What happens with dysarthria and what types are there?
Clear speech requires the brain to precisely and coordinately control dozens of muscles. With dysarthria, the nervous regulation of these muscles is disrupted: they become weak, tense, or move uncoordinated. Unlike aphasia, with dysarthria speech understanding, reading and word selection are preserved. It differs from dyslalia in that it is not individual sounds that suffer, but the entire sound side of speech: articulation, voice, breathing, tempo and intonation. The type of dysarthria is determined by which part of the nervous system is affected.
- Pseudobulbar - with bilateral damage to the pathways from the cerebral cortex
- Bulbar - with damage to the brain stem and cranial nerves
- Cerebellar - scanned, intermittent speech
- Extrapyramidal - quiet, monotonous speech in Parkinson's disease
- Cortical - for focal lesions of the cortex
- Erased - mild form in children
Causes and risk factors
In children, dysarthria most often occurs due to brain damage during pregnancy, childbirth or in the first months of life: hypoxia, hemorrhages, infections, severe jaundice. This is common in many children with cerebral palsy. Severe dysarthria occurs in children with mild neurological symptoms and is often combined with general speech underdevelopment. In adults, the main causes are acute cerebrovascular accidents and trauma. Gradually increasing dysarthria occurs with Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, myasthenia gravis, brain tumors, and also with alcohol intoxication.
- Perinatal damage to the nervous system
- Cerebral palsy
- Stroke and transient ischemic attack
- Traumatic brain injury
- Parkinson's disease, multiple sclerosis
- Amyotrophic lateral sclerosis, myasthenia gravis
- Tumors and inflammatory diseases of the brain
Signs of dysarthria
Speech with dysarthria sounds unclear, like “porridge in the mouth,” especially with long words and a fast pace. The voice may be weak, hoarse, nasal or monotonous, and breathing may be shallow, causing the person to speak in short sentences. Chewing and swallowing are often impaired at the same time, and drooling appears. In children with erased dysarthria, parents notice that the child does not chew solid food well, cannot learn to rinse his mouth for a long time, is awkward with his hands, and sounds are difficult to introduce into speech after being introduced by a speech therapist.
- Slurred, slurred speech
- Slow or uneven pace
- Nasal tone of voice
- Weak, monotonous voice
- Drooling
- Difficulty chewing and swallowing
- Fatigue when speaking
What examinations are needed
The neurologist evaluates the movements of the tongue, lips, soft palate, swallowing, muscle tone, reflexes, coordination and finds out how quickly the disorders appeared. To find the cause in adults, MRI of the brain is prescribed; if a neuromuscular disease is suspected, electroneuromyography and special tests are prescribed. In children, the course of pregnancy and childbirth is taken into account, the results of observation by a neurologist, and, if necessary, an EEG and MRI are performed. The speech therapist examines in detail articulatory motor skills, sound pronunciation, voice, breathing and determines the form and degree of dysarthria.
- Neurological examination
- Speech therapy examination
- MRI of the brain
- Electroneuromyography for suspected neuromuscular disease
- EEG in children according to indications
- Swallowing assessment
Treatment and activities
Treatment consists of therapy for the underlying disease and restoration of speech. After a stroke, classes with a speech therapist begin as early as possible, as soon as the condition allows. They use articulatory gymnastics, breathing and voice exercises, and work on the tempo and rhythm of speech. For children, speech therapy massage, development of fine motor skills, production and automation of sounds are added to the classes. For diseases with a progressive course, a speech therapist helps maintain speech intelligibility and, if necessary, master means of alternative communication. Regularity of classes and the participation of loved ones are important.
- Regular sessions with a speech therapist
- Articulation gymnastics at home
- Breathing and voice exercises
- Speech therapy massage for children
- Development of fine motor skills
- Treatment of the underlying disease by a neurologist
- Alternative methods of communication in severe forms