Overview.
Dysarthria is a speech disorder due to neuropathy, paralysis, decreased contractility or uncoordinated movement of speech-related muscles. It is also known as motor dysarthria because its pathology is based on movement disorders. The main manifestations may be complete inability to speak, abnormal vocalization, abnormal phonation, abnormal pitch and volume, and slurred speech. Clinically, there are three types of dysarthria: motor dysarthria, organic dysarthria and functional dysarthria. The purpose of rehabilitation therapy for dysarthria is to promote the patient’s vocalization and speech, and to regain the motor function of the organ of sound.
Causes
1. The causes of motor dysarthria are commonly found in cerebrovascular accident, brain tumor, cerebral palsy, amyotrophic lateral sclerosis, myasthenia gravis, cerebellar injury, Parkinson’s disease, multiple sclerosis and so on.
2. Organic dysarthria is commonly caused by congenital cleft lip and palate, congenital cleft face, and traumatic injury to the morphology and function of the vocal organs.
3. Functional dysarthria may be related to auditory reception of speech, discrimination, cognitive factors, motor factors in the acquisition of phonological skills, and certain factors in language development.
Symptoms
Patients with dysarthria mainly show changes in the auditory characteristics of speech such as inability to pronounce words, slurring of words, abnormal sound, pitch, speed, rhythm, and nasal overtones, which means that speech is slurred and not fluent. In severe cases, the speech is indistinguishable from sounds, and it is difficult to understand the sentences. In the most severe cases, the patient is unable to speak at all and has dysarthria. However, people with dysarthria often have normal content and grammar, and have no difficulty in understanding the speech of others, but only in the expression of spoken language. Dysarthria can be the main or only symptom, or it can be a secondary symptom.
Examination
1. Examination of the organs of articulation
While observing the organs of articulation in a quiet state, the patient is instructed and imitated to make gross movements and evaluate the following aspects. Part: The part of the organ of sound that has movement disorders. Morphology: Confirms whether the morphology of each organ is abnormal. Degree: To determine the degree of abnormality. Nature: Determine whether the abnormality is central, peripheral, or dysfunctional. Speed of movement: Confirm whether the movement is simple, repetitive, low speed or rhythmic change. Range of motion: To determine whether the range of motion is limited and whether coordinated motor control is depressed. Force of movement: confirm whether muscle force is low. Precision and smoothness of movement: can be judged by coordinated movement and continuous movement.
2. Phonological examination
Phonological examination is a systematic evaluation of the patient’s speech level and abnormal movement disorders by using Putonghua speech as the standard tone and phonological similarity movement. The evaluation includes: (1) conversation; (2) word test, which consists of 50 pictures containing 50 words; (3) syllable recapitulation test, which selects 140 common and relatively common syllables; (4) article test; and (5) sound-alike movement test, which selects sound-alike movements of 15 representative sounds. By analyzing the results of the above examinations, mispronunciation, mispronunciation conditions, error mode, method of articulation, stimulatedness, sound-alike movement, and type of error were determined.
Diagnosis
Alterations in the auditory characteristics of speech, such as inability to pronounce words, slurring of words, abnormalities in sound, pitch, speed, rhythm, and excessive nasality, which means slurred and disfluent speech, are observed in the patient. In severe cases, the speech is indistinguishable from sounds, and it is difficult to understand the sentences. In the most severe cases, the person is unable to speak at all and is unable to formulate sounds. However, the content and grammar of speech are often normal, and there is no difficulty in understanding the speech of others, but only an impairment of oral expression. The diagnosis is made on the basis of the patient’s history of the disease and the results of the examination of the organs of articulation and the articulatory examination.
Treatment
1. Breathing training
(1) First of all, the sitting posture should be adjusted. If the patient can sit steadily, the torso should be straight, the shoulders should be horizontal, and the head should be kept in the center position.
(2) If the patient’s expiration time is short and weak, an assisted respiratory training method can be adopted. The therapist will place both hands on the patient’s rib arches on both sides slightly above the position, and then let the patient breathe naturally, and then give the pressure to the chest at the end of the expiration, so as to make the patient’s expiration volume increase, and this kind of training can be combined with the training of vocalization and articulation together.
(3) Separation of oral and nasal breathing, inhale smoothly through the nose and exhale slowly through the mouth.
(4) When the therapist counts 1, 2, 3, the patient inhales, then counts 1, 2, 3 and holds his/her breath, then counts 1, 2, 3 for 10 seconds.
(5) Exhale as long as possible to pronounce “s”, “f” and other fricative sounds, but no sound, after several weeks of training, exhale synchronized pronunciation, adhere to 10 seconds.
2. Relaxation training
Including: relaxation of the feet, legs and buttocks, relaxation of the abdomen, chest and back, relaxation of the hands and upper limbs and relaxation of the shoulders, neck and head.
3. Pronunciation training
(1) Abnormal volume training The training of too weak volume can require the patient to first hold his breath, cough and other training to improve the pressure under the vocal folds, and train the breathing power such as blowing, then practice the pronunciation of vowels to improve the volume; the training of too strong volume can first make the patient relax, reduce the strength of laryngeal expiratory airflow, soften the voice, voicelessness, and training of whispering to reduce the volume; the training of single volume can make the patient first relax, reduce the intensity of laryngeal expiratory airflow, soften the voice, and voicelessness, and training of whispering to reduce the volume; the training of single volume can make the patient first relax. The patient can be trained to change the laryngeal airflow, such as blowing a balloon or a harmonica, so that the patient can change from a small voice to a loud voice with reference to the training.
(2) Training of abnormal pitch mainly focuses on the training of single pitch and pitch change disorder, and the training content includes sigh-like vocalization training, four-tone tone recognition and pronunciation training, and pitch change training can be humming training, i.e., using a small piece of song tunes, and the patient hums with reference to the pitch change. In the process of pitch practice, pay attention to the consistency of the patient’s pronunciation and the relaxation of the larynx. Gradually transition from monophonic pitch changes to pitch changes of words and sentences.
(3) Training of spasmodic vocalization Relaxation training, effective relaxation can be accomplished by deep breathing and chewing activities, and common training contents of soft vocalization include sigh-like vocalization, slow exhalation vocalization and whispering. Spontaneous sighing is a very natural soft voice, which requires the patient to relax and breathe in a way that the voice is made after the exhalation, paying attention to the passage of the airflow in the vocal folds and not intermittent, and can start with the “h” sound first.
(4) Training for abnormal sound quality The training for correcting nasal leakage can be guided by the airflow method, such as blowing training, breath-holding training, cheek puffing training, etc. The training for correcting nasal phonation can be divided into active training and passive training. Active training can make the patient alternately move the soft palate by sending out the root of the tongue to send out the air and not to send out the air; passive training can be carried out by lifting the soft palate to pronounce the sound and pinching the nose to pronounce the sound.
Rehabilitation assessment
The assessment mainly includes the presence, type and degree of dysarthria. It is often necessary to combine medical, laboratory examination and speech evaluation to make a judgment. The main contents include respiratory function assessment, resonance function assessment, vocal organ function assessment (including subjective perception assessment and objective assessment), sound-forming organ function assessment and psychosocial assessment.