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  ICD9          = {{ICD9|784.5}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = D004401 |
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{{SI}}
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{{CMG}}
{{CMG}}; {{AE}} {{ZMalik}}
 
{{SK}} [[Motor Speech Disorder]]


==Overview==
==Overview==
'''Dysarthria''' is a [[speech disorder]] resulting from [[Brain damage|neurological injury]], characterised by poor articulation (cf [[aphasia]]: disorder of the content of speech). Any of the speech subsystems ([[Respiratory system|respiration]], [[phonation]], [[resonance]], [[prosody]], [[articulation]] and movements of jaw and tongue) can be affected.  
[[Dysarthria]] is a [[motor]] [[speech]] disorder caused by a [[neurological]] deficit resulting in weakening or [[paralysis]] of the [[muscles]] responsible for speech formation. The term dysarthria is derived from New [[Latin]]. Dysarthria may be classified according to presentation of symptoms into 7 subgroups. Neurological deficit in [[CNS]] and/or [[PNS]] causes [[weakness]] and/or [[paralysis]] of [[muscles]] responsible for speech. Dysarthria must be differentiated from other [[motor speech disorders]] like [[apraxia]] and [[developmental verbal dyspraxia]]. [[Incidence]] and [[prevalence]] is not fully established. Dysarthria affects men and women equally. There are no established [[risk factors]] for dysarthria. There is insufficient evidence to recommend routine [[screening]] for dysarthria. Common complications of dysarthria include [[social distancing]], irritability, and [[depression]]. Detailed history and examination are important to identify the cause and to classify dysarthria. There are no [[CT scan]] findings associated with dysarthria. However, it provides a detailed image of [[CNS]] to help identify the underlying cause of the speech problems. Treatment includes exercises and techniques to adjust [[speech]] rate, strengthen [[muscles]] of [[articulation]], increase breath support, improve [[articulation]], safe chewing and swallowing, avoiding conversations when feeling tired, repeat words and syllables, and techniques to deal with the frustration while speaking.  


Disarthic speech is due to some disorder in the nervous system, which in turn hinders control over for example tongue, throat, lips or lungs. Swallowing problems, [[dysphagia]], are often present.
==Historical Perspective==


Cranial nerves that control these muscles include the [[facial nerve]] (VII), the [[glossopharyngeal nerve]] (IX), the [[vagus nerve]] (X), and the [[hypoglossal nerve]] (XII).
*The term dysarthria is derived from New [[Latin]].
*'Dys' means dysfunctional/impaired and 'arthr' means joint/vocal [[articulation]].<ref> "Definition of DYSARTHRIA". www.merriam-webster.com. Retrieved 2020-03-07. </ref>
*Tradiationally, dysarthria has been defined as disorders of oral [[speech]] resulting from lesions within the nervous system.<ref name="Hirose1986">{{cite journal|last1=Hirose|first1=Hajime|title=Pathophysiology of Motor Speech Disorders (Dysarthria)|journal=Folia Phoniatrica et Logopaedica|volume=38|issue=2-4|year=1986|pages=61–88|issn=1421-9972|doi=10.1159/000265824}}</ref>
*Recently, dysarthria includes speech disorders resulting from problems in muscular control of speech formation.<ref>Darley, F. L., Aronson, A. E., & Brown, J. R. (1975). Motor speech disorders. Philadelphia, PA: W.B. Saunders.</ref>


==Classification==
==Classification==
Dysarthrias are classified in multiple ways based on the presentation of symptoms.  Specific dysarthrias include [[Spastic]], [[Flaccid]], Hyperkinetic, Hypokinetic, [[Ataxic]], Unilateral [[upper motor neuron]], and Mixed dysarthria.
 
*Dysarthria may be classified according to presentation of symptoms into the following:<ref name="DuffyJosephs2012">{{cite journal|last1=Duffy|first1=Joseph R.|last2=Josephs|first2=Keith A.|title=The Diagnosis and Understanding of Apraxia of Speech: Why Including Neurodegenerative Etiologies May Be Important|journal=Journal of Speech, Language, and Hearing Research|volume=55|issue=5|year=2012|issn=1092-4388|doi=10.1044/1092-4388(2012/11-0309)}}</ref> <ref>1459-Blanchet%20(1).pdf</ref>
 
{| class="wikitable"
|'''Type of Dysarthria'''||'''Area of Lesion'''||'''Main Feature'''
|-
  |[[Flaccid]]||Bilateral/unilateral [[lower motor neuron]]||Weakness, [[hyporeflexia]], lack of normal muscle tone
|-
|[[Spastic]]||Bilateral [[upper motor neuron]](UMN)||Weakness, [[hyperreflexia]], [[hypertonicity]]
|-
|Unilateral UMN||Unilateral [[upper motor neuron]]||Weakness, reduced range of motion, decreased fine motor control of tongue & lips
|-
|[[Ataxic]]||[[Cerebellum]]||Poorly coordinated movements of speech mechanism, scanning/drunken speech
|-
|[[Hyper-kinetic]]||[[Basal ganglia]]||Quick involuntary movements (hyperkinesis)
|-
|[[Hypo-kinetic]]||[[Basal ganglia]]||Less movement (hypokinesis), increased muscle tone
|-
|Mixed||More that one type of dysarthria co-exist||Mixed presentation
|}


==Pathophysiology==
==Pathophysiology==
The reasons behind dysarthria can be many; among the diseases are [[Amyotrophic lateral sclerosis|ALS]], [[Parkinson's disease]],  botulism, cranial nerve lesions, chorea, [[prion]] protein related diseases, and [[cerebral palsy]]. Dysarthria can also be an early symptom of stroke, and of other forms of traumatic brain injury. More common causes are [[intoxication]] and [[anesthesia]], although these are transient. Another possibility is [[myasthenia gravis]].


== Causes of Dysarthria==
*Dysarthria is a [[motor speech disorder]], marked by poor articulation caused by neuromuscular impairment.<ref> O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company </ref>
*Neurological deficit in [[CNS]] and/or [[PNS]] causes [[weakness]] and/or [[paralysis]] of [[muscles]] responsible for speech.
*Following subsystems contribute to speech formation, impairment of these subsystems results into poor perceptual speech:<ref>{{cite journal |vauthors=Mackenzie C |title=Dysarthria in stroke: a narrative review of its description and the outcome of intervention |journal=Int J Speech Lang Pathol |volume=13 |issue=2 |pages=125–36 |date=April 2011 |pmid=21480809 |doi=10.3109/17549507.2011.524940 |url=}}</ref>
**[[Respiration]]
**[[Phonation]]
**[[Resonance]]
**[[Prosody]]
**[[Articulation]]
 
==Causes==
Common causes of dysarthria  include:
{| class="wikitable"
|'''Pathology'''||'''Disease'''
|-
|[[Lower motor neuron]]||[[Myasthenia gravis]], [[muscular dystrophy]], cranial nerve VII, IX, X, XII, motor neuron disease
|-
|[[Upper motor neuron]](UMN)||[[Stroke]], [[Multiple sclerosis]], [[amyotrophic lateral sclerosis]], [[brain tumor]], [[brain injury]], [[cerebral palsy]]
|-
|[[Cerebellum]]||[[Spinal-Cerebellar Ataxia]], [[multiple sclerosis]], [[alcohol]], [[tumor]], [[paraneoplastic]] disorder
|-
|[[Basal ganglia]] - Hyperkinetic||[[Huntington's disease]]
|-
|[[Basal ganglia]] - Hypokinetic||[[Parkinsonism]]
|-
|Toxic and metabolic||[[Wilson's disease]], [[hypoxic encephalopathy]], [[central pontine myelinolysis]], [[botulism]]
|}


In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
==Differentiating Dysarthria from other Diseases==


=== Neurological ===
*Dysarthria must be differentiated from other [[motor speech disorders]] like [[apraxia]] and [[developmental verbal dyspraxia]].
*[[Apraxia]] is a neurological disorder where there are abilities and motivations to form speech but the patient cannot due to [[neurological deficit]].
*[[Development verbal dyspraxia]] lacks muscle weakness and is characterized by the developmental inability to motor plan volitional movement for the production of speech. Links to the [[FOXP2]] gene have been identified.<ref> Duffy, J. R. (2013). Motor speech disorders (3rd ed.)St. Louis, MO: Elsevier Mosby. </ref>


* [[Abscess]]
==Epidemiology and Demographics==
* [[Amyotrophic Lateral Sclerosis]] ([[ALS]])
* [[Botulism]]
* [[Brainstem]] [[stroke]]
* [[Dermatomyositis]]
* [[Diabetic]] nerve infarction
* [[Hypothyroidism]]
* [[Mitochondrial disease]]
* [[Myasthenia gravis]]
* [[Myotonic muscular dystrophy]]
* Nerve gas/ [[organophosphate poisoning]]
* [[Parkinson's Disease]]
* [[Polymyositis]]
* Prolonged effects of [[anesthesia]]
* [[Stroke]]
* [[Tumor]]


=== Structural ===
*[[Incidence]] and [[prevalence]] is not fully established.
* [[Tumor]]s:
*Disease based [[prevalence]] of dysarthria is as following:
*:* Lips
**[[Stroke]]: Approximately 8%–60% of individuals with stroke present with dysarthria.<ref name="BogousslavskyVan Melle1988">{{cite journal|last1=Bogousslavsky|first1=J|last2=Van Melle|first2=G|last3=Regli|first3=F|title=The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke.|journal=Stroke|volume=19|issue=9|year=1988|pages=1083–1092|issn=0039-2499|doi=10.1161/01.STR.19.9.1083}}</ref>
*:* Squamous cell epithelium of the oropharynx and vocal cords
**[[Parkinson's disease]]: Approximately 70%–100% of individuals develop dysarthria.<ref name="HarteliusSvensson1994">{{cite journal|last1=Hartelius|first1=L.|last2=Svensson|first2=P.|title=Speech and Swallowing Symptoms Associated with Parkinson’s Disease and Multiple Sclerosis: A Survey|journal=Folia Phoniatrica et Logopaedica|volume=46|issue=1|year=1994|pages=9–17|issn=1421-9972|doi=10.1159/000266286}}</ref>
*:* [[Tongue]]
**[[Multiple sclerosis]]: 25% and 50% of individuals with multiple sclerosis present with dysarthria at some point.<ref name="DarleyBrown1972">{{cite journal|last1=Darley|first1=Frederic L.|last2=Brown|first2=Joe R.|last3=Goldstein|first3=Norman P.|title=Dysarthria in Multiple Sclerosis|journal=Journal of Speech and Hearing Research|volume=15|issue=2|year=1972|pages=229–245|issn=0022-4685|doi=10.1044/jshr.1502.229}}</ref>
**[[Amyotrophic lateral sclerosis]]: Approximately 30%-100% depending on the stage of the disease.<ref name="ChenGarrett2016">{{cite journal|last1=Chen|first1=Anton|last2=Garrett|first2=C. Gaelyn|title=Otolaryngologic presentations of amyotrophic lateral sclerosis|journal=Otolaryngology–Head and Neck Surgery|volume=132|issue=3|year=2016|pages=500–504|issn=0194-5998|doi=10.1016/j.otohns.2004.09.092}}</ref>
**[[Traumatic brain injury]]: Approximately 10%–65% of individuals with traumatic brain injury develop dysarthria.<ref>{{cite journal|journal=Cochrane Database of Systematic Reviews|issn=14651858|doi=10.1002/14651858}}</ref>
*There is no racial predilection to dysarthria.
*Dysarthria affects men and women equally.


=== Less Common Etiologies ===
==Risk Factors==
* Acute [[dystonic reaction]]
* [[Amyloidosis]]
* Anaerobic infection
* [[Cleft palate]]
* Mild [[cerebral palsy]]
* Poor dentition or ill-fitting [[dentures]]
* Sedative/[[anticonvulsant]] intoxication
* Unrecognized foreign accent


==== Drug Side Effect ====
*There are no established [[risk factors]] for dysarthria.
*[[Asenapine maleate]]
 
*[[Cytarabine]]
==Screening==
*[[Botulinum toxin]]
 
*[[Eslicarbazepine acetate]]
*There is insufficient evidence to recommend routine [[screening]] for dysarthria.
*[[Flurazepam]]
 
*[[Lacosamide]]
==Natural History, Complications, and Prognosis==
*[[lomustine]]
 
*[[Loxapine]]  
*Common complications of dysarthria include [[social distancing]], irritability, and [[depression]].
*[[Olanzapine]]
*[[Prognosis]] varies depending on the severity of underlying disease and response to [[speech therapy]].
*[[Oprelvekin]]
 
*[[Pramipexole]]
==Diagnosis==
*[[Perphenazine]]
===Diagnostic Study of Choice===
*[[Triazolam]]
 
*There are no established criteria for the diagnosis of dysarthria.
*Detailed history and examination are important to identify the cause and to classify dysarthria.
*Speech assessment should be conducted by a speech-language pathologist to identify perceptual speech and subsystem involvement.
 
===History and Symptoms===
 
*[[Medical sign|Signs]] and [[Symptom|symptoms]] of dysarthria vary, depending on the underlying cause and the type of dysarthria.<ref> O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company </ref>
*[[Patient]] may present with slow or rapid [[speech]], nasal speech, uneven or monotone, [[Slurred speech resident survival guide|slurred speech]] and/or abnormal speech volume or rhythm.<ref name="Mackenzie2011">{{cite journal|last1=Mackenzie|first1=Catherine|title=Dysarthria in stroke: A narrative review of its description and the outcome of intervention|journal=International Journal of Speech-Language Pathology|volume=13|issue=2|year=2011|pages=125–136|issn=1754-9507|doi=10.3109/17549507.2011.524940}}</ref>
 
===Physical Examination===
 
*[[Physical examination]] varies depending on the underlying cause of dysarthria.
 
===Laboratory Findings===
 
*There are no [[diagnostic]] laboratory findings associated with dysarthria. Laboratory findings defer on the basis of the underlying [[cause]].
 
===Electrocardiogram===
 
*There are no [[ECG]] findings associated with dysarthria.
 
===X-ray===
 
*There are no [[x-ray]] findings associated with dysarthria.
 
===Echocardiography or Ultrasound===
 
*There are no [[echocardiography]]/[[ultrasound]] findings associated with dysarthria.
 
===CT Scan===
 
*There are no [[CT scan]] findings associated with dysarthria. However, it provides a detailed image of [[CNS]] to help identify the underlying cause of the speech problems.
 
===MRI===
 
*There are no [[MRI]] findings associated with dysarthria. However, it provides a detailed image of [[CNS]] to help identify the underlying cause of the speech problems.
 
===Other Imaging Findings===
 
*There are no other [[imaging]] findings associated with dysarthria.
 
===Other Diagnostic Studies===
 
*There are no other [[diagnostic]] studies associated with dysarthria.


==Treatment==
==Treatment==
The articulation problems that dysarthria causes can be treated together with a speech language pathologist using a range of techniques which sometimes includes strengthening the speech musculature. Devices that make coping with dysarthria easier include speech synthesis software and text-based telephones.
===Medical Therapy===
 
*Treatment is focused on achieving independent daily living for the patients.
*A [[speech language pathologist]] assist in improving [[respiration]], [[phonation]], [[resonance]], [[prosody]] and/or [[articulation]] using various techniques.
*These treatment includes exercises and techniques to adjust [[speech]] rate, strengthen [[muscles]] of [[articulation]], increase breath support, improve [[articulation]], safe chewing and swallowing, avoiding conversations when feeling tired, repeat words and syllables, and techniques to deal with the frustration while speaking.
*If dysarthria is severe, another possible technique includes using a computer or flip cards to communicate more effectively.<ref>"Dysarthria". PubMed Health.</ref>
*[[Augmentative and alternative communication]] (AAC) is used by [[speech language pathologist]] to supplement or replace natural speech.
*[[Lee Silverman voice treatment]](LSVT) focuses on increasing vocal loudness and is found to be effective in patients with [[Parkinson's disease]].<ref>e National Collaborating Centre for Chronic Conditions, ed. (2006). "Other key interventions". Parkinson's Disease. London: Royal College of Physicians. pp. 135–146.</ref>
*Pitch Limiting Voice Treatment (PLVT) increases loudness without increasing [[pitch]].<ref name="de SwartWillemse2003">{{cite journal|last1=de Swart|first1=B. J.M.|last2=Willemse|first2=S. C.|last3=Maassen|first3=B.A.M.|last4=Horstink|first4=M. W.I.M.|title=Improvement of voicing in patients with Parkinson's disease by speech therapy|journal=Neurology|volume=60|issue=3|year=2003|pages=498–500|issn=0028-3878|doi=10.1212/01.WNL.0000044480.95458.56}}</ref>
*Treat the underlying [[cause]] and slowing progression of the disease-causing [[motor]] [[speech]] dysfunction.
 
===Surgery===
 
*[[Surgical]] intervention is not recommended for the management of dysarthria.
 
===Primary Prevention===
 
*There are no established measures for the [[primary prevention]] of dysarthria.
 
===Secondary Prevention===
 
*There are no established measures for the secondary prevention of dysarthria.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
[[Category:UP-to-date]]
 
[[fr:Dysarthrie]]
[[fr:Dysarthrie]]
[[pl:Dyzartria]]
[[pl:Dyzartria]]
[[tr:Dizartri]]
[[tr:Dizartri]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Communication disorders]]
[[Category:Communication disorders]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
{{WH}}
{{WS}}

Latest revision as of 00:56, 22 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Synonyms and keywords: Motor Speech Disorder

Overview

Dysarthria is a motor speech disorder caused by a neurological deficit resulting in weakening or paralysis of the muscles responsible for speech formation. The term dysarthria is derived from New Latin. Dysarthria may be classified according to presentation of symptoms into 7 subgroups. Neurological deficit in CNS and/or PNS causes weakness and/or paralysis of muscles responsible for speech. Dysarthria must be differentiated from other motor speech disorders like apraxia and developmental verbal dyspraxia. Incidence and prevalence is not fully established. Dysarthria affects men and women equally. There are no established risk factors for dysarthria. There is insufficient evidence to recommend routine screening for dysarthria. Common complications of dysarthria include social distancing, irritability, and depression. Detailed history and examination are important to identify the cause and to classify dysarthria. There are no CT scan findings associated with dysarthria. However, it provides a detailed image of CNS to help identify the underlying cause of the speech problems. Treatment includes exercises and techniques to adjust speech rate, strengthen muscles of articulation, increase breath support, improve articulation, safe chewing and swallowing, avoiding conversations when feeling tired, repeat words and syllables, and techniques to deal with the frustration while speaking.

Historical Perspective

  • The term dysarthria is derived from New Latin.
  • 'Dys' means dysfunctional/impaired and 'arthr' means joint/vocal articulation.[1]
  • Tradiationally, dysarthria has been defined as disorders of oral speech resulting from lesions within the nervous system.[2]
  • Recently, dysarthria includes speech disorders resulting from problems in muscular control of speech formation.[3]

Classification

  • Dysarthria may be classified according to presentation of symptoms into the following:[4] [5]
Type of Dysarthria Area of Lesion Main Feature
Flaccid Bilateral/unilateral lower motor neuron Weakness, hyporeflexia, lack of normal muscle tone
Spastic Bilateral upper motor neuron(UMN) Weakness, hyperreflexia, hypertonicity
Unilateral UMN Unilateral upper motor neuron Weakness, reduced range of motion, decreased fine motor control of tongue & lips
Ataxic Cerebellum Poorly coordinated movements of speech mechanism, scanning/drunken speech
Hyper-kinetic Basal ganglia Quick involuntary movements (hyperkinesis)
Hypo-kinetic Basal ganglia Less movement (hypokinesis), increased muscle tone
Mixed More that one type of dysarthria co-exist Mixed presentation

Pathophysiology

Causes

Common causes of dysarthria include:

Pathology Disease
Lower motor neuron Myasthenia gravis, muscular dystrophy, cranial nerve VII, IX, X, XII, motor neuron disease
Upper motor neuron(UMN) Stroke, Multiple sclerosis, amyotrophic lateral sclerosis, brain tumor, brain injury, cerebral palsy
Cerebellum Spinal-Cerebellar Ataxia, multiple sclerosis, alcohol, tumor, paraneoplastic disorder
Basal ganglia - Hyperkinetic Huntington's disease
Basal ganglia - Hypokinetic Parkinsonism
Toxic and metabolic Wilson's disease, hypoxic encephalopathy, central pontine myelinolysis, botulism

Differentiating Dysarthria from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

  • There is insufficient evidence to recommend routine screening for dysarthria.

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

  • There are no established criteria for the diagnosis of dysarthria.
  • Detailed history and examination are important to identify the cause and to classify dysarthria.
  • Speech assessment should be conducted by a speech-language pathologist to identify perceptual speech and subsystem involvement.

History and Symptoms

  • Signs and symptoms of dysarthria vary, depending on the underlying cause and the type of dysarthria.[14]
  • Patient may present with slow or rapid speech, nasal speech, uneven or monotone, slurred speech and/or abnormal speech volume or rhythm.[15]

Physical Examination

Laboratory Findings

  • There are no diagnostic laboratory findings associated with dysarthria. Laboratory findings defer on the basis of the underlying cause.

Electrocardiogram

  • There are no ECG findings associated with dysarthria.

X-ray

  • There are no x-ray findings associated with dysarthria.

Echocardiography or Ultrasound

CT Scan

  • There are no CT scan findings associated with dysarthria. However, it provides a detailed image of CNS to help identify the underlying cause of the speech problems.

MRI

  • There are no MRI findings associated with dysarthria. However, it provides a detailed image of CNS to help identify the underlying cause of the speech problems.

Other Imaging Findings

  • There are no other imaging findings associated with dysarthria.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with dysarthria.

Treatment

Medical Therapy

Surgery

  • Surgical intervention is not recommended for the management of dysarthria.

Primary Prevention

Secondary Prevention

  • There are no established measures for the secondary prevention of dysarthria.

References

  1. ↑ "Definition of DYSARTHRIA". www.merriam-webster.com. Retrieved 2020-03-07.
  2. ↑ Hirose, Hajime (1986). "Pathophysiology of Motor Speech Disorders (Dysarthria)". Folia Phoniatrica et Logopaedica. 38 (2–4): 61–88. doi:10.1159/000265824. ISSN 1421-9972.
  3. ↑ Darley, F. L., Aronson, A. E., & Brown, J. R. (1975). Motor speech disorders. Philadelphia, PA: W.B. Saunders.
  4. ↑ Duffy, Joseph R.; Josephs, Keith A. (2012). "The Diagnosis and Understanding of Apraxia of Speech: Why Including Neurodegenerative Etiologies May Be Important". Journal of Speech, Language, and Hearing Research. 55 (5). doi:10.1044/1092-4388(2012/11-0309). ISSN 1092-4388.
  5. ↑ 1459-Blanchet%20(1).pdf
  6. ↑ O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company
  7. ↑ Mackenzie C (April 2011). "Dysarthria in stroke: a narrative review of its description and the outcome of intervention". Int J Speech Lang Pathol. 13 (2): 125–36. doi:10.3109/17549507.2011.524940. PMID 21480809.
  8. ↑ Duffy, J. R. (2013). Motor speech disorders (3rd ed.)St. Louis, MO: Elsevier Mosby.
  9. ↑ Bogousslavsky, J; Van Melle, G; Regli, F (1988). "The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke". Stroke. 19 (9): 1083–1092. doi:10.1161/01.STR.19.9.1083. ISSN 0039-2499.
  10. ↑ Hartelius, L.; Svensson, P. (1994). "Speech and Swallowing Symptoms Associated with Parkinson's Disease and Multiple Sclerosis: A Survey". Folia Phoniatrica et Logopaedica. 46 (1): 9–17. doi:10.1159/000266286. ISSN 1421-9972.
  11. ↑ Darley, Frederic L.; Brown, Joe R.; Goldstein, Norman P. (1972). "Dysarthria in Multiple Sclerosis". Journal of Speech and Hearing Research. 15 (2): 229–245. doi:10.1044/jshr.1502.229. ISSN 0022-4685.
  12. ↑ Chen, Anton; Garrett, C. Gaelyn (2016). "Otolaryngologic presentations of amyotrophic lateral sclerosis". Otolaryngology–Head and Neck Surgery. 132 (3): 500–504. doi:10.1016/j.otohns.2004.09.092. ISSN 0194-5998.
  13. ↑ Cochrane Database of Systematic Reviews. doi:10.1002/14651858. ISSN 1465-1858. Missing or empty |title= (help)
  14. ↑ O'Sullivan, S. B.; Schmitz, T. J. (2007). Physical Rehabilitation (5th ed.). Philadelphia: F. A. Davis Company
  15. ↑ Mackenzie, Catherine (2011). "Dysarthria in stroke: A narrative review of its description and the outcome of intervention". International Journal of Speech-Language Pathology. 13 (2): 125–136. doi:10.3109/17549507.2011.524940. ISSN 1754-9507.
  16. ↑ "Dysarthria". PubMed Health.
  17. ↑ e National Collaborating Centre for Chronic Conditions, ed. (2006). "Other key interventions". Parkinson's Disease. London: Royal College of Physicians. pp. 135–146.
  18. ↑ de Swart, B. J.M.; Willemse, S. C.; Maassen, B.A.M.; Horstink, M. W.I.M. (2003). "Improvement of voicing in patients with Parkinson's disease by speech therapy". Neurology. 60 (3): 498–500. doi:10.1212/01.WNL.0000044480.95458.56. ISSN 0028-3878.
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