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Journal of Clinical Neuroscience :... Feb 2022Myotonic dystrophy (DM) is an autosomal dominant neuromuscular and multisystem disease that is divided into two types, DM1 and DM2, according to mutations in DMPK and... (Review)
Review
Myotonic dystrophy (DM) is an autosomal dominant neuromuscular and multisystem disease that is divided into two types, DM1 and DM2, according to mutations in DMPK and CNBP genes, respectively. DM patients may manifest with various speech and language abnormalities. In this review, we had an overview on speech and language abnormalities in both DM1 and DM2. Our literature search highlights that irrespective of age, all DM patients (i.e. congenital, juvenile, and adult onset DM1 as well as DM2 patients) exhibit various degrees of speech impairments. These problems are related to both cognitive dysfunction (e.g. difficulties in written and spoken language) and bulbar/vocal muscles weakness and myotonia. DM1 adult patients have also a significant decrease in speech rate and performance due to myotonia and flaccid dysarthria, which can improve with warming up. Weakness, tiredness, and hypotonia of oral and velopharyngeal muscles can cause flaccid dysarthria. Hearing impairment also plays a role in affecting speech recognition in DM2. A better understanding of different aspects of speech and language abnormalities in DM patients may provide better characterization of these abnormalities as markers that can be potentially used as outcome measures in natural history studies or clinical trials.
Topics: Adult; Dysarthria; Humans; Mutation; Myotonic Dystrophy; Speech
PubMed: 34789418
DOI: 10.1016/j.jocn.2021.10.031 -
Seminars in Speech and Language Aug 2014This article reviews the occurrence of motor speech disorders of dysarthria and apraxia of speech following closed head injury and other traumatic brain injuries in... (Review)
Review
This article reviews the occurrence of motor speech disorders of dysarthria and apraxia of speech following closed head injury and other traumatic brain injuries in adults as they apply to sport concussion and related trauma. Athletic sideline and speech-language pathology screenings are considered. Procedures for clinical assessment and diagnosis of motor speech disorder, most particularly dysarthria, are discussed with special reference to closed head injury. Included are the evaluation components of cranial nerve and speech mechanism examination, nonspeech musculature examination, perceptual and instrumental assessment procedures, quasi-standardized testing for dysarthria, and the determination of restrictions of participation in everyday life activities. The resultant output of such an evaluation is described in depth. Future directions for clinical research on motor speech disorders following sports concussion are also briefly considered.
Topics: Adult; Brain Concussion; Disability Evaluation; Dysarthria; Humans; Neuropsychological Tests; Speech-Language Pathology
PubMed: 25116216
DOI: 10.1055/s-0034-1384684 -
BMC Neurology Nov 2021Non-progressive dysarthria is an acquired motor speech disorder resulting from neurological diseases such as stroke and traumatic brain injury. The evidence base for the...
BACKGROUND
Non-progressive dysarthria is an acquired motor speech disorder resulting from neurological diseases such as stroke and traumatic brain injury. The evidence base for the assessment of non-progressive dysarthria remains limited with professional practices relying mainly on therapists' clinical experience. Limited information on the assessment practices of Lebanese speech and language therapists (SLTs) is available. Such information is crucial for the development of adequate therapy services for clients with non-progressive dysarthria. This study aims to explore the assessment practices and attitudes of Lebanese SLTs working with adults with non-progressive dysarthria and to investigate their adherence to the framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF).
METHODS
A cross-sectional study was conducted in Lebanon between March and May 2021. Data was collected through an online survey that included information on socio-demographic characteristics, practices, and attitudes of SLTs who assess adults with non-progressive dysarthria.
RESULTS
A total of 50 Lebanese SLTs responded to the survey. The majority of SLTs (78%) assessed clients with non-progressive dysarthria across all ICF domains. SLTs reported dissatisfaction with the available assessment tools (64%) and reliance on informal tools (84%). In addition, 68% of the SLTs suggested the crucial need for the development of Arabic formal assessments that can quantitatively evaluate dysarthria and determine severity. The survey also showed that the respondents demonstrated a preference for the use of impairment-based tools.
CONCLUSION
It can be concluded that the assessment practices of Lebanese SLTs, generally, follow the international trend and the recommended professional guidelines. Further research initiatives should be held to develop Arabic formal assessment tools for non-progressive dysarthria.
Topics: Adult; Attitude of Health Personnel; Cross-Sectional Studies; Dysarthria; Humans; Language Therapy; Lebanon; Speech; Speech Therapy
PubMed: 34789195
DOI: 10.1186/s12883-021-02484-2 -
Journal of Pediatric Rehabilitation... 2022The Radboud Dysarthria Assessment (RDA) was published in 2014. Adaptation into a pediatric version (p-RDA) was required because of relevant differences between children...
PURPOSE
The Radboud Dysarthria Assessment (RDA) was published in 2014. Adaptation into a pediatric version (p-RDA) was required because of relevant differences between children and adults. The purpose of this study was to assess the feasibility of the p-RDA and to test intra-rater and inter-rater reliability as well as the validity of the two severity scales (function and activity level).
METHODS
Video recordings were made of 35 participants with (suspected) dysarthria (age 4 to 17 years) while being assessed using the p-RDA. Intra-rater reliability was assessed by one, and inter-rater reliability by two experiments using the Intraclass Correlation Coefficient (ICC). Validity of the severity scales was tested by correlating the consensus scores with the independently rated scores on four communication scales, three mobility scales, and one self-care scale using Spearman correlation coefficients (rs).
RESULTS
The assessment was applicable for 89% of the tested sample, with good intra-rater and inter-rater reliability (ICC = 0.88-0.98 and 0.83-0.93). The p-RDA severity scales (function and activity level) correlated from substantially to strongly with the communication scales (rs = 0.69-0.82 and 0.77-0.92) and self-care scale (rs = 0.76-0.71) and correlated substantially with the mobility scales (rs = 0.49-0.60).
CONCLUSION
The feasibility, reliability and validity of the p-RDA are sufficient for clinical use.
Topics: Adolescent; Adult; Child; Child, Preschool; Dysarthria; Humans; Reproducibility of Results; Self Care
PubMed: 34744057
DOI: 10.3233/PRM-190671 -
The Laryngoscope Jun 2022To investigate the presence, degree, predictors, and trajectory of dysphagia, dysphonia, and dysarthria among adults hospitalized with COVID-19 across the Republic of... (Observational Study)
Observational Study
OBJECTIVE
To investigate the presence, degree, predictors, and trajectory of dysphagia, dysphonia, and dysarthria among adults hospitalized with COVID-19 across the Republic of Ireland (ROI) during the first wave of the pandemic.
STUDY DESIGN
Prospective observational cohort study.
METHODS
Adults with confirmed COVID-19 who were admitted into 14 participating acute hospitals across ROI and referred to speech and language therapy between March 1st and June 30th 2020 were recruited. Outcomes obtained at initial SLT evaluation and at discharge were oral intake status (Functional Oral Intake Scale), perceptual voice quality (GRBAS), and global dysarthria rating (Dysarthria Severity Scale).
RESULTS
Data from 315 adults were analyzed. At initial SLT assessment, 84% required modified oral diets, and 31% required tube feeding. There were high rates of dysphonia (42%) and dysarthria (23%). History of intubation (OR 19.959, 95% CI 6.272, 63.513; P = .000), COVID-19 neurological manifestations (OR 3.592, 95% CI 1.733, 7.445; P = .001), and age (OR 1.034; 95% CI 1.002, 1.066; P = .036) were predictive of oral intake status. History of intubation was predictive of voice quality (OR 4.250, 95% CI 1.838, 9.827; P = .001) and COVID-19 neurological manifestations were predictive of dysarthria (OR 2.275; 95% CI 1.162, 4.456; P = .017). At discharge, there were significant improvements in oral intake (Z = -7.971; P = .000), voice quality (Z = -5.971; P = .000), and dysarthria severity (Z = -2.619; P = .009), although need for modified oral intake (59%), dysphonia (23%), and dysarthria (14%) persisted.
CONCLUSION
Dysphagia, dysphonia, and dysarthria were widespread among adults hospitalized with COVID-19 and they persisted for many at discharge. Prompt SLT evaluation is required to minimize complications.
LEVEL OF EVIDENCE
3 Laryngoscope, 132:1251-1259, 2022.
Topics: Adult; COVID-19; Deglutition Disorders; Dysarthria; Dysphonia; Hoarseness; Humans; Ireland; Prospective Studies
PubMed: 34622966
DOI: 10.1002/lary.29900 -
European Annals of Otorhinolaryngology,... Aug 2022
Topics: Dysarthria; Humans; Tongue; Tongue Diseases
PubMed: 34625390
DOI: 10.1016/j.anorl.2021.07.013 -
Journal of Speech, Language, and... Jan 2023While dysarthria and dysphagia are known bulbar manifestations of amyotrophic lateral sclerosis (ALS), the relative prevalence of speech and swallowing impairments and...
PURPOSE
While dysarthria and dysphagia are known bulbar manifestations of amyotrophic lateral sclerosis (ALS), the relative prevalence of speech and swallowing impairments and whether these bulbar symptoms emerge at the same time point or progress at similar rates is not yet clear. We, therefore, sought to determine the relative prevalence of speech and swallowing impairments in a cohort of individuals with ALS and to determine the impact of disease duration, severity, and onset type on bulbar impairments.
METHOD
Eighty-eight individuals with a confirmed diagnosis of ALS completed the ALS Functional Rating Scale-Revised (ALSFRS-R), underwent videofluoroscopy (VF), and completed the Sentence Intelligibility Test (SIT) during a single visit. Demographic variables including disease duration and onset type were also obtained from participants. Duplicate, independent, and blinded ratings were completed using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale and SIT to index dysphagia (DIGEST ≥ 1) and dysarthria (< 96% intelligible and/or < 150 words per minute) status. Descriptive statistics, Pearson chi-squared tests, independent-samples tests, and odds ratios were performed.
RESULTS
Dysphagia and dysarthria were instrumentally confirmed in 68% and 78% of individuals with ALS, respectively. Dysarthria and dysphagia were associated ( = .01), and bulbar impairment profile distributions in rank order included (a) dysphagia - dysarthria (59%, = 52), (b) no dysphagia - dysarthria (19%, = 17), (c) no dysphagia - no dysarthria (13%, = 11), and (d) dysphagia - no dysarthria (9%, = 8). Participants with dysphagia or dysarthria demonstrated 4.2 higher odds of exhibiting a bulbar impairment in the other domain than participants with normal speech and swallowing (95% CI [1.5, 12.2]). There were no differences in ALSFRS-R total scores or disease duration across bulbar impairment profiles ( > .05). ALSFRS-R bulbar subscale scores were significantly lower in individuals with dysphagia versus no dysphagia (8.4 vs. 10.4, < .0001) and dysarthria versus no dysarthria (8.5 vs. 10.9, < .0001). Dysphagia and onset type ( = .003) and dysarthria and onset type were associated ( < .0001).
CONCLUSIONS
Over half of the individuals with ALS in this study demonstrated both dysphagia and dysarthria. Of those with only one bulbar impairment, speech was twice as likely to be the first bulbar symptom to degrade. Future studies are needed to confirm these findings and determine the longitudinal progression of bulbar impairments in this patient population.
Topics: Humans; Amyotrophic Lateral Sclerosis; Severity of Illness Index; Deglutition Disorders; Dysarthria; Deglutition
PubMed: 36525626
DOI: 10.1044/2022_JSLHR-22-00312 -
Developmental Medicine and Child... Apr 2021To investigate whether dysarthria syndromes acquired in adulthood can also be observed in children with cerebral palsy (CP) and, if so, whether they align with...
AIM
To investigate whether dysarthria syndromes acquired in adulthood can also be observed in children with cerebral palsy (CP) and, if so, whether they align with children's CP subtypes.
METHOD
Twenty-six children with CP participated (mean age 7y 8mo [SD 1y 2mo], 5y 1mo-9y 10mo; 16 males and 10 females). Speech samples were elicited in a computer-based game and were analysed using the auditory perceptual criteria of the Bogenhausen Dysarthria Scales (BoDyS). For statistical classification, three comparison groups of adults with standard dysarthria syndromes (i.e. spastic, hyperkinetic, and ataxic) were used. Their BoDyS data were entered into a mixture discriminant analysis, with data from the comparison groups as the training sample and those from the children with CP as the test sample. Results were related to findings in a group of adults with CP.
RESULTS
Among the children with CP, most had spastic (n=14), while fewer had ataxic (n=9) or hyperkinetic (n=3), dysarthria. However, syndrome allocations were significantly more ambiguous than in adults with CP. For 11 children, their dysarthria syndromes did not align with their CP subtype.
INTERPRETATION
Dysarthria syndromes are less clear cut in children than in adults with CP because of a number of developmental factors.
WHAT THIS PAPER ADDS
Children with cerebral palsy (CP) show diverse patterns of dysarthric symptoms. Dysarthria syndromes do not seem to manifest fully during childhood. Dysarthria syndrome and CP subtype may not align in children with CP.
Topics: Cerebral Palsy; Child; Child, Preschool; Dysarthria; Female; Humans; Male; Speech
PubMed: 32970343
DOI: 10.1111/dmcn.14679 -
Journal of the International... May 2021To investigate the impact of cognitive impairment on spoken language produced by speakers with multiple sclerosis (MS) with and without dysarthria.
OBJECTIVE
To investigate the impact of cognitive impairment on spoken language produced by speakers with multiple sclerosis (MS) with and without dysarthria.
METHOD
Sixty speakers comprised operationally defined groups. Speakers produced a spontaneous speech sample to obtain speech timing measures of speech rate, articulation rate, and silent pause frequency and duration. Twenty listeners judged the overall perceptual severity of the samples using a visual analog scale that ranged from no impairment to severe impairment (speech severity). A 2 × 2 factorial design examined main and interaction effects of dysarthria and cognitive impairment on speech timing measures and speech severity in individuals with MS. Each speaker group with MS was further compared to a healthy control group. Exploratory regression analyses examined relationships between cognitive and biopsychosocial variables and speech timing measures and perceptual judgments of speech severity, for speakers with MS.
RESULTS
Speech timing was significantly slower for speakers with dysarthria compared to speakers with MS without dysarthria. Silent pause durations also significantly differed for speakers with both dysarthria and cognitive impairment compared to MS speakers without either impairment. Significant interactions between dysarthria and cognitive factors revealed comorbid dysarthria and cognitive impairment contributed to slowed speech rates in MS, whereas dysarthria alone impacted perceptual judgments of speech severity. Speech severity was strongly related to pause duration.
CONCLUSIONS
The findings suggest the nature in which dysarthria and cognitive symptoms manifest in objective, acoustic measures of speech timing and perceptual judgments of severity is complex.
Topics: Cognitive Dysfunction; Dysarthria; Humans; Language; Multiple Sclerosis; Speech Acoustics
PubMed: 33190658
DOI: 10.1017/S1355617720001113 -
International Journal of... Apr 2017The purpose is to investigate acoustic and tongue body kinematic vowel dispersion patterns and vowel space in speakers with and without dysarthria secondary to...
PURPOSE
The purpose is to investigate acoustic and tongue body kinematic vowel dispersion patterns and vowel space in speakers with and without dysarthria secondary to amyotrophic lateral sclerosis (ALS).
METHOD
Acoustic and tongue kinematic vowel spaces were examined at the same time sampling point using electromagnetic articulography in 11 speakers with dysarthria secondary to ALS and 11 speakers without dysarthria. Tongue kinematic data were collected from the tongue body sensor (∼25 mm posterior from the tongue apex). A number of acoustic and tongue body kinematic variables were tested.
RESULT
The result showed that the acoustic and tongue kinematic vowel dispersion patterns are different between the groups. Acoustic and tongue body kinematic vowel spaces are highly correlated; however, unlike acoustic vowel space, tongue body kinematic vowel space was not significantly different between the groups.
CONCLUSION
Both acoustic and tongue kinematic vowel dispersion patterns are sensitive to the group difference, especially with high vowels. The tongue kinematic vowel space approach is too crude to differentiate the speakers with dysarthria secondary to ALS from speakers without dysarthria. To examine tongue range of motion in speakers with dysarthria, a more refined articulatory kinematic approach needs to be examined in the future.
Topics: Adult; Aged; Aged, 80 and over; Amyotrophic Lateral Sclerosis; Biomechanical Phenomena; Dysarthria; Female; Humans; Male; Middle Aged; Speech Acoustics; Speech Intelligibility; Speech Production Measurement; Tongue
PubMed: 27336197
DOI: 10.1080/17549507.2016.1193899