El objetivo de la investigación es elaborar una metodología para desarrollar la psicomotricidad de niños con disartria pseudobulbar que revele las peculiaridades fundamentales del proceso. La ...problemática fundamental se dirige a las carencias detectadas en el proceso didáctico de los estudiantes con este trastorno que restringen su desarrollo psicomotriz y su inclusión social. Los referentes principales de la temática son Bécquer (2002), López (2012), Figueredo (2014) y Huepp (2018). Ellos han ofrecido tratados cognitivos en las dimensiones motriz, cognitiva y afectiva de los alumnos; no obstante, sus contribuciones no se destinan a personas con disartria pseudobulbar. Para la investigación fueron empleados métodos científicos como el análisis-síntesis, sistémico estructural funcional, así como técnicas entre las que se encuentran pruebas motoras y el estudio de caso. La propuesta contribuye, desde el desarrollo de operaciones psicomotrices, a beneficiar la eficacia motora y la inclusión social de los escolares con este trastorno y les permite apropiarse de una movilidad independiente, segura y con calidad, desde la superación de barreras sociales impuestas.
Purpose: Motor speech abnormalities are highly common and debilitating in individuals with idiopathic Parkinson's disease (IPD). These abnormalities, collectively termed hypokinetic dysarthria (HKD), ...have been traditionally attributed to hypokinesia and bradykinesia secondary to muscle rigidity and dopamine deficits. However, the role of rigidity and dopamine in the development of HKD is far from clear. The purpose of the present study was to offer an alternative view of the factors underlying HKD. Method: The authors conducted an extensive, but not exhaustive, review of the literature to examine the evidence for the traditional view versus the alternative view. Results: The review suggests that HKD is a highly complex and variable phenomenon including multiple factors, such as scaling and maintaining movement amplitude and effort; preplanning and initiation of movements; internal cueing; sensory and temporal processing; automaticity; emotive vocalization; and attention to action (vocal vigilance). Although not part of the dysarthria, nonmotor factors, such as depression, aging, and cognitive-linguistic abnormalities, are likely to contribute to the overall speech symptomatology associated with IPD. Conclusion: These findings have important implications for clinical practice and research.
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
Multiple sclerosis produces neurological impairments that are variable in duration, severity and quality. Speech is frequently impaired, resulting in decreased communication skills and quality of ...life. Advancements in technology now makes it possible to use quantitative acoustic assessment of speech as biomarkers of disease progression.
Four domains of speech have been identified: articulation (slow articulation and imprecise consonants), voice (pitch and loudness instability), respiration (decreased phonatory time and expiratory pressure) and prosody (longer and frequent pauses, deficient loudness control). Studies also explored I) predictive models for diagnosis of MS and of ataxia using speech variables, II) the relationship of dysarthria with cognition and III) very few studies correlated neuroimaging with dysarthria. We could not identify longitudinal studies of speech or dysarthria in Multiple Sclerosis.
Refinement of objective measures of speech has enhanced our understanding of Multiple Sclerosis-related deficits in cross-sectional analysis while both integrative and longitudinal studies are identified as major gaps. This review highlights the potential for using quantitative acoustic assessments as clinical endpoints for diagnosing, monitoring progression and treatment in disease modifying trials.
Summary Objectives A large percentage of patients with Parkinson's disease have hypokinetic dysarthria, exhibiting reduced peak velocities of jaw and lips during speech. This limitation implies a ...reduction of speech intelligibility for such patients. This work aims at testing a cost-effective markerless approach for assessing kinematic parameters of hypokinetic dysarthria. Study Design Kinematic parameters of the lips are calculated during a syllable repetition task from 14 Parkinsonian patients and 14 age-matched control subjects. Methods Combining color and depth frames provided by a depth sensor (Microsoft Kinect), we computed the three-dimensional coordinates of main facial points. The peak velocities and accelerations of the lower lip during a syllable repetition task are considered to compare the two groups. Results Results show that Parkinsonian patients exhibit reduced peak velocities of the lower lip, both during the opening and the closing phase of the mouth. In addition, peak values of acceleration are reduced in Parkinsonian patients, although with significant differences only in the opening phase with respect to healthy control subjects. Conclusions The novel contribution of this work is the implementation of an entirely markerless technique capable to detect signs of hypokinetic dysarthria for the analysis of articulatory movements during speech. Although a large number of Parkinsonian patients have hypokinetic dysarthria, only a small percentage of them undergoes speech therapy to increase their articulatory movements. The system proposed here could be easily implemented in a home environment, thus, increasing the percentage of patients who can perform speech rehabilitation at home.
Purpose: The purpose of this study is to conduct a systematic review of interventions for the treatment of non-progressive dysarthria in adults.
Materials and methods: Five electronic databases ...(PubMed, Embase, CINAHL, PSYCINFO, Cochrane Collaboration) were searched for all studies that described and evaluated treatment used for non-progressive dysarthria in adults. Studies were included if (1) participants were adults (18+ years) with a confirmed diagnosis of non-progressive dysarthria, (2) participants received intervention with pre-post outcome data, and (3) the article was published between 2006 and 2017 (including early online publications). Data extracted included the number of participants; etiology; dysarthria type and severity; age; gender; presence of a control group; intervention tasks, frequency and duration; outcome measures; and conclusions. Data extraction was completed by a member of the research team independently and crosschecked by another team member.
Results: Of the 6728 articles identified, 21 met the inclusion criteria. The predominant study design was a case study or case series. The methodological quality of the studies varied. Typically, the interventions included impairment-based and activity level tasks targeting conversation. Approximately half of the interventions adhered to a treatment manual.
Conclusions: The evidence base to guide treatment for non-progressive dysarthria is increasing, with interventions showing promise in results, participant numbers, and positive participant feedback.
Implications for rehabilitation
The evidence base to guide treatment for non-progressive dysarthria is increasing, but remains limited.
The majority of evidence is of moderate methodological quality.
The emergence of new research indicates that health professionals need to be continuously aware and critically appraise new literature in the area.
A 37-years-old NZ European man presented with a history of five years of progressive neurological deficits. These included dysarthria, hyper-salivation, vivid dreams, sleep disordered breathing, ...elevated hemi-diaphragm, left upper limb paraesthesia, syncopal episodes, lethargy, irregular bowels, difficulty passing urine, difficulty with temperature regulation, locked and painful jaw, anxiety, reduced sleep and headaches. On examination, he had mild dysarthria, wasted tongue with deviation to left and weakness on the left. The reflexes were brisk in the lower limbs with an up-going plantar response on the left. MRI revealed an ill-defined heterogeneous enhancement of the medulla extending to the right cerebellar peduncle. The patient underwent extensive work up and treatment trial with steroids with a working diagnosis of Neuro-sarcoidosis. He developed several further symptoms of tremors and further paraesthesia over the next three months. The patient had a sudden death and the final diagnosis of Alexander disease was revealed in his autopsy.Retrospectively, the symptoms collectively clearly point to a neurological disorder, but during the five years of the disease progression, his complaints were approached individually as separate issues by multiple specialities. Due to this, despite the numerous red flags, these were unrecognised and the patient presented to Neurology with an advanced illness. This is a valuable case for learning and it reminds us how an eye for detail and careful observation in history and examination is critical, especially for patients presenting as a diagnostic challenge. This very fact is also what makes Neurology such a fascinating and intriguing specialty.
Purpose: The perceptual consequences of rate reduction, increased vocal intensity, and clear speech were studied in speakers with multiple sclerosis (MS), Parkinson's disease (PD), and healthy ...controls. Method: Seventy-eight speakers read sentences in habitual, clear, loud, and slow conditions. Sentences were equated for peak amplitude and mixed with multitalker babble for presentation to listeners. Using a computerized visual analog scale, listeners judged intelligibility or speech severity as operationally defined in Sussman and Tjaden (2012) . Results: Loud and clear but not slow conditions improved intelligibility relative to the habitual condition. With the exception of the loud condition for the PD group, speech severity did not improve above habitual and was reduced relative to habitual in some instances. Intelligibility and speech severity were strongly related, but relationships for disordered speakers were weaker in clear and slow conditions versus habitual. Conclusions: Both clear and loud speech show promise for improving intelligibility and maintaining or improving speech severity in multitalker babble for speakers with mild dysarthria secondary to MS or PD, at least as these perceptual constructs were defined and measured in this study. Although scaled intelligibility and speech severity overlap, the metrics further appear to have some separate value in documenting treatment-related speech changes.
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