Document 6448226

Childhood Dysarthria
Kathleen Mikullitz
&
Kimme Norton
What is Childhood Dysarthria?
A group of motor speech disorders that affects
the neuromuscular execution of speech
Characterized by abnormalities in:
„
„
CNS and/or PNS
Neuromuscular features, including: strength,
steadiness, tone, accuracy, and speed and range of
movement
Can affect ALL systems necessary for speech:
„
Respiration, phonation, articulation, resonance, and
prosody
(van Mourik, Catsman-Berrevoets, Paquier, Yousef-Bak, & van Dongen, 1997; Duffy, 2005)
Types and Symptoms
„
„
„
„
„
„
„
Flaccid – Weakness
Spastic – Rigidity
Ataxic – Incoordination
Hypokinetic – Rigidity; Problems with initiating
movement
Hyperkinetic – Involuntary movements
Unilateral Upper Motor Neuron – Weakness;
Incoordination
Mixed – Variable
(Duffy, 2005; Andrianopoulos, 2008)
Childhood Dysarthria
Congenital or Developmental:
„
The neurologic insult takes place at birth or
prior to the development of speech and
language
Acquired:
„
The individual may have developed some
speech and language skills prior to the
neurologic insult
(Caruso & Strand, 1999)
Speech Characteristics
Marked difficulties with strength, speech, and accuracy
of articulatory movement.
Weak vocal quality (lack of respiratory support)
Hypo- or hypernasality
Weak articulatory contacts
Rapid or slow speaking rate
Distortion of vowels that involve spreading intrinsic
tongue muscles:
„
/i/, /ai/, /ei/, and /ɔ ɪ/.
Imprecise or weakly targeted consonants
„
/r/, /l/, and /s/
Generally weak, mushy, garbled, imprecise speech
(McCaffrey, 2008)
Non-Speech Characteristics
Difficulties with:
„
„
„
Sucking
Chewing
Swallowing
May cause:
„
„
„
Drooling
Gagging
Choking
(McCaffrey, 2008)
Disorders/Syndromes Associated
with Childhood Dysarthria
Neurodevelopmental:
„
Spina Bifida and Hydrocephalus
Genetic:
„
Fragile X syndrome
Chromosomal:
„
Down’s syndrome
Sporadic:
„
Prader-Willi syndrome
Neurodevelopmental:
Spina Bifida with Hydrocephalus (SBH)
Spina Bifida: Incomplete fusion of the vertebral column
Hydrocephalus: Excess of cerebrospinal fluid (CSF) in
the brain Æ Enlarged skull
SBH: Malformation of the cerebellum
„
Ataxic dysarthria
Three clusters of speech:
„
„
„
Articulatory inaccuracy
Prosodic excess
Phonatory-prosodic insufficiency
(Bhatnagar, 2002; Huber-Okrainec, Dennis, Brettschneider, & Spiegler, 2002)
Genetic:
Fragile X Syndrome
Prevalence: 1:4,000
Cause: Mutation of FMR1 gene on the X
chromosome
Speech is characterized by:
„
„
„
Dysarthria
Dyspraxia
Articulatory distortions and substitutions
(Shprintzen, 2000; Turner, Webb, Wake, & Robinson, 1996, as cited in Roberts, Mirrett,
Anderson, Burchinal, & Neebe, 2002)
Chromosomal:
Down’s Syndrome
Prevalence: 1:1,000
Cause: A third 21st chromosome Æ Trisomy 21
Primary feature: Hypotonia Æ Dysarthria
„
“Floppy”
Speech is characterized by:
„
„
„
„
„
„
Low pitch
Hypernasality
Breathiness
Articulatory distortions
Increased rate
Reduced prosody
(Jung, Gagne, Godden, Leeper, Moon, & Seewalk, 1989; Shprintzen, 2000)
Sporadic:
Prader-Willi Syndrome
Prevalence: 1: 12,000-15,000
Cause: Deletion on chromosome 15q11
„
Long arm of the paternally derived chromosome
Delayed motor development secondary to hypotonia
„
Flaccid dysarthria
Speech is characterized by:
„
„
„
Hypernasality
Reduced intelligibility
Articulation errors
(Stark, 2006; Prader-Willi Syndrome Association, 2008)
Treatment
Depends on type and severity of symptoms
„ Children generally receive a better prognosis than
adults due to neural plasticity
Intervention is not a “one size fits all” solution
„ Beneficial to the child
„ What problem does it solve?
Evidence based
„ Grounded in theory?
How much treatment is necessary?
(Caruso & Strand, 1999; Yorkston & Beukelman, 2004)
Severity-Based Treatment
Level of severity and type of dysarthria
influences the course and structure of
intervention
Remediation of mild to moderate
dysarthria
„
Compensatory strategies
Remediation of severe dysarthria
„
Alternative form of communication necessary
(Caruso & Strand, 1999)
Treatment May Target:
Respiration:
„ To obtain sufficient breath support for speech
Phonation:
„ To reduce excessive Breathiness
Resonance:
„ To reduce hypernasality
Articulation:
„ To coordinate and strengthen the articulators
Prosody:
„ To create phonetic contrasts in speech
Loudness:
„ Feedback, Visi-pitch, delayed auditory feedback (DAF)
(Caruso & Strand, 1999)
Treatment Ideas
Promote the inclusion of:
„
„
„
„
„
Family members and caregivers to increase
generalization
Alternative modes of communication
Enhancement strategies (e.g., eye contact and facial
expression)
Repair strategies and self-monitoring
Strategies to improve listener comprehension
Support the development of:
„
„
„
Phonological awareness and literacy
Receptive and expressive language
Self-esteem
(Caruso & Strand, 1999)
Future Research
Childhood Dysarthria
„ Prevalence: Currently unknown
Masked by primary diagnosis
Diagnosticians need to include assessment
for dysarthria within the testing battery
„ Intervention
Identification of effective treatment methods
Evidence-Based Practice
References
Andrianopoulos, M. V. (2008). Introduction to motor speech disorders. Retrieved
January 22, 2008, from University of Massachusetts Amherst,
Communication Disorders Website:
http://www-unix.oit.umass.edu/~mva/pdf/ComDis_624_lecture_1A_08.pdf
Bhatnagar, S. C. (2002). Neuroscience for the study of communicative disorders.
(2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Caruso, A. J. & Strand, E. A. (1999). Clinical management of motor speech
disorders in children. New York: Thieme
Duffy, J. R. (2005) Motor speech disorders: Substrates, differential diagnosis, and
management. St. Louis, MO: Elsevier Mosby.
Huber-Okrainec, J., Dennis, M., Brettschneider, J. & Spiegler, B. J. (2002).
Neuromotor speech deficits in children and adults with spina bifida and
hydrocephalus. Brain and Language, 80(3), 592-602.
Jung, J. H., Gagne, J. P., Godden, A. L., Leeper, H. A., Moon, J. B., & Seewald, R.
C. (1989). Genetic syndromes in communication disorders. Austin, TX: PROED.
McCaffrey, P. (2008). Neuropathologies of swallowing and speech. Retrieved April
29, 2008, from California State University, Chico, The Neuroscience on the
Web Series:
http://www.csuchico.edu/~pmccaffrey/syllabi/SPPA342/342unit14.html
References – Continued…
Prader-Will Syndrome Association. (2008, February 21). Basic facts about PWS: A
diagnosis and reference guide for physicians and other health professionals.
Retrieved April 29, 2008, from the World Wide Web:
http://www.pwsausa.org/syndrome/basicfac.htm
Roberts, J. E., Mirrett, P., Anderson, K., Burchinal, M., & Neebe, E. (2002). Early
communication, symbolic behavior, and social profiles of young males with
fragile X syndrome. American Journal of Speech-Language Pathology, 11, 295304.
Shprintzen, R. J. (2000). Syndrome identification for speech-language pathology: An
illustrated pocketguide. San Diego, CA: Singular.
Stark, S. (2006). Neurodevelopmental disorders with genetic etiologies and
speech and language disorders.
van Mourik, M., Catsman-Berrevoets, C. E., Paquier, P. F., Yousef-Bak, E., & van
Dongen, H. R. (1997). Acquired childhood dysarthria: Review of its clinical
presentation. Pediatric Neurology, 17(4), 299-307.
Yorkston, K. M., & Beukelman, D. R. (2004, May 11). Dysarthria: Tools for clinical
decision-making. The ASHA Leader, pp. 4-5, 20-21.