellar lesions were defined after manual transfer from individual 2D-MR images onto 3D images of a spatially normalized healthy brain. Cerebellar children showed few and mild clinical signs of dysarthria. No difference was present in the sentence production task compared to controls. In five cerebellar children, syllables were prolonged in the syllable repetition task after surgery. Syllable duration normalized in an additional four-week session in all but one case. The MR-analysis showed that superior paravermal cerebellar areas likely involved in dysarthria in adults (paravermal lobules HVI, Crus I) were not significantly affected. In children, speech impairments appear to be rare after cerebellar surgery because tumors most commonly affect posterior–inferior and medial parts of the cerebellum while critical cerebellar regions are likely spared. The results suggest a similar localization of speech functions in the cerebellum in children and adults.

Exploring interdisciplinary management of Parkinson's disease

ABSTRACT Speech and/or swallowing impairment occurs in a high percentage of patients with Parkinson's disease. Mutch et al. (1986) report that in a study of 249 Parkinson's disease patients, 65% had speech difficulty and 18.5% of 265 Parkinson's disease patients surveyed reported swallowing impairment. The benefits of speech and language therapy for these patients have been recognised. Clearly, these patients can only benefit if they can access a speech and language therapy service. This pilot interdisciplinary project, between a speech and language therapy service and a general practice unit, set out to audit access to and awareness of the speech and language therapy service for patients with Parkinson's disease in a primary care setting. All the Parkinson's disease patients in one general practice unit were identified and invited to a speech and language therapy assessment. A survey of these patients and their carers was completed by interview investigating their awareness of their communication/swallowing difficulties and perceived need for speech and language therapy. A postal survey of all general practitioners in the Trust area was carried, out examining attitudes and past practice of general practitioners concerning referral of adult patients to the speech and language therapy service. Past referrals of Parkinson's disease patients to the service were analysed to establish historic access routes to the service. Speech and language therapy assessment and patient interviews were completed for 13 Parksinson's disease patients. Interviews were carried out with 10 carers. Questionnaires were sent to 69 general practitioners and 37 responses (54%) were received. Results of the general practitioner survey indicated poor awareness of the role of speech and language therapy for this client group. Patient and carer survey findings highlighted accurate perceptions regarding patient dysarthria symptoms. Speech and language assessment identified four of 13 patients requiring direct therapy and a further eight patients who could benefit from advice and information. Only one patient had no dysarthria symptoms. Referral analysis indicated that of 18 patients referred with Parkinson's disease to speech and language therapy, one had been referred by a general practitioner. The findings highlight the need for increased awareness among patients, carers and members of the primary healthcare team about the role of speech and language therapy with this client group, in order to ensure timely and appropriate referral. The outcome of this interdisciplinary audit project indicates benefits for patients, carers and general practitioners through improved identification of need and mutual education. The aims, process and issues involved in interdisciplinary audit of this kind are described, along with guidelines for the selection of suitable interdisciplinary audit topics.

Acoustic analysis of dysarthria associated with multiple sclerosis

Approximately 40% of all individuals with multiple sclerosis (MS) present some degree of speech impairment. MS speakers with dysarthria are a heterogeneous group and the speech disorder is characterized by disturbances of the temporal patterning of speech as well as articulatory and phonatory symptoms. Previous research also indicates that the neuromotor dysfunction manifests itself in the fundamental frequency of sustained phonation, even in the absence of other speech symptoms. The present study was designed with the specific purpose of exploring the temporal, spectral and phonatory acoustic features of five MS speakers as compared to those of two normal controls. It was found that the dysarthric symptoms of these MS speakers largely mirror their different underlying neuromotor dysfunctions, and that they exhibit temporal and articulatory deviation when compared to the normal speakers. It is also suggested that a Fourier spectrum analysis of the derived pitch of the sustained phonation in MS speakers is...

Lesion locations associated with speech perception deficits following penetrating head injury

Speech discrimination and identification tasks assessing voicing and place distinctions were given to 16 unilaterally brain injured subjects free of aphasic or dysarthric symptoms 12–15 yr post head injury. Seven subjects did not demonstrate any difficulty with these speech tasks, while five left-and four right-brain-injured subjects showed moderate difficulties. These difficulties were more pronounced on the discrimination than on the identification tasks. Analysis of CT scans demonstrated that the lesion locations most clearly associated with the speech discrimination deficits were upper levels of the white matter subjacent to cortical regions in either hemisphere.

Dysarthric symptomatology of Friedreich's ataxia

Subjective judgments of 16 speech dimensions were used to rate the speech of 22 Friedreich's ataxics. The study attempted to determine what groupings of speech dimensions describe the ataxic speech and if the subjects could be grouped by their speech symptoms. The results indicated that two speech factors were present, a general dysarthric factor and a phonatory stenosis factor. Subject groupings revealed three groups, the first characterized by a general dysarthria without vocal stenosis, the second characterized by phonatory stenosis and mild general dysarthric symptoms, and the third characterized by mild symptoms on both speech factors. Evidence was presented to show that more than one pattern of dysarthria could occur in one family.