Dysarthria Assessment and Treatment

with SpeechViewer III

by

Debra K. Smith and Amy Draper

Outline

I. Neurological Basis of Dysarthria

II. Case History
A. Assessment
B. Treatment
III. Classification of dysarthrias

IV. Implementation of SpeechViewer III as Therapy Tool

A. Loudness Range
B. Pitch Range
C. Pitch Control
D. Voice Timing

What is Dysarthria?

Dysarthria is a motor speech disorder that results from muscular impairment. Muscular
weakness, slowness, or incoordination can affect all the basic processes of speech -
respiration, phonation, resonance, articulation, and prosody. Articulation errors are the
most common feature of dysarthria, followed by impairments of voice, resonance, and
fluency.

Etiology and Course of Disease

Dysarthrias are often defined by their etiology and course of progression. Dysarthrias
may be acquired or congenital and may follow a variety of courses. Dysarthrias may be
developmental (Cerebral Palsy), recovering (post stroke), stable (long term post stroke),
or degenerative (Amyotrophic Lateral Sclerosis). Different types of lesions or damage in
the central and peripheral nervous systems cause different types of dysarthria.

Assessment

There are six types of dysarthrias, each characterized by a different etiology and different
speech behaviors. During a diagnostic evaluation, it is easy to confuse the dysarthrias, as
many of their characteristics overlap and more than one type may be present. To complete
an assessment of dysarthria, it is important to obtain a complete oral-facial examination
and a good speech sample at structured levels and in continuous speech. These samples
will be the basis for identifying the primary speech characteristics your client exhibits.
Formal tests such as Enderby's (1983) Frenchay Dysarthria Assessment or Yorkston,
Beukelman, and Traynor's (1984) Assessment of Intelligibility of Dysarthric Speech are
useful assessment tools.

Classification/Characteristics of Dysarthrias

Flaccid Dysarthria

Site of lesion: Lower motor neuron

Possible causes: Viral infection, Tumor, CVA, Congenital conditions, disease, palsies and
trauma.

Primary Speech Characteristics: Hypernasality, imprecise consonants, breathiness,

monopitch, nasal emission.

Spastic Dysarthria

Site of Lesion: Upper motor neuron

Possible Causes: CVA, Tumor, Infection, Trauma, Congenital Conditions

Primary Speech Characteristics: Imprecise consonants, monopitch, reduced stress, harsh

vocal quality, monoloudness, low pitch, slow rate, hypernasality, strained-strangled voice,
short phrases.

Mixed Dysarthria (Flaccid/Spastic)

Site of Lesion: Upper and Lower motor neuron

Possible Causes: ALS, Trauma, CVA

Primary Speech Characteristics: Imprecise consonants, hypernasality, harsh vocal quality,

slow rate, monopitch, short phrases, distorted vowels, low pitch , monoloudness, excess
and equal stress, prolonged intervals.

Ataxic Dysarthria

Site of Lesion: Cerebellar system

Possible Causes: CVA, Tumor, Trauma, Congenital Condition, Infection, Toxic effects
Primary Speech Characteristics: Imprecise consonants, excess and equal stress, irregular
articulatory breakdowns, distorted vowels, harsh voice, loudness control problems,
variable nasality.

Hypokinetic Dysarthria

Site of Lesion: Extrapyramidal System

Possible Causes: Parkinsonism, Drug induced

Primary Speech Characteristics: Monopitch, reduced stress, monoloudness, imprecise

consonants, inappropriate silences, short rushes of speech, harsh voice, breathy voice.

Hyperkinetic Dysarthria

Site of Lesion: Extrapyramidal system

Possible Causes: Chorea, Infection, Gilles de la Tourette Syndrome, Ballism, Athetosis,

CVA, Tumor, Dystonia, Drug induced, Dyskinesia.

Primary Speech Characteristics: Imprecise consonants, distorted vowels, harsh voice

quality, irregular articulatory breakdowns, strained-strangled voice, monopitch,
monoloudness.

Case History

Mrs. "A" is a 70 you with a history of stroke and right hemiparesis. Speech /Language
evaluation was recommended by physician. Portions of the Minnesota Test for
Differential Diagnosis of Aphasia (MTDDA) were administered. Results were as follows:
Auditory Comprehension: Mrs. "A" was able to recognize common objects with 100%
accuracy. Identifying items named serially, understanding sentences and repeating up to 7
digits were performed with 100% accuracy. Oral Expression: Pt. Was able to repeat
monosyllabic words and phrases upon request. Mrs. "A" was able to complete sentences,
give biographical information, express ideas and define words. Patient was also able to
name pictures of common objects with 100% accuracy indicating the absence of anomia.
Cognitive: Mrs. "A" was oriented x3. She was able to generate and recognize ideas in
categories, sequence four steps and functional problem solve. Oral Mech. Exam: An oral
mechanism exam was given to assess labial lingual strength, ROM and coordination.
Labial and madibular strength was adequate. Tongue movement and strength was also
adequate. During prolongation of "ah" it was noted that voice quality was "harsh and
breathy" while the duration of the vowel was 3 seconds indicating the lack of respiration
needed for speech. Speech was also monopitched and very soft. Sequential motion rate
was WNL for speed indicating the absence of apraxia.

Impressions: Mrs. "A" is a well oriented, pleasant individual. She presents with a harsh,
breathy voice, monopitch, soft and lack of adequate respiration for speech secondary to
dysarthria. Recommendations: It is recommended that Mrs. "A" receive speech/language
services to increase respiration during speech and improve voice quality.

Implementation of SpeechViewer III

SpeechViewer III is an IBM Independence Series product for speech/language

pathologists, teachers, and other professionals to use in modifying speech patterns. The
SpeechViewer III (SPV3) consists of speech exercises for direct client therapy and
clinical management functions for keeping client records. SPV3 uses visual and auditory
feedback to analyze and improve the speech skills of people who have speech, language,
or hearing disorders. It is also useful for people who are trying to modify inflection,
pronunciation, and vocal quality when learning new languages, relearning
language/speech, or improving an accent. Using the SPV3, speech professionals and their
clients can monitor and gain control over such speech attributes as voicing, pitch,
loudness, phoneme accuracy, and speech timing. SPV3 is a sophisticated, clinical tool
that takes advantage of high-resolution graphics and high-performance sound capability
in personal computers. It has a menu-bar format for access to speech exercises, point-
and-click capability, and enhanced phoneme model creation.

Implementation of the SpeechViewer III can be used in the treatment of clients with
dysarthria. There are a variety speech attributes in the SpeechViewer III program that can
be applied to clients with dysarthria. The speech attributes included in the exercise menu
include, loudness exercises, pitch exercises, and voicing and voice timing exercises.

Exercises

Loudness Range

This exercise uses volume or movement of an object to show the loudness range of
sound. As a client makes sounds into the microphone, the volume or movement of an
object varies according to the loudness of the sound, as long as the sound is above the
loudness threshold. Since many clients with dysarthria exhibit difficulties with adequate
breath support and appropriate loudness levels for speech, the Loudness Range exercises
provide targets and models for addressing these issues. Clients with ataxic, flaccid,
hyperkinetic, hypokinetic, and spastic dysarthria may benefit from this exercise.

Loudness Range Statistics

Statistics for the Loudness Range exercises are collected over a series of "trials." A "trial"
is one sustained sound, above the loudness threshold, that causes an object to move,
inflate, or deflate. Statistics are collected from the start of the exercise and continue to
accumulate until you reset them.

Pitch Range
This exercise shows changes in pitch in the form of a mobile moving up and down a
vertical pitch scale. As a client voices into the microphone, varying your pitch, the mobile
indicates the upper and lower limits of the pitch range. This exercise may be implemented
with clients who exhibit problems with breath support. The client must have adequate
respiration to sustain pitch levels. Clients with spastic dysarthria exhibit pitch breaks and
may benefit from this exercise.

Pitch Range Statistics

Statistics for the Pitch Range exercises are collected over a series of "trials." A "trial" is
one sustained voiced sound that causes the mobile to rise or fall. Statistics are collected
from the start of the exercise and continue to accumulate until you reset the statistics.

Pitch Control

This exercise shows pitch control in the form of a mobile moving through a obstacle
course. Voicing controls the horizontal movement, while pitch controls the vertical
movement. This exercise would be useful for clients with spastic dysarthria because
while speaking, clients must maintain pitch control.

Pitch Control Statistics

Statistics for the Pitch Control exercises are collected for each "trial." A "trial" is the
movement of the mobile from the starting position to the right side of the screen,
beginning with all targets in place. Statistics are collected from the start of the exercise
and continue to accumulate until you reset them. This chart lists the statistics kept for the
Pitch Control exercises.

Voice Timing

This exercise shows voice timing in the form of a mobile moving horizontally. When
voicing is present, the mobile rises to a fixed height and continues at that level; when
voicing is absent, the mobile returns to the lower level and continues at that level. This
exercise would be useful for clients with hyperkinetic dysarthria because clients often
exhibit voice stoppages in speech.

The following exercises would be beneficial with the client mentioned in the case history
section. All exercises require proper breath support, which is the primary clinical concern
with this particular client. Loudness exercises would also be beneficial for Mrs. "A"
because she exhibits difficulties with appropriate loudness levels during speech. The
SpeechViewer III is an excellent tool for clients with dysarthria in conjunction with other
exercises for breath support, loudness, and articulation.

Voice Timing Statistics

Statistics for the Voice Timing exercise are collected for each "trial." A "trial" is the
movement of a mobile from its starting position, over a pattern of obstacles, to its ending
position. Statistics are collected from the start of the exercise and continue to accumulate
until you reset them.

Additional Internet Links

Healthtouch Dysarthria

EPG for Dysarthria

Dysarthria and Apraxia of Speech

PAS 444 - Neuropathologies of Speech