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Dysarthria and Dysphasia

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Definitions

Epidemiology

Dysarthria

Dysphasia

References

PatientPlus articles are written by ! doctors and are based on research e"idence# !

and European $uidelines% They are designed for health professionals to use# so youmay find the language more technical than thecondition leaflets%

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&ee also' (phasia written for patients

Dysarthria is a disorder of speech whilst dysphasia is a disorder of language%

&peech is the process of articulation and pronunciation% )t in"ol"es the bulbar

muscles and the physical ability to form words%

Language is the process in which thoughts and ideas become spoken% )t in"ol"es

the selection of words to be spoken# called semantics# and the formulation of

appropriate sentences or phrases# called synta*%

DefinitionsDysarthria is a speech disorder caused by disturbance of muscular control% Dysphasia

+also called aphasia, is an impairment of language% They often co-e*ist%

&trictly speaking# the words anarthria and aphasia mean a total absence of ability to

form speech or language but they are often used when dysarthria and dysphasia would

be more correct% )n particular# dysphasia and aphasia are used interchangeably# with

aphasia in more common use%

Dysphasia can be recepti"e or e*pressi"e% Recepti"e dysphasia is difficulty in

comprehension# whilst e*pressi"e dysphasia is difficulty in putting words together to

make meaning% )n reality there is usually considerable o"erlap of these conditions but a

person who has pure dysarthria without dysphasia would be able to read and write as

normal and to make meaningful gestures# pro"ided that the necessary motor pathways

are intact%

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(pra*ia of speech is different to both dysphasia and dysarthria# and is the loss of ability

to plan and e*ecute the oral motor tasks needed in order to speak%./0

)nability to write is agraphia or dysgraphia if incomplete% )nability to manipulate numbers

is acalculia or dyscalculia if incomplete% Difficulty reading is dysle*ia%

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"oinant heisphere

The speech area is in the left# dominant side of the brain in about 112 of right-handed

people% The remaining /2 may represent inherent left-handers who ha"e been forced to

write with their right% )n left-handed people# the right hemisphere is the dominant side in

only 342% Thus impairment of the speech area with a stroke# causing left-sided

weakness# is rare% )t will occur in "irtually no right-handers and in only 342 of left-

handers%

(s a general rule# a lesion of the left hemisphere will cause dysphasia whilst# in the right

hemisphere# it will cause neglect# "isuo-spatial and cogniti"e problems%.50

Epidemiology

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The aetiology is damage or disease of the brain and so it is most common with

ad"ancing age% Disease is usually "ascular# neoplastic or degenerati"e% (round 672 of

cases arise from strokes and around a third of people who ha"e strokes will ha"e

dysphasia%.30)n younger people it is usually a result of head in8ury%

Dysarthria

Causes of dysarthria

Dysarthria is caused by upper motor neurone lesions of the cerebral hemispheres or

lower motor neurone lesions of the brain stem% )t also results from disruption to the

integrated action of upper motor neurones# basal ganglia and cerebellum%

#eatures of dysarthria

There may be some "ariation depending upon the site of the lesion

&lurred and weak articulation with a weak "oice is typical of pseudobulbar palsy

from a stroke% 9ther neurological signs are usually unilateral with a right-sided

hemiplegia +left side of brain,% )t may be on the left in a minority of left-handers%

Brain stem stroke may lead to bilateral signs with dysarthria or anarthria%

&lurred# scanning and staccato speech caused by cerebellar lesions is typical

ofmultiple sclerosis%

( dysrhythmic# dysphonic and monotonous "oice is caused by disease of the

e*trapyramidal system in Parkinson:s disease%;o"ement is rigid and stiff in

Parkinson:s disease and that includes phonation%

)ndistinct articulation# hypernasality and bilateral weakness caused by lower

motor neurone disorders can occur with motor neurone disease%

$anageent of dysarthria

&peech and language therapy is re

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taught techni

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damage the semantic content of language while lea"ing the language production

function intact% The conse

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E/aining patients ith dysphasia

Tests for recepti"e dysphasia may include asking patients to read words or a passage%

They are then asked to e*plain words or the passage% =omprehension of spoken

material is assessed by asking the patient to listen to a passage and e*plain it or#

alternati"ely# by asking them to follow certain instructions such as# point to the door%

Tests for e*pressi"e dysphasia include'

(sking the patient to name a series of ob8ects and some of their parts% For

e*ample# ask the patient# @hat is thisC# pointing to a pen# your tie and watch in

turn% Then ask# @hat part of the watch is thisC# pointing to the strap and then the

face or hands%

)f language is limited then dysphasia may be tested by holding up a pen and

asking# )s this a penC )f the patient says# es# then point to your watch and ask#

)s this a penC This demands a different reply% Look out for difficulty in finding the

right word and perse"eration% This is inappropriate repetition of the same word or

phrase%

=an the patient talk spontaneously on a familiar topicC Tell me about your

family% Tell me about the work you used to do%

=an the patient count numbers or recite days of the weekC @rite a brief dictated

passageC @rite a brief spontaneous passageC =opy a short passageC

(ll tests of literacy and numeracy must be interpreted in the light of premorbid function

For e*ample# impairment in numeracy in a former accountant probably represents a

substantial decline%

$anageent of dysphasiaReferral to speech and language therapy is the usual practice for dysphasia where a

thorough assessment of the nature of the problem is followed by e*ercises to encourage

the reco"ery of fluent speech and understanding% Therapy tends to be tailored to the

needs of the indi"idual patient% The "alue of these inter"entions has been assessed by a

number of =ochrane re"iews% The most recent concluded that speech and language

therapy was effecti"e in impro"ing communication# but that there was not enough

e"idence to discern which particular type of therapy to recommend%.70

*rognosis

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Dysphasiaaphasia may ha"e a se"ere# debilitating effect on the e"eryday life of the

patient% &e"ere dysphasias are likely to show little impro"ement but other forms can

show rapid impro"ement% The probability of reco"ery following trauma is higher than

following stroke% Prognosis for the reco"ery of linguistic function "aries enormously and

is difficult to predict as it is affected by many factors%.0There is a possibility that some

drugs may enhance the ability to learn and hence to reco"er language after a stroke but

this is still "ery much in the e*perimental stage and there are no large trials or re"iews% .G0

.60

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