Dysarthria
Dysarthria, poorly articulated speech, is characterized by slurring and labored, irregular rhythm. It may be accompanied by nasal voice tone caused by palate weakness. Whether it occurs abruptly or gradually, dysarthria is usually evident in ordinary conversation. It’s confirmed by asking the patient to produce a few simple sounds and words, such as “ba,” “sh,” and “cat.” However, dysarthria is occasionally confused with aphasia, loss of the ability to produce or comprehend speech.
Dysarthria results from damage to the brain stem that affects cranial nerves IX, X, or XII. Degenerative neurologic disorders and cerebellar disorders commonly cause dysarthria. In fact, dysarthria is a chief sign of olivopontocerebellar degeneration. It may also result from ill-fitting dentures.
Act Now: If the patient displays dysarthria, ask him about associated difficulty swallowing. Then determine respiratory rate and depth. Measure vital capacity with a Wright respirometer, if available. Assess blood pressure and heart rate. Usually, tachycardia, slightly increased blood pressure, and shortness of breath are early signs of respiratory muscle weakness.
Ensure a patent airway. Place the patient in Fowler’s position and suction him if necessary. Administer oxygen, and keep emergency resuscitation equipment nearby. Anticipate intubation and mechanical ventilation in progressive respiratory muscle weakness. Withhold oral fluids in the patient with associated dysphagia.
If dysarthria isn’t accompanied by respiratory muscle weakness and dysphagia, continue to assess for other neurologic deficits. Compare muscle strength and tone in the limbs. Then evaluate tactile sensation. Ask the patient about numbness or tingling. Test deep tendon reflexes (DTRs), and note gait ataxia. (See Documenting deep tendon reflexes.) Assess cerebellar function by observing rapid alternating movement, which should be smooth and coordinated. Next, test visual fields and ask about double vision. Check for signs of facial weakness, such as ptosis. Finally, determine level of consciousness (LOC) and mental status.
Assessment
History
Obtain a history of the condition. When did it begin? Has it gotten better? Ask if dysarthria worsens during the day. Then obtain a drug and alcohol history. Also, ask about a history of seizures.
Physical examination
Explore dysarthria completely. Speech improves with resolution of a transient ischemic attack, but not in a completed stroke. Observe dentures for a proper fit. Ask the patient to produce a few simple sounds and words. Compare muscle strength and tone in the limbs on one side of the body with the other. Assess the patient’s tactile sense, DTRs, and note gait ataxia. Assess cerebellar function, test visual fields, and ask about the presence of double vision. Check for signs of facial weakness. Evaluate LOC and mental status.
Pediatric pointers
Dysarthria in children usually results from brain stem glioma, a slow-growing tumor that primarily affects children. It may also result from cerebral palsy.
Dysarthria may be difficult to detect, especially in an infant or a young child who hasn’t perfected speech. Be sure to look for other neurologic deficits, too. Encourage speech in a child with dysarthria; a child’s potential for rehabilitation is typically greater than an adult’s.
Medical causes
See Dysarthria: Causes and associated findings, pages 114 and 115.
Alcoholic cerebellar degeneration
Alcoholic cerebellar degeneration commonly causes chronic, progressive dysarthria along with ataxia, diplopia, ophthalmoplegia, hypotension, and altered mental status.
Amyotrophic lateral sclerosis (ALS)
Dysarthria occurs when ALS affects the bulbar nuclei; it may worsen as the disease progresses. Other signs and symptoms include dysphagia; difficulty breathing; muscle atrophy and weakness, especially of the hands and feet; fasciculations; spasticity; hyperactive DTRs in the legs; and occasionally excessive drooling. Progressive bulbar palsy may cause crying spells or inappropriate laughter.
Basilar artery insufficiency.
Basilar arteryinsufficiency causes random, brief episodes of bilateral brain stem dysfunction, resulting in dysarthria. Accompanying it are diplopia, vertigo, facial numbness, ataxia, paresis, and visual field loss, all of which last for minutes to hours.
Botulism
The hallmark of botulism is acute cranial nerve dysfunction causing dysarthria, dysphagia, diplopia, and ptosis. Early findings include dry mouth, sore throat, weakness, vomiting, and diarrhea. Later, descending weakness or paralysis of muscles in the extremities and trunk causes hyporeflexia and dyspnea.
Manganese poisoning
Chronic manganese poisoning causes progressive dysarthria accompanied by weakness, fatigue, confusion, hallucinations, drooling, hand tremors, limb stiffness, spasticity, gross rhythmic movements of the trunk and head, and propulsive gait.
Mercury poisoning
Chronic mercury poisoning also causes progressive dysarthria accompanied by weakness, fatigue, depression, lethargy, irritability, confusion, ataxia, and tremors.
Multiple sclerosis
When demyelination affects the brain stem and cerebellum, the patient displays dysarthria accompanied by nystagmus, blurred or double vision, dysphagia, ataxia, and intention tremor. Exacerbations and remissions of these signs and symptoms are common. Other findings include paresthesia, spasticity, intention tremor, hyperreflexia, muscle weakness or paralysis, constipation, emotional lability, and urinary frequency, urgency, and incontinence.
Myasthenia gravis.
Myasthenia gravis is a neuromuscular disorder that causes dysarthria associated with a nasal voice tone. Typically, the dysarthria worsens during the day and may temporarily improve with short rest periods. Other findings include dysphagia, drooling, facial weakness, diplopia, ptosis, dyspnea, and muscle weakness.
Olivopontocerebellar degeneration
Dysarthria, a major sign, accompanies cerebellar ataxia and spasticity.
Parkinson’s disease
Parkinson’s disease produces dysarthria and a monotone voice. It also produces muscle rigidity, bradykinesia, involuntary tremor usually beginning in the fingers, difficulty in walking, muscle weakness, and stooped posture. Other findings include masklike facies, dysphagia, and occasionally drooling.
Shy-Drager syndrome
Marked by chronic orthostatic hypotension, Shy-Drager syndrome eventually causes dysarthria as well as cerebellar ataxia, bradykinesia, masklike facies, dementia, impotence and, possibly, stooped posture and incontinence.
Stroke (brain stem)
Brain stem stroke is characterized by bulbar palsy, resulting in the triad of dysarthria, dysphonia, and dysphagia. The dysarthria is most severe at onset; it may lessen or disappear with rehabilitation and training. Other findings include facial weakness, diplopia, hemiparesis, spasticity, drooling, dyspnea, and decreased LOC.
Stroke (cerebral)
A massive bilateral stroke causes pseudobulbar palsy. Bilateral weakness produces dysarthria that’s most severe at onset. This sign is accompanied by dysphagia, drooling, dysphonia, bilateral hemianopsia, and aphasia. Sensory loss, spasticity, and hyperreflexia may also occur.
Other causes
Drugs
Dysarthria can occur when anticonvulsant dosage is too high. Ingestion of large doses of barbiturates may also cause dysarthria.
Nursing considerations
Encourage the patient with dysarthria to speak slowly so that he can be understood. Give him time to express himself, and encourage him to use gestures. Dysarthria usually requires consultation with a speech pathologist.
Patient teaching
Instruct the patient and his family about communication techniques. Encourage the patient to express his feelings. Provide guidelines on foods or liquids that should be avoided due to risk for aspiration. Refer the patient to a speech therapist.
Pictures
Book Source Details
- Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
More About Causes of Brain symptoms
» Next page: Battle's sign (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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