Dysarthria Correcting a Speech Disorder

Dysarthria

CORRECTING a SPEECH DISORDER

This study used the descriptive-normative type of research in recording, describing, interpreting, analyzing and comparing data on dysarthria. It introduces communication disorders, specifically dysarthria and its causes, symptoms, assessment and treatments. The role of the speech language pathologist is outlined along with the methods he uses in every phase of diagnosis and treatment. Issues, however, still remain concerning some modes of treatment of the disorder and research continues on intervention.

Disorder or impairment in a person's ability to communication can be distressing if not recognized and adequately treated (Melfi et al., 2011). If one's voice quality, pitch or volume is different from others of the same age, culture or location, he may have a voice disorder. One type if called dysarthria. It refers to a group of motor speech disorders, which develops from a disturbance in the neuromuscular control of speech. That disturbance may be a stroke, brain injury, Parkinson's disease, amyotrophic lateral sclerosis or ALS, multiple sclerosis, Huntington's disease, cerebral palsy or tumors (Ashley, 2006). The most common symptoms include slurred speech or imprecise articulation, abnormal rate of speech, low volume, and impaired voice quality. Causes include paralysis, weakness or a lack of coordination of the muscles involved in speech. The five types are flaccid, ataxic, spastic, hyperkinetic and hypokinetic. Flaccid dysarthria is associated with brain stem stroke or progressive bulbar palsy; ataxic disarthria with multiple sclerosis; spastic disarthria with stroke; hyperkinetic disarthria with Huntington's chorea; and hypokinetic disarthria with Parkinson's Disease (Ashley).

Assessment and Treatment: the Role of the Speech Language Pathologist

Assessment consists of a complete oral-peripheral examination of the speech muscles both at rest and when moving (Ashley, 2006). The speech language pathologist evaluates facial muscles and muscles used in chewing in structure, symmetry, strength, precision, and speed. He asks the patient to imitate his demonstrated labial and lingual movements in speaking and non-speaking posts. By making the patient perform diadochokinetic tasks, the pathologist can detect the speed, precision, and rhythm control of the respiratory, phonatory, and articulatory structures. He observes respiration both at rest and when speaking. Speech instruments are also used as objective measurements in combination with standard tests of intelligibility. Among those are the Assessment of Intelligibility of Dysarthric Speech and French Dysarthria Assessment (Ashley). The use of acoustic methods can identify any of the three classes of subclinical manifestations of dysarthria (Ganty et al., 2012). These characteristics may be temporal, spectral, or phonatory (Ganty et al.).

Treatment varies according to the cause, type, severity of symptoms, and communication needs of the patient (Ashley, 2006). Changing the patient's speech or speaking conditions can bring overall improvement. The intention is usually to improve articulation by increasing lip, tongue movement and strength in order to achieve speech clarity. Other goals are to reduce the rate of speech and increase breath support. Management strategies include increasing volume by increasing phonatory effort or improving intelligibility through rate reduction and increased volume of the voice (Ashley). The pathologist will instruct the patient to perform exercises for vocal efficiency, velopharyngeal and resonatory stimulation, articulatory stimulation and for dealing with the prosodic aspects (Ganty et al., 2012). The pathologist also imparts communicative interaction strategies for the patient and his or her speaking partner to perform and augmentative strategies for the patient's use (Ganty et al.). The pathologist should be told by the patient's family or caregiver about the origin of his communication defect so he can develop an appropriate technique from it (Ashley, 2006. This is especially important if the defect developed from a degenerative disease (Ashley).

Controversies in Treatment

Non-Speech Methods and Procedures

Thorough discussion and investigation of certain non-speech methods and procedures, which were claimed to treat developmental speech sound disorders, revealed no substantive evidence to support the claim (Ruscello, 2008). These methods and procedures were said to influence tongue, lip and jaw resting postures, increase strength, improve muscle tone. Ease up a range of motion, and foster muscle control. They are said to be used before or together with actual speech production treatment. The evaluation found that these methods and procedures are questionable in matters concerning the implied cause of developmental speech sound disorders, the neurophysiologic differences between the limbs and oral musculature, the development of new theories of movement and movement control, and the sparseness of research on these methods and procedure (Ruscello).

Neuromuscular Treatments

A review of the theoretical foundation for these treatments revealed limited empirical support to validate its use (Clark, 2003). It also showed that clinicians did not have sufficient foundational knowledge to judge the reliability of these treatment strategies. The treatment strategies consisted of strength training to alleviate dysarthria and/or dysphagia. Their theoretical foundations included active exercises, passive exercises, and physical modalities. The techniques address neuromuscular impairments in the limb muscles. They were to be applied to speech and swallow muscles. The key issues set up were the selection of treatment targets, specific training, progression and recovery. The factors claimed to influence the potential effectiveness of passive exercises and physical modalities and additional issues that contributed to the controversy concerning oral motor therapies were presented and investigated (Clark).

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