Pediatric Dysarthria - Types, Causes, Symptoms, Diagnosis, and Treatment

Introduction

Dysarthria can affect breathing and can cause paralysis. There can be weakness or lack of coordination of the muscles of the lips, tongue, palate, jaw, and larynx (voice box). Children with dysarthria may have difficulty controlling and coordinating the strength, speed, range, and duration of movements necessary for speech; hence, their speech may be difficult to understand. The child cannot control their tongue and voice box, and the words may be slurred.

What Are the Types of Dysarthria?

The types differ based on the parts affected by the nervous system as follows:

• Central Dysarthria: It is caused by damage to the brain.

• Peripheral Dysarthria: It is caused by damage to the organs involved in speech.

Other classification includes:

• Developmental Dysarthria: This type of dysarthria develops as a consequence of brain damage before or at birth. Children are affected by this type.

• Acquired Dysarthria: This type of dysarthria is acquired later in life as a consequence of injury to the brain, stroke, or brain tumor. Adults are affected by this type.

• Spastic Dysarthria: People with generalized muscle weakness and abnormal reflexes may also have speech issues. The central nervous system (CNS), which includes the brain and the spinal cord, is affected in spastic dysarthria.

• Flaccid Dysarthria: The peripheral nervous system (PNS), which links the brain and the spinal cord to other parts of the body, may be affected in this type of dysarthria. The characteristic sign of this type is difficulty pronouncing consonant sounds. It can occur due to a tumor in the brain stem, surgery, or due to traumatic brain injury.

• Ataxic Dysarthria: Cerebellum is part of the brain that is involved in receiving sensory information and maintaining movements. Ataxic dysarthria can occur due to damage in the cerebellum, which causes poor coordination and slurred speech.

• Hypokinetic Dysarthria: The extrapyramidal system is the area in the brain that regulate subconscious muscle movements. Malfunction in this area causes hypokinetic dysarthria.

• Hyperkinetic Dysarthria: The basal ganglia of the brain, which is responsible for involuntary muscle movement, is affected in this type of dysarthria.

What Are the Causes of Dysarthria?

Cerebral palsy is a condition caused by brain damage before or at birth that leads to loss of control of arms and legs. Studies show that about 20 percent of the children diagnosed with cerebral palsy have speech affected by dysarthria. Cerebral palsy and brain injury are the major causes of speech and language disorders. Brain tumors, Parkinson’s disease (a disorder affecting the CNS that causes impaired movements), stroke, and multiple sclerosis (a disease in which the immune system destroys the protective covering of the nerves) can also affect speech.

What Are the Signs and Symptoms of Pediatric Dysarthria?

The symptoms of pediatric dysarthria are as follows:

• Slowed down speech.

• Slurred, unclear speech.

• Excessively loud or soft speech.

• Difficulties in controlling the volume.

• Hoarse, nasal, and breathy quality of voice.

• Speech made with effort caused by insufficient breath control.

• Lack of control of pitch. Speech may be high or low-pitched or can be monotone.

• Difficulty putting in long words.

• Difficulty in moving the jaws and tongue.

• Pooling or drooling of saliva.

• Difficulty in chewing and swallowing.

• Unclear consonant and vowel sounds.

How Does Dysarthria Differ From Apraxia?

Apraxia is a developmental disorder that affects motor skills and is associated with cerebral palsy. Apraxia is mistaken for dysarthria. Both dysarthria and apraxia affect the muscle tone, and the plan and act of moving the muscles is called muscle tone. Muscle function is normal in people with apraxia but has difficulty in voluntary movements like speaking or talking. The problem lies in the transfer of messages from the brain to the muscles to make them move, while dysarthria is associated with disrupted muscle control.

How Is Pediatric Dysarthria Diagnosed?

The health care professional will conduct a physical examination and ask for medical history. A speech-language pathologist (expert in the evaluation, diagnosis, treatment, and prevention of communication disorders) will assess the severity of dysarthria. The ability to breathe and move the lips, tongue, and face will be evaluated. The professionals will ask to perform certain language and movement tasks like:

• Biting the lower lip.

• Blowing out the candle.

• Counting.

• Repeating words and sentences.

• Singing.

• Sticking out the tongue.

Other tests include:

• Magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain and neck.

• Assessing the ability to swallow.

• Electromyography to test the electrical activity of the muscle and nerves.

• Blood tests to detect inflammation or infection.

• A lumbar puncture (spinal tap) can be carried out in which a needle is inserted into the spinal cord to obtain a small amount of cerebrospinal fluid from the spinal cord and test for serious infections, disorders, and tumors of the brain and spinal cord.

• Brain biopsy can be advised in which a small brain tissue sample is taken if a brain tumor is suspected.

• Neuropsychological tests may be performed to assess the thinking (cognitive) and understanding skills, along with the ability to read, write and understand. Dysarthria does not affect speech and writing directly, but an underlying health condition can.

How to Treat Dysarthria in Children?

The treatment is planned based on the type, underlying cause, and symptoms. Those diagnosed with infections can resolve dysarthria after treatment with antibiotics or after eliminating the toxin. A speech-language pathologist (SLP) may suggest exercises and techniques to overcome speech and language difficulties as follows:

• Recommend exercises to strengthen the muscles of the jaw, mouth, and throat.

• Breathing techniques to increase or decrease the child’s volume.

• Teaching specific speech techniques such as pausing while talking to slow down in their speech.

• The child will be asked to breathe deeply to increase the length of the speech that can be produced in one breath.

• Maintain the appropriate and even pitch of the voice.

The speech-language pathologist may increase the complexity of the words and sentences as the child improves.

Communication skills may be improved by:

• Maintaining eye contact with the person who talks.

• Communicating in a quiet environment.

• Using facial expressions and gestures to convey the meaning.

• Use different words to reply to a message.

• Carrying a notepad and pen to communicate if necessary.

The speech-language pathologist may use supplementary communication supports like alternative and augmentative communication (AAC). This is effective in children who are unable to communicate using speech alone, as these can augment and even substitute speech. Examples of this method include:

• Picture and alphabet boards.

• Speech-generating devices.

• A sign language that is used by people with disabilities.

Alternative and augmentative communication methods can be short-term or long-term based on the child’s ability to communicate with speech. This is extremely effective in long-term treatment options for kids to enable conversations at school, home, and other places.

What Are the Tips to Speak for Children With Dysarthria?

A few tips are:

• Let the child initiate the speech with a topic word so that the listeners know what the child is going to talk about.

• Speaking slowly and loudly.

• Let the child not talk if they feel tired.

• Using short sentences and pausing frequently.

• Ensuring that the listeners understand.

• Write or draw if there is difficulty in talking.

What Points Should Be Kept in Mind While Talking With a Child Having Dysarthria?

The following points should be kept in mind:

• Watch the child or maintain eye contact as they speak.

• Reducing distractions and having conversations in a quiet environment.

• Asking for clarification if there is trouble understanding.

• Do not finish the child’s words or sentences or correct errors by interrupting.

• Speak normally and clearly with the child.

• Keep papers and pencils ready.

• Help the child to create a book with pictures, words, and photos to assist them while talking.

• Involve the child in talking as much as possible.

• Give time for the child to take and ask yes or no questions.

Conclusion

Dysarthria is a speech disorder caused due to weakness in the muscles involved in speech. A child can develop dysarthria at or after birth as a result of injury or other causes. Dysarthria can pose a challenge to the child while communicating. However, a speech-language pathologist can help the child overcome the condition using certain exercises, techniques, and other aids.