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 crossvalidation
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
“Speech is slower, it tires
me”
“My speech is nasal”
Swallowing difficulty
Drooling
Difficult to control laughter
or crying (pseudobulbar
affect)
Pathologic reflexes
Weakness
Spasmodic Dysphonia
Negative impact on job,
social life, and emotions
Vocal fatigue caused by
increased effort in speech
Body motions or tenseness
may be present secondary
to spasms (AD type)
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
spasmodic dysphonia: A meta-analysis. Journal of Speech, Language, and Hearing Research,
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
assessment of prosodic impairment in dysarthria. Clinical Linguistics & Phonetics. 13-24.
Carouso, Anthony & Strand, Edythe (1999). Clinical Management of Motor Speech Disorders in Children.
Thieme: New York.
Damrose, J.F., Goldman, S.N., Groessl, E.J., & Orloff, L.A. (2004). The impact of long- term
botulinum toxin injections on symptom severity in patients with spasmodic dysphonia. Journal
of Voice, 18, 415-422.
Duffy, Joseph R.; Kent, Raymond D. (2001). Darley's contributions to the understanding,
differential diagnosis, and scientific study of the dysarthrias. Aphasiology, 15, 275-289.
Duffy, J.R. (2005). Motor Speech Disorders: Substrates, differential diagnosis, and management (2nd
ed). Elsevier Mosby: St. Louis, MO.
Eadie, Tanya L.; Nicolici, Christina; Baylor, Carolyn; Almand, Kimberly; Waugh, Patricia; Maronian,
Nicole. (2007) Effect of Experience on Judgments of Adductor Spasmodic Dysphonia. Annals
of Otology, Rhinology & Laryngology, 116, 695-701.

Finitzo, T. & Freeman, F. (1989). Spasmodic Dysphonia, whether and where: Results of seven
years of research. Journal of Speech and Hearing Research, 32, 541-555.
Lee, L., Daughton, S., Scheer, S., Stemple, J.C., Weinrich, B., Miller-Seiler, T., Goeller, S., &
Levin, L. (2003). Use of acupuncture for the treatment of adductor spasmodic dysphonia: A
preliminary investigation. Journal of Voice, 17, 411-424.
Mackenzie, K.; Millar, A.; Deary, I. J.; Wilson, J. A. (1999) Does voice therapy work? A
randomized controlled trial of the efficacy of voice therapy for dysphonia. Clinical Otolaryngology &
Allied Sciences, 24, 377.
National Spasmodic Dysphonia Association (2008). Understanding Spasmodic Dysphonia (DVD).
Roy, N., Leeper, H., Blomgren, M., & Cameron, R.M. (2001). A description of phonetic acoustic,
and physiological changes associated with improved intelligibility in a speaker with spastic
dysarthria. American Journal of Speech-Language Pathology, 10, 274-291.
Roy, N., Mauszycki, Shannon, Merrill, Ray, Gouse, Manon, Smith, Marshall (2007) Toward Improved
Differential Diagnosis of Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia.
Folia Phoniatrica et Logopaedica. 59, 83-90.
Sapienza, G.M., Cannito, M.P., Murray, T., Branski, R., Woodson, G. (2002). Acoustic variations
in reading produces by speakers with spasmodic dysphonia. Journal of Speech, Language, and
Hearing Research, 45, 830-844.
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.
Journal of Voice, 16, 422-424
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
and Perceptual Findings. Journal of Speech, Language & Hearing Research, 47, 766-783.
Wingate, J.M., Ruddy, B.H., Lundy, D.S., & Lehman, J. (2005). Voice Handicap Index results for
older patients with adductor spasmodic dysphonia. Voice, 19, 124-131.
Yorkston, Kathryn M.; Beukelman, David R. (2004). Dysarthria Tools for Clinical Decision-Making.
ASHA Leader, Vol. 9 Issue 9, p4-21, 4p