Bulbar dysarthria

Bulbar dysarthria is a violation of the speech apparatus, which is associated with the innervation of the muscles of the pharynx, larynx, and sky, as a result of which the strength of the voice decreases, nasal appears. This disease affects the organs of speech, 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. Violated the speed of reading and writing, in some cases - the speed of development of the speech apparatus slows down.

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Causes of the bulbar dysarthria

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

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

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

In adults, most often bulbar dysarthria can occur as a result of severe brain trauma, cerebrovascular diseases after a stroke, surgery associated with neurosurgery, tumors (benign and malignant), intoxication (alcohol, narcotic, drug). 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 emergence of dysarthria:

• Birth trauma. Children born with the diagnosis of cerebral palsy, most often have different forms of dysarthria, in particular bulbar. Also, because of severe toxicosis, oxygen deficiency, bad habits of the mother, the child still in the womb can get such a complication. Strongly premature babies are also at risk, since the neonatal nervous system is not yet fully formed.
• Incompatibility of Rh factor parents.
• Infectious diseases of the nervous system. This is extremely rare.

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Symptoms of the bulbar dysarthria

Determine if the person is sick is difficult enough. There are symptoms of bulbar dysarthria, diagnosing which can determine the disease and begin timely treatment: indistinct and fuzzy speech, articulation is broken, arbitrary salivation, masky face, spasms of the respiratory musculature.  

Dysarthria is characterized by a number of non-verbal and speech symptoms. Non-verbal can include paralysis and paresis of the muscles of the limbs and trunk in general, which block movement and entail a violation of the perception of space. Also, there may be disruption of the oculomotor muscles, which entail disturbances in visual functions, the lack of the possibility of fixing a glance on the subject. Violations of the emotional-volitional sphere, mental development, violation of articulation, respiration, and muscle tone are often possible.

Speech symptoms are characterized by a loss of articulation, the voice loses its voicelessness, becomes deaf, and speech is indistinct, monotonous. Vowels and voiced consonants sound nasal, speech is dominated by dull sounds. The speech is slow, heavy, quickly tires the patient. General motor activity in bulbar dysarthria is impaired, because the integrity of perception is impaired due to the disease.

People with such a disease are hard enough to squint their eyes or move their eyebrows. The first signs of bulbar dysarthria in children are problems with breastfeeding, frequent regurgitation or choking. In slightly older - the lack of characteristic for this age of babbling, distortion of sounds and, consequently, the possibility of hearing impairment.

An experienced speech therapist can 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 pseudobulbarnaya.

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

For subcortical dysarthria, the contractions of facial muscles and the vocal apparatus are characteristic. Speech in this case is smooth and slow, but under certain emotional situations and anxiety can break. Often this form of dysarthria is a companion for hearing loss.

Mozzekchkovaya dysarthria accompanies other forms of deviation and as an independent form of the disease is rare enough, expressed in a chanted speech with frequent shouting.

Pseudobulbar dysarthria occurs most often. With this form, the brain is affected least of all and speech differs little from normal, with a small exception: at the junction of several consonants or vowels, not all letters are pronounced, "swallowed" or can be replaced by others.

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Diagnostics of the bulbar dysarthria

In the definition and diagnosis of bulbar dysarthria involved two doctors - a neuropathologist and speech therapist. Speech therapist should conduct an examination of the whole speech apparatus, sound reproduction, mobility of the muscles of the face, lips. After that the doctor makes his conclusion.

Further it is necessary to address to the neuropathologist, since dysarthria is also a disease of the nervous system. The neurologist prescribes treatment on the basis of examining the speech therapist and his own. Most often, you can do with a minimal correction of speech.

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Treatment of the bulbar dysarthria

Before you start the treatment you need to undergo instrumental and differential diagnostics to determine the level of the disease's complexity and visit a doctor of a neurologist and speech therapist. After visiting a specialist, you should usually go through some tests to find out the disorder: take the necessary tests, electromyography of the tongue, MRI brain, esophagoscopy, clinical and EMG tests for myasthenia gravis or other tests that the doctor will appoint.

Treatment of bulbar dysarthria should have a comprehensive approach both medicamentous, and employment with a speech therapist-defectologist, exercise therapy. Specialists first of all pay attention to the development of muscle groups, which are responsible for facial expressions and help in the formation of speech. A full course of dysarthria treatment can last up to several months, but an integrated approach can shorten this period, and the result of treatment can be made more stable.

At an early age, bulbar dysarthria is given to treatment more simply. Children with bulbar dysarthria are recommended to attend special speech therapy groups in the kindergarten or in general specialized institutions.

Drug treatment consists in the appointment of a neurotrophic nootropic medication to the neurologist that improves brain function and mental activity, also stimulates cognitive abilities and facilitates the learning process.

The effective treatments are Piracetam, Lucecam, Finlepsin, Carbamazepine. The dosage and period of application of the medicinal preparations is individual (4.8 g / day during the first week, 2.4 g / day in the following days, divided into 2-3 priomy). Contraindications to the use for patients with terminal stage of renal failure, acute circulatory disorders of the brain, Chorea Hattington. Among the side effects may be 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, which led to speech disorders. This can be surgical treatment:

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

Complex treatment of dysarthria includes the use of medicines, physiotherapy exercises, physiotherapy, acupuncture, speech therapist work on speech development and correction, as well as treatment of concomitant diseases.

The work of the speech therapist in this case is aimed at developing the articulation organs. This impact includes:

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

Exercises to reduce salivation in bulbar dysarthria

1. Immitation of swallowing and chewing with the head thrown back. It is desirable to perform such exercises with a closed mouth.
2. For a few seconds (5-10 seconds), keep the mouth wide open, with the tongue lying on the bottom of the mouth.
3. Lips hold objects of different diameters (paper, a cocktail tube, a pencil, small bottles from the medicine).
4. Inflating and drawing in both cheeks simultaneously with the closed mouth.
5. Alternately, puff one or the other cheek.

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Prevention

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

To avoid such a disease, one must take care of the child's health before birth: eat right, give up bad habits, immediately consult a doctor if there is a danger of any infectious disease or threat of pregnancy disruption. At the adult at the slightest infringement of speech, the letter or hearing also it is necessary to address immediately to the expert.

Treatment of bulbar dysarthria is considered complete and successful in the event that the speech is completely restored and the facial musculature comes to normal.

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Forecast

The prognosis for bulbar dysarthria is not unambiguous, because the disease entails irreversible disorders of the nervous system and the brain.

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