Dysarthria

Dysarthria, poorly articulated speech, is characterized by slurring and labored, irregular rhythm. It may be accompanied by nasal voice tone caused by palate weakness. Dysarthria is occasionally confused with aphasia, 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.

Emergency Actions

If the patient displays dysarthria, ask him about associated difficulty swallowing. Then determine his respiratory rate and depth, and measure vital capacity. Assess blood pressure and heart rate. Usually, tachycardia, slightly increased blood pressure, and shortness of breath are early signs of respiratory muscle weakness.

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 intubation and mechanical ventilation in progressive respiratory muscle weakness. Withhold oral fluids in the patient with associated dysphagia.

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. While taking the patient’s history, pay attention to his speech. Dysarthria is usually evident in ordinary conversation. Observe dentures for a proper fit.

Physical assessment

Perform a complete neurologic examination. Ask the patient to produce a few simple sounds and words, such as “ba,” “sh,” and “cat.” 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. Finally, determine level of consciousness (LOC) and mental status.

Medical causes

Alcoholic cerebellar degeneration

Alcoholic cerebellar degeneration commonly causes chronic, progressive dysarthria along with ataxia, diplopia, ophthalmoplegia, hypotension, and altered mental status.

Amyotrophic lateral sclerosis

Dysarthria occurs when amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig disease, affects the bulbar nuclei; it may worsen as the disease progresses. Other signs and symptoms of ALS 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 dry mouth, sore throat, weakness, vomiting, and diarrhea. Later, descending weakness or paralysis of muscles in the extremities and trunk causes hyporeflexia and dyspnea.

Manganese poisoning

Chronic manganese poisoning causes progressive dysarthria accompanied by weakness, fatigue, confusion, hallucinations, drooling, hand tremors, limb stiffness, spasticity, gross rhythmic movements of the trunk and head, and propulsive gait.

Mercury poisoning

Chronic mercury poisoning also causes progressive dysarthria accompanied by weakness, fatigue, depression, lethargy, irritability, confusion, ataxia, and tremors. Changes in vision, hearing, and memory may also occur.

Multiple sclerosis

When demyelination affects the brain stem and cerebellum, 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 of multiple sclerosis include paresthesia, spasticity, intention tremor, hyperreflexia, muscle weakness or paralysis, constipation, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

Myasthenia gravis is a neuromuscular disorder that 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. The patient may also have abnormal eye movement, sexual dysfunction, bowel and bladder problems, and difficulty swallowing.

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 in walking, muscle weakness, and stooped posture. Other findings include masklike facies, dysphagia, and occasionally drooling.

Stroke (brain stem)

Brain stem stroke is characterized by bulbar palsy, resulting in the triad of dysarthria, dysphonia, and dysphagia. The dysarthria is most severe at onset; it may lessen or disappear with rehabilitation and training. Other findings include facial weakness, diplopia, hemiparesis, spasticity, drooling, dyspnea, and decreased LOC.

Stroke (cerebral)

A massive bilateral cerebral 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.

Other causes

Drugs

Dysarthria can occur when anticonvulsant dosage is too high. Ingestion of large doses of barbiturates may also cause dysarthria.

Special considerations

Dysarthria usually requires consultation with a speech pathologist. Administer medications and treatments, as indicated, to treat underlying medical conditions. Assess swallow and gag reflexes before feeding the patient to prevent aspiration.

Pediatric pointers

Dysarthria in children usually results from brain stem glioma, a slow-growing tumor that primarily affects children. It may also result from cerebral palsy.

Dysarthria may be difficult to detect, especially in an infant or a young child who hasn’t perfected speech. Be sure to look for other neurologic deficits, too. Encourage speech in a child with dysarthria; a child’s potential for rehabilitation is typically greater than an adult’s.

Patient counseling

Encourage the patient with dysarthria to speak slowly so that he can be understood. Give him time to express himself, and encourage him to use gestures. Allow him to express his feelings about his difficulties with verbal communication.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Speech disorders

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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Speech disorders: Introduction (review 24 causes)
• Next Book Extract About Speech disorders: Hoarseness (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

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