Showing papers on "Dysarthria published in 1994"

Speech and swallowing symptoms associated with Parkinson's disease and multiple sclerosis: A survey.

Abstract: A survey of approximately 460 patients with Parkinson's disease (PD) or multiple sclerosis (MS) shows that speech and swallowing difficulties are very frequent within these groups. Seventy percent of the PD patients and 44% of the MS patients had experienced impairment of speech and voice after the onset of their disease. Forty-one percent of the PD patients and 33% of the MS patients indicated impairment of chewing and swallowing abilities. The speech disorder was regarded as one of their greatest problems by 29% of the PD patients and by 16% of the MS patients. Only a small number of patients, 3% of the PD and 2% of the MS group, had received any speech therapy.

The syndrome of 'cerebellar' mutism and subsequent dysarthria

Abstract: "Cerebellar" mutism refers to a specific childhood disorder in which a complete but transient loss of speech, followed by dysarthria, occurs after removal of a cerebellar tumor. We present a consecutive series of 15 children with this disorder, which we prefer to designate "mutism and subsequent dysarthria." The conditions in which it develops suggest also an extracerebellar component of cerebellar mutism. Hydrocephalus at presentation, localization of tumor adjacent to the fourth ventricle, and postsurgical edema of the pontine tegmentum are involved in its development.

Speech Rate and Rhythm in Cerebellar Dysarthria: An Acoustic Analysis of Syllabic Timing

Abstract: Auditory-perceptual studies reported inconsistent data with respect to syllabic timing in cerebellar dysarthria, ie both reduced and increased variability of syllable durations The present study pe

Effects of Temporal Alterations on Speech Intelligibility in Parkinsonian Dysarthria

Abstract: The effect of two types of temporal alterations, paced and synthetic, on the intelligibility of parkinsonian dysarthric speech was investigated. Six speakers with idiopathic Parkinson’s disease ser...

Perceptual speech characteristics of dysarthric speakers following severe closed head injury

Abstract: The perceptual speech characteristics of a group of 20 severely closed head-injured (CHI) subjects were compared with those of a normal non-neurologically impaired control group matched for age and sex. The CHI subjects were found to be significantly less intelligible than the controls, and exhibited deficits in the prosodic, resonatory, articulatory, respiratory and phonatory aspects of speech production. The most frequently occurring deviant speech dimensions related to disturbances of prosody, resonance, articulation and respiration, with those deviant speech dimensions pertaining to phonation being less apparent in the speech of the CHI subjects. The findings are discussed in relation to the heterogeneity of the CHI population and the effects of CHI on neuromuscular function. The study highlights the need for accurate, instrumental physiological evaluation of the motor subsystems involved in speech production.

Pure dysarthria, isolated facial paresis, or dysarthria-facial paresis syndrome.

Abstract: Pure dysarthria, isolated supranuclear facial paresis, and their combination without somatic motor dysfunction are rarely encountered clinical syndromes and have not yet been clearly characterized.Thirteen patients (9 men, 4 women; aged 33 to 72 [mean, 56] years) with unilateral strokes who developed dysarthria with or without facial paresis but without somatic motor dysfunction were reviewed in addition to case reports from previous literature.Computed tomographic scan and/or magnetic resonance imaging showed infarcts on the corona radiata in 4 patients, basal ganglia abutting the internal capsule in 3, basal ganglia-corona radiata in 1, pontine base in 3, and cortical-subcortical bulbar motor area in 2. The dysarthria and facial paresis were usually mild and transient, and either one was likely to be unnoticed.It is suggested that pure dysarthria or isolated facial paresis syndrome be considered as an extreme continuum of dysarthria-facial paresis syndrome, which is likely to be a variant of dysarthria-...

Intelligibility and the acoustic characteristics of speech in amyotrophic lateral sclerosis (ALS).

Abstract: The purpose of this study was to analyze the changes in specific speech parameters in 14 patients, 7 dysarthric and 7 non-dysarthric, with amyotrophic lateral sclerosis (ALS), over a 6-month period...

Motor Speech Treatment Hierarchy: a systems approach

Abstract: The Motor Speech Treatment Hierarchy used to guide PROMPT intervention represents a theoretical framework for the application of all bottom-up motor speech treatments. In addition, the hierarchy can be used prior to motor speech treatment to evaluate what aspects of the child's neuromotor system are intact and which elements are operating ineffectively or partially. When consideration is given to the development of the speech motor system and the interaction among the various valves and/or articulators, it becomes apparent that treatment must focus on the integration of all these aspects in order to be successful. The goal of intervention must be the voluntary control of all speech actions. But voluntary control of all speech actions is not possible for all children, and the clinician must realize that compensatory actions, although beneficial in the short term, will limit more complex interactions later. It is for these reasons that more attention should be given to mastery of control at the lower stages of the hierarchy. The clinician should not assume that all actions are intact based upon the perceived quality of speech. For the child with "pure" DAS, intervention usually begins at stage V or VI, whereas for children with developmental dysarthria, intervention begins at lower levels of the hierarchy. The responsibility, as always, lies with the clinician to determine the most appropriate level at which intervention should begin and the steps needed to achieve the best speech production. The clinician's knowledge provides the foundation for changing deviant motor speech patterns and for providing for our clients voluntary control of motor speech function. It has been the aim of this article to provide for clinicians a framework for treatment that will enhance their clinical effectiveness.

Transient mutism after posterior fossa surgery.

Abstract: An 8-year-old girl developed mutism after removal of a vermian medulloblastoma. The mutism was not accompanied by long tract signs or cranial nerve palsy. The girl started to regain her speech 2 weeks postoperatively, showing marked improvement 2 months after the operation, after passing through a dysarthric phase. Magnetic resonance imaging showed only normal postoperative changes without abnormalities of dentate nuclei or supranuclear region. Nineteen similar cases of transient mutism following cerebellar operations have been reported in the literature, most of them with a delayed postoperative onset. In all patients the recovery of speech started to appear 4 days to 4 months postoperatively, and all patients passed through a monotonous, dysarthric phase. The absence of long tract or other brain stem signs, together with the presence of dysarthria during the recovery of speech, suggested a cerebellar cause of the transient mutism. Various hypotheses advanced to explain the pathogenesis of this speech disorder are analyzed.

Speech disorders in children treated for posterior fossa tumours: ataxic and developmental features

Abstract: The oromotor and speech abilities of 19 children (14 boys and five girls) who had been treated for posterior fossa tumour were evaluated using three assessment procedures. All subjects completed the Frenchay Dysarthria Assessment and the Fisher-Logemann Test of Articulation Competence. Perrceptual analyses were also performed on the subjects' connected speech samples. Based on the three assessment procedures, 11 of the 19 tumour subjects were judged to be speech disordered The 11 speech-disordered subjects were then compared to a control group matched for age and sex to determine the nature and severity of speech abnormalities which may occur subsequent to the treatment of posterior fossa tumour in childhood. Both developmental and dysarthric features were identified in the speech of the 11 tumour subjects. The deviant speech characteristics exhibited by the tumour subjects included imprecise consonants, excess stress and reduced intelligibility, as well as the retention of developmental phonological proc...

Laryngeal dysfunction in dysarthric speakers following severe closed-head injury

Abstract: The laryngeal function of 19 severely closed head-injured subjects with a perceptible dysarthria was assessed using electrolaryngography and a computerized airflow/air pressure analysis system (Aerophone II). Variables measured included parameters of the Lx waveform (Fo, duty cycle and closing time) as well as aerodynamic parameters such as subglottal pressure, glottal resistance, average phonatory sound pressure level, phonatory flow rate and ad/abduction rate. Values were compared to those recorded from a non-neurologically impaired control group matched for age and sex, and correlated with the findings of a perceptual speech analysis. The findings are discussed in relation to the effects of a severe closed-head injury on laryngeal function. The clinical implications of the findings for the assessment and treatment of vocal dysfunction in head-injured subjects are also discussed.

Combined palatal-lift and EPG-feedback therapy in dysarthria: A case study

Abstract: A therapeutic intervention in a case of severe dysarthria after closed-head injury is described. The patient, whose articulation was characterized by a severe velopharyngeal incompetence, was supplied with a palatal lift prosthesis. In order to help the patient improve his remaining deficit of lingual motor control he was further treated with an EPG feedback device. The clinically relevant details of this intervention are described and the treatment effects are documented on the basis of EPG, acoustic, and perceptual data.

Prosodic deviation in dysarthria: a case study.

Abstract: Traditionally, prosodic difficulties in dysarthria have been described in phonetic terms with little attention being paid to the phonological implications of these impairments. This case study attempts to illustrate the need for a phonological level of analysis. The speech of a 30-year-old ataxic dysarthric is analysed using Crystalˆs framework and the patterns are discussed in terms of the effect of the phonetic difficulties on the speaker's ability to use his intonation system to mark meaning contrasts. The analysis reveals that this speaker has developed a personal subsystem where he retains some of the features of 'normalˆ speech and systematically exploits variables still under his control to compensate for other deficits. This study highlights both the value of considering phonological aspects in the analysis of disordered prosody and the need for careful assessment of the appropriacy of the compensatory strategies that have been developed.Traditionnellement les difficultes prosodiques chez le dysar...

Aberrant reinnervation following hypoglossal nerve damage

Abstract: Hypoglossal nerve damage is a known complication of carotid endarterectomy, occurring in approximately 5% of endarterectomies. The vast majority of these patients recover without functional disability from this injury even if the tongue remains hemiplegic. We report 2 patients who suffered hypoglossal nerve section during neck surgery. Although they were initially mildly symptomatic, they developed increasingly severe dysarthria and dysphagia beginning 4 months after surgery. EMG revealed abnormal coactivation of the genioglossus and styloglossus muscles on the affected side, suggesting aberrant reinnervation. Aberrant reinnervation is a well-known complication of facial nerve injury, but has not been previously recognized in hypoglossal nerve injury. Like the face, the tongue is composed of many muscles that must perform complex movements. Normally, injury to one hypoglossal nerve causes little or no disability, but when aberrant reinnervation occurs, the tongue no longer moves in a coordinated manner, and significant dysarthria ensues.

Is 20 years too long?: improving intelligibility in long-standing dysarthria--a single case treatment study.

Abstract: Resource management decisions by most speech and language therapists would suggest that treatment for a dysarthric client of 20 years' duration should be a low priority. This study describes the therapy of a dystonic client who had been virtually speechless for 20 years because of his severe dysarthria. Assessment of his speech revealed that lip rounding was particularly difficult for him. He was offered eight sessions of general dysarthria therapy and eight sessions of therapy specifically designed to reduce lip tension. The hypotheses driving this therapy plan were that it would be possible to effect changes in his longstanding speech patterns and that therapy focused on reducing lip tension would be more effective than non-specific dysarthria therapy. An intelligibility test was designed to monitor any changes in his speech production. Therapy improved the client's intelligibility and increased his confidence and consequent functional use of speech.

Speech motor control disorder after HIV infection

Abstract: We examined the clinical characteristics of six right-handed patients who developed speech motor control disorders after human immunodeficiency virus (HIV) infection. They exhibited an ataxic dysarthria, characterized by irregular articulatory breakdowns in consonant and vowel timing; were slow in timed decision-making tasks; and had impaired procedural learning. Other aspects of the neurologic examination revealed signs of diffuse CNS involvement including action-intention tremors, ataxic gait, and release signs. None developed HIV-associated dementia during 1 year of follow-up. Motor speech control disorder appears to be related to a cerebellar dysfunction.

Congenital bilateral perisylvian syndrome: analysis of the first four reported Korean patients

Abstract: The advent of MRI technique has enabled the diagnosis of neuronal migration disorders(NMD) and made it possible to make "in vivo" diagnosis. Congenital bilateral perisylvian syndrome(CBPS) is a recently described disease identify characterized by pseudobulbar palsy, epilepsy, mental retardation, and migration disorders in the bilateral perisylvian area. We have identified four CBPS patients based on neuroimaging and dysarthria patterns among the candidates for epilepsy surgery. All the patients had orofacial diplegia and variable degrees of mental retardation. In the spectrographic analysis of dysarthria, the loss of specific characteristics of formants of vowels and increment of noise in the high frequency formants were observed. Epilepsy was present in all, but only one patient showed intractable seizure requiring surgical intervention. MRI was most helpful in identifying NMD and polymicrogyria in both centroparietal areas in this context. Great alertness is needed to identify this disorder to determine the etiology of epilepsy and dysarthria of uncertain origin.

Communication disorders: what to look for, and when to refer.

Abstract: Communication impairments, with or without a swallowing disorder, are common among older adults. Aphasia, which is usually caused by a focal lesion, can affect spoken and written language, auditory comprehension, and reading ability but by itself does not affect intellectual and cognitive abilities. A cognitive-communicative impairment is related to underlying cognitive deficits in memory, attention, or visual perception and is seen with traumatic brain injury and nontreatable dementia. Voice and speech impairments such as dysarthria and apraxia of speech may lead to self-imposed social isolation and depression. Dysphagia may accompany a communication disorder or exist independently. As a primary care physician, your in-office workup can help diagnose a communication disorder and identify candidates for referral to an otolaryngologist and/or speech-language pathologist.

EMG Biofeedback in the Treatment of Dysarthria

Abstract: An EMG biofeedback technique was developed for the treatment of dysarthria. It aims at increasing the quantity of information about the myofacial system which can be used by the patients to improve the control of their musculature and speech production. This therapy tool consisting of an application software module (copyright INSERM/CNRS 92) is adaptable for a lot of muscles and speech realizations.

[Mutism in central motor disorders--a review of the literature].

Abstract: Mutism can be defined as "a condition in which there is no, or very little, oral-verbal expression, whereas comprehension of speech ... is normal or at least at a considerably higher level" (Lebrun, 1990). Benson (1979) enumerates five neuroanatomical correlates of mutism: (a) damage to the Broca region, (b) lesion of the supplementary motor area of the dominant hemisphere, (c) dysfunction of the mesencephalic reticular system, (d) thalamotomy, and (e) bilateral pathology of cortical and subcortical motor structures. The last item refers to syndromes of mutism resulting from central motor disorders. Depending on location and size of the lesion this pathophysiological interpretation should hold true for the fourth point as well. In mutism due to central motor disturbances lacking verbal expression represents the most severe degree of dysarthria, i.e. anarthria. The present review provides a detailed description of mutism following corticobulbar, striatal, and cerebellar dysfunctions.

A case of bilateral cerebellar peduncle infarction with bilateral hearing impairment of a sudden onset

Abstract: We reported a patient with bilateral cerebellar peduncle infarcts who had an abrupt onset of bilateral hearing loss. A hypertensive 56-year-old man suddenly experienced bilateral hearing loss without other accompanying neurological deficits. He was hospitalized and treated for "idiopathic deafness". In addition, dysarthria and ataxic gait appeared two days later and he was transferred to our hospital. On neurological examination, the patient presented with diplopia, neurosensory hearing loss (approximately 70 dB) ataxic dysarthria, bilateral cerebellar ataxia and bilateral Babinski's signs. Auditory brain stem evoked response demonstrated prolonged delay of interpeak latency between waves III-IV. CT and MRI revealed fresh ischemic lesions symmetrically located at the middle cerebellar peduncles and cerebellar medullary body. Cerebral angiography showed total occlusion of the left vertebral artery and a stenotic right vertebral artery at the ostium of the posterior inferior cerebellar artery. We postulated that hearing impairment in this patient resulted from transient ischemia of the bilateral auditory tract in the brain stem or the peripheral cochlear system, but the definitive cause of the transient hearing loss remains undetermined. Concomitant appearance of a symmetrical infarction at the cerebellar peduncles is rare. We suggest that a circulation defect involving a multivascular system, which resulted in "border zone infarction" occurred at these regions.