By Iram Sharif
Dysarthria
(Role of speech language therapist, occupational
Dysarthria is an umbrella term used for motor speech disorders
caused by muscle (muscles of phonation, respiration, articulation and reflex
activities) weakness. The muscle weakness make it harder for a person to talk.
This muscle weakness range from mild to severe and thus specify the severity of
problem. Its signs and symptoms are varied as having slurred or mumbled (salad
like speech that is very difficult to understand by the listener) speech,
person talks either very fast or very slow, robotic or choppy, very soft speech,
harsh or breathy voice. Person can speak with too much resonance (oral sounds
are emitted from nose), assimilative resonance (vowels are sound out from nose
adjacent to nasal consonants), with low or no resonance. As volume, regulation,
and control of expiratory air is necessary to correct the phonation (voice
production). So good breath control is needed to attain normal healthy voice.
Because poor breathe control will cause motor speech problems, poor quality of
voice and incorrect realization of phonemes. Good phonation (voice production)
also depends upon the healthy pitch and inflection (modulation of intonation)
levels. Person with dysarthria not be able to move lips, jaws, tongue, throat or
vocal cord muscles precisely. When muscles like lips, jaws, tongue, and throat
do not move precisely, they cause articulatory difficulties (production of
sounds). And these articulatory difficulties reduce the comprehensibility of
speech of these persons for the listeners. This condition is referred to as
unintelligible speech. Unintelligibility Also disturbs the rate, rhythm, stress
and intonation patterns. So intelligibility is the basic index for judging the
speech comprehension, integration and coordination of motor speech process.
Dysarthria is caused due to brain damage and it is categorized by
muscular severity, location and type of lesion in the brain. Common
classification includes flaccid (lack of normal muscle tone), spastic (greater
than normal muscle tone), ataxic (imprecise/inaccurate or slow muscle
movements), mixed, hyper (quick, unstained, involuntary movements) and hypo
(slow or limited movements) kinetic dysarthria. Childhood (when brain is
underdeveloped either born with dysarthria or after birth due to brain damage)
and adulthood (when brain has fully developed) dysarthria.
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Management
Its treatment/management needs a team approach.
1.
General
health physician
2.
Specialized
doctors
3.
Neurologists
4.
Ear,
nose, throat (ENT) Specialists
5.
Neuropsychiatrists
6.
Neuropsychologists
7.
Clinical psychologists
8.
Speech
and language therapists/pathologists (work on speech, language, communication,
socio-cognitions & swallowing
conditions)
9.
Physical
therapists (to enhance person’s physical capacity)
10.
Occupational
therapists (to enhance person’s functional capacity)
11.
Case/Social
workers or nurses
12.
Specially
trained attendants
And any other health professional according to the need
of patient.
Here I shall discuss
briefly the roles of some health professionals to develop awareness in common
people
Speech language
therapists/pathologists (SLT/SLP)
They play their role
in screening, assessment, diagnosis and treatment in dysarthria. They work on
facial muscles by using messages/exercises (face, lips, jaws, tongue, cheeks
etc.), compensatory mechanisms, speech generating devices, provide
communication aids, therapies, and many more procedures depends upon the nature
of disorder. They also can counsel the patients about their disorder, also provide
education aimed at preventing further complications related to dysarthria. If patient has
swallowing problem with the motor disorders then they also provide aid in
relieving the problem by utilizing messages, exercises, alternative feeding
methods, postural and food modifications. They work in team approach with other
professionals. They help the patients to maximize their potential.
Occupational
therapists (OT)
They promote functionality and facilitate movements
to patients with motor disorders. They provide functional training of motor
skills (bed mobility and transfers, balance and mobility, reducing fall risk,
and improving hand function), process skills (organization and task
adaptation), and psychosocial adaptation. To maximize function, OT performs
task modifications (use of adapted utensils, built-up handles, adaptive
clothing), environmental modifications (rearranging furniture, organizing ramps
and walk-in shower, grab bars) and prescription of assistive devices (raised
toilet seats, walking aids, splints and braces).
Clinical psychologist
They psycho-educate the
patients about the nature, symptoms, prognosis, causes and management of
disorders. Clinical psychologists play a bridging role in between neurologists
and psychiatrists. They are a critical member of rehabilitation team approach
to help the patients in gaining their maximum potential. Neurogenic, structural
and especially functional/psychogenic/psychological movement disorders (gait
disorders, tremor, dystonia, etc.) are source of disability or distress usually managed through
behavior therapy, functional cognitive behavior therapies, hypnosis and
effective counselling techniques. These therapies are provided by clinical
psychologists. They also help in ongoing assessment to get qualification of
treatment as proven good or bad. They can make referrals and suggestion of
assistive devices and aids. Like OTs clinical psychologists facilitate
daily/adaptive (communication, cognition, dressing, toileting, fine & gross
motor skills, independent living, safety management living skills, eating,
drinking, reading, writing, memory, organization, task management, psychosocial
and many other self-management skills). Daily
scheduling, transitions between activities all are managed by clinical
psychologists.
Case workers
They
work like social workers or any related discipline like social work. They work as
professionals in team approach and are a part of assessment and management of
disorders. Caseworker duties consist of evaluating
client necessities, attending to concerns, educate and motivate the clients to
change, make referrals to community agencies and also play a central role in coordination
of care providers. They provide coordinate care and services to the patients. They
work on clients’ problem-solving skills. The caseworker develops a case plan by
identifying (client' needs, resiliency, motivation and strengths/weaknesses
etc.) the action steps required to bring the desired changes in the clients. Timelines based on goal accomplishments are not
only discussed but also written into the plan.
References
Makoutonina,
M., & Rao, A. (2018). Role of the occupational therapist. Retrieved from
Mary,
Dr. (2018). The Role of Caseworkers. Work - Chron.com, Retrieved from
http://work.chron.com/role-caseworkers-23053.html.
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