Bulbar dysarthria

Bulbar dysarthria is a speech disorder associated with the innervation of the muscles of the pharynx, larynx, and palate, as a result of which the voice strength decreases and nasal speech appears. This disease affects the speech organs, such as the palate, tongue, and lips. Dysarthria can occur in people of different ages and children. But at an early age, the disease is more dangerous for development. The speed of reading and writing is impaired, and in some cases, the rate of development of the speech apparatus slows down.

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Causes bulbar dysarthria

In 65-85% of cases, dysarthria is accompanied by congenital disorders of the nervous system, such as cerebral palsy. In this case, the localization of organic brain damage occurs long before birth, in utero or in the early stages of the child's development (usually up to 2 years).

Also, this disease in children at the early stages of development occurs as a complication after infections that affect the central nervous system (meningitis, encephalitis), brain injuries, purulent otitis.

Bulbar dysarthria also develops as a consequence of pathological development of the placenta, rapid or protracted labor, severe toxicosis, and infectious diseases of the mother in the early stages of pregnancy.

In adults, bulbar dysarthria can most often occur as a result of severe brain injury, cerebrovascular diseases, after a stroke, neurosurgical surgery, tumors (benign and malignant), intoxication (alcohol, drugs, medicine). It can occur in patients with multiple sclerosis, Parkinson's disease.

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Risk factors

There are several main factors that contribute to the development of dysarthria:

• Birth injuries. Children born with a diagnosis of cerebral palsy most often have different forms of dysarthria, in particular bulbar. Also, due to severe toxicosis, oxygen deficiency, bad habits of the mother, the child can get such a complication in the womb. Very premature babies are also at risk, since the nervous system in newborns is not yet fully formed.
• Rhesus incompatibility of parents.
• Infectious diseases of the nervous system. This is extremely rare.

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Symptoms bulbar dysarthria

It is quite difficult to determine whether a person is ill. There are symptoms of bulbar dysarthria, diagnosing which can help determine the disease and begin timely treatment: slurred and unclear speech, impaired articulation, involuntary salivation, mask-like face, spasms of the respiratory muscles.

Dysarthria is characterized by a number of non-speech and speech symptoms. Non-speech symptoms include paralysis and paresis of the muscles of the limbs and trunk in general, which block movement and lead to a violation of spatial perception. Disorders of the oculomotor muscles are also possible, which lead to visual impairments and the inability to fixate the gaze on an object. Disorders of the emotional-volitional sphere, mental development, articulation disorders, breathing, and muscle tone are often possible.

Speech symptoms include loss of articulate speech, the voice loses its sonority, becomes muffled, and speech is slurred and monotonous. Vowels and voiced consonants sound nasal, and muffled sounds dominate speech. Speech is slow, heavy, and quickly tires the patient. General motor skills are impaired in bulbar dysarthria, since the integrity of perception is impaired due to the disease.

People with this disease have a hard time closing their eyes or moving their eyebrows. The first signs of bulbar dysarthria in children are problems with breastfeeding, frequent regurgitation or choking. In slightly older children, there is a lack of babbling typical for this age, distortion of sounds and, as a result, the possibility of hearing loss.

An experienced speech therapist will be able to quickly determine the degree of development of bulbar dysarthria and prescribe a course of treatment.

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Forms

Depending on the affected anatomical structure in the cerebral cortex, several forms of dysarthria are distinguished: bulbar, subcortical, cerebellar, cortical and pseudobulbar.

Bulbar dysarthria is manifested by paralysis of the facial muscles and vocal apparatus, which entails speech and breathing disorders. Most often, this form occurs with brain tumors.

Subcortical dysarthria is characterized by contractions of the facial muscles and vocal apparatus. Speech in this case is smooth and slow, but in certain emotional situations and excitement it can break down. Often this form of dysarthria is accompanied by hearing loss.

Mesozoic dysarthria accompanies other forms of deviations and as an independent form of the disease is quite rare, expressed in scanned speech with frequent shouting.

Pseudobulbar dysarthria is the most common. In this form, the brain is affected the least and speech differs little from normal, with a few exceptions: at the junction of several consonants or vowels, not all letters are pronounced, are “swallowed” or can be replaced by others.

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Diagnostics bulbar dysarthria

Two doctors take part in the definition and diagnosis of bulbar dysarthria - a neurologist and a speech therapist. The speech therapist must examine the entire speech apparatus, pronunciation, mobility of the facial muscles, lips. After which the doctor makes his conclusion.

Next, you need to see a neurologist, since dysarthria is also a disease of the nervous system. The neurologist prescribes treatment based on the speech therapist's examination and his own. Most often, you can get by with minimal speech correction.

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Treatment bulbar dysarthria

Before starting treatment, it is necessary to undergo instrumental and differential diagnostics to determine the level of complexity of the disease and visit a neurologist and speech therapist. After visiting a specialist to identify the disorder, it is usually necessary to undergo some examinations: take the necessary tests, electromyography of the tongue, MRI of the brain, esophagoscopy, clinical and EMG tests for myasthenia or other tests that the doctor prescribes.

Treatment of bulbar dysarthria should have a comprehensive approach, both medication and classes with a speech therapist-defectologist, exercise therapy. Specialists primarily pay attention to the development of muscle groups that are responsible for facial expressions and help in speech formation. A full course of treatment for dysarthria can last up to several months, but a comprehensive approach can shorten this period, and make the treatment result more sustainable.

At an early age, bulbar dysarthria is easier to treat. Children with bulbar dysarthria are recommended to attend special speech therapy groups in kindergarten or even specialized institutions.

Drug treatment involves the neurologist prescribing nootropic drugs that help improve brain function and mental performance, and also stimulate cognitive abilities and facilitate the learning process.

Effective treatments include Piracetam, Lucetam, Finlepsin, Carbamazepine. The dosage and period of use of drugs is individual (4.8 g / day during the first week, 2.4 g / day in the following days, divided into 2-3 doses). Contraindications for use for patients with terminal renal failure, acute cerebrovascular accidents, Huntington's chorea. Side effects may include nervousness, hyperkinesia, headaches, nausea, blood clotting disorders, weight gain.

The fight against dysarthria in adults should be based on the therapy of the underlying problem that led to speech disorders. This may be surgical treatment:

• tumor removal;
• elimination of hemorrhage;
• removal of an abscess.

A comprehensive method of treating dysarthria includes the use of medications, exercise therapy, physiotherapy, acupuncture, speech therapy to develop and correct speech, as well as treatment of concomitant diseases.

The speech therapist's work in this case is aimed at developing the organs of articulation. Such influence includes:

• work on expressiveness of speech;
• correction of speech breathing and voice;
• articulation gymnastics;
• correction of pronunciation of speech sounds;
• tongue massage.

Exercises to Reduce Salivation in Bulbar Dysarthria

1. Imitation of swallowing and chewing with the head thrown back. It is advisable to do this exercise with the mouth closed.
2. Keep your mouth wide open for several seconds (5-10 sec), with your tongue lying on the floor of your mouth.
3. Use your lips to hold objects of different diameters (paper, a cocktail straw, a pencil, small medicine bottles).
4. Inflating and sucking in both cheeks simultaneously with the mouth closed.
5. Puff out one cheek and then the other one.

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Prevention

Prevention of the disease at this stage has not yet been developed, because the causes of the development of bulbar dysarthria have not yet been fully determined.

To avoid such a disease, it is necessary to take care of the child's health even before birth: eat right, give up bad habits, immediately consult a doctor if there is a risk of any infectious disease or a threat of miscarriage. In an adult, at the slightest speech, writing or hearing disorder, it is also necessary to immediately consult a specialist.

Treatment of bulbar dysarthria is considered complete and successful when speech is fully restored and facial muscles return to normal.

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Forecast

The prognosis for bulbar dysarthria is not clear, because the disease entails irreversible damage to the nervous system and brain.

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