Childhood dysarthria refers to a speech difficulty that may occur following an injury or disease to the brain, cranial nerves or nervous system. Injury or disease to the speech musculature may also cause dysarthric like symptoms. When the part of the brain that controls speech production is damaged, the link from the brain to the muscles of speech is affected.
Dysarthria can present in varying degrees of severity depending on localization and severity of brain damage. The production of speech sounds may be very difficult and in some cases speech may not be possible. The lips, tongue, palate, facial muscles, and the vocal folds (chords) may be uncoordinated or immobile. Further difficulties may occur if breathing is also affected as the lungs provide the energy for speech.
An individual with dysarthria may have slurred, hoarse, jerky or strained speech and may be difficult to understand or completely unintelligible. Intelligibility may be further hindered by low volume, variable rate and rhythm, and irregular pitch. As well as traumatic brain injury, dysarthria can be caused by brain tumour, stroke, cerebral palsy, long term use of certain medication, and degenerative diseases. Other co-occuring problems may include difficulties with swallowing and saliva control.
Types of dysarthria
Ataxic Dysarthria can cause poor coordination of the speech muscles meaning that speech and volume is slow, erratic and irregular. Speech maybe explosive and extra stress may be put on syllables.
Flaccid Dysarthria can cause a breathy voice that is often nasal in quality (because of poor control of the soft palate). There is often an obvious paralysis or weakness of the facial muscles.
Spastic Dysarthria can cause a very slow, indistinct, monotone voice, and at times it may seem strained with some sounds being difficult to articulate.
Hyperkinetic Dysarthria presents with a harsh, strained voice.
Hypokinetic Dysarthria presents with a hoarse voice and low volume.
A Mixed Dysarthria can have a mix of the symptoms mentioned above, and will depend on the type of neuron damage as to whether speech is more harsh or breathy.
Treatment of Dysarthria
For treatment with dysarthria, a speech and language pathologist / therapist (SLP/T) can work on improving speech difficulties caused by dysarthria with therapy exercises. Depending on the severity of the brain damage, speech may not return to normal. However, the SLP/T can focus on exercises and compensatory strategies to help improve speech production and intelligibility. For those with a mild to moderate dysarthria, speech should still be their main form of communication. For those with severe dysarthria, looking at other ways to communicate may be appropriate and the SLP/T may focus on alternative forms of communication or assistive communication to help the individual with dysarthria express themselves and be understood.
Muscle and Breathing Exercises
There are a wide variety of exercises and approaches, and their use will depend on the patient, severity and location of the brain lesion or disorder (cerebral palsy, traumatic brain injury, stroke etc), and the type of dysarthria. Breathing exercises may also be helpful, as poor breath control will effect volume and sentence length. Our lungs are the bellows, the power source that creates the energy for speech.
Compensatory strategies may include, slowing speech (this is probably the most obvious way to become more intelligible), or producing each word, or syllable individually, rather than in a stream of connected speech. Some individuals learn to use more gesture when they speak to enhance their message, while others may use an alphabet chart or a book of visuals to express their needs. Modern technology is now also being used by some individuals to communicate in the form of devices with speech output.
Adapting the environment
You can help a person with dysarthria by enhancing the communication environment. This can be achieved by creating an environment that is free from noise and distractions, looking at the dysarthric person when they are talking to see lip movements, facial expression and gesture, and allowing the individual time to get their message across. Having a pen and paper at hand for words or diagrams can also help.
Factors that Influence prognosis
Obviously general health and the extent of the illness or trauma will have an affect on the outcome, especially if the disease is progressive, but there are other factors that can influence prognosis. Younger patients generally have a better prognosis, as do those who get good medical treatment and follow-up speech and language therapy input. A positive and motivated disposition prior to, and following the diagnosis of dysarthria, and having good support systems in the form of family and friends usually provides the basis for a better prognosis.
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