n

difficulty in articulating words due to disease of the central nervous system　(⇔dysphasia)

Dysarthriaはかつては構音器官のレベルで生じる不完全な構音articulationの障害と定義された。しかし、その後、発声発語器官全体の(あるいはいずれかの)レベルで生じるspeechの障害として拡大して理解されるようになり、現在では広く共通の理解に至っている。すなわち、dysarthriaを「構音の障害」としてとらえる解釈は古典的定義であり、「speechの障害」としてとらえる解釈は今日の正しい定義である。(かつてわれわれはDysarthriaを「構音障害」と呼んでいた、といえる新たなる時代を迎えよう:小島氏への異論西尾正輝　より抜粋)

WordNet

impaired articulatory ability resulting from defects in the peripheral motor nerves or in the speech musculature
an impairment of language (especially speech production) that is usually due to brain damage
partial or total loss of articulate speech resulting from lesions of the central nervous system

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/05 13:01:38」(JST)

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[Wiki en表示]

Dysarthria (from Ancient Greek δυσ- dys, "hard, difficult, bad" and ἄρθρωσις arthrosis, "articulation") is a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system^[1] and is characterized by poor articulation of phonemes (cf. aphasia: a disorder of the content of language).^[2] In other words, it is a condition in which problems effectively occur with the muscles that help produce speech, often making it very difficult to pronounce words. It is unrelated to any problem with understanding cognitive language.^[3] Any of the speech subsystems (respiration, phonation, resonance, prosody, and articulation) can be affected, leading to impairments in intelligibility, audibility, naturalness, and efficiency of vocal communication.^[4]

Dysarthria that has progressed to or presents as a total loss of speech may be referred to as anarthria.

Neurological injury due to damage in the central or peripheral nervous system may result in weakness, paralysis, or a lack of coordination of the motor-speech system, producing dysarthria.^[1] These effects in turn hinder control over the tongue, throat, lips or lungs for example; swallowing problems (dysphagia) are also often present.

The term dysarthria does not include speech disorders from structural abnormalities, such as cleft palate, and must not be confused with apraxia of speech, which refers to problems in the planning and programming aspect of the motor-speech system.^[4]

Cranial nerves that control these muscles include the trigeminal nerve's motor branch (V), the facial nerve (VII), the glossopharyngeal nerve (IX), the vagus nerve (X), and the hypoglossal nerve (XII).

Classification

Dysarthrias are classified in multiple ways based on the presentation of symptoms. Specific dysarthrias include spastic (resulting from bilateral damage to the upper motor neuron), flaccid (resulting from bilateral or unilateral damage to the lower motor neuron), ataxic (resulting from damage to cerebellum), unilateral upper motor neuron (presenting milder symptoms than bilateral UMN damage), hyperkinetic and hypokinetic (resulting from damage to parts of the basal ganglia, such as in Huntington's disease or Parkinsonism), and the mixed dysarthrias (where symptoms of more than one type of dysarthria are present). The majority of dysarthric patients are diagnosed as having 'mixed' dysarthria, as neural damage resulting in dysarthria is rarely contained to one part of the nervous system — for example, multiple strokes, traumatic brain injury, and some kinds of degenerative illnesses (such as amyotrophic lateral sclerosis) usually damage many different sectors of the nervous system.

Ataxic dysarthria is an acquired neurological and sensorimotor speech deficit. It is a common diagnosis among the clinical spectrum of ataxic disorders.^[5] Since regulation of skilled movements is a primary function of the cerebellum, damage to the superior cerebellum and the superior cerebellar peduncle is believed to produce this form of dysarthria in ataxic patients.^[6] Growing evidence supports the likelihood of cerebellar involvement specifically affecting speech motor programming and execution pathways, producing the characteristic features associated with ataxic dysarthria. This link to speech motor control can explain the abnormalities in articulation and prosody, which are hallmarks of this disorder.^[7] Some of the most consistent abnormalities observed in patients with ataxia dysarthria are alterations of the normal timing pattern, with prolongation of certain segments and a tendency to equalize the duration of syllables when speaking. As the severity of the dysarthria increases, the patient may also lengthen more segments as well as increase the degree of lengthening of each individual segment.^[8]

Common clinical features of ataxic dysarthria include abnormalities in speech modulation, rate of speech, explosive or scanning speech, slurred speech, irregular stress patterns, and vocalic and consonantal misarticulations.^[9]^[10]

Dysarthria may affect a single system; however, it is more commonly reflected in multiple motor-speech systems. The etiology, degree of neuropathy, existence of co-morbidities, and the individual's response all play a role in the effect the disorder has on the individual's quality of life. Severity ranges from occasional articulation difficulties to verbal speech that is completely unintelligible.^[1]

Individuals with dysarthria may experience challenges in the following:

Timing
Vocal quality
Pitch
Volume
Breath control
Speed
Strength
Steadiness
Range
Tone^[1]^[4]

Examples of specific observations include a continuous breathy voice, irregular breakdown of articulation, monopitch, distorted vowels, word flow without pauses, and hypernasality.^[4]

Causes

The causes of dysarthria can be many, including toxic, metabolic, degenerative diseases (such as parkinsonism, ALS, Huntington's disease, Niemann-Pick disease, ataxia etc.), traumatic brain injury, or thrombotic or embolic stroke. These result in lesions to key areas of the brain involved in planning, executing, or regulating motor operations in skeletal muscles (i.e. muscles of the limbs), including muscles of the head and neck (dysfunction of which characterises dysarthria). These can result in dysfunction, or failure of: the motor or somatosensory cortex of the brain, corticobulbar pathways, the cerebellum, basal nuclei (consisting of the putamen, globus pallidus, caudate nucleus, substantia nigra etc.), brainstem (from which the cranial nerves originate), or the neuro-muscular junction (in diseases such as myasthenia gravis) which block the nervous system's ability to activate motor units and effect correct range and strength of movements.

Causes:

Brain tumor
Cerebral palsy
Guillain-Barre syndrome
Head injury
Hypothermia
Lyme disease
Multiple sclerosis
Parkinson's disease
Stroke
Wilson's disease
Intracranial hypertension (formerly known as pseudotumor cerebri)
Tay-Sachs, and late onset Tay-Sachs (LOTS), disease
Central pontine myelinolysis

Treatment

Articulation problems resulting from dysarthria are treated by speech language pathologists, using a variety of techniques. Techniques used depend on the effect the dysarthria has on control of the articulators. Traditional treatments target the correction of deficits in rate (of articulation), prosody (appropriate emphasis and inflection, affected e.g. by apraxia of speech, right hemisphere brain damage, etc.), intensity (loudness of the voice, affected e.g. in hypokinetic dysarthrias such as in Parkinson's), resonance (ability to alter the vocal tract and resonating spaces for correct speech sounds) and phonation (control of the vocal folds for appropriate voice quality and valving of the airway). These treatments have usually involved exercises to increase strength and control over articulator muscles (which may be flaccid and weak, or overly tight and difficult to move), and using alternate speaking techniques to increase speaker intelligibility (how well someone's speech is understood by peers). With the speech language pathologist, there are several skills that are important to learn; safe chewing and swallowing techniques, avoiding conversations when feeling tired, repeat words and syllables over and over in order to learn the proper mouth movements, and techniques to deal with the frustration while speaking. Depending on the severity of the dysarthria, another possibility includes learning how to use a computer or flip cards in order to communicate more effectively.^[3]

More recent techniques based on the principles of motor learning (PML), such as LSVT (Lee Silverman voice treatment)^[11] speech therapy and specifically LSVT may improve voice and speech function in PD.^[12] For Parkinson's, aim to retrain speech skills through building new generalised motor programs, and attach great importance to regular practice, through peer/partner support and self-management. Regularity of practice, and when to practice, are the main issues in PML treatments, as they may determine the likelihood of generalization of new motor skills, and therefore how effective a treatment is.

Augmentative and alternative communication (AAC) devices that make coping with a dysarthria easier include speech synthesis and text-based telephones. These allow people who are unintelligible, or may be in the later stages of a progressive illness, to continue to be able to communicate without the need for fully intelligible speech.

References

^ ^a ^b ^c ^d O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company. ^{[page needed]}
^ Duffy, Joseph (2005). Motor Speech Disorders: Substrates, Eifferential Eiagnosis, and Management. St. Louis, Mo: Elsevier Mosby. ISBN 0323024521.
^ ^a ^b "Dysarthria". PubMed Health.
^ ^a ^b ^c ^d MacKenzie, C (2011). "Dysarthria in stroke: A narrative review of its description and the outcome of intervention". International Journal of Speech-Language Pathology 13 (2): 125–36. doi:10.3109/17549507.2011.524940. PMID 21480809.
^ Eigentler, A; Rhomberg, J; Nachbauer, W; Ritzer, I; et al. (2011). "The scale for the assessment and rating of ataxia correlates with dysarthria assessment in Friedreich's ataxia". Journal of Neurology 259 (3): 420–6. doi:10.1007/s00415-011-6192-9. PMID 21805332.
^ Caplan, Louis R. (2012). "Ataxia in Patients with Brain Infarcts and Hemorrhages". In Subramony, Sankara H.; Dürr, Alexandra. Ataxic Disorders. Handbook of Clinical Neurology 103. pp. 147–60. doi:10.1016/B978-0-444-51892-7.00008-5. ISBN 978-0-444-51892-7. PMID 21827886.
^ Spencer, K; Slocomb, D (2007). "The neural basis of ataxic dysarthria". The Cerebellum 6 (1): 58–65. doi:10.1080/14734220601145459. PMID 17366266.
^ Kent, RD; Netsell, R; Abbs, JH (September 1979). "Acoustic characteristics of dysarthria associated with cerebellar disease". J Speech Hear Res 22 (3): 627–48. PMID 502519.
^ Ogawa, K; Yoshihashi, H; Suzuki, Y; Kamei, S; et al. (2010). "Clinical study of the responsible lesion for dysarthria in the cerebellum". Internal Medicine 49 (9): 861–4. doi:10.2169/internalmedicine.49.2913. PMID 20453409.
^ Wang, Y-T; Kent, RD; Duffy, JR; Thomas, JE (2009). "Analysis of Diadochokinesis in Ataxic Dysarthria Using the Motor Speech Profile Program™". Folia Phoniatrica et Logopaedica 61 (1): 1–11. doi:10.1159/000184539. PMC 2790744. PMID 19088478.
^ Fox, C; Ramig, L; Ciucci, M; Sapir, S; et al. (2006). "The Science and Practice of LSVT/LOUD: Neural Plasticity-Principled Approach to Treating Individuals with Parkinson Disease and Other Neurological Disorders". Seminars in Speech and Language 27 (4): 283–99. doi:10.1055/s-2006-955118. PMID 17117354.
^ The National Collaborating Centre for Chronic Conditions, ed. (2006). "Other key interventions". Parkinson's Disease. London: Royal College of Physicians. pp. 135–46. ISBN 1-86016-283-5.

External links

Online Speech and Voice Disorder Support (VoiceMatters.net)
American Speech-Language-Hearing Association
News About Dysarthria

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における詳細な神経学的検査 the detailed neurologic examination in adults
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English Journal

Effect of edaravone on acute brainstem-cerebellar infarction with vertigo and sudden hearing loss.

Inoue Y1, Yabe T2, Okada K2, Nakamura Y2.Author information 1Department of Otolaryngology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan. Electronic address: inoue-yuta@hotmail.co.jp.2Department of Otolaryngology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.AbstractWe report 2 cases with acute brainstem and brainstem-cerebellar infarction showed improvement of their signs and symptoms after administration of edaravone. Case 1, a 74-year-old woman who experienced sudden vertigo, also had dysarthria and left hemiplegia. Magnetic resonance imaging (MRI) showed an abnormal region in the right ventrolateral medulla oblongata. The patient's vertigo and hemiplegia improved completely after treatment. Case 2, a 50-year-old man who experienced sudden vertigo and sensorineural hearing loss (SNHL), developed dysarthria after admission. MRI revealed acute infarction in the right cerebellar hemisphere. Magnetic resonance angiography revealed dissection of the basilar artery and occlusion of the right anterior inferior cerebellar artery. The patient's vertigo and hearing remarkably improved. We have described 2 patients whose early symptoms were vertigo and sudden SNHL, but who were later shown to have ischemic lesions of the central nervous system. Edaravone is neuroprotective drug with free radical-scavenging actions. Free radicals in the ear are responsible for ischemic damage. Edaravone, a free radical scavenger, may be useful in the treatment of vertigo and SNHL.
Auris, nasus, larynx.Auris Nasus Larynx.2014 Jun;41(3):303-6. doi: 10.1016/j.anl.2013.10.001. Epub 2013 Oct 28.
We report 2 cases with acute brainstem and brainstem-cerebellar infarction showed improvement of their signs and symptoms after administration of edaravone. Case 1, a 74-year-old woman who experienced sudden vertigo, also had dysarthria and left hemiplegia. Magnetic resonance imaging (MRI) showed an
PMID 24176488

The safety and efficacy of thalamic deep brain stimulation in essential tremor: 10 years and beyond.

Baizabal-Carvallo JF1, Kagnoff MN, Jimenez-Shahed J, Fekete R, Jankovic J.Author information 1Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, , Houston, Texas, USA.AbstractBACKGROUND: Deep brain stimulation (DBS) has proven to be a safe and effective therapy for refractory essential tremor, but information regarding long-term outcomes is lacking.
Journal of neurology, neurosurgery, and psychiatry.J Neurol Neurosurg Psychiatry.2014 May;85(5):567-72. doi: 10.1136/jnnp-2013-304943. Epub 2013 Oct 4.
BACKGROUND: Deep brain stimulation (DBS) has proven to be a safe and effective therapy for refractory essential tremor, but information regarding long-term outcomes is lacking.OBJECTIVES: We aimed to assess the long-term safety and efficacy of DBS in patients with essential tremor.METHODS: Patients
PMID 24096713

Use of the extended therapy outcome measure for children with dysarthria.

Enderby P.Author information University of Sheffield , Sheffield , UK.AbstractIncreasing demand on healthcare resources has led to a greater emphasis on the examination of the impact of service delivery on outcomes. Clinical assessments frequently do not cover all aspects of change associated with interventions for those with complex conditions. This paper reviews the need for more comprehensive outcome measurement suitable for clinical practice and benchmarking. It describes an extension of the Therapy Outcome Measure for specific use in reflecting the impact of the broad range of interventions commonly required when managing children with dysarthria. Three case histories are used to illustrate the approach, and data from four speech-language pathology services are used to illustrate the value of benchmarking.
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A Case of Cerebellar Ataxia Associated with HIV Infection.

Anand KS1, Wadhwa A, Garg J.Author information 1Department of Neurology, DR R.M.L. Hospital, New Delhi, India.AbstractCerebellar complications of HIV infection primarily manifested in ataxia, usually arise as the result of cerebellar lesions due to opportunistic infections, vasculitis or neoplastic processes. A 28 year old female known to have HIV infection for last four years, presented to our hospital with progressive unsteadiness in walking, slurring of speech and intention tremors for the last two months. There was no family history of similar complaints, and she was on Anti retroviral treatment for last one and a half years. The results of examination were notable for severe dysarthria, slow saccades, a conspicuous dysmetria and dysdiadokokinesia. She had no cognitive, sensory or motor deficits. MRI revealed diffuse cerebellar atrophy. Extensive laboratory work up failed to disclose a cause for subacute ataxia. Isolated cerebellar degeneration in an HIV patient is rare and should prompt a diagnostic work up.
Journal of the International Association of Providers of AIDS Care.J Int Assoc Provid AIDS Care.2014 Apr 23. [Epub ahead of print]
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Japanese Journal

Dysarthria 例の発話速度調節訓練に影響を与える要因の一考察(第1報)

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Related Pictures

★リンクテーブル★

リンク元	「100Cases 13」「小脳」「構音障害」「dysphasia」「anarthria」
拡張検索	「spastic dysarthria」

「100Cases 13」

Dysarthria
Classification and external resources
Specialty	Neurology
ICD-10	R47.1
ICD-9-CM	784.5
DiseasesDB	4015
MedlinePlus	007470
MeSH	D004401

　　[★]

☆case13　手の筋力の低下

■glossary

brisk adj. (人・態度が)活発な、元気のよい、きびきびした。ぶっきらぼうな、素っ気ない。(商売が)活況の(⇔dull)。小気味のよい、(大気など)爽快な、気持ちのよい。(味などが)ピリッとする。鋭い。(飲料が)盛んに泡立つ

dysarthria n. difficulty in articulating words due to disease of the central nervous system　構音障害

dysphasia n. loss of or deficiency in the power to use or understand language as a result of injury to or disease of the brain　失語症、言語障害

multidisciplinary adj. 集学的な

gastrostomy 胃瘻造設術

feeding gastrostomy n. Surgery A procedure in which an opening is created in the anterior wall of the stomach to allow suction decompression and improved respiratory function by eliminating the need for a nasogastric feeding tube

■症例

67歳、男性　元大学講師(retired university lecturer)

主訴：左手の筋力低下と筋萎縮

現病歴：左手を使った労作後に左手の筋力が低下する(例えば、ドライバーを使った後など)。前腕の筋に疝痛をみとめる。発話はわずかに流暢であり(slight slurred)、水を飲んだあとで窒息しだす。服用薬はシンバスタチン、アスピリン、アテノロール。喫煙はしない。飲酒は週にワインのボトルを1本あける。

既往歴：高血圧が15年間続いている。3年前に心筋梗塞。

家族歴：妻と暮らしている。大きくなった2人の子供がいる。

・診察 examination

　血圧：146/88 mmHg。心血管系、呼吸器系、腹部に異常を認めない。上肢に萎縮を認める。特に左手に著しい萎縮を認める。両側の上腕の筋にいくらか線維性筋攣縮を認める。筋力は左で全般的に低下(globaly reduced)、右手でわずかに低下。筋緊張は正常。上腕二頭筋反射・上腕三頭筋反射は両側ともに活発に認められる(brisk)。感覚喪失(sensory loss)は認めない。わずかに構音障害を認める

■キーワード＆着目するポイント

　筋萎縮、線維性筋攣縮、感覚喪失なし

■解説

(第1パラグラフ)　疫学

・この男は運動ニューロン疾患。

・この疾患は原因不明の疾患で、脊髄、脳神経核、運動皮質に影響を及ぼす。

・この病気は普通50-70歳で出現する。

(第2パラグラフ) 症状

・筋力低下と筋萎縮は一側の手か腕にあらわれるのが一般的　←　両側性でないということか。

・筋力低下は運動後に最も顕著に表れる

・前腕の疝痛は疾患の初期に一般的である。

・患者は下肢の筋力低下あるいは構音障害や言語障害を訴えてやってくることがある。