Showing papers on "Dysarthria published in 1999"

Tumour type and size are high risk factors for the syndrome of "cerebellar" mutism and subsequent dysarthria.

Abstract: OBJECTIVE—"Cerebellar mutis" and subsequent dysarthria (MSD) is a documented complication of posterior fossa surgery in children. In this prospective study the following risk factors for MSD were assessed: type, size and site of the tumour; hydrocephalus at presentation and after surgery, cerebellar incision site, postoperative infection, and cerebellar swelling. METHODS—In a consecutive series of 42 children with a cerebellar tumour, speech and neuroradiological studies (CT and MRI) were systematically analysed preoperatively and postoperatively. Speech was assessed using the Mayo Clinic lists and the severity of dysarthria using the Michigan rating scale. RESULTS—Twelve children (29%) developed MSD postoperatively. The type of tumour, midline localisation, and vermal incision were significant single independent risk factors. In addition, an interdependency of possible risk factors (tumour>5 cm, medulloblastoma) was found. CONCLUSION—MSD often occurs after paediatric cerebellar tumour removal and is most likely after removal of a medulloblastoma with a maximum lesion diameter>5 cm.

Clinical Management of Motor Speech Disorders in Children

Abstract: 1. Motor Speech Disorders in Children: Definitions, Background and a Theoretical Framework 2. Motor Control: Neurophysiology and Functional Development, 3. Assessment Procedures for Treatment Planning in Children with Phonologic and Motor Speech Disorders 4. Treatment of Developmental Apraxia of Speech: Integral Stimulation Methods 5. Treatment of Developmental Apraxia of Speech: Tactile-Kinesthetic, Rhythmic and Gestural Approaches 6. Treatment of Children Exhibiting Phonological Disorder with Motor Speech Involvement 7. Management of Children with Dysarthria, 8. Issues in Pediatric Feeding and Swallowing 9. Perspectives on Stuttering as a Motor Speech Disorder 10. Augmentative and Alternative Communication for Children with Motor Speech Disorders 11. Functional Treatment Outcomes in Young Children with Motor Speech Disorders

Phonological processing and reading abilities in adolescents and adults with severe congenital speech impairments

Abstract: Use of phonological coding during reading and short-term memory tasks was examined in 12 participants with congenital speech impairments who had reading grade levels of 3.0 or better. Six of the participants had no intelligible speech (anarthria) and six had moderate to severe speech production impairments (dysarthria). All 12 participants were capable of judging the homophony of printed words and nonwords, indicating that accurate phonological coding of text can occur in the absence of speech. Moreover, five participants with dysarthria and two with anarthria appeared to employ phonological coding in short-term memory tasks, as indicated by a phonological similarity effect in serial order memory, and also more weakly by a word length effect in serial order memory. These data indicate that persons with severe congenital speech impairments can learn to use phonological coding during reading and short-term memory tasks; articulatory coding is therefore not a necessary part of the phonological coding process...

Reliability of the Multi-Dimensional Voice Program for the Analysis of Voice Samples of Subjects With Dysarthria

Abstract: Computer-based analysis systems are increasingly available for the clinical assessment of speech and voice functions. These systems have the potential to provide immediate quantitative information to assist clinical assessment and treatment. The Multi-Dimensional Voice Program (MDVP) is a computer program that can calculate as many as 33 acoustic parameters from a voice sample. The MDVP appears to have potential for rapid quantitative assessments of voice in both research and clinical applications. This report evaluates the robustness and reliability of MDVP for vocal analyses of 32 individuals with dysarthria of various etiologies. It is concluded that the reliability is generally very good and that MDVP has potential as a tool for the semi-automatic analysis of voice samples in dysarthria. Some parameters appear to hold particular value in the description of voice qualities in these speech disorders.

Acquired Neurogenic Communication Disorders: A Clinical Perspective

Abstract: Section I: Aphasia and aphasia therapy. Aphasia therapy: a clinical framework. Recovery of function in aphasia. Living with aphasia: a framework for therapy interventions. Cognitive neuropsychology and aphasia therapy: the case of word retrieval. Section II: Motor speech disorders. Dysarthria: clinical features, neuroanotomical framework and assessment. Dysarthria: an overview of treatment. Changing ideas in apraxia of speech. Instrumentation in the assessment and therapy of motor speech disorders: a survey of techniques and case studies with EPG.

Regulation of parkinsonian speech volume: the effect of interlocuter distance

Abstract: This study examined the automatic regulation of speech volume over distance in hypophonic patients with Parkinson's disease and age and sex matched controls. There were two speech settings; conversation, and the recitation of sequential material (for example, counting). The perception of interlocuter speech volume by patients with Parkinson's disease and controls over varying distances was also examined, and found to be slightly discrepant. For speech production, it was found that controls significantly increased overall speech volume for conversation relative to that for sequential material. Patients with Parkinson's disease were unable to achieve this overall increase for conversation, and consistently spoke at a softer volume than controls at all distances (intercept reduction). However, patients were still able to increase volume for greater distances in a similar way to controls for conversation and sequential material, thus showing a normal pattern of volume regulation (slope similarity). It is suggested that speech volume regulation is intact in Parkinson's disease, but rather the gain is reduced. These findings are reminiscent of skeletal motor control studies in Parkinson's disease, in which the amplitude of movement is diminished but the relation with another factor is preserved (stride length increases as cadence-that is, stepping rate, increases).

Isolated dysarthria due to extracerebellar lacunar stroke: a central monoparesis of the tongue

Abstract: OBJECTIVES—The pathophysiology of dysarthria can preferentially be studied in patients with the rare lacunar stroke syndrome of "isolated dysarthria". METHODS— A single study was carried out on seven consecutive patients with sudden onset of isolated dysarthria due to single ischaemic lesion. The localisation of the lesion was identified using MRI. The corticolingual, cortico-orofacial, and corticospinal tract functions were investigated using transcranial magnetic stimulation. Corticopontocerebellar tract function was assessed using 99mTc hexamethylpropylene amine oxime-single photon emission computerised tomography (HMPAO-SPECT) in six patients. Sensory functions were evaluated clinically and by somatosensory evoked potentials. RESULTS—Brain MRI showed the lesions to be located in the corona radiata (n=4) and the internal capsule (n=2). No morphological lesion was identified in one patient. Corticolingual tract function was impaired in all patients. In four patients with additional cortico-orofacial tract dysfunction, dysarthria did not differ from that in patients with isolated corticolingual tract dysfunction. Corticospinal tract functions were normal in all patients. HMPAO-SPECT showed no cerebellar diaschisis, suggesting unimpaired corticopontocerebellar tract function. Sensory functions were not affected. CONCLUSION—Interruption of the corticolingual pathways to the tongue is crucial in the pathogenesis of isolated dysarthria after extracerebellar lacunar stroke.

Temporal and spectral aspects of coarticulation in ataxic dysarthria : An acoustic analysis

Abstract: In order to analyze the impact of cerebellar disorders on temporal and spectral aspects of coarticulation, 9 individuals with cerebellar dysfunction and 9 controls were asked to produce test senten...

Effect of Bilateral Subthalamic Nucleus Stimulation and Dopatherapy on Oral Control in Parkinson’s Disease

Abstract: This study focuses on the speech organs of a parkinsonian patient who initially had been treated with levodopa for 13 years, and had become severely disabled by motor fluctuations. This patient has been treated with bilateral chronic stimulation of the subthalamic nucleus (STN) for the last 2 years. Upper lip, lower lip and tongue force production were examined before surgery under off and on medication conditions, and 2 years after surgery under off and on stimulation conditions. We compared the effect of stimulation and dopatherapy on the speech organs. L-Dopa had a poor effect whereas bilateral stimulation improved oral control and speech intelligibility. These results suggest that STN stimulation influences speech organs in a different way from the dopaminergic system and similarly affects oral and limb motor systems.

Speech and oral motor learning in individuals with cerebellar atrophy.

Abstract: The purpose of this study was to determine whether cerebellar pathology interferes with motor learning for either speech or novel tasks. Practice effects were contrasted between persons with cerebe...

Intelligibility of dysarthric speech in words and sentences: development of a computerised assessment procedure in Swedish

Abstract: This is a description of the construction of a Swedish quantitative and qualitative computerised intelligibility assessment of dysarthric speech including words and sentences. The Word section is based on minimal pairs in a multiple choice answering format (rhyme test). In the Sentence section, words are randomised into grammatically correct nonsense sentences. Ten normal speakers and nine speakers with different types and degrees of dysarthria participated in an evaluation made by three qualified clinicians. The results show that this assessment procedure gives a reliable quantitative measure of word and sentence intelligibility of dysarthric speech. However, low inter- and intrajudge agreement makes the qualitative results less reliable. Still, the qualitative results do give a valuable supplement to the quantitative data.

Electropalatographic assessment of articulatory timing characteristics in dysarthria following traumatic brain injury

Abstract: Electropalatography (EPG) is an instrumental technique that records the location and timing of tongue-to-palate contacts during speech (Hardcastle, 1984; Hardcastle, Gibbon, & Jones, 1991a; Hardcastle, Jones, Knight, Trudgeon, & Calder, 1989). Such a technique would be valuable in objectively assessing the articulatory disturbances exhibited by individuals with dysarthria following traumatic brain injury (TBI). To date, however, only a limited number of studies have reported using EPG for this purpose. The aims of the present study were to use EPG to assess the articulatory timing characteristics exhibited by three male subjects (aged 23, 27, and 29 years) with dysarthria following severe TBI and to examine the EPG results in relation to perceptual and physiological (nonspeech) findings. A word list, consisting of the lingual consonants, / t, d, s, z, k, g /, in the word-initial position of single-syllable real words of CV and CVC construction (where V = / a /), was read aloud three times by each subject while wearing an EPG palate. The results obtained by the TBI subjects were compared with a non-neurologically impaired control and are discussed in a series of three case discussions. Both longer and shorter consonant phase durations were exhibited, as were the features of undershooting and overshooting. The findings demonstrated that electropalatography provides greater insight into the nature of the underlying articulatory disturbances exhibited by individuals with dysarthria following TBI.

Progressive dysarthria : Case reports and a review of the literature

Abstract: Two patients presenting with progressive dysarthria as the single initial manifestation of a neurodegenerative condition are described. The nature of the dysarthria as well as the additional symptoms that developed in the course of the disorder are very different in these two cases. Nevertheless, neuroimaging findings are strikingly similar and suggest bilateral involvement of posterior inferior frontal lobe structures, mainly in the dominant cerebral hemisphere. The clinical syndrome of these patients can therefore be considered an example of frontotemporal degeneration presenting without dementia or compartmental alteration, at least in the early stages. This broadens the clinical spectrum of frontotemporal degeneration and demonstrates the need for a syndromal subclassification of this nosological entity.

Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: report of one case.

Abstract: Summary The eA cacy of traditional and physiological biofeedback methods for modifying abnormal speech breathing patterns was investigated in a child with persistent dysarthria following severe traumatic brain injury (TBI). An A-B-A-B single-subject experimental research design was utilized to provide the subject with two exclusive periods of therapy for speech breathing, based on traditional therapy techniques and physiological biofeedback methods, respectively. Traditional therapy techniques included establishing optimal posture for speech breathing, explanation of the movement of the respiratory muscles, and a hierarchy of non-speech and speech tasks focusing on establishing an appropriate level of sub-glottal air pressure, and improving the subject’s control of inhalation and exhalation. The biofeedback phase of therapy utilized variable inductance plethysmography (or Respitrace) to provide realtime, continuous visual biofeedback of ribcage circumference during breathing. As in traditional therapy, a hierarchy of non-speech and speech tasks were devised to improve the subject’s control of his respiratory pattern. Throughout the project, the subject’s respiratory support for speech was assessed both instrumentally and perceptually. Instrumental assessment included kinematic and spirometric measures, and perceptual assessment included the Frenchay Dysarthria Assessment, Assessment of Intelligibility of Dysarthric Speech, and analysis of a speech sample. The results of the study demonstrated that real-time continuous visual biofeedback techniques for modifying speech breathing patterns were not only eA ective, but superior to the traditional therapy techniques for modifying abnormal speech breathing patterns in a child with persistent dysarthria following severe TBI. These results show that physiological biofeedback techniques are potentially useful clinical tools for the remediation of speech breathing impairment in the paediatric dysarthric population.

Troyer syndrome: a combination of central brain abnormality and motor neuron disease?

Abstract: Hereditary spastic paraplegia is a group of clinically and genetically heterogeneous disorders consisting of pure and complicated forms. A variant with the additional features of severe atrophy of the small hand muscles, dysarthria, mental retardation, and short stature has been termed Troyer syndrome (MIM#275900) after the name of Old Order Amish families suffering from these symptoms. We report here an Austrian family with two individuals who exhibit all the features of Troyer syndrome, and provide additional data on this disorder. Electrophysiological studies showed chronic denervation and reduced motor nerve conduction velocities but normal sensory potentials. Muscle biopsy revealed a neurogenic pattern while the sural nerve was normal on histological examination. Brain abnormalities on magnetic resonance imaging consisted of a thin corpus callosum with a poorly developed cingulate gyrus and mild periventricular signal hyperintensities. These findings characterize the Troyer syndrome as a disorder of the first and second motor neuron with additional damage in the brain. The morphological features observed in this family may contribute to the grouping and subsequent understanding of complicated forms of hereditary spastic paraplegia, together with similar observations in other, more recently reported families.

Cerebral Blood Flow in Pure Dysarthria: Role of Frontal Cortical Hypoperfusion

Abstract: Background and Purpose—Isolated dysarthria, termed pure dysarthria, develops rarely after stroke, and its pathophysiology remains unclear. To clarify the underlying mechanism of pure dysarthria, we...

Brainstem anesthesia presenting as dysarthria

Abstract: After having a retrobulbar injection for anesthesia before cataract surgery, a patient developed dysarthria. This was the presenting sign for penetration of the optic nerve sheath by the retrobulbar injection, with subsequent brainstem anesthesia. Thereafter, the patient demonstrated cranial nerve dysfunctions with tongue deviation, tachycardia, hypertension, and contralateral sixth and third nerve palsies. I believe this is the first documented case in which dysarthria is the presenting sign for brainstem anesthesia resulting from a retrobulbar injection.

Transient Muteness Followed by Dysarthria in Patients with Pontomesencephalic Stroke

Abstract: Dysarthria is the principal motor abnormality following vascular damage to pontine paramedian structures, owing to the involvement of corticobulbar fibres. Here we describe 2 cases of adults affected by dysarthria following transient muteness as the result of a stroke in pontomesencephalic structures. Their clinical outcome was very similar to that of young patients who have undergone surgery of the 4th ventricle. Recently the importance of pons involvement has also been underlined in these cases. This case report suggests the existence of a functional network for speech, in which the pontomesencephalon is an important station for the triggering and the efficacy of verbal production.

What Do Speech Pathologists Know About HIV

Abstract: Speech pathologists have reported assessing and treating patients with the human immunodeficiency virus (HIV) but there has been little research into the nature or frequency of such communication or swallowing disorders. All speech pathologists with adult patients in the State of New South Wales, Australia, were surveyed about their exposure to patients with HIV. Of 148 replies, 24% had seen patients they knew to have HIV. These patients were referred for a range of disorders including dysphagia, dysarthria, aphasia and language impairment, voice, vocational rehabilitation, augmentative communication, saliva management, and AIDS dementia complex.The knowledge that the speech pathologists had about possible communication and swallowing impairments arising from HIV was also surveyed. Clinicians were generally unsure of the disorders that might arise from infection with HIV and the frequency of such disorders. There was a significant difference between the knowledge of respondents who had seen patients they ...

Assessment of dysarthric speech: a case for a combined perceptual and physiological approach

Abstract: Traditionally, the assessment of dysarthric speech has mainly involved the use of perceptual evaluation measures. The inherent inadequacies of this method of assessment have resulted in the development of a range of instrumental assessment techniques to provide more objective analyses of the underlying physiological impairments of the speech apparatus in individuals with a dysarthric speech disturbance. The aim of the current study was to highlight the importance of a combined approach to the assessment of dysarthria with reference to two case studies of individuals with dysarthric speech: a 32-year-old adult who suffered a severe closed head injury and a nine-year-old child who experienced a cerebrovascular accident involving the basilar artery. Each subject was assessed using a battery of perceptual and physiological techniques. The results for each case indicated that instrumental measures were effective in identifying the severity and nature of the underlying physiological impairments in the various subsystems of the speech mechanism, and highlighted the importance of verifying perceptual judgements with instrumental measures. The results are discussed in relation to the value of a combined perceptual and physiological approach in determining an accurate evaluation and diagnosis of the dysarthric speech impairment and in defining appropriate treatment goals.

New approaches in the treatment of speech disorders in children with an organic brain lesion

Abstract: Speech disorders encountered in children presenting with neurological pathology make their medical and social rehabilitation a real challenge. Overall sixty children were examined. Of these, 38 had infantile cerebral paralysis, 22 that being presented with sequelae of the hypoxic affection of the brain in ante- and perinatal period, who exhibited speech disorders (alalia, dysarthria, retarded speech development). Described in the paper are features of bloodflow disorders in intracranial and vertebral arteries as evidenced by ultrasonic Doppler technique and changes in brain bioelectrical activity according to findings from electroencephalomapping. In 53 patients, a positive effect was obtained as a result of therapy conducted in accordance with the stimulation type techniques (electroscalp therapy against the background of intramuscular administration of nicotinic acid plus laser therapy, transcutaneous electrostimulation, employment of such drug preparations as cogitum, nero-force, sirdalud).

Sepedi-toets vir Spraakverstaanbaarheid

Abstract: The aim of this study was to develop the "Sepedi-toets vir Spraakverstaanbaarheid" to objectively evaluate the speech intelligibility of the client and to give appropriate phonetic information. This study evolved from the present need for evaluation mechanisms and therapeutic services in the indigenous African languages. The words used in the test had to conform to the requirements of certain phonetic criteria. Words and sentences of differing lengths were included The procedures followed by the test administrator were different for mother tongue speakers than those for non-mother tongue speakers. After the compilation of the test it was applied to four dysarthria speakers. Upon execution of the test it was evident that differences in judgement of speech intelligibility exist between mother tongue and non-mother tongue speakers. Useful phonetic information was obtained through the qualitative analysis of the speech productions. It appears that the "Sepedi-toets vir Spraakverstaanbaarheid" can be used in the clinical environment to obtain a more objective evaluation of the client.

A Short Test for Evaluating Dysarthria

Abstract: 1987年に発足した運動障害性 (麻痺性) 構音障害小委員会の10年間の活動経過について報告した.本委員会では, 1980年に本学会言語障害検査法検討委員会・運動障害性構音障害小委員会によって発表された「運動障害性 (麻痺性) 構音障害dysarthriaの検査法―第1次案」 (以下, 第一次案) を基に「dysarthriaの有無とタイプの鑑別ができ, さらに臨床的に使いやすい短縮版検査を作成すること」を目的に活動を行った.この活動の経過を以下の順にまとめ報告した. (1) 臨床上よくみられるdysarthriaの4つのタイプの患者と健常者に対し第一次案を実施し比較検討した結果, (2) この結果に基づき, 第一次案から検査項目を取捨選択して作成した短縮版 (試案) の内容, (3) 短縮版 (試案) を用いた判別分析の結果, (4) 短縮版 (試案) に検討を加え作成した短縮版の内容.

Lip and tongue function differently affected in individuals with multiple sclerosis

Abstract: Clinical dysarthria test scores on lip function and tongue function were compared for 77 dysarthric as well as non-dysarthric subjects with multiple sclerosis (MS) and 15 control subjects. Results showed that tongue function was consistently more severely affected than lip function. When comparing non-dysarthric MS individuals with control subjects, the MS subjects' scores on tongue function (but not lip function) were significantly lower

New hope for patients with pure lower motor neuron syndromes.

Abstract: Motor neuron disease is still one of the most dramatic neurological conditions; it reflects a range of which one end encompasses patients with the bulbar form of amyotrophic lateral sclerosis who have dysarthria and dysphagia and have a dramatically shortened life expectancy. For patients with probable or definite motor neuron disease according to established criteria, the recent introduction of the antiglutamate drug riluzole gives a mean prolongation of life after diagnosis of some 3 months.1 The other end of the range of motor neuron disease is formed by patients with so called multifocal motor neuropathy. This is characterised by lower motor neuron dysfunction in the areas of selected motor nerves. Neurophysiological demonstration of conduction block over these nerves is pivotal for the diagnosis.2 Before the discovery of multifocal motor neuropathy as a separate and treatable condition, patients with …