Dysarthria

DYSARTHRIA, dysarthria (from the Greek dys- meaning a qualitative disorder, and arthron-joint), a disorder of articulate speech, pronunciation. Meige proposed a new term—distomia. D. differs from aphasia in that the psychological aspect of speech, speech representations, and inner speech are preserved. An aphasic person does not know how to speak, does not know how to say something, while a dysarthric person cannot pronounce words well. Stuttering has its own characteristics, is a special case of distomia, and does not fall under the concept of D. Mutism is the absence of speech altogether (mainly of psychological origin), and anarthria is a severe degree of dysarthric disorder, in which speech is already impossible due to a gross lesion of the neuromotor apparatus of speech. D. is observed with lesions of one or another area in the brain that is related to the motor apparatus of speech (operculum and other places in the cerebral cortex, adjacent or generally connected with the process of pronunciation, subcortical nodes, brainstem, nuclei of cranial nerves related to the act of speech, cerebellum). D. is observed mainly in the pronunciation of consonants (labial, palatal, dental), rather than vowels. D. in its manifestations and intensity depends on the different degree and character of lesions: weakness of pronunciation up to complete paralysis, spasm, scanning, explosiveness, incoordination, trembling, indistinctness (unclearness) in the pronunciation of individual syllables, their combinations, words, phrases. The speed of pronunciation and duration of speech (fatigue) also affect the manifestation of D. The musculature of the lips, tongue, soft palate, and larynx are ultimately the organs whose functional disorders lead to dysarthric phenomena. However, disorders in the area of innervation of breathing (dyspnea by P. Marie) and phonation (dysphonia; in particular monotony of speech) are also reflected in these. Such physical defects as cleft lip, poor condition, improper development or absence of teeth, anomalies and injuries of the jaws, perforation of the palate, hypertrophy of the tonsils, adenoid growths, diseases of the nose and tongue, etc., can significantly affect pronunciation and lead to D. In children, as speech defects that may also persist in adults, the following D. are distinguished: lisping, slurring, stuttering, mumbling, lisping, rolling (rumbling), nasal speech, babbling, muttering. When examining D., it is necessary to examine separately a) breathing (expiration and inspiration at rest and during conversation), b) voice (speed, strength, clarity, mobility, laryngoscopy, phonograph, vowels, consonants), c) articulation (examination of the organs of the oral cavity and accessory cavities; it is important to conduct the examination not only at rest but also during pronunciation; repeated performance of tasks by the examinee sometimes until fatigue, pronunciation of difficult words and phrases, studying the accents of speech when repeating, reading, voluntary speech); simultaneously, accompanying phenomena are noted: movements from other musculature, trembling, facial expression, vasomotor phenomena, influence of psychological state.-Individual types of D. in clinical practice: 1) stumbling on syllables, smearing of speech in progressive paralysis; 2) scanning in disseminated sclerosis; 3) gradually progressive speech disorder in the form of weakening and loss of individual sounds in progressive bulbar paralysis (amyotrophic lateral sclerosis); 4) D. in other types of bulbar paralysis; 5) dysarthria in the form of incoordination or ataxia of speech movements in diseases of the cerebellum and its systems; 6) choreic twitchings, athetoid disorders, tics in the act of speech in various types of chorea, athetosis, Wilson's disease, status marmoratus striati by Vogt and other diseases of subcortical nodes; 7) stuttering; 8) D. in cases of apoplexy and other focal diseases of the brain, as well as pseudobulbar paralysis as a result of diaschisis and direct damage to cortical centers and conducting pathways related to the act of speech; 9) D. in diseases of the frontal lobes of the brain; 10) monotony of speech in trembling paralysis and parkinsonism; 11) nasal speech in diphtheritic polyneuritis, due to paralysis of the soft palate; 12) rarer forms of dysarthria in poliomyelitis, tabes, myopathy, myotonia, myasthenia, syringobulbia and others.-Disorders of speech of dysarthric character can also be of psychological origin, being a hysterical symptom. D. are also observed in psychoses (oligophrenia, schizophrenia, etc.).-Treatment of D. is complex and depends on the underlying disease. In addition to general methods of treatment, psychotherapy, treatment by exercises, which aims to teach the patient to master the speech apparatus that is disobedient to his will, is of great importance in suitable cases (see Logopedics).