Bulbar dysarthria is a speech disorder that occurs due to damage to the cranial nerves. The disease is accompanied not only by pronunciation disorders, but also by difficulty swallowing. This pathology is one of the most common speech therapies. If the bulbar form of dysarthria occurred 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. It becomes very difficult for a child suffering from dysarthria to write and read, which negatively affects his development.
Pathology Description
By the term "dysarthria," doctors mean any speech impairment. These disorders can have a different origin. With bulbar dysarthria, a lesion is formed in the region of IX, X and XII pairs of cranial nerves. They innervate the vocal apparatus. They are also called bulbar nerves.
This department of the nervous system is divided into 3 parts:
- Gulletopharyngeal nerve (IX pair). Innervates the pharyngeal region.
- Vagus nerve (X pair). Its branches extend to the muscles of the pharynx, palate, and upper respiratory tract.
- The hyoid nerve (XII pair). Responsible for the innervation of the muscles of the tongue.
With bulbar dysarthria, damage to these structures occurs. As a result, the patient weakens and atrophies the muscles of the pharynx, tongue and larynx. Speech becomes fuzzy, and the voice loses its sonority.
If the vagus nerve is damaged, the soft palate sags, and air, when articulating sounds, exits through the nose. This leads to the appearance of nasal. If the innervation of the pharyngeal musculature is impaired, then the patient has difficulty swallowing food and fluid.
In a sick person, connections between the central nervous system 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 speak. 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, different forms of articulation disorders are distinguished. It is very important to differentiate bulbar and pseudobulbar dysarthria. Symptoms of these two forms of speech impairment may be similar. Both types of dysarthria are accompanied by a fuzzy and excessively quiet pronunciation of sounds.
With pseudobulbar dysarthria, brain cells are affected. With the bulbar form of pathology, damage occurs only on the peripheral nerves. Pseudobulbar dysarthria is accompanied by common neurological manifestations:
- significant memory impairment;
- difficulty concentrating;
- decreased motor activity.
In addition, with the bulbar form, weakening and atrophy of the muscles of the speech apparatus are noted. With pseudobulbar dysarthria, the tone of the muscles of the pharynx and tongue is increased. It is very difficult to independently distinguish between these two forms of pathology. Accurate differential diagnosis can only be done by a neurologist.
Etiology
Lesions of the cranial nerves and speech disorders usually develop against the background of other diseases. Specialists identify the following causes of bulbar dysarthria:
- Head injuries. Bulbar nerves can be damaged by bruises or compression. In young children, birth injury can cause pathology.
- Circulatory disorders. Deficiency of blood supply in the area of the bulbar nerves leads to damage to neurons. The cause of ischemia can be a stroke, atherosclerosis, hypertension, as well as vascular disorders in diabetes.
- Brain infections. Bulbar nerves can be squeezed by edematous and inflamed brain tissues. Dysarthria often develops as a complication of meningitis, encephalitis, polio, as well as advanced neurosyphilis.
- Brain neoplasms. Bulbar nerves can be compressed by brain tumors.
- Degenerative pathologies of the central nervous system. These are severe genetic pathologies in which atrophy and cell death occurs in the medulla oblongata. These pathological processes affect the bulbar nerves. After all, their nuclei are located in the medulla oblongata.
- Anomalies of the craniovertebral transition. These pathological processes are localized in the area of transition of the skull to the spine. Craniovertebral diseases rarely cause dysarthria. However, in some cases, with such diseases, the medulla oblongata and the nuclei of the bulbar nerves can be compressed.
Symptoms How to recognize
The main symptom of bulbar dysarthria is a violation of articulation. The patient has the following speech disorders:
- slurred articulation;
- replacing interrupted and vibrating consonants with slotted sounds;
- vague pronunciations of vowels;
- monotony and slowing down of speech;
- distortion of the rhythm of words and sentences;
- loss of expressiveness of speech.
At the same time, dysphonia develops. This means that a person’s voice becomes quiet and deaf. Nasal and hoarseness appears.
A characteristic symptom of bulbar dysarthria is swallowing disorder - 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, problems with swallowing fluids appear. Dysphagia is often combined with damage to the facial nerve. This is manifested in the depletion of facial expressions and asymmetries 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.
Common neurological symptoms depend on the underlying disease that caused dysarthria. The patient may experience headaches, dizziness, and nausea. If speech disorders are triggered by 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, periods of remission are very short. Soon a new exacerbation sets in, in which the symptomatology of the disease progresses and grows.
Possible complications
Bulbar dysarthria in adults often leads to social isolation. Due to difficulties in pronouncing sounds, a person begins 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 extremely negatively affect physical health and provoke the following complications:
- Aspiration pneumonia. Due to dysphagia, food often enters the respiratory tract. This can lead to pneumonia.
- Laryngeal muscle paralysis. Due to a violation of innervation, the muscles of the larynx can be completely immobilized. This leads to severe respiratory distress and even suffocation.
- Bulbar palsy. This is the most dangerous complication. It occurs when lesions of the nuclei of the bulbar nerves, which are located in the medulla oblongata. Paralysis can spread to the respiratory and cardiovascular center, which leads to the death of the patient.
If this pathology occurred 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 such children have difficulty in fine motor skills and perception of information.
Diagnostics
At the beginning 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 involved in the diagnosis and treatment of such diseases. In addition, a speech therapist consultation 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:
- Neurologist examination. The patient has a significant decrease in the palatine and pharyngeal reflexes, folding and atrophy of the tongue, sagging curtains of the sky.
- Speech therapist consultation. The specialist determines the clarity, rhythm and volume of speech.
- MRI or CT scan of the head. This study allows you to determine the cause of dysarthria. To identify brain tumors, neurodegenerative pathologies, the effects of stroke and injuries, MRI is more often used. When diagnosing cysts and brain hematomas, a CT scan is more informative.
- USDG or duplex scanning. These studies evaluate blood circulation in the medulla oblongata and bulbar nerves.
- Biopsy. For microscopic examination, brain tissue is taken. 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 spinal puncture is prescribed. This test is necessary if you suspect a brain infection. Serological analysis of cerebrospinal fluid allows to detect the presence of pathogens
Drug therapy
The choice of treatment for bulbar dysarthria depends on the etiology of the disorder. Prescribing medications is only part of complex therapy. The use of drugs must necessarily be combined with speech therapy classes.
Most often, patients are prescribed nootropic drugs:
- Piracetam
- Cavinton
- Fezam;
- "Vinpocetine".
These drugs improve cerebral circulation and stimulate brain function.
To stop pathological changes in the bulbar nerves, neuroprotective agents are prescribed:
- Mexidol;
- Semax
- "Cerebrolysin";
- Glutamic acid.
These drugs protect neurons from damage and ill effects.
Patients with bulbar disorders often suffer from increased salivation. This makes their speech even more slurred and complicates communication 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 is completely dependent on the variety of the underlying disease. With neuroinfection, a course of antibiotic therapy is carried out. If a patient has neoplasms in the brain, surgery may be required.
Circulatory disorders and neurodegenerative pathologies require long-term treatment with nootropic drugs. After drug therapy is completed, rehabilitation is needed to restore movement and speech.
Speech Therapy
If speech disorders are associated with damage to nerves and muscles, then long speech therapy sessions are required to normalize articulation. Correction work with bulbar dysarthria is necessary to solve the following problems:
- training for clarity and expressiveness of speech;
- muscle development of the mouth;
- restore normal voice volume;
- error correction in the articulation of sounds and words;
- setting the right breath during a conversation.
Speech therapy classes are conducted 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 height and strength of the voice.
Further speech therapy work with bulbar dysarthria is carried out in several stages:
- The development of new speech skills. The speech therapist conducts the same exercises with the patient as in the preparatory period, but in a more complicated version.
- The development of communicative skills. Very often, patients in the speech therapist’s office demonstrate normal and correct speech. However, when changing the situation and communicating with other people, they again return to the incorrect pronunciation. At this stage, additional psychologist consultation 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, the correct intonation and the placement of stress.
Children are also being worked on to prevent disorders of writing and reading skills.
Forecast
Is it possible to completely get 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 etiotropic treatment and eliminate the cause of dysarthria.
If treatment was started too late, then even after drug therapy and speech therapy work, the patient retains small speech impairments. In advanced cases, restoring normal articulation is not always possible.
With bulbar paralysis, the prognosis worsens significantly. The patient may die from respiratory failure or cardiac activity. An adverse outcome is often observed in brain tumors and degenerative lesions of the central nervous system.
Prevention
Specific prophylaxis of bulbar disorders is not currently developed. Similar pathologies usually develop against the background of other neurological diseases. Doctors recommend following these guidelines:
- Timely and completely cure head injuries and brain infections.
- Keep track of your blood pressure and cholesterol levels. Hypertension and atherosclerosis are quite common causes of bulbar nerve ischemia.
- Visit a neurologist regularly and, if necessary, do an MRI of the head.
- If you have difficulty pronouncing sounds and swallowing, seek medical help immediately.
- All patients who have had a stroke and other neurological pathologies should remain under medical supervision for some time.
These measures will help reduce the risk of bulbar disorders.