Paediatric dysarthria Flashcards
What are the subsystems of speech? (5)
- Respiration
- Phonation
- Articulation
- Resonance
- Prosody
What is dysarthria? (3)
- Neurological disorder resulting in disorder to the neuromuscular execution of speech
- Impairment in one or more of the speech subsystems
- Impacts naturalness/intelligibility of the speaker
What causes dysarthria in children?
TBI, cerebral palsy, cortical malformations, metabolic conditions, genetic conditions, etc
Two things to determine to diagnose dysarthria (paeds)
- Disturbance in tone associated with CNS/PNS damage
- Perceptually detectable speech deficits in connected speech in line with neuromotor disturbance
How to assess for paediatric dysarthria (4)
- OPE
- Rate conversational speech with Mayo Clinic Paediatric Dysarthria Scale
- Frenchay Dysarthria Assessment if >12y
- Intelligibility assessment, eg. GFTA-2 intelligibility rating, PCC/PWC/PPC from DEAP,
What to look for in OPE for paediatric dysarthria
Weakness, spasticity, fluctuating tone, incoordination or involuntary movements can cause:
- Asymmetry
- Altered strength
- Altered range
- Altered rate
- Altered smoothens of movement
of the articulators
What are the limitations of the Mayo Clinic Dysarthria Classification for paediatric dysarthria? (3)
- Child brain is plastic so what might correspond to a certain type of dysarthria in adults might not be accurate for children as their brains are not fully developed
- Most basic level re: the neural basis of dysarthria
- Based on neuroimaging and regions, not networks
What are the benefits of the Mayo Clinic Dysarthria Classification for paediatric dysarthria? (4)
- Evidence-based
- Ease of use
- Able to perceptually determine the possible level/s of physiological breakdown of the motor speech system
- Help in treatment target selection
Paediatric dysarthria assessment - decision making (6)
- Summarise assessment observations
- Clinical hypotheses as to why (eg. nasality = velopharyngeal?)
- Continue assessment where necessary (eg. instrumental)
- Relative contributions of motor vs linguistic or cognitive deficits
- Overall strengths/weaknesses of motor system in different contexts
- Identify aspects of impairment where change is most possible
Neural basis of paediatric dysarthria
- Can arise from lesions at various levels along speech motor tracts from primary motor cortex to basal ganglia to cerebellum, corticospinal or corticobulbar tracts
- Greater risk for dysarthria when there is bilateral involvement of speech motor pathways
- May arise with unilateral involvement but less severely, more evidence needed here
Findings from Cochrane review - Speech therapy for children with dysarthria acquired before 3 years of age
- Primary outcome = intelligibility
- Secondary outcomes = speech features, QOL, cost, tx satisfaction, adverse effects
- Looked at long term and short term outcomes
- Interventions that follow principles of motor learning may increase speech intelligibility, voice quality and clarity
What are the motor learning principles?
A set of processes associated with practice or experience leading to relatively permanent changes in the capability for movement
Therapy approaches for paediatric dysarthria
- LSVT
- Speech Systems Approach
What is LSVT LOUD for childhood dysarthria?
- Approach considers neuroplasticity and PMLs
- Intensive
- Adapted from LSVT used in PD
- Used in children with dysarthria associated with CP
Target = healthy vocal loudness
Delivery of LSVT LOUD for childhood dysarthria
- 4x 1hr sessions per week for 4 weeks, =16 sessions
- Delivered by LSVT certified clinicians
- Structured homework and carryover exercises every day
- Maximum performance tasks (long/high/low ‘ahh’): enhance respiratory-laryngeal strength, coordination, endurance, quality
- Speech hierarchy exercises and functional phrases: chosen by child, to shift function into daily comm, goals different for each child
