As neurologists note, in many cases, patients with pseudobulbar dysarthria themselves do not notice the first signs of pathology, and their relatives pay attention to the changes in their speech when it becomes muffled.
The following clinical symptoms of pseudobulbar dysarthria are distinguished:
- the rate of speech is abnormally slow, speech is quiet and fuzzy (the spoken word sounds as if a person is trying to "squeeze out" words);
- vocalization nasal (pronounced nasal);
- the tongue is strained (spastic) and rotates poorly in the mouth (but its muscles are not atrophied);
- speech is monotonous, because the total spasticity of the muscles of the larynx does not allow you to vary the pitch;
- spasms of the vocal cords (dysphonia);
- difficulties in the simultaneous movement of the tongue and jaws cause difficulties with chewing and swallowing (dysphagia);
- increased mandibular (mandibular) and pharyngeal reflexes;
- To close the mouth, a certain effort is required, which causes drooling;
- reduced or there is no possibility to control facial muscles of the face (for example, a smile often looks like a grin);
- spontaneous manifestations of abnormal affective behavior, a syndrome of involuntary mourning and / or laughter.
In some cases, disruption of innervation can affect the pyramidal pathways of the passage of nerve impulses, which is manifested in increased tonus of other muscle groups (spastic paresis) or hyperreflexia.
Pseudobulbar dysarthria in children
Pseudobulbar dysarthria in children may be a consequence of idiopathic cerebral neuropathies caused by hereditary dysontogenesis; hereditary globoid-cellular or metachromatic leukodystrophy; leukoencephalitis of Van Bogart; acute encephalomyelitis; secondary post-vaccination encephalitis; caused by gene mutations of Tay-Sachs disease (GM2-gangliosidosis); brain tumors (medulloblastoma, astrocytoma, ependymoma); craniocerebral injuries (including trauma to the cervical spine obtained at birth); juvenile progressive pseudobulbar syndrome. He was included in the list of causes of this type of dysarthria in children and cerebral palsy, although in most cases cerebral cortical lesions, cerebellar lesions, etc., and not specifically nerve fibers of the corticobulbar pathway are observed in cerebral palsy.
The manifestation of pseudobulbar dysarthria can begin in a child with frequent choking and coughing, problems with chewing and swallowing, salivation, mimicry, and later - at the age when children begin to speak - problems with sound reproduction of different degrees of severity are revealed.
Speech therapists recommend that parents pay attention to how actively the children's mimic muscles "work", whether the child can stick out his tongue, tightly cover his lips or pull them out with a "tube", widen his mouth widely, etc. It should also be borne in mind that in children with pseudobulbar dysarthria speech is slowed and incomprehensible, and when a child tries to say something, it is tense and therefore most often silent.
Because of the stiffness of the muscles, the automaticity of articulation is not developed, and such a child speaks poorly even at the age of five or six. Moreover, pseudobulbar dysarthria in children leads not only to the lack of lexical stock sufficient for communication, but also makes it difficult to adequately perceive another's speech. The most severe degree of pseudobulbar dysarthria in childhood is anarthria, that is, complete dysfunction of articulatory muscles.