1/13. Progressive dysarthria. case reports and a review of the literature.Two patients presenting with progressive dysarthria as the single initial manifestation of a neurodegenerative condition are described. The nature of the dysarthria as well as the additional symptoms that developed in the course of the disorder are very different in these two cases. Nevertheless, neuroimaging findings are strikingly similar and suggest bilateral involvement of posterior inferior frontal lobe structures, mainly in the dominant cerebral hemisphere. The clinical syndrome of these patients can therefore be considered an example of frontotemporal degeneration presenting without dementia or compartmental alteration, at least in the early stages. This broadens the clinical spectrum of frontotemporal degeneration and demonstrates the need for a syndromal subclassification of this nosological entity.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/13. dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour.The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/13. Differential motor speech outcomes in children treated for mid-line cerebellar tumour.PRIMARY OBJECTIVE: To investigate the nature of the motor speech impairments and dysarthria that can arise subsequent to treatment for childhood mid-line cerebellar tumours (CMCT). research design: The motor speech ability of six cases of children with CMCT was analysed using perceptual and physiological measures and compared with that of a group of non-neurologically impaired children matched for age and sex. MAIN OUTCOME AND RESULTS: Three of the children with CMCT were perceived to exhibit dysarthric speech, while the remaining three were judged to have normal speech. The speech disorder in three of the children with CMCT was marked by deviances in prosody, articulation and phonation. The underlying pathophysiology was linked to cerebellar damage and expressed as difficulty in co-ordinating the motor speech musculature as required for speech production. These deficits were not identified in the three non-dysarthric children with CMCT. CONCLUSION: Differential motor speech outcomes occur for children treated for CMCT and these are discussed within the realm of possible mechanisms responsible for these differences. The need for further investigation of the risk factors for development of motor speech impairment in children treated for CMCT is also highlighted.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/13. Speech deterioration in amyotrophic lateral sclerosis: a case study.Few detailed reports have been published on the nature of speech and voice changes during the course of amyotrophic lateral sclerosis (ALS). The subject of this case study is a woman who was diagnosed as having ALS with bulbar signs at the age of 53. speech intelligibility, pulmonary function, and selected speech and voice functions were tested during an approximately 2-year course of her disease. Over this period, her speech intelligibility, as measured by a multiple-choice word identification test, declined from 98% to 48%. Phonetic features that were most affected during the intelligibility decline included voicing contrast for syllable-initial and syllable-final consonants, place of articulation contrasts for lingual consonants, manner of articulation for lingual consonants, stop versus nasal manner of production, features related to the liquid consonants, and various features related to syllable shape. An acoustic measure, average slope of the second-formant frequency, declined in association with the intelligibility reduction and is thought to reflect the loss of lingual motoneurons. Her pulmonary function also declined over the observation interval, with particularly severe reduction in measures of air flow. Oral diadochokinesis and measures of vocal function (including jitter, shimmer, and signal-to-noise ratio) were highly variable across test sessions. These results are discussed in terms of the challenges they present to sensitive assessment of change and to management of the communication disability in ALS.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/13. Neurogenic stuttering as a manifestation of stroke and a mask of dysphonia.R. L. was a 52-year-old man who was referred for an SLP consultation to determine the nature of his fluency disorder, whether or not treatment would be beneficial, and finally whether resumption of pre-trauma vocational status was feasible. The patient was involved in a motor vehicle accident with no resulting detectable trauma. However, shortly after the accident, R. L. developed a severe dysfluency that was later described as cortical stuttering. We reviewed the medical and rehabilitation work-up that attempted to determine whether the communication disorder was functional or organic in origin. Once the fluency disorder was determined to be caused by a suspected small, focal, hemispheric lesion, a five-month treatment program was undertaken that used a noval prosthetic approach to restore fluency. Once fluency was restored with the use of an artificial larynx, a residual anomia was detected and treated. The case of R. L. illustrates a stuttering that appeared to be caused by a combined neurogenic dyspraxic (vocal control), dysarthric (motor control), and dysnomic (word-finding) dysfluency. The literature on this issue was reviewed and the underlying mechanism of recovery was discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/13. Ramp-and-hold force control in the upper and lower lips: developing new neuromotor assessment applications in traumatically brain injured adults.The relation among several parameters of the ramp-and-hold force contraction and target force level was quantified for the upper and lower lip in 40 normal adults and in 4 young adults who had sustained traumatic brain injury (TBI). Using visual feedback, subjects produced ramp-and-hold compression lip forces as rapidly and accurately as possible to end-point target levels ranging from 0.25 to 2.00 newtons. In normal adults, significant positive linear relations were found between the parameters of the ramp-and-hold lip force task and target force level, including the peak rate of force change, peak force, and the mean and standard deviation of force during the hold phase. Though males and females have been shown to differ greatly on absolute maximum force-generating capabilities, they are virtually identical on the measures used to quantify the lip force ramp-and-hold task over the range of compression forces studied. Preliminary investigation of lip force control in 4 TBI subjects suggests that these quantitative measures are useful in determining the distribution and nature of motor impairment between the upper and lower lips during a dynamic force control task.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/13. rehabilitation of communication impairment in dystonia musculorum deformans.Augmentative and alternative communication (AAC) aids were used in three young, intellectually normal patients with dystonia musculorum deformans (DMD) who had severe speech and writing impediments. These aids included speech therapy, communication boards, and voice synthesizers for verbal communication and typewriters, memowriters, and computer software and printers for written communication. At times customized accessing was needed which required specific adaptive modifications. Implementation of the AAC aids system was determined effective for DMD patients in view of the intellect-sparing nature of the disorder. Improvement was hampered by the progressive nature of the disease and by the emotional stress of accepting the long-term use of AAC. Correct and early diagnosis of communication impediments are crucial for the appropriate AAC aids prescription and implementation. An AAC protocol is suggested to meet the special communication needs of DMD patients.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
8/13. An instrumental phonetic study of lingual activity in articulation-disordered children.Traditional auditory-based assessment procedures for diagnosing articulation disorders are limited in that they provide no direct information on activities of the speech organs. In this study electropalatography (EPG) was used to obtain details of tongue contacts with the hard palate in 4 articulation-disordered children, 2 of whom had been categorized as dysarthric. Their lingual-palatal contact patterns during four repetitions of word lists containing lingual consonants in different phonetic environments, were compared with each other and with a group of normal speakers. EPG provided relevant diagnostic information in that all 4 experimental subjects showed patterns that differed from the normals in both spatial configuration and variability. The nature of their distorted patterns allowed a tentative diagnosis of 2 of the children as verbal dyspraxic.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/13. Progressive speech deterioration and dysphagia in amyotrophic lateral sclerosis: case report.amyotrophic lateral sclerosis (ALS) is a degenerative neurologic disease having both upper and lower motor neuron signs and symptoms. When the speech musculature is involved, a mixed dysarthria and dysphagia usually result. In a 49-year-old man with ALS, dysarthria and dysphagia progressed from mild to severe forms over 17 months. Eleven months after the patient first experienced symptoms, neurologic examination showed fasciculations of the extremities and tongue, limb weakness, and hyperreflexia of the limbs and velopharyngeal mechanism. tongue strength was one-fourth that of normal. Lingual alternate motions rates for consonant-vowel syllables were also reduced. To enhance lingual strength and swallowing, a tongue-strengthening program was developed for use with articulation training; to augment velopharyngeal function, a palatal lift was fitted; and to increase extremity strength, physical therapy was initiated. Six months after the initial neurologic examination, medical and speech reevaluation showed progressive weakness of the body parts affected initially; continued decline in tongue strength and lingual alternate motion rate; hypoactive reflex activity, indicative of progressive involvement of the lower motor neuron system; and continued deterioration of articulation and phonation owing to the progressive nature of the disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/13. dysarthria in adults: physiologic approach to rehabilitation.A case study is used to illustrate a physical approach to the speech rehabilitation of adults with dysarthria. The approach emphasizes the component-by-component analysis of the peripheral speech mechanism, where the selection and sequencing of treatment procedures follow directly from the physiologic nature and severity of involvement in each component. The selection and sequencing of procedures also are conditioned by the inherent physical interdependencies of these component parts. Several biofeedback procedures of our own are incorporated that have not been reported previously. The case illustration is of a young man injured in an auto accident whose speech intelligibility improves from approximately 5-10% to 95% during the rehabilitation period. Effects of treatment upon individual components of the speech mechanism are illustrated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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