Spastic Dysarthria vs. Spasmodic Dysphonia Symptoms, Treatment, and Differential Diagnosis Ariella Ruderman & Jasmine Smith

Spastic Dysarthria „

Caused by bilateral damage to UMN ‰

„

„

Degenerative disease, vascular causes, TBI, unknown

Hypertonia, hyperreflexia, spasticity, neuropath. reflexes Speech: slow, effortful, may be hypernasal, imprecise artic., hoarseness, strain-strangle, monopitch/pitch breaks, short phrases, monoloud (Duffy 2005)

Spasmodic Dysphonia „

„

Cause: probably supranuclear (once thought psychogenic) AD type ‰ ‰

„

AB type ‰ ‰ ‰

„

VF's spasm shut Vocal strain, voice blocks VF's spasm open Breathy voice, aphonic moments Worse during unvoiced consonants

TASK SPECIFIC! Symptoms only occur during connected speech Stemple (2000), Finitzo (1989)

Diagnosing motor-speech disorders based on voice production and quality „

Darley, Aronson Brown ‰

„

showed each type of dysarthria manifests “clinically distinguishable auditory-perceptual characteristics.” (Duffy & Kent, 2001)

Voice features correspond to physiology (shown by DAB in original tests of validity of their methods but crossvalidation using modern imaging techniques in order)

„

Birth of the SLP as diagnostician!

Acoustic-perceptual analysis A tool developed by DAB to guide listening to the features of a patient’s speech ‰

Created a rating scale: 38 perceptual features (newer examples: GRBAS scale: Grade, Roughness, Breathiness, Asthenia, Strain; CAPE-V: Consensus Auditory Perceptual Evaluation–Voice)

„

Advantages: ‰ ‰

„

Requires only a trained ear After some debate has been shown to be effective, even in novice clinicians (Bunton, et al. 2007)

Disadvantages: ‰ ‰ ‰

Subjective Efficacy debated in the research Thorough training required

Other assessment tools „

Acoustic analysis ‰

„ „

laryngostroboscopic recordings electroglottography (EGG) ‰

„

Assesses laryngeal functioning

electromyography (EMG) ‰

„

ex. Visi-pitch,

Assesses muscle function

videofluoroscopic assessment ‰

Swallowing test

Video Segments „

Spastic Dysarthria (2 mins) ‰

‰ ‰

Breathy, slow, monotone, monoloud, effortful, hoarse Rigid left arm Possible co-existing language disorder (ex. “time”)

Video Segments „

Spasmodic Dysphonia (3 mins) ‰

AB Type (Mary) „

‰

AB Type, AB Type, + Tremor (Stephie) „

‰

Strained voice, effortful, breathy on some unvoiced sounds, tremor on /a/

AD Type, + Paroximal Dyskinesia (Jerome) „

‰

Breathy, especially on unvoiced sounds (/h/)

Voice blocks, strained, hoarse (esp. on /a/)

AD Type, + Tremor (Dot) „

Monopitch, monoloud, slow, effortful (Don’t confuse with PD!), voice breaks and tremor on /a/

Patient Complaints, Other Symptoms „ „

„ „ „ „

„ „

Spastic Dysarthria “Speech is slower, it tires me” “My speech is nasal” Swallowing difficulty Drooling Difficult to control laughter or crying (pseudobulbar affect) Pathologic reflexes Weakness

„ „

„

„

„

Spasmodic Dysphonia Negative impact on job, social life, and emotions Vocal fatigue caused by increased effort in speech Body motions or tenseness may be present secondary to spasms (AD type) Frustration getting accurate DX

Treatment „

Spastic Dysarthria ‰

Voice Therapy „

„

LSVT, etc.

Spasmodic Dysphoina ‰

Botox to stop spasms „

‰

Section RLN (CN X)--paresis of VF's „

‰

Cycle lasting ~3-4 months Permanent

Acupuncture (pt feels better, sounds same) Boutsen (2003), Damrose (2004), Stemple (2000)

References „ „

„

„

„

„

„ „ „

„ „ „

ASHA Leader (2001). It's Not a Nasty Cold...It's Spasmodic Dysphonia. 6,16. Baylor, C.R., Yorkston, K.M., Eadie, T.L., & Maronian, N.C. (2006). The psychosocial consequence of BOTOX injections for spasmodic dysphonia: A qualitative study of patient’s experiences. Journal of Voice, 21, 231-247. Baylor, Carolyn R.; Yorkston, Kathryn M.; Eadie, Tanya L. (2005) The consequences of spasmodic dysphonia on communication-related quality of life: A qualitative study of the insider's experiences. Journal of Communication Disorders. 38, 395-419. Bender, B.K., Cannito, M.P., Murry, T., & Woodson, G.E. (2004). Speech intelligibility in severe adductor spasmodic dysphonia. Journal of Speech, Language, and Hearing Research, 47, 2133. Boutsen, F., Cannito, M.P., Taylor, M., Bender, B. (2002). Botox treatment in adductor spasmodic dysphonia: A meta-analysis. Journal of Speech, Language, and Hearing Research, 45, 469-482. Bunton, Kate; Kent, Raymond D.; Duffy, Joseph R.; Rosenbek, John C.; Kent, Jane F. (2007). Language Listener Agreement for Auditory-Perceptual Ratings of Dysarthria. Journal of Speech, & Hearing Research, 50, 1481-1495. Bunton, Kate; Kent, Ray D.; Kent, Jane F.; Rosenbek, John C. (2000) Perceptuo-acoustic assessment of prosodic impairment in dysarthria. Clinical Linguistics & Phonetics. 13-24. Carouso, Anthony & Strand, Edythe (1999). Clinical Management of Motor Speech Disorders in Children. Thieme: New York. Damrose, J.F., Goldman, S.N., Groessl, E.J., & Orloff, L.A. (2004). The impact of longterm botulinum toxin injections on symptom severity in patients with spasmodic dysphonia. Journal of Voice, 18, 415-422. Duffy, Joseph R.; Kent, Raymond D. (2001). Darley's contributions to the understanding, differential diagnosis, and scientific study of the dysarthrias. Aphasiology, 15, 275-289. Duffy, J.R. (2005). Motor Speech Disorders: Substrates, differential diagnosis, and management (2nd ed). Elsevier Mosby: St. Louis, MO. Eadie, Tanya L.; Nicolici, Christina; Baylor, Carolyn; Almand, Kimberly; Waugh, Patricia; Maronian, Nicole. (2007) Effect of Experience on Judgments of Adductor Spasmodic Dysphonia. Annals of Otology, Rhinology & Laryngology, 116, 695-701.

„ „

„

„ „

„

Finitzo, T. & Freeman, F. (1989). Spasmodic Dysphonia, whether and where: Results of seven years of research. Journal of Speech and Hearing Research, 32, 541-555. Lee, L., Daughton, S., Scheer, S., Stemple, J.C., Weinrich, B., Miller-Seiler, T., Goeller, S., & Levin, L. (2003). Use of acupuncture for the treatment of adductor spasmodic dysphonia: A preliminary investigation. Journal of Voice, 17, 411-424. Mackenzie, K.; Millar, A.; Deary, I. J.; Wilson, J. A. (1999) Does voice therapy work? A randomized controlled trial of the efficacy of voice therapy for dysphonia. Clinical Otolaryngology & Allied Sciences, 24, 377. National Spasmodic Dysphonia Association (2008). Understanding Spasmodic Dysphonia (DVD). Roy, N., Leeper, H., Blomgren, M., & Cameron, R.M. (2001). A description of phonetic acoustic, and physiological changes associated with improved intelligibility in a speaker with spastic dysarthria. American Journal of Speech-Language Pathology, 10, 274-291. Roy, N., Mauszycki, Shannon, Merrill, Ray, Gouse, Manon, Smith, Marshall (2007) Toward Improved Differential Diagnosis of Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia. Folia Phoniatrica et Logopaedica. 59, 83-90.

„ „

„

„ „

Sapienza, G.M., Cannito, M.P., Murray, T., Branski, R., Woodson, G. (2002). Acoustic variations in reading produces by speakers with spasmodic dysphonia. Journal of Speech, Language, and Hearing Research, 45, 830-844. Sataloff, R.T., Deman-Ackah, Y.D., Simpson, L.L., Park, J.B., Zwislewski, A., Sokolow, C., & Mandel, S. (2002). Botulinim toxin type B for treatment of spasmodic dysphonia: A case report. Journal of Voice, 16, 422-424 Stemple, J.C., Glaze, L.E., Klaben, B.G. (2000). Clinical Voice Pathology: Theory and management (3rd ed). Singular Publishing Group: San Deigo, CA. Tjaden, Kris; Wilding, Gregory E. (2004). Rate and Loudness Manipulations in Dysarthria: Acoustic and Perceptual Findings. Journal of Speech, Language & Hearing Research, 47, 766-783.

„ „ „

Wingate, J.M., Ruddy, B.H., Lundy, D.S., & Lehman, J. (2005). Voice Handicap Index results for older patients with adductor spasmodic dysphonia. Voice, 19, 124-131. Yorkston, Kathryn M.; Beukelman, David R. (2004). Dysarthria Tools for Clinical Decision-Making. ASHA Leader, Vol. 9 Issue 9, p4-21, 4p