Treatment of Dysarthria in Patients with Multiple Sclerosis. Barbara Bryant Jane Vyce

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1 Treatment of Dysarthria in Patients with Multiple Sclerosis Barbara Bryant Jane Vyce

2 What is MS? An autoimmune disease Destruction of myelin Destruction of axons

3 What is MS? Etiology/Pathophysiology Cause is unknown No specific gene has been identified Age of onset Symptoms occur between the ages of Rarely manifests before age 15 or after age 60

4 Epidemiology Affects 250, ,000 people in the US Women are twice as likely as men to be affected Northern European heritage are most likely to be affected Very rare among Asians, North & South American Indians, and Eskimos Higher incidence in Northern US, Canada and Northern Europe than the rest of the world Rare between the equator and latitudes degrees north and south National MS Society

South American Indians, and Eskimos Higher incidence in Northern US, Canada and Northern Europe than

5 Environmental Factors Climate Humidity Hours of daily sunshine Resistance to certain viruses Consumption of cow s milk Toxins Trauma

6 Progression Slowly progressive disease of the CNS Four types of MS Relapsing-Remitting 80-85% Secondary Progressive 70% of the 80-85% Primary Progressive 15-20% Progressive-Relapsing Rare National MS Society

7 Symptoms & Signs Weakness Fatigue Sensory loss Bladder or bowel dysfunction Vertigo Dysphagia Ataxia Dysarthria National MS Society

8 Effects on Speech, Language and Swallowing Swallowing Language Speech Spastic Ataxic Mixed: spastic and ataxic Duffy (2005)

9 Treatment Glutamate Excitotoxicity Pitt, Werner, & Raine (2000) FM Technology Lewis, et al (2006) Music Therapy Wiens, Reimer, & Guyn (1999) Deep Brain Stimulation -Putzer, Barry, & Moringlane (2007) Inspiratory -Klefbeck & Nedjad (2003) Expiratory - Chiara, Martin, & Sapienza (2007) Rate and Loudness -Miller (no date) & Tjaden & Wilding (2004)

-Putzer, Barry, & Moringlane (2007) Inspiratory -Klefbeck & Nedjad (2003) Expiratory -

10 Deep Brain Stimulation 7 patients with MS with severe ataxia and intention tremor Electrodes implanted into left and/or right ventrolateral area of thalamus Limb ataxia and tremor improved Decreased articulatory performance Strained phonation in female patients Putzer, Barry, & Moringlane (2007)

ventrolateral area of thalamus Limb ataxia and tremor improved Decreased

11 Inspiratory Muscle Training Patients received 10 weeks of training Inspiratory Muscle Training (IMT) device One month post-training benefit Klefbeck & Nedjad (2003)

12 Expiratory Muscle Training 17 participants with MS 8 week training period Positive Expiratory Pressure (PEP) threshold trainer Maximum Expiratory Pressure (MEP) Vowel prolongation increased, e.g. [ah] No effects of dysarthria Chiara, Martin, & Sapienza (2007)

trainer Maximum Expiratory Pressure (MEP) Vowel prolongation

13 Rate Rigid rate control Metronome Finger tapping Alphabet board Rhythmic rate control Visipitch Auditory feedback Direct Magnitude Production (DMP) Reduced rate Improved intelligibility Loss of naturalness of speech Miller (no date)

Direct Magnitude Production (DMP) Reduced rate Improved

14 Loudness Lee Silverman Voice Treatment (LSVT) Increased vowel space Increased intelligibility Increased ease of perception Tjaden & Wilding (2004)

15 Summary Variability among MS Varying types of dysarthrias Varying degrees of severity of dysarthria No clear-cut treatment options

16 Judy

17 References Chiara, T., Martin, D. & Sapienza, C. (March 2007). Expiratory Muscle Strength Training: Speech Production Outcomes in Patients with Multiple Sclerosis. Neurorehabilitation and Neural Repair, 21(3), Duffy, J. R. (2005). Motor Speech Disorders (2nd ed.). St Louis Missouri: Elsevier Mosby. Klefbeck, P. & Nedjad, J. (July 2003). Effect of Inspiratory Muscle Training in Patients with Multiple Sclerosis. Arch Phys Med Rehabil, 84, Lewis, S., Hutter, M., Lilly, D., Bourdette, D., Saunders, J. & Fausti, S. (November 2006). Frequency Modulation (FM) Technology as a Method for Improving Speech Perception in Noise for Individuals with Multiple Sclerosis. Journal of American Academic Audiology, 17, McHenry, M.A., The effect of pacing strategies on the variability of speech movement sequences in dysarthria. Journal of speech, language, and hearing research, 46, Miller, P.H., no date. Dysarthria in Multiple Sclerosis. National Multiple Sclerosis society: Clinical bulletin. Retrieved from

Effect of Inspiratory Muscle Training in Patients with Multiple Sclerosis. Arch Phys Med Rehabil, 84, 994-999. Lewis, S., Hutter, M., Lilly, D., Bourdette, D., Saunders, J. & Fausti, S.

18 References cont. Multiple Sclerosis- Mayo Clinic. Retrieved , from Multiple Sclerosis. Retrieved , from National MS Society. Speech and Swallowing Disorders. Retrieved , from Pitt, D., Werner, P. & Raine, C. (January 2000). Glutamate Excitotoxicity in a Model of Multiple Sclerosis. Nature America, 6(1), Putzer, M., Barry, W. & Moringlane, J. (June 2007). Effect of Deep Brain Stimulation on Different Speech Subsystems in Patients with Multiple Sclerosis. Journal of Voice, 6(6), Tjaden, K. & Wilding, G. (August 2004). Rate and Loudness Manipulations in Dysarthria: Acoustic and Perceptual Findings. Journal of Speech, Language, and Hearing Research, 47(2), Wiens, M., Reimer, M. & Guyn, L. (March 1999). Music Therapy as a Treatment for Improving Respiratory Muscle Strength in Patients with Advanced Multiple Sclerosis: A Pilot Study. Rehabilitation Nursing, 24(2), Young, E. Autoimmune disease risk for teachers revealed. New Scientist. Retrieved , from

org/sourcebook Pitt, D., Werner, P. & Raine, C. (January 2000). Glutamate Excitotoxicity in a Model of Multiple Sclerosis. Nature America, 6(1), 67-71. Putzer, M., Barry, W. & Moringlane, J.

Maria Tosoni & Lindsey Gannon

Maria Tosoni & Lindsey Gannon Thoracic Muscles Muscles of Inspiration External Intercostal Muscles & Intercartilaginous Intercostal Muscles Muscles of Expiration Interosseus Intercostal Muscles Abdominal