Dysarthria is a speech
disorder that is due to
a weakness or incoordination of the
speech muscles. Speech is slow, weak, imprecise or
uncoordinated. It can affect both children and adults.
"Childhood dysarthria" can be congenital or acquired. It is
often a symptom of a disease, such as cerebral palsy, Duchenne
muscular dystrophy, myotonic dystrophy, Bell palsy. In both
adults and children, it can result from head injury.
In adults, dysarthria is
can be caused by stroke, degenerative disease (Parkinson's,
Huntington's, amyotrophic lateral sclerosis, multiple
sclerosis, myasthenia gravis), infections (meningitis), brain
tumours, and toxins (drug or alcohol abuse, lead poisoning,
carbon monoxide, etc.).
In order for speech to be
clear, a number of subsystems must work together. A weakness
in any one of the systems can result in dysarthria. So can an
incoordination between systems. The lungs (respiratory
subsystem) supply the air necessary to power the speech
system. The voice box or larynx (laryngeal) sets the air
vibrating and creates voice. The soft palate (velopharyngeal)
acts a door between the oral and nasal cavities and channels
air to one or both cavities resulting in different sound
quality. The lips, tongue, teeth, and jaw (articulatory) move
to further channel and shape the sounds into the various
vowels and consonants.
If the respiratory
subsystem is weak, then speech may be too quiet and produced
one word at a time. If the laryngeal system is weak, speech
may be breathy, too quiet and slow. If the velopharyngeal
subsystem is not working, speech may sound too nasal or nasal
sounds may be misssing. If the articulatory subsystem is not
working, speech may sound slurred, may have many errors and
may be slow and laboured.
Therapy for dysarthria
focuses on maximizing the function of all systems.
Compensatory strategies are often used. Individuals with
dysarthria may be advised to take frequent pauses for breath,
to over-articulate, or to pause before important words to make
them stand out. If there is muscle weakness, they may benefit
from performing oro-facial exercises. This helps to strengthen
the muscles of the face and mouth that are used for speech.
For some people, speech
is not a viable option. Alternative or augmentative systems
are frequently used. These can be low tech or high tech. An
example of a low tech system would be an alphabet board. The
individual points to letters to spell out messages. "Pic-syms"
are picture symbols, black and white line drawings with print
that can be combined on a communication board or book. The
individual points to the appropriate picture or combination of
pictures to communicate. High tech systems include computers
and voice output devices. A regular computer keyboard, monitor
and word processor can be used to type out and display
messages. Programs that predict words and sentences can speed
up this method of communicating. Some indivduals are unable to
read and have a computer system that uses symbols - they
select a symbol and the printed word is produced. Voice output
systems are similar to the computer setups already described
but rather than having the printed word as output, the spoken
word is produced. Simple devices have the ability to let an
individual access a limited number of pre-recorded phrases by
pushing the appropriate key. More complex systems allow for
creative productions. Any of these systems can be used as a
back-up by individuals who do have some functional speech.
There are times when it is too tiring or too time-consuming to
use speech. Then the alternative system is used.
Most dysarthric speakers
need more time to get their message across. It helps to allow
them extra time and to listen face to face. When you haven't
understood what they've said, it's better to say so than to
pretend you have understood. It helps to repeat the part that
you did understand as a question, so they only have to repeat
the part you didn't get. For example, if you hear "I would
like a XX", rather than saying pardon and getting a repetition
that may sound the same, try asking "You would like a... ?"
with rising inflection, or "What would you like?" If a person
is using an augmentative device, consider it to be valid and
equal to speech. Don't insist that they "say it" if you have
understood they message they sent by the augmentative system.