Dr. Huntley's
Diagnosis
Checklist
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See what questions
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Dysarthria, poorly articulated speech, is characterized by slurring and labored, irregular rhythm. It may be accompanied by a nasal voice tone caused by palate weakness. Whether it occurs abruptly or gradually, dysarthria is usually evident in ordinary conversation. It's confirmed by asking the patient to produce a few simple sounds and words, such as “ba,” “sh,” and “cat.” However, dysarthria is occasionally confused with aphasia, the loss of the ability to produce or comprehend speech.
Dysarthria results from damage to the brain stem that affects cranial nerves IX, X, or XII. Degenerative neurologic disorders and cerebellar disorders commonly cause dysarthria. In fact, dysarthria is a chief sign of olivopontocerebellar degeneration. It may also result from ill-fitting dentures.
Ensure a patent airway. Place the patient in Fowler's position and suction him if necessary. Administer oxygen, and keep emergency resuscitation equipment nearby. Anticipate endotracheal intubation and mechanical ventilation in progressive respiratory muscle weakness. Withhold oral fluids in the patient with associated dysphagia.
If dysarthria isn't accompanied by respiratory muscle weakness and dysphagia, assess for other neurologic deficits. Compare muscle strength and tone in the limbs. Then evaluate tactile sensation. Ask the patient about numbness or tingling. Test deep tendon reflexes (DTRs), and note gait ataxia. Assess cerebellar function by observing rapid alternating movement, which should be smooth and coordinated. Next, test visual fields and ask about double vision. Check for signs of facial weakness such as ptosis. Next, determine the patient's level of consciousness (LOC) and mental status.
Obtain a patient history. Explore dysarthria completely. When did it begin? Has it gotten better? Speech improves with resolution of a transient ischemic attack, but not in a completed stroke. Ask if dysarthria worsens during the day. Then obtain a drug and alcohol history. Also ask about a history of seizures. Check dentures for a proper fit.
Alcoholic cerebellar degeneration.Alcoholic cerebellar degeneration commonly causes chronic, progressive dysarthria along with ataxia, diplopia, ophthalmoplegia, hypotension, and an altered mental status.
Amyotrophic lateral sclerosis (ALS).Dysarthria occurs when ALS affects the bulbar nuclei; it may worsen as the disease progresses. Other signs and symptoms include dysphagia; difficulty breathing; muscle atrophy and weakness, especially of the hands and feet; fasciculations; spasticity; hyperactive DTRs in the legs; and, occasionally, excessive drooling. Progressive bulbar palsy may cause crying spells or inappropriate laughter.
Basilar artery insufficiency.Basilar artery insufficiency causes random, brief episodes of bilateral brain stem dysfunction, resulting in dysarthria. Accompanying it are diplopia, vertigo, facial numbness, ataxia, paresis, and visual field loss, all of which last for minutes to hours.
Botulism.The hallmark of botulism is acute cranial nerve dysfunction causing dysarthria, dysphagia, diplopia, and ptosis. Early findings include a dry mouth, a sore throat, weakness, vomiting, and diarrhea. Later, descending weakness or paralysis of muscles in the extremities and trunk causes hyporeflexia and dyspnea.
Mercury poisoning.Chronic mercury poisoning causes progressive dysarthria accompanied by weakness, fatigue, depression, lethargy, irritability, confusion, ataxia, and tremors.
Multiple sclerosis (MS).When demyelination affects the brain stem and cerebellum as with MS, the patient displays dysarthria accompanied by nystagmus, blurred or double vision, dysphagia, ataxia, and intention tremor. Exacerbations and remissions of these signs and symptoms are common. Other findings include paresthesia, spasticity, intention tremor, hyperreflexia, muscle weakness or paralysis, constipation, emotional lability, and urinary frequency, urgency, and incontinence.
Myasthenia gravis.Myasthenia gravis causes dysarthria associated with a nasal voice tone. Typically, the dysarthria worsens during the day and may temporarily improve with short rest periods. Other findings include dysphagia, drooling, facial weakness, diplopia, ptosis, dyspnea, and muscle weakness.
Olivopontocerebellar degeneration.Dysarthria, a major sign of olivopontocerebellar degeneration, accompanies cerebellar ataxia and spasticity.
Parkinson's disease.Parkinson's disease produces dysarthria and a monotone voice. It also produces muscle rigidity, bradykinesia, involuntary tremor usually beginning in the fingers, difficulty walking, muscle weakness, and a stooped posture. Other findings include masklike facies, dysphagia, and occasionally drooling.
Shy-Drager syndrome.Marked by chronic orthostatic hypotension, Shy-Drager syndrome eventually causes dysarthria as well as cerebellar ataxia, bradykinesia, masklike facies, dementia, impotence and, possibly, a stooped posture and incontinence.
Stroke (brain stem).A brain stem stroke is characterized by bulbar palsy, resulting in the triad of dysarthria, dysphonia, and dysphagia. Dysarthria is most severe at its onset; it may lessen or disappear with rehabilitation and training. Other findings include facial weakness, diplopia, hemiparesis, spasticity, drooling, dyspnea, and a decreased LOC.
Stroke (cerebral).A massive bilateral stroke causes pseudobulbar palsy. Bilateral weakness produces dysarthria that's most severe at onset. This sign is accompanied by dysphagia, drooling, dysphonia, bilateral hemianopsia, and aphasia. Sensory loss, spasticity, and hyperreflexia may also occur.
Drugs.Dysarthria can occur when the anticonvulsant dosage is too high. Ingestion of large doses of barbiturates may also cause dysarthria.
▪ Consult with a speech pathologist, as needed.
▪ Administer medications and treatments as needed.
▪ Assess the patient's swallow and gag reflexes before feeding him.
▪ Give the patient time to express himself.
▪ Encourage the patient to express his feelings.
▪ Encourage the patient with dysarthria to speak slowly so that he can be understood.
▪ Encourage him to use gestures to aid communication.
▪ Discuss different ways to communicate.
▪ Explain to the patient his diagnosis and the treatment plan.
Read excerpts from these other book chapters related to Speech changes:
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7 
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