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142
Citation: Perrotta G (2020) Dysarthria: Defi nition, clinical contexts, neurobiological profi les and clinical treatments. Arch Community Med Public Health 6(2): 142-145.
DOI: https://dx.doi.org/10.17352/2455-5479.000094
https://dx.doi.org/10.17352/acmphDOI:
2455-5479ISSN:
MEDICAL GROUP
Abstract
Starting from the general concept of Dysarthria, the present work focuses on the clinical, neurobiological, and functional aspects of the morbid condition, suggesting
a multidimensional treatment between physiotherapy, psychotherapy, and rehabilitation exercises for lost skills.
Mini Review
Dysarthria: Defi nition, clinical
contexts, neurobiological
profi les and clinical treatments
Giulio Perrotta*
Psychologist sp.ed Strategic Psychotherapist, Forensic Criminologist, Jurist sp.ing SSPL, Lecturer,
Essayist, Italy
Received: 25 June, 2020
Accepted: 20 July, 2020
Published: 21 July, 2020
*Corresponding author: Giulio Perrotta, Psychologist
sp.ed Strategic Psychotherapist, Forensic
Criminologist, Jurist sp.ing SSPL, Lecturer, Essayist,
Italy, E-mail:
https://www.peertechz.com
Contents of the manuscript
“Dysarthria” is a motor language disorder that derives
from a neurological injury involving the motor component of
language and is characterized by a poor articulation capacity of
the phonemes; in practice, dysarthria is a condition in which
problems are inherent in the muscles responsible for producing
language, often to the point of making words extremely diffi cult.
Any type of language subsystem (breathing, phonation,
resonance, prosody and articulation) can be involved and lead
to impairments in the intelligibility, audibility, naturalness,
and effectiveness of voice communication [1-4].
Therefore, dysarthria [5]:
a) It is not connected to any problem of language
comprehension;
b) Does not include speech disorders related to structural
abnormalities, such as cleft lip or cleft palate;
c) Differs from speech apraxia, which refers to problems
related to the planning and programming aspect of the
motor system linked to language;
d) Differs from aphasia which is instead a disorder of the
content (and not of the articulation) of language;
e) Refers to the partial loss of the aforementioned
capacity (when the loss is total, it will be referred to as
“anarthria”);
f) May affect a single system or be more commonly refl ected
in the interest of multiple vocal motor systems. Patients
experience diffi culties in all specifi c components of
the phonemic joint: synchronization, vocal quality,
intonation, volume, breath control, speed, strength,
constancy, range and tone.
The etiological causes of dysarthria can be manifold,
including [4,5-8]:
a) Heavy metal poisoning.
b) Metabolic dysfunctions and pathologies affecting the
glands.
c) Abuse or intoxication or systematic hypersensitivity
to certain drugs (for example, antipsychotics, opioids,
hallucinogens, and benzodiazepines).
d) Serious intoxication by narcotic and/or alcoholic
substances.
e) Neurodegenerative and oncological diseases affecting
the central and / or peripheral nervous tissue.
f) Traumatic and vascular brain injuries (capable of causing
dysfunctions affecting the motor or somatosensory
cerebral cortex, corticobulbar pathways, cerebellum,
nuclei of the base -putamen, pale globe, caudate nucleus,
substantia nigra, brain stem -da which originate the
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Citation: Perrotta G (2020) Dysarthria: Defi nition, clinical contexts, neurobiological profi les and clinical treatments. Arch Community Med Public Health 6(2): 142-145.
DOI: https://dx.doi.org/10.17352/2455-5479.000094
cranial nerves-, or the neuromuscular junction - motive
plate, for example in diseases such as myasthenia
gravis), capable of weakening the affected tissue or
provoking weakness, paralysis or loss of coordination of
the motor system of speech. These effects, in turn, may
be able to hinder the organic functioning of the tongue,
throat, lips or diaphragmatic muscles, also associated
with swallowing (causing, in comorbidity, dysphagia)
or even the cranial nerves that control these muscles,
such as the motor branch of the trigeminal nerve (V),
the facial nerve (VII), the glossopharyngeal nerve (IX),
the vagus nerve (X), and the hypoglossal nerve (XII) [9].
These hypotheses involve injuries in key areas of the brain
involved in the planning, execution, or regulation of motor
activities of the different phonation-related skeletal muscles
[2].
Dysarthria can be classifi ed in different ways depending on
the presentation of symptoms. We therefore distinguish the
following six forms [10].
a) “Spastic”, resulting from bilateral damage to the
superior motor neuron.
b) “Flabby”, resulting from bilateral or unilateral damage
to the motor neuron.
c) “Ataxic”, resulting from damage to the cerebellum. It is
an acquired neurological and sensory-motor language
defi cit. Since the regulation of fi ne movements is a
primary function of the cerebellum, it is therefore
believed that damage to the upper cerebellum or
cerebellar peduncle can produce this form of dysarthria
in ataxic patients. Some of the most consistent
anomalies observed in patients with ataxic dysarthria
are the alterations of the normal temporal pattern, with
prolongation of some segments of the language and a
tendency to equalize the duration of the pronunciation
of the syllables. As the severity of dysarthria increases,
the patient can also stretch multiple segments of speech
as well as increase the degree of elongation of each
segment. Common clinical features of ataxic dysarthria
include abnormalities in vocal modulation, inaccurate
consonants, irregular articulatory interruptions,
distorted vowels, explosive speech, equal and excessive
emphasis, inappropriate intervals, and silences.
d) “Unilateral superior motor neuron”, characterized by
milder symptoms compared to bilateral damage.
e) “Hyperkinetic”/“hypokinetic”, resulting from damage
in certain areas of the basal ganglia, such as in
Huntington’s disease or parkinsonism.
f) “Mixed”, characterized by symptoms typical of more
than one type of dysarthria. This is also the most
common form, statistically, as neurological tissue
damage is often localized across multiple regions and
areas of the nervous system.
The articulatory disorders resulting from dysarthria are
treated with specifi c speech therapy, to correct or improve
the management of defi cits in speed (of articulation), in
prosody (appropriate emphasis and infl ection, problems that
are found, for example, in apraxia of speech, in lesions of the
right cerebral hemisphere, etc.), in the intensity (volume of the
voice, typically damaged in case of hypokinetic dysarthria, as
occurs in Parkinson’s disease), in resonance (ability to alter
the “vocal tract” and spaces of resonance, or those cavities
containing air arranged in series or parallel - from the glottis
to the lips, to the nasopharynx - which are put into vibration
at the level of the vocal cords for a correct emission of the
sound of the language) and in the phonation (control of the
strings vowels for an adequate quality of the voice and the
emission of specifi c ranges of sounds, also through the control
of the airways). These treatments generally involve a series
of exercises aimed at increasing the strength and control of
the articulatory muscles (which may be fl abby and weak, or
too underdeveloped and diffi cult to put into action), and the
use of language techniques alternatives to increase speech
intelligibility (i.e. to improve speech understanding by others).
Depending on the severity of the dysarthria, another possibility
includes learning to use a computer or using cards depicting
words or symbols (fl ip cards) to be able to communicate more
effectively [5,10-16].
Therefore, the treatment [2,4] of dysarthria varies according
to the site of the lesion: depending on the type of dysarthria,
activities will be carried out that allow the patient to reduce
the disorder that has arisen. The diagnosis, therefore, involves
computed tomography or magnetic resonance imaging and
a series of tests in which some fundamental parameters are
considered: comprehension, repetition, production, reading,
writing, and naming. As the tongue, mandible, trachea, vocal
cords, epiglottis, esophagus, lips, and larynx are involved,
the treatment starts with the setting of a correct cost-
diaphragmatic breathing and continues with specifi c activities
that allow the patient to improve his skills in phonation,
resonance, articulation, diakinesis (i.e. the ability to make
rapid movements in succession and alternately), rhythm and
prosody of speech.
In particular, there are three methods to intervene clinically
on dysarthria [2,4]:
1) “Relaxation and breathing techniques”, which are
necessary to train the patient functionally, also
intervening on pathological conditions of anxious and
nervous origin;
2) “Vocalization techniques”, neurolinguistic and logopedic
matrix, to accustom the phonatory apparatus to a better
physical and emotional management of the exercises;
3) “Rhythmic voice techniques”, to favor the best possible
result, according to the severity of the morbid condition;
4) “Correct posture and possible postural corrections” (for
example, the mobilization of the scapular cingulate
and the vertebral axis), to favor the above-mentioned
exercises.
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Citation: Perrotta G (2020) Dysarthria: Defi nition, clinical contexts, neurobiological profi les and clinical treatments. Arch Community Med Public Health 6(2): 142-145.
DOI: https://dx.doi.org/10.17352/2455-5479.000094
Some exercises that are proposed concern precisely these
critical elements [17,18]:
A) Sit or lie down in a comfortable position and close your
eyes: try to perceive your breathing: where it happens, how
strong it is; leave your breathing calm, do not force it; try to
perceive what the individual parts of the body are like: feet, legs,
seat, hands, arms, neck, belly, back, face; try to understand if
they are hot, cold, light, heavy, painful, tense, big, thin.
B) Sit on a chair with your feet fi rmly on the ground, place
your knees at 90 degrees and bring your pelvis back and forth
concentrating on the point of rotation.
C) Lift and lower your shoulders; lift your shoulders and
drop them after 5 seconds; lift and lower one shoulder at a
time; push your shoulders forwards/backward; make circles
with your shoulders; push your chin towards your chest and
then return to a neutral position; bend your head to the right
and left-leaning on your shoulders; look over your right and
then your left shoulder; stretch your arms upwards; make your
hands and arms “shake”.
D) Lie down comfortably with a heavy book on your belly;
watch the book rise and fall with your breathing; put a hand on
your belly and try to perceive its movements while breathing;
inspire with your nose, hold your breath for a moment, then
slowly exhale through your mouth; inhale through your nose
and slowly exhale making a sssssss..., fffffff..., schschsch
(long); make s-s-s...,f-f-f...,sch-sch-sch (short); sing
melodies known by the “mmmm. “; blowing imagining to
extinguish many candles; imagining to inhale deeply with the
nose the scent of a rose; deeply inspiring and pronouncing a
prolonged vowel (ahhhh...ehhhh...ihhhh...ohhhh...uhhh) and
then stopping before the air ends.
E) Tighten the teeth strongly - all the muscles of the face
are activated; squeeze the eyes strongly - all the muscles of the
face are activated; alternate an angry expression by wrinkling
the forehead with a surprised expression by opening the eyes
wide and raising the eyebrows; massage the face; yawn.
F) Open and close the mouth showing the teeth; move the
jaw right / left; forward / backward; with the mouth open /
closed exaggerate chewing.
G) With closed lips: alternatively iron and make a circle
with the lips showing the teeth: alternatively iron and make a
circle with the lips; alternatively, pull the corner of the mouth
aside; whistle.
H) Swell the cheeks keeping the lips tight - no air should
come out; vacuum the cheeks to make them explode in a sound
kiss; move the air from one cheek to the other.
I) Alternatively pull out / bring the tongue back in; mouth
slightly open, push the tongue alternately left and right;
alternatively “clean” the upper lip than lower lip; with the
mouth open, lick the lips, changing the direction of the circle;
tongue towards the nose / the chin; clean the teeth with the
tongue; count the teeth with the tongue; massage the palate/
cheeks with the tongue; push the tip of the tongue (front, side,
top, bottom) against a spatula; snap with the tongue (like a
horse); press the tongue against the cheeks.
J) Gradually increase the volume by thinking about different
distances of the interlocutor using short sentences Es: How’s
it going? Be good! Come here! All right! You answer it! It’s not
time. Is it ready?; vary the intensity of the vowels; vary the
frequency of the vowels; go up and down in frequency with
a “mhhh”; sound chewing; associate the /tr/ to the vowels,
keeping them as stable as possible; practice the strongest
phonetic attacks; practice the softer attacks by placing nasal
sounds in front (m/n).
K) Emphasize the keyword in a sentence; lower or increase
the tone of voice, “play” with questions and answers; slow
down the eloquence by spelling out the words starting from
short words to get to sentences; speak following the rhythm of
a metronome.
Etiology, the degree of neuropathy, the existence of
comorbidities, and individual response all play a role in
the effect that the disorder has on the individual’s quality
of life. The severity of the disorder is variable, from an
occasional diffi culty in articulating the verbal language to
a completely incomprehensible speech; for this reason, it
is suggested to combine a specifi c cognitive-behavioral or
strategic psychotherapy with speech therapy [19], also because
dysarthria in itself, as a pathological state, in its clinical sense
may be able to negatively affect other psychological conditions,
previous or concomitant, or feed the development of new
psychopathologies, more or less acute in the manifestations, as
happens in anxious states [20] and depressants [21], in post-
traumatic stress events [22] caused by serious psychological
trauma [23], in panic attacks [24], in sleep disturbances on a
psychosomatic basis [25], in obsessive disorders-compulsive
[26] and psychopathological personality disorders in general.
Dysarthria is also one of the causes that increases suicidal risk
[27], especially concerning the subjective value of language
for the patient. The best clinical approach is therefore the
combination of speech therapy, psychotherapy, and targeted
pharmacological techniques [1,2,4].
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Citation: Perrotta G (2020) Dysarthria: Defi nition, clinical contexts, neurobiological profi les and clinical treatments. Arch Community Med Public Health 6(2): 142-145.
DOI: https://dx.doi.org/10.17352/2455-5479.000094
Copyright: © 2020 Perrotta G. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
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