Academic journal article Journal of Medical Speech - Language Pathology

Dysarthria as an Indicator of Neurological Disease: Characterizing Articulatory Disturbances in a Case of Dysarthria of Unknown Etiology Using Instrumental Methods

Academic journal article Journal of Medical Speech - Language Pathology

Dysarthria as an Indicator of Neurological Disease: Characterizing Articulatory Disturbances in a Case of Dysarthria of Unknown Etiology Using Instrumental Methods

Article excerpt

Speech difficulties can be the first sign of a neurological problem, from acute conditions such as stroke, through to chronic neurological diseases, including multiple sclerosis and motor neuron disease. In cases of dysarthria for which the etiology has not yet been determined or is unclear, such as the case to be presented in this article, the role of the speech pathologist in characterizing the dysarthria is paramount from two standpoints. First, a detailed description of the speech deficit and the subsystem (i.e., articulatory, velopharyngeal, laryngeal, respiratory) impairments could aid the neurologist in determining the nature and site of the underlying neurological disturbance. Driven by the seminal articles of Darley, Aronson, and Brown (1969a, 1969b), research into dysarthria over the past 30 years has sought to ascertain clinicoanatomic relations among central nervous system (CNS) lesions and resultant speech disturbances (Kent, Duffy, Slama, Kent, & Clift, 2001). Advances in neuroimaging techniques and neural stimulation methods (e.g., transcranial magnetic stimulation), together with advances in instruments designed to assess the speech mechanism, such as electromagnetic articulography described in this study, hold the potential for thorough insights into the neuropathological bases of dysarthria to be gained.

A second function of characterizing the dysarthric speech disturbance is to enhance the management of the patient and the treatment of his or her speech disturbance. The goal may be to improve speech production or, particularly in the case of an individual with a progressive, degenerative neurological disorder, to stabilize or maintain adequate speech function. To effectively treat speech disturbances, it is increasingly being recognized that it is essential to determine the nature and severity of the underlying physiological impairments so that specific treatment methods can be employed to target those impairments (DePaul & Abbs, 1995; Netsell & Daniel, 1979; Theodoros, Murdoch, & Stokes, 1995). Perceptual assessments allow hypotheses to be formed regarding the underlying physiological impairments (Darley, Aronson, & Brown, 1975; Ludlow, Bassich, & Connor, 1985; Yorkston, Beukelman, & Bell, 1988); however, caution is needed in the interpretation of perceptual findings since similar perceptual features may result from different neuromuscular deficits, and particular speech symptoms may influence or confound the perception of other deviant speech features (e.g., severe articulation problems may influence judgments of hypernasality; Rosenbek & LaPointe, 1985; Theodoros, Murdoch, & Horton, 1999; Yorkston et al., 1988). It is, therefore, necessary to confirm or refute the hypotheses that arise from perceptual assessments using more objective and detailed analyses of the functioning of the motor speech system (Theodoros et al., 1999; Yorkston et al., 1988). Physiological instrumental assessment techniques can be used to provide the objective results needed (Darley et al., 1975; Yorkston et al., 1988).

The study below reports a case of a man with dysarthria of unknown etiology, with the speech disturbance his only presenting neurological sign. The results of a battery of perceptual and physiological instrumental articulatory assessments are presented. In particular, the study highlights the usefulness of objective instrumental assessments in providing goals for therapy.

CASE HISTORY

Mr. X, a 42-year-old Caucasian male, first became aware of slurring his speech at a wake for a friend who had died of motor neurone disease. Immediately prior to onset, Mr. X had contracted a severe viral infection when travelling overseas and 2 weeks prior to this, he had been running and suddenly felt dizzy and disorientated. Mr. X was diagnosed by his neurologist and speech pathologist with dysarthria, that presented in an atypical pattern, especially in the absence of other clear neurological signs. …

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