Dysarthira Definition, Types and Dysarthria Profile

Dysarthria is a speech disorder that happens due to the weakness of the speech muscles. It occurs due to neurological injury to the motor speech system. Dysarthria is a type of Motor Speech Disorder. (Definition of Dysarthria).

 Anarthria is the severe form of dysarthria. 

It may affect any group of muscles which helps in speech production. These may include muscles of breathing, throat, tongue, and face. Patients with this speech disorder have difficulty in using the sub-system of speech. These are respiration, phonation, resonance, articulation, and prosody.

Read More: Childhood Apraxia of Speech

Structures involved in the speech system include the following.

• Respiratory muscles
• Larynx
• Pharynx
• Velophayranx
• Tongue 
• Jaws
• Facial muscles
• Lips

Read More: Articulation Disorder & Phonological Disorder

Dysarthric Speech

Patients with this disorder exhibit difficulty in speaking. This difficulty depends on the severity of the problem. Their speech may have the following characteristics (Dysarthria Symptoms). 

• Mumbling
• Breathy / whispering like voice
• Poor rhythm, stress, and intonation
• Poor intelligibility / articulation
• Hypo-nasality or hyper-nasality
• Hoarseness of voice
• Gurgly voice
• Speech may be fast or very slow
• Unnatural
• Poor control on the loudness of the voice

Dysarthria Causes

There are several neurological conditions that can result in dysarthria. We can divide them into two categories.

• Developmental: Cerebral Palsy, Down's Syndrome, etc. (Dysarthria in children)
• Acquired: Stroke, Brain tumor, Head injury, Parkinson's disease, etc. 

Former one occurs before or during birth while the later one can happen late at any age. These conditions affect the motor system which controls the muscles of the speech. This may affect the muscle's tone, movement, range, strength, and range. Thus affecting the speech of the patient.

People Also Reading: What is Social Communication Disorder

Dysarthria Types

We can divide this disorder into the following categories.

Spastic

Spastic dysarthria may happen due to damage in Upper Motor Neuron, UMN. The following are the signs of this disorder.

• A slow rate of speech
• Poor articulation 
• Nasal air emission
• Breathlessness
• Audible inspiration

Flaccid 

It occurs after the Lower Moter Neuron lesion, LMN. The characteristics of flaccid dysarthria are as follows.

• Hyper-nasality
• Nasal air emission
• Breathiness
• Audible inspiration

Hypokinetic

A lesion in the Extrapyramidal system causes Hypokinetic dysarthria. It can exhibit the following signs.

• Decrease and mono loudness
• Mono pitch voice
• Rushes of speech

Hyperkinetic

Hyperkinetic Dysarthria also occurs due to the lesion in the Extrapyramidal system. Have a look at the symptoms. 

• Variation in the precision of articulation
• Hyper-nasality episodes
• Loudness variations
• Interruption in phonation

Ataxic

Damage to Cerebellum can cause Ataxic Dysarthria. Characteristics of Ataxic Speech is as follows. 

• Phoneme prolongations
• Inappropriate rhythm
• Increased stress
• A slow rate of speech
• Loudness variations

Mixed

The lesion in multiple motor systems can cause Mixed Dysarthria. Here are the characters of this type.

• Mono-pitch
• Reduced stress
• Mono-loudness
• Harshness and strangled voice
• Imprecise articulation
• The slow rate of speech
• Hyper-nasality
• Inappropriate prosody

Dysarthria Profile For Assessment 

A Speech Pathologist assesses Dysarthria. Usually, SLP applies Dysarthria Profile for assessing the clients. Have a look at different parts and their tasks.

1. Respiration

a. Respiration at rest: normal, shallow.

b. Speed of the respiration at rest: normal, rapid, slow. 

c. Respiration during speech: normal, shallow. 

d. Speed of the respiration during speech: normal, rapid, slow. 

e. The patient speaks on: exhalation, inhalation, residual air.

f: Respiration occurs with: strider, without strider.

2. Phonation

a. Pitch of the voice: normal, too high, too low.

b. Pitch breaks: do occur, do not occur. 

c. The intonation of speech: monotonous, normal, inappropriate. 

d. The tone of the voice: normal, hyper-nasal, hypo-nasal. 

e. Voice quality: normal, hoarse, breathy, weak, strident, intermittent.

3. Facial Musculature

a. At rest:  face droops on the right side, droops on the left side, moves involuntarily.
b. During smile face: droops on the left side, droops on the right side, moves involuntarily.
c. The tone of the lips appears: normal, decreased, increased.
d. At rest, tongue appears: normal, large, small, floppy, bunched, wasted, fasciculation, tremulous, furred, with food residue, deviating to right, deviating to the left. 
e. The tone of the tongue appears: normal, increased, decreased. 
f. At rest, soft palate: normal, deviates to the right, deviates to the left. 
g. During phonation, soft palate: normal, deviates to the left, deviates to the right. 

4. Diadochokinesis

a. Score every task: No. in 5 seconds. 

5. Articulation 

6. Intelligibility / Rate / Prosody

a. Rate of speech: normal, too fast, too slow, festinates, slows down. 

b. The rhythm of speech: normal, syllable, staccate with prolongations, with insufficient stressing.  

7. Communication Competence (For Self Screening)

8. Eating and Swallowing (Self Screening)

Read More: Robertson Dysarthria Profile pdf (Revised)

Dysarthria Treatment

After the assessment, the therapist makes a treatment plan. It depends on various factors. For example, severity, medical condition, age, type of dysarthria, etc.

Speech Pathologist starts working on all the parameters. Have a look at this.

• Breathing exercises
• Phonatory exercises
• Strengthing of muscles including the tongue, lips, cheeks, jaws, etc. 
• Work on diadokokinesia rate
• Activities for precision in articulation (Sounds, words, and sentences)
• Tasks for intelligibility
• Work on prosody (Rhythm, Stress, and Intonation)
• Alternative-Augmentative Communication (If necessary)

These tasks will help to cope with different challenges. For instance;

• Breath control
• Muscle tone
• Voice quality
• Muscle strength
• Naturalness in voice/speech
• Range of movement
• Speed of the movement
• Pitch of the voice

Treatment includes various exercises depending on the area you are working on. These will help in strengthening the muscles and control of the vocal muscles.

Counseling and interaction with patient's caregivers is another important aspect of the plan. A clinician will give home-tasks for better progress.

Tips for Family

It is important for the family members to support the client during the treatment. Until the client gets better, you should follow some instructions.

• Always try to motivate the client for exercises and activities throughout the plan. 
• Appreciate his/her efforts. 
• Do not interrupt while a client is talking.
• Don't speak before he/she completes it.
• Make the environment comfortable for speaking. 
• Make sure the client gets enough time to talk to avoid tiredness. 
• Ask the client to speak in his/her comfort zone without being hasty and anxious. 
• Use of gestures, writing, and images to assist in the conversation. 
• Stay with the client and assist him/her during social interaction.

Dysarthria vs Aphasia: 

Dysarthria is a speech disorder while the aphasia is a language disorder. An aphasic client may have difficulty in understanding, expression of language or both. Aphasia does not have muscle weakness like in dysarthria. 

Conclusion

"Dysarthria" is a common speech disorder after neurological injury. Both adults and children can be affected by this disorder. It is important to start speech therapy as early as possible. Progress is better with early dysarthria treatment.