Paediatric dysarthria

Question 1

What are the subsystems of speech? (5)

Answer 1

1. Respiration
2. Phonation
3. Articulation
4. Resonance
5. Prosody

Question 2

What is dysarthria? (3)

Answer 2

• 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

Question 3

What causes dysarthria in children?

Answer 3

TBI, cerebral palsy, cortical malformations, metabolic conditions, genetic conditions, etc

Question 4

Two things to determine to diagnose dysarthria (paeds)

Answer 4

1. Disturbance in tone associated with CNS/PNS damage
2. Perceptually detectable speech deficits in connected speech in line with neuromotor disturbance

Question 5

How to assess for paediatric dysarthria (4)

Answer 5

• 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,

Question 6

What to look for in OPE for paediatric dysarthria

Answer 6

Weakness, spasticity, fluctuating tone, incoordination or involuntary movements can cause:
- Asymmetry
- Altered strength
- Altered range
- Altered rate
- Altered smoothens of movement
of the articulators

Question 7

What are the limitations of the Mayo Clinic Dysarthria Classification for paediatric dysarthria? (3)

Answer 7

• 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

Question 8

What are the benefits of the Mayo Clinic Dysarthria Classification for paediatric dysarthria? (4)

Answer 8

• 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

Question 9

Paediatric dysarthria assessment - decision making (6)

Answer 9

1. Summarise assessment observations
2. Clinical hypotheses as to why (eg. nasality = velopharyngeal?)
3. Continue assessment where necessary (eg. instrumental)
4. Relative contributions of motor vs linguistic or cognitive deficits
5. Overall strengths/weaknesses of motor system in different contexts
6. Identify aspects of impairment where change is most possible

Question 10

Neural basis of paediatric dysarthria

Answer 10

• 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

Question 11

Findings from Cochrane review - Speech therapy for children with dysarthria acquired before 3 years of age

Answer 11

• 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

Question 12

What are the motor learning principles?

Answer 12

A set of processes associated with practice or experience leading to relatively permanent changes in the capability for movement

Question 13

Therapy approaches for paediatric dysarthria

Answer 13

1. LSVT
2. Speech Systems Approach

Question 14

What is LSVT LOUD for childhood dysarthria?

Answer 14

• Approach considers neuroplasticity and PMLs
• Intensive
• Adapted from LSVT used in PD
• Used in children with dysarthria associated with CP
  Target = healthy vocal loudness

Question 15

Delivery of LSVT LOUD for childhood dysarthria

Answer 15

• 4x 1hr sessions per week for 4 weeks, =16 sessions
• Delivered by LSVT certified clinicians
• Structured homework and carryover exercises every day

1. Maximum performance tasks (long/high/low ‘ahh’): enhance respiratory-laryngeal strength, coordination, endurance, quality
2. Speech hierarchy exercises and functional phrases: chosen by child, to shift function into daily comm, goals different for each child

Question 16

Goals for LSVT LOUD sessions to challenge motor system, increase task complexity

Answer 16

• Reducing verbal/visual cueing
• Reduce modelling
• Adding dual cognitive loads (eg.solving a maths problem while using target voice)
• Adding dual motor tasks (eg. walking while talking)
• Increased vocal length and endurance
• Adding environmental distractors (eg. background noise)

Question 17

What is the Speech Systems approach/Speech Systems Intelligibility Treatment (SSIT) for childhood dysarthria?

Answer 17

• Improve intelligibility by helping control breathing, provide steady support for speech across sentences
• Follows PMLs

Focus on 3 key areas:
1. Maintaining adequate volume
2. ‘Chunking’ speech into phrases if breath support can’t be maintained
3. Slowing speech, esp if child is rushing sentences as they run out of air

Question 18

Service delivery of SSIT for childhood dysarthria

Answer 18

• 3x 40-45min sessions per week for 6 week = 18 sessions
• How child is taught depends on their individual subsystems affected

Initial session
- Discuss importance of breathing
- Clinician models good comm
- Assess child’s sustained sounds
- Measure dB
- Decide 10 phrases to use in therapy
- Name their voice ‘big voice/strong voice’

Subsequent sessions
- Establish voice with /ah/
- Practice their phrases
- Practice their voice in hierarchical exercises

Question 19

Future directions for childhood dysarthria interventions

Answer 19

• Speech Systems approach via Telehealth
• Home-based therapies
• Singing-based therapy