Spastic Dysarthria vs. Spasmodic Dysphonia

Spastic Dysarthria vs.
Spasmodic Dysphonia

Symptoms, Treatment, and Differential
Diagnosis

Ariella Ruderman & Jasmine Smith

Spastic Dysarthria

„ Caused by bilateral damage to UMN

‰ Degenerative disease, vascular causes, TBI,
unknown

„ Hypertonia, hyperreflexia, spasticity,
neuropath. reflexes

„ Speech: slow, effortful, may be hypernasal,
imprecise artic., hoarseness, strain-strangle,
monopitch/pitch breaks, short phrases,
monoloud

(Duffy 2005)

Spasmodic Dysphonia

„ Cause: probably supranuclear (once thought
psychogenic)

„ AD type

‰ VF's spasm shut
‰ Vocal strain, voice blocks

„ AB type

‰ VF's spasm open
‰ Breathy voice, aphonic moments
‰ Worse during unvoiced consonants

„ TASK SPECIFIC! Symptoms only occur during
connected speech

Stemple (2000), Finitzo (1989)

Diagnosing motor-speech disorders
based on voice production and
quality

„ Darley, Aronson Brown

‰ showed each type of dysarthria manifests
“clinically distinguishable auditory-perceptual
characteristics.” (Duffy & Kent, 2001)

„ Voice features correspond to physiology

(shown by DAB in original tests of validity of their methods but cross-
validation using modern imaging techniques in order)

„ Birth of the SLP as diagnostician!

Acoustic-perceptual analysis

A tool developed by DAB to guide listening to the features of a
patient’s speech

‰ Created a rating scale: 38 perceptual features

(newer examples: GRBAS scale: Grade, Roughness, Breathiness,
Asthenia, Strain; CAPE-V: Consensus Auditory Perceptual Evaluation–Voice)

„ Advantages:

‰ Requires only a trained ear
‰ After some debate has been shown to be effective, even in novice

clinicians (Bunton, et al. 2007)

„ Disadvantages:

‰ Subjective
‰ Efficacy debated in the research
‰ Thorough training required

Other assessment tools

„ Acoustic analysis

‰ ex. Visi-pitch,

„ laryngostroboscopic recordings
„ electroglottography (EGG)

‰ Assesses laryngeal functioning

„ electromyography (EMG)

‰ Assesses muscle function

„ videofluoroscopic assessment

‰ Swallowing test

Video Segments

„ Spastic Dysarthria (2 mins)

‰ Breathy, slow, monotone, monoloud, effortful,
hoarse

‰ Rigid left arm
‰ Possible co-existing language disorder (ex. “time”)

Video Segments

„ Spasmodic Dysphonia (3 mins)

‰ AB Type (Mary)

„ Breathy, especially on unvoiced sounds (/h/)

‰ AB Type, AB Type, + Tremor (Stephie)

„ Strained voice, effortful, breathy on some unvoiced
sounds, tremor on /a/

‰ AD Type, + Paroximal Dyskinesia (Jerome)

„ Voice blocks, strained, hoarse (esp. on /a/)

‰ AD Type, + Tremor (Dot)

„ Monopitch, monoloud, slow, effortful (Don’t confuse with
PD!), voice breaks and tremor on /a/

Patient Complaints, Other Symptoms

„ Spastic Dysarthria „ Spasmodic Dysphonia
„ “Speech is slower, it tires
„ Negative impact on job,
me” social life, and emotions
„ “My speech is nasal”
„ Swallowing difficulty „ Vocal fatigue caused by
„ Drooling increased effort in speech
„ Difficult to control laughter
„ Body motions or tenseness
or crying (pseudobulbar may be present secondary
affect) to spasms (AD type)
„ Pathologic reflexes
„ Weakness „ Frustration getting accurate
DX

Treatment

„ Spastic Dysarthria

‰ Voice Therapy

„ LSVT, etc.

„ Spasmodic Dysphoina

‰ Botox to stop spasms

„ Cycle lasting ~3-4 months

‰ Section RLN (CN X)--paresis of VF's

„ Permanent

‰ Acupuncture (pt feels better, sounds same)

Boutsen (2003), Damrose (2004), Stemple (2000)

References
„ ASHA Leader (2001). It's Not a Nasty Cold...It's Spasmodic Dysphonia. 6,16.

„ Baylor, C.R., Yorkston, K.M., Eadie, T.L., & Maronian, N.C. (2006). The psychosocial

consequence of BOTOX injections for spasmodic dysphonia: A qualitative study of

patient’s experiences. Journal of Voice, 21, 231-247.

„ Baylor, Carolyn R.; Yorkston, Kathryn M.; Eadie, Tanya L. (2005) The consequences of

spasmodic dysphonia on communication-related quality of life: A qualitative study of

the insider's experiences. Journal of Communication Disorders. 38, 395-419.

„ Bender, B.K., Cannito, M.P., Murry, T., & Woodson, G.E. (2004). Speech intelligibility in severe

adductor spasmodic dysphonia. Journal of Speech, Language, and Hearing Research, 47, 21-

33.

„ Boutsen, F., Cannito, M.P., Taylor, M., Bender, B. (2002). Botox treatment in adductor
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45, 469-482.

„ Bunton, Kate; Kent, Raymond D.; Duffy, Joseph R.; Rosenbek, John C.; Kent, Jane F. (2007).
Listener Agreement for Auditory-Perceptual Ratings of Dysarthria. Journal of Speech, Language

& Hearing Research, 50, 1481-1495.

„ Bunton, Kate; Kent, Ray D.; Kent, Jane F.; Rosenbek, John C. (2000) Perceptuo-acoustic
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„ Finitzo, T. & Freeman, F. (1989). Spasmodic Dysphonia, whether and where: Results of seven
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„ National Spasmodic Dysphonia Association (2008). Understanding Spasmodic Dysphonia (DVD).

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„ Roy, N., Mauszycki, Shannon, Merrill, Ray, Gouse, Manon, Smith, Marshall (2007) Toward Improved
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„

„ Sapienza, G.M., Cannito, M.P., Murray, T., Branski, R., Woodson, G. (2002). Acoustic variations

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„ Sataloff, R.T., Deman-Ackah, Y.D., Simpson, L.L., Park, J.B., Zwislewski, A., Sokolow, C., &

Mandel, S. (2002). Botulinim toxin type B for treatment of spasmodic dysphonia: A case report.

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„ Stemple, J.C., Glaze, L.E., Klaben, B.G. (2000). Clinical Voice Pathology: Theory and

management (3rd ed). Singular Publishing Group: San Deigo, CA.

„ Tjaden, Kris; Wilding, Gregory E. (2004). Rate and Loudness Manipulations in Dysarthria: Acoustic
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„

„ Wingate, J.M., Ruddy, B.H., Lundy, D.S., & Lehman, J. (2005). Voice Handicap Index results for
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ASHA Leader, Vol. 9 Issue 9, p4-21, 4p