Bulbar dysarthria is a speech disorder that occurs as a result of damage to the cranial nerves. The disease is accompanied not only by pronunciation disorders, but also by swallowing difficulties. This pathology is one of the most common speech therapy disorders. If the bulbar form of dysarthria arose in adulthood, then this does not lead to a loss of writing and reading skills. In childhood, the consequences of such a speech disorder are much more serious. A child suffering from dysarthria finds it very difficult to write and read, which negatively affects his development.
Description of pathology
Under the term "dysarthria" doctors mean any speech disorder. These disorders may have various origins. With bulbar dysarthria, the lesion is formed in the region of the IX, X and XII pairs of cranial nerves. They innervate the speech apparatus. They are alsocalled bulbar nerves.
This section of the nervous system is divided into 3 parts:
- Glossopharyngeal nerve (IX pair). Innervates the region of the pharynx.
- Vagus nerve (X pair). Its branches extend to the muscles of the pharynx, palate and upper respiratory tract.
- Hypoglossal nerve (XII pair). Responsible for the innervation of the muscles of the tongue.
When bulbar dysarthria occurs damage to these structures. As a result, the patient weakens and atrophies the muscles of the pharynx, tongue and larynx. Speech becomes slurred and the voice loses its sonority.
When the vagus nerve is damaged, the soft palate sags, and air escapes through the nose when articulating sounds. This leads to the appearance of nasality. If the innervation of the pharyngeal muscles is impaired, then the patient has difficulty swallowing food and liquids.
In a sick person, connections between the CNS and the muscles of the oral cavity are lost. The movements of the tongue and lips become uncoordinated, which makes it very difficult for the patient to talk. When communicating with the patient, you can notice a small mobility of the muscles of the face and increased salivation.
Different forms of dysarthria: similarities and differences
In speech therapy and neurology, there are different forms of articulation disorders. It is very important to differentiate bulbar and pseudobulbar dysarthria. The symptoms of these two forms of speech disorders may be similar. Both varieties of dysarthria are accompanied by indistinct and excessively quiet pronunciation of sounds.
When pseudobulbar dysarthria affects brain cells. Atbulbar form of pathology damage occurs only on the peripheral nerves. Pseudobulbar dysarthria is accompanied by common neurological manifestations:
- significant memory impairment;
- difficulty concentrating;
- decrease in motor activity.
In addition, with the bulbar form, there is a weakening and atrophy of the muscles of the speech apparatus. With pseudobulbar dysarthria, the tone of the muscles of the pharynx and tongue is increased. It is very difficult to distinguish these two forms of pathology on their own. An accurate differential diagnosis can only be made by a neurologist.
Etiology
Cranial nerve lesions and speech disorders usually develop in the background of other diseases. Experts identify the following causes of bulbar dysarthria:
- Head injuries. Bulbar nerves can be damaged by bruising or compression. In young children, birth trauma can cause pathology.
- Circulatory disorders. The lack of blood supply in the area of the bulbar nerves leads to damage to neurons. Ischemia can be caused by stroke, atherosclerosis, hypertension, and vascular disorders in diabetes mellitus.
- Infection of the brain. Bulbar nerves can be compressed by edematous and inflamed brain tissues. Dysarthria often develops as a complication of meningitis, encephalitis, polio, and advanced neurosyphilis.
- Neoplasms of the brain. Bulbar nerves can be compressed by brain tumors.
- Degenerative pathologies of the central nervous system. These are heavy geneticpathologies in which atrophy and cell death occur in the medulla oblongata. These pathological processes also affect the bulbar nerves. After all, their nuclei are located in the medulla oblongata.
- Anomalies of the craniovertebral junction. These pathological processes are localized in the region of transition of the skull to the spine. Diseases of the craniovertebral region rarely cause dysarthria. However, in some cases, with such diseases, the medulla oblongata and nuclei of the bulbar nerves can be compressed.
Symptomatics. How to recognize?
The main symptom of bulbar dysarthria is impaired articulation. The patient has the following speech disorders:
- indistinct articulation;
- replacement of stop and vibrating consonants with fricative sounds;
- fuzzy pronunciation of vowels;
- monotone and slow speech;
- distortion of the rhythm of words and sentences;
- loss of expressiveness of speech.
At the same time, dysphonia develops. This means that the person's voice becomes quiet and deaf. Nasal and hoarseness appears.
A characteristic symptom of bulbar dysarthria is swallowing disorders - dysphagia. At the initial stage, frequent choking occurs, food enters the respiratory tract. Then it becomes difficult for the patient to swallow solid food. In advanced cases, there are problems with swallowing liquids. Dysphagia is often combined with damage to the facial nerve. This is manifested in the impoverishment of facial expressions and asymmetry of the face, as well as in increased salivation.
The main characteristic of bulbar dysarthria is the triad of symptoms. These are speech disorders, dysphonia and dysphagia. In such cases, the doctor suspects damage to the bulbar nerves.
General neurological symptoms depend on the underlying disease that caused the dysarthria. The patient may experience headaches, dizziness, nausea. If speech disorders are provoked by a neuroinfection, then a fever appears.
The bulbar form of dysarthria often occurs after head injuries. In this case, speech and swallowing disorders may disappear for a while. However, the periods of remission are very short. Soon a new exacerbation sets in, in which the symptoms of the disease progress and increase.
Possible Complications
Bulbar dysarthria in adults often leads to social isolation. Difficulties with pronunciation of sounds cause a person to avoid communicating with people. The patient is aware of his speech impediment. This can cause depression and neurotic disorders.
However, psychological problems are far from the only negative consequence of the bulbar form of dysarthria. This pathology can have an extremely negative impact on physical he alth and provoke the following complications:
- Aspiration pneumonia. Due to dysphagia, food often enters the respiratory tract. This can lead to pneumonia.
- Paralysis of the muscles of the larynx. Due to a violation of the innervation of the muscles of the larynx, it can be completely immobilized. This leads to severe breathing problems and even suffocation.
- Bulbar paralysis. This is the most dangerous complication. It occurs when the nuclei of the bulbar nerves, which are located in the medulla oblongata, are damaged. Paralysis can spread to the respiratory and cardiovascular center, resulting in the death of the patient.
If this pathology occurs in a child of preschool age, then this may adversely affect his mental development. Dysgraphia and dyslexia are quite common consequences of dysarthria in children. What are these violations? With dysgraphia, a child with great difficulty masters writing, and with dyslexia, there are problems with reading. This is due to the fact that these children have difficulty in fine motor skills and the perception of information.
Diagnosis
At the onset of the disease, the patient notices that it has become difficult for him to speak and swallow. However, only a specialist can accurately diagnose bulbar dysarthria. Which doctor should I contact for speech disorders? In most cases, articulation disorders are associated with pathological processes in the central nervous system or peripheral nerves. A neurologist is responsible for diagnosing and treating such diseases. In this case, an additional consultation with a speech therapist is required.
It is very important to differentiate bulbar dysarthria from other types of speech disorders. For this purpose, the following diagnostic examinations are prescribed:
- Examination by a neurologist. The patient has a significant decrease in palatine and pharyngeal reflexes, folding andatrophy of the tongue, drooping curtain of the sky.
- Speech therapist consultation. The specialist determines the clarity, rhythm and volume of speech.
- MRI or CT of the head. This study allows you to determine the cause of dysarthria. MRI is more commonly used to detect brain tumors, neurodegenerative pathologies, consequences of stroke and trauma. When diagnosing cysts and hematomas of the brain, CT examination is more informative.
- USDG or duplex scanning. These studies allow you to evaluate blood circulation in the medulla oblongata and bulbar nerves.
- Biopsy. Brain tissue is taken for microscopic examination. They are obtained during surgery or endoscopic examination. This analysis allows you to determine the nature of the tumor or the presence of degenerative changes.
In rare cases, a lumbar puncture is prescribed. This study is necessary if a brain infection is suspected. Serological analysis of CSF reveals the presence of pathogens
Drug therapy
The choice of treatment for bulbar dysarthria depends on the etiology of the disorder. The prescription of medications is only part of complex therapy. The use of drugs must be combined with speech therapy classes.
Most patients are prescribed nootropics:
- "Piracetam";
- "Cavinton";
- "Fezam";
- "Vinpocetine".
These drugs improve cerebral circulation and stimulate the brain.
To stop pathological changes in the bulbar nerves, neuroprotective agents are prescribed:
- "Mexidol";
- "Semax"
- "Cerebrolysin";
- "Glutamic acid".
These drugs protect neurons from damage and harmful effects.
Patients with bulbar disorders often suffer from increased salivation. This makes their speech even more slurred and makes it difficult to communicate with others. Patients are prescribed the antidepressant Amitriptyline. It reduces the activity of the salivary glands. In addition, the drug eliminates neurotic disorders associated with speech disorders.
Etiotropic treatment completely depends on the variety of the underlying disease. With neuroinfections, a course of antibiotic therapy is carried out. If the patient has neoplasms in the brain, then surgery may be required.
Impaired cerebral circulation and neurodegenerative pathologies require long-term treatment with nootropics. After the end of drug therapy, rehabilitation is needed to restore movement and speech.
Speech therapy classes
If speech disorders are associated with damage to nerves and muscles, then long speech therapy sessions are required to normalize articulation. Corrective work in bulbar dysarthria is necessary to address the followingtasks:
- training for clarity and expressiveness of speech;
- development of the muscles of the mouth;
- restoring normal voice volume;
- correcting errors in the articulation of sounds and words;
- setting the correct breathing during a conversation.
Speech therapy classes are carried out in stages. During the preparatory period, the doctor massages the tongue to partially restore the mobility of the muscles of the organ. The patient is prescribed a set of exercises for the development of articulatory muscles, as well as the regulation of the pitch and strength of the voice.
Further speech therapy work with bulbar dysarthria is carried out in several stages:
- Developing new speech skills. The speech therapist conducts the same exercises with the patient as in the preparatory period, but in a more complicated version.
- Development of communication skills. Very often, patients in the speech therapist's office demonstrate normal and correct speech. However, with a change of scenery and communication with other people, they again return to the wrong pronunciation. At this stage, additional psychological counseling may be required. This will help develop the patient's motivation for correct speech and self-control skills.
- Work on voice modulation. Exercises are conducted to form the expressiveness of speech, correct intonation and placement of stress.
Pediatric patients are also being worked on to prevent writing and reading disorders.
Forecast
Is it possible to completelyget rid of bulbar dysarthria? The prognosis of this speech disorder depends entirely on its etiology. With timely drug therapy and regular speech therapy sessions, complete normalization of speech and swallowing function is possible. However, it is very important to undergo a course of etiotropic treatment and eliminate the cause of dysarthria.
If the treatment was started too late, then even after drug therapy and speech therapy, the patient retains slight speech disorders. In advanced cases, it is not always possible to restore normal articulation.
When bulbar palsy prognosis worsens significantly. The patient may die from respiratory or cardiac arrest. An unfavorable outcome is often observed in brain tumors and degenerative lesions of the central nervous system.
Prevention
Specific prevention of bulbar disorders has not yet been developed. Such pathologies usually develop against the background of other neurological diseases. Doctors advise following these guidelines:
- Treat head injuries and brain infections promptly and completely.
- Keep track of your blood pressure and cholesterol levels. Hypertension and atherosclerosis are fairly common causes of ischemia of the bulbar nerves.
- Regularly visit a neurologist and, if necessary, do an MRI of the head.
- Seek medical attention immediately if you have difficulty speaking or swallowing.
- All stroke and other neurological patients should staysome time under dispensary observation.
These measures will help reduce the risk of bulbar disorders.
