STUDY - Technical - New Dacian's Medicine
Dysarthria
(Classical / Allopathic Medicine)
Dysarthria (poorly
articulated speech) is characterized by slurring and labored
irregular rhythm. It may be accompanied by nasal voice tone
caused by palate weakness. Whether it occurs abruptly or
gradually, dysarthria is usually evident in ordinary
conversation. It's confirmed by asking the patient to produce
a few simple sounds and words, such as “ba,” “sh,” and “cat.”
However, dysarthria is occasionally confused with aphasia, a
loss of the ability to produce or comprehend speech.
Dysarthria results
from damage to the brain stem that affects cranial nerves IX,
X, or XI. Degenerative neurologic disorders commonly cause
dysarthria. In fact, dysarthria is a chief sign of
olivopontocerebellar degeneration. It may also result from
ill-fitting dentures.
ALERT:
If the patient displays dysarthria:
- ask him about the associated difficulty swallowing
- determine respiratory rate and depth, measuring vital capacity with a Wright respirometer, if available
- assess blood pressure and heart rate (Tachycardia, slightly increased blood pressure, and shortness of breath are early indications of respiratory muscle weakness.)
- ensure a patent airway
- place the patient in Fowler's position
- keep emergency resuscitation equipment nearby.
If dysarthria isn't accompanied by respiratory muscle weakness and dysphagia, perform a focused assessment.
If the patient displays dysarthria:
- ask him about the associated difficulty swallowing
- determine respiratory rate and depth, measuring vital capacity with a Wright respirometer, if available
- assess blood pressure and heart rate (Tachycardia, slightly increased blood pressure, and shortness of breath are early indications of respiratory muscle weakness.)
- ensure a patent airway
- place the patient in Fowler's position
- keep emergency resuscitation equipment nearby.
If dysarthria isn't accompanied by respiratory muscle weakness and dysphagia, perform a focused assessment.
HISTORY:
Ask the patient when the dysarthria began. Has it improved? Does it worsen during the day?
Review the patient's medical history for seizures.
Ask the patient if he has experienced numbness or tingling in his limbs.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient when the dysarthria began. Has it improved? Does it worsen during the day?
Review the patient's medical history for seizures.
Ask the patient if he has experienced numbness or tingling in his limbs.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Assess the patient for other neurologic deficits. Compare muscle strength and tone in the limbs.
Evaluate tactile sensation. Test deep tendon reflexes, and note gait ataxia.
Test visual fields, and ask the patient about double vision.
Check for signs of facial weakness such as ptosis.
Determine the level of consciousness and mental status.
Assess the patient for other neurologic deficits. Compare muscle strength and tone in the limbs.
Evaluate tactile sensation. Test deep tendon reflexes, and note gait ataxia.
Test visual fields, and ask the patient about double vision.
Check for signs of facial weakness such as ptosis.
Determine the level of consciousness and mental status.
SPECIAL
CONSIDERATIONS:
Encourage the patient with dysarthria to speak slowly so that he can be understood. Give him time to express himself, and encourage him to use gestures.
Encourage the patient with dysarthria to speak slowly so that he can be understood. Give him time to express himself, and encourage him to use gestures.
PEDIATRIC
POINTERS:
Dysarthria in children usually results from brain stem glioma, a slow-growing tumor that primarily affects children. It may also result from cerebral palsy.
Dysarthria may be difficult to detect, especially in an infant or a young child who hasn't perfected speech. Be sure to look for other neurologic deficits.
Dysarthria in children usually results from brain stem glioma, a slow-growing tumor that primarily affects children. It may also result from cerebral palsy.
Dysarthria may be difficult to detect, especially in an infant or a young child who hasn't perfected speech. Be sure to look for other neurologic deficits.
PATIENT
COUNSELING:
Dysarthria usually requires consultation with a speech therapist. Provide emotional support to the patient and his family. Teach the patient alternate ways to communicate.
Dysarthria usually requires consultation with a speech therapist. Provide emotional support to the patient and his family. Teach the patient alternate ways to communicate.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)