Dysarthria

Types of Dysarthria
The three primary types of dysarthrias seen in children are spastic, flaccid and ataxic.

• Spastic dysarthria: Speech may be slow and labored, with poor articulation. Voice is usually harsh or strained. The voice may sound like the child is talking through his nose.
• Flaccid dysarthria; Hypernasality with nasal air escape is the main characteristic. Articulation is poor, and speech often sounds monotonal.
• Ataxic dysarthria; Speech is often very irregular in terms of breathing, sound production, rate and rhythm.

How you can help your child:
There are many ways that you can help your child with speech and communication in general. The following guidelines should help improve overall communication and make interaction with your child less frustrating for him and everyone involved:

• When attempting any communication, the area should be quiet and the child should have your complete attention.
• When the child is tired, speech probably will be worse. Help him by asking simple questions or ones that can be answered with single words or short phrases.
• If you have not understood your child, be honest. Have him repeat what he said or gesture or use other words to get the idea across. If the child is old enough, he might try drawing or writing.
• The speech pathologist who works with your child should be able to help you with specific ways to improve his speech. Suggestions may include slowing his rate, opening his mouth more, speaking louder or taking more frequent breaths.

Children vary in their acquisition of language skills. Some children speak only single words until age two, and others string several words together at 20 months. Some talk almost constantly while others seem to use language very sparingly. Some children use language to control their environment while others use it only in response to their environment. Parents, you should not become alarmed when your child does not meet every criterion for his or her developmental age. Rather, you should use this criteria as a measure to enable you to monitor your child's developmental language skills. This will help you to determine if evaluation or intervention may be helpful.

Resonance disorders are generally classified into one of two categories, hypernasality or hyponasality. Hypernasality is the result of velopharyngeal incompetence or VPI, which is the inability of the soft palate and related musculature to close the nasopharynx (the area in the throat that separates the oral and nasal cavities). It is the movement of these structures (along with subsequent closure of the nasopharynx) that enables one to produce most consonant sounds. If your child has VPI, this results in too much air traveling into the nasal cavity during speech production and may cause your child to sound "nasal" or be unintelligible. Hyponasality is the result of too little air moving into the nasal cavity during speech, which results in a "stuffy" speech quality (as if the child has a cold). The severity of a resonance disorder may range from mild (affecting one sound only) to severe (resulting in the inability to produce consonant sounds and intelligible speech).

Characteristics / Hypernasality

• The child may be unintelligible.
• The child has a "nasal" quality to his or her speech.
• The child has few or no consonant sounds.
• Air is audibly escaping from the child's nose rather than his or her mouth during speech.  
• The child sounds as if he or she constantly has a cold.
• The child cannot correctly produce "m", "n" or "-ing" sounds.
• The child may snore loudly while sleeping.

Common causes

• Cleft palate
• Submucous cleft palate
• Short and / or weak palate
• Deep pharynx
• Neurological factors (for example, head injury, stroke, cerebral palsy)
• Recent adenoidectomy / tonsillectomy
• Large adenoids and / or tonsils
• Nasal obstruction
• Other congenital causes (for example, certain syndromes)

Diagnosis
Diagnosis of a resonance disorder is obtained through a speech evaluation, which may include any one or all of the following diagnostic instruments:

• Oral-motor exam
• Nasometry
• Articulation testing
• Pressure Flow testing
• Videofluoroscopy
• Nasal endoscopy (this is typically done by an ENT)

Treatment
Treatment typically involves a trial period of speech therapy following the diagnosis of VPI. This trial period of therapy may last from three to six months. If it is determined during this time that a child has made adequate progress, then therapy is likely to continue. However, while speech therapy can be beneficial to improve hypernasal speech in some children (particularly those with sound specific to mild hypernasality), physical management may be necessary for those children exhibiting more severe VPI or those who do not respond to therapy. Physical management typically involves referral to the appropriate physician, usually a plastic surgeon or ENT, for surgery or a prosthetic device. If further management is needed, your speech pathologist will refer you to the appropriate physician for a consultation.