Motor Speech Disorders and Dysarthria

ALS and Motor Speech

• ALS involves multiple dysarthrias.
• Two dysarthrias combine to form the speech symptoms of ALS.
• ALS can affect speech.

Deep Brain Stimulation

• Deep brain stimulation involves placing wires in the brain.
• It is used as a treatment for tremors and Parkinson's.

Dysarthria and Social Media

• An individual shared a video about their dyskinesia on social media (Facebook/Instagram Reel).
• The person described uncontrollable muscle movements, spasms, and tremors in their leg and glute.
• Dyskinesia involves uncontrollable movements that interfere with speech components.
• The severity of dyskinesia can vary depending on the individual.

Infographics in Therapy

• Infographics are useful for providing information to clients and leaving strategies at their bedside.
• Therapy Insights/Therapy Ed is a company that provides pre-made infographics for therapists, but Canva is also an option.
• A binder with assessment tools and educational materials can be very helpful when working in a hospital setting or on the move.
• Visuals and pictures are essential for making infographics effective because patients often don't read much written information.
• Infographics should be short, sweet, and to the point.
• Using a great graphic and building information around it can result in a better product.
• Canva offers free access and graphics through a classroom link on Blackboard.

Financial Considerations for CFs

• CFs (Clinical Fellows) often face tight budgets due to low pay and licensure costs.
• Joining ISHLA (Illinois Speech-Language-Hearing Association) can save money on licensure fees after graduation, requiring a two-year membership.

Review of Hyperkinetic and Hypokinetic Dysarthria Posters

• The class reviewed posters about hyperkinetic and hypokinetic dysarthria, checking for completeness and areas needing further review.

Choice of Review Method

• The class had the option to take a Kahoot quiz or review spastic and unilateral upper motor neuron dysarthria first.
• The majority opted to review spastic and unilateral upper motor neuron dysarthria before taking the quiz.
• The review covers chapters 4, 8, and 9, with a 20-question quiz at the end.

Spastic vs. Unilateral Upper Motor Neuron Dysarthria

• Textbooks often compare flaccid vs. spastic dysarthria, but a better comparison is between spastic dysarthria and unilateral upper motor neuron dysarthria.
• Spastic dysarthria involves increased muscle tone (spasticity, rigidity).
• Flaccid dysarthria involves decreased muscle tone.
• Hyperkinetic and hypokinetic dysarthria involve increased or decreased movement, respectively.
• All types of dysarthria involve weakness.
• Spastic dysarthria results from bilateral damage to upper motor neurons, preventing communication to lower motor neurons for muscle activation.
• Unilateral upper motor neuron dysarthria results from unilateral damage to upper motor neurons.

Severity

• Spastic dysarthria is generally more severe than unilateral upper motor neuron dysarthria.
• Spastic dysarthria often results from multiple events (e.g., two or more strokes) or diseases causing bilateral damage.
• Unilateral upper motor neuron dysarthria often results from a single stroke and can be mild.
• Unilateral upper motor neuron dysarthria primarily affects articulation and prosody, with possible mild hypernasality or phonation issues.
• Spastic dysarthria involves a wider range of speech component issues due to bilateral damage.

Comparison with Flaccid Dysarthria

• Spastic and flaccid dysarthria are commonly compared because both can present bilaterally.
• Spastic dysarthria is characterized by a harsh voice, while flaccid dysarthria has a breathy voice.
• Hypernasality is more characteristic of flaccid dysarthria than spastic dysarthria.
• Spastic dysarthria is associated with pseudo bulbar affect (uncontrolled laughing or crying without awareness).

Unilateral Upper Motor Neuron Dysarthria

• Unilateral upper motor neuron dysarthria is milder, and individuals can often return to their baseline with strategies and speech therapy.

Multiple Sclerosis

• Multiple sclerosis (MS) is a "snowflake disease," meaning each person's experience is unique.
• MS affects individuals differently, and symptoms may vary in presentation and timing.
• There is a clinic in Mount Laurel that specializes in treating individuals with MS, offering PT, OT, speech therapy, and counseling with an individualized approach.
• Celebrities like Christina Applegate have been vocal about their struggles with MS.
• Stem cell treatments have shown promise for some individuals with MS, like Selma Blair but results vary
• Speech-language pathologists must avoid check boxes and create an individualized plan for each person, regardless of their diagnosis.

Spastic Dysarthria: Case Study

• A 69-year-old man with a brain stem stroke one week prior has spastic dysarthria with bilateral damage to descending pyramidal and extrapyramidal tracts.
• Terms like pyramidal and extrapyramidal tracts are also relevant in hypokinetic and hyperkinetic dysarthrias.
• The patient's speech is largely unintelligible.
• Key observations include impaired breathing patterns, posture issues, and harsh vocal quality.
• His voice sounds gravelly.
• Prosody is affected leading to monotone speech due to limited lip movement.
• Oral motor exercises for spastic dysarthria should focus on stretching and relaxation, not strengthening.
• The patient had good lingual range of motion but poor labial range of motion.

Unilateral Upper Motor Neuron Dysarthria: Case Study

• A 64-year-old man with a single right hemisphere stroke affecting the frontal and parietal lobes has unilateral upper motor neuron dysarthria, complaining of multiple symptoms including slurred speech.
• The patient is more intelligible than the previous example.
• Respiration, articulation, and prosody are affected. His voice is breathy.
• It's important to determine if breathiness is due to the stroke or a pre-existing condition (e.g., COPD).
• The presented case may not be the best representation of unilateral upper motor neuron dysarthria.

Key Characteristics of Spastic Dysarthria

• Bilateral damage to upper motor neurons results in slow, effortful speech with harsh vocal quality.
• Increased muscle tone affects motor skills.
• Damage originates in the brain stem and affects pyramidal and extrapyramidal systems, impairing movement regulation.
• Muscle weakness leads to decreased range of motion.
• Affected extrapyramidal system causes increased muscle tone, resulting in harsh vocal quality.

Diagnosis

• Clinicians typically diagnose dysarthria in general, focusing on speech components rather than specific types.
• Insurance companies are more interested in whether speech is disordered than the specific diagnosis.

Upper Motor Neuron Disorders

• Damage to upper motor neurons or lower motor neurons helps determine the type of dysarthria.
• Muscle tone and speech characteristics help identify the appropriate treatment approach.
• Mixed dysarthrias are common due to the interconnectedness of the brain, making precise diagnosis challenging.
• Research on dysarthria is based on limited participant pools, suggesting a need for further investigation.

Comparison of Cases

• The second case (unilateral upper motor neuron dysarthria) may seem worse due to individual factors.
• Goal is to illustrate how the presentations aren't the same.
• Flaccid dysarthria is easier to identify due to physical weakness and effects on multiple speech components.
• Spastic dysarthria can be more intelligible than flaccid dysarthria.

Causes of Spastic Dysarthria

• Multiple strokes are needed for spastic dysarthria. A single stroke typically results in unilateral upper motor neuron dysarthria.
• Severe brain stem stroke can on rare occasions cause spastic dysarthria.
• ALS can cause spastic dysarthria, with weakness starting in extremities or speech, leading to different types of mixed dysarthria.
• The youngest person diagnosed with ALS that the professional in the transcript had worked with was 23.
• Traumatic brain injury can cause mixed dysarthria due to diffuse brain damage.
• Multiple sclerosis is a mixed dysarthria with varying symptoms and progression.
• Brain stem tumors can cause mixed dysarthria, depending on location, size, and treatment.
• Cerebral anoxia and viral/bacterial infections can also contribute.

Speech Characteristics

• Harsh vocal quality, imprecise articulation, and reduced range of motion are common.
• Strained and strangled vocal quality, air is forced rather than flowing and creating a sense of physical difficulty.
• There may be low pitch, hypernasality (without nasal emissions), mono pitch, mono loudness, short phrases, and slow rate of speech.
• Respiration may or may not be affected and pseudo bulbar affect (uncontrollable laughing or crying) may occur.
  *Drooling may also occur.

Spastic vs. Flaccid

• Comparison of spastic and flaccid dysarthria is primarily for diagnostic purposes due to the damage occurring to either upper or lower motor neurons but mixed dysarthria is more common.

Evaluation

• Connected speech, reading tasks (rainbow passage, grandfather passage), AMR/SMR, and vowel prolongation are useful for evaluation and treatment to determine the impact on their communications abilities.

Treatment

• Treatment focuses on stretching and relaxing muscles rather than strengthening.
• Relaxation and stretching exercises are important.
• Easy onset of phonation helps reduce harsh vocal quality with voice issues.

Stretching and Relaxation Exercises

• Neck stretches, shoulder rolls, easy onset of phonation (e.g., using /h/), yawn-sigh approach during speech and relaxing with stretches and exercises.

Articulation

• Tongue and lip exercises for all aspects of speech are important.
• Over-articulation with increased loudness can improve speech intelligibility.

Lip Stretching Exercises

• Smiling exercises, whistling, blowing bubbles, etc. can be very beneficial

Pitch Range Exercises

• High to low pitch glides and intonation drills aid in improved articulation.

Prosthetic Treatments for Mild Hypernasality

• Surgical or prosthetic treatments (e.g., Teflon injections) may be considered.
• Increasing loudness can mask mild hypernasality.
• Visual feedback apps (e.g., Blah Blah Blah) can help individuals monitor loudness levels outside of therapy sessions.

Unilateral Upper Motor Neuron Dysarthria

• Results from unilateral damage to upper motor neurons and the main speech difficulties include:
• Imprecise production of consonants (articulation difficulty).
• Dominant speech problem is imprecise production of consonants, which is articulation difficulty. Damage to one side of the brain.
• If damage occurs on the left side, expect aphasia and apraxia of speech which can be mild enough to lead to spontaneous recovery.
• If occurs on the right side neglect will be impacted and their may be cognitive deficits/defects.
• Strokes are the most common cause (91%), followed by tumors and traumatic brain injury.
• Standard articulation treatment is used. Key aspects, the traditional Arctic tasks and exaggerate constants with minimal contrastive drils.