Treatment of Dysarthria in Patients with Multiple Sclerosis Barbara Bryant Jane Vyce
What is MS? An autoimmune disease Destruction of myelin Destruction of axons
What is MS? Etiology/Pathophysiology Cause is unknown No specific gene has been identified Age of onset Symptoms occur between the ages of 20 40 Rarely manifests before age 15 or after age 60
Epidemiology Affects 250,000 350,000 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 30 35 degrees north and south National MS Society
Environmental Factors Climate Humidity Hours of daily sunshine Resistance to certain viruses Consumption of cow s milk Toxins Trauma
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
Symptoms & Signs Weakness Fatigue Sensory loss Bladder or bowel dysfunction Vertigo Dysphagia Ataxia Dysarthria National MS Society
Effects on Speech, Language and Swallowing Swallowing Language Speech Spastic Ataxic Mixed: spastic and ataxic Duffy (2005)
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)
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)
Inspiratory Muscle Training Patients received 10 weeks of training Inspiratory Muscle Training (IMT) device One month post-training benefit Klefbeck & Nedjad (2003)
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)
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)
Loudness Lee Silverman Voice Treatment (LSVT) Increased vowel space Increased intelligibility Increased ease of perception Tjaden & Wilding (2004)
Summary Variability among MS Varying types of dysarthrias Varying degrees of severity of dysarthria No clear-cut treatment options
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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), 239-249. 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, 994-999. 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, 605-616. McHenry, M.A., 2003. The effect of pacing strategies on the variability of speech movement sequences in dysarthria. Journal of speech, language, and hearing research, 46, 702-710. Miller, P.H., no date. Dysarthria in Multiple Sclerosis. National Multiple Sclerosis society: Clinical bulletin. Retrieved 2008-04-18 from www.nationalmssociety.org/prc.asp
References cont. Multiple Sclerosis- Mayo Clinic. Retrieved 2008-05-06, from http://www.mayoclinic.com/health/multiple-sclerosis/ds00188/dsection=1 Multiple Sclerosis. Retrieved 2008-03-08, from http://www.fpnotebook.com/neuro/demyelinating/mltplsclrs.htm National MS Society. Speech and Swallowing Disorders. Retrieved 2008-02-14, from www.nationalmssociety.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. (June 2007). Effect of Deep Brain Stimulation on Different Speech Subsystems in Patients with Multiple Sclerosis. Journal of Voice, 6(6), 741-753. 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), 766-783. 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), 74-80. Young, E. Autoimmune disease risk for teachers revealed. New Scientist. Retrieved 2008-05-05, from http://www.newscientist.com/article/dn1106-autoimmune-diseaserisk-for-teachers-revealed.html