Treatment of Dysarthria in Patients with Multiple Sclerosis

Barbara Bryant Jane Vyce What is MS?

• An autoimmune disease • Destruction of myelin • Destruction of axons What is MS?

• Etiology/Pathophysiology ƒ Cause is unknown ƒ No specific gene has been identified • Age of onset ƒ Symptoms occur between the ages of 20 – 40 ƒ Rarely manifests before age 15 or after age 60 Epidemiology

• Affects 250,000 – 350,000 people in the US • Women are twice as likely as men to be affected • Northern European heritage are most likely to be affected • Very rare among Asians, North & South American Indians, and Eskimos • Higher incidence in Northern US, Canada and Northern Europe than the rest of the world • Rare between the equator and latitudes 30 – 35 degrees north and south ƒ National MS Society Environmental Factors

• Climate • Humidity • Hours of daily sunshine • Resistance to certain viruses • Consumption of cow’s milk •Toxins •Trauma Progression

• Slowly progressive disease of the CNS • Four types of MS ƒ Relapsing-Remitting – 80-85% ƒ Secondary Progressive – 70% of the 80-85% ƒ Primary Progressive – 15-20% ƒ Progressive-Relapsing – Rare ƒ National MS Society Symptoms & Signs

•Weakness • Fatigue • Sensory loss • Bladder or bowel dysfunction • Vertigo • Dysphagia •Ataxia • Dysarthria ƒ National MS Society Effects on Speech, Language and Swallowing • Swallowing • Language • Speech ƒ Spastic ƒ Ataxic ƒ Mixed: spastic and ataxic ƒ Duffy (2005) Treatment

• Glutamate Excitotoxicity – Pitt, Werner, & Raine (2000)

• FM Technology – Lewis, et al (2006)

• Music Therapy – Wiens, Reimer, & Guyn (1999)

• Deep Brain Stimulation -Putzer, Barry, & Moringlane (2007)

• Inspiratory -Klefbeck & Nedjad (2003)

• Expiratory - Chiara, Martin, & Sapienza (2007)

• Rate and Loudness -Miller (no date) & Tjaden & Wilding (2004) Deep Brain Stimulation

• 7 patients with MS with severe ataxia and intention tremor • Electrodes implanted into left and/or right ventrolateral area of thalamus • Limb ataxia and tremor improved • Decreased articulatory performance • Strained phonation in female patients ƒ Putzer, Barry, & Moringlane (2007) Inspiratory Muscle Training

• Patients received 10 weeks of training • Inspiratory Muscle Training (IMT) device • One month post-training benefit ƒ Klefbeck & Nedjad (2003) Expiratory Muscle Training

• 17 participants with MS • 8 week training period • Positive Expiratory Pressure (PEP) threshold trainer • Maximum Expiratory Pressure (MEP) • Vowel prolongation increased, e.g. [ah] • No effects of dysarthria ƒ Chiara, Martin, & Sapienza (2007) Rate

• Rigid rate control ƒ Metronome ƒ Finger tapping ƒ Alphabet board • Rhythmic rate control ƒ Visipitch ƒ Auditory feedback ƒ Direct Magnitude Production (DMP) Reduced rate • Improved intelligibility • Loss of naturalness of speech ƒ Miller (no date) Loudness

• Lee Silverman Voice Treatment (LSVT) • Increased vowel space • Increased intelligibility • Increased ease of perception ƒ Tjaden & Wilding (2004) Summary

• Variability among MS • Varying types of dysarthrias • Varying degrees of severity of dysarthria • No clear-cut treatment options Judy References

• Chiara, T., Martin, D. & Sapienza, C. (March 2007). Expiratory Muscle Strength Training: Speech Production Outcomes in Patients with Multiple Sclerosis. Neurorehabilitation and Neural Repair, 21(3), 239-249. • Duffy, J. R. (2005). Motor Speech Disorders (2nd ed.). St Louis Missouri: Elsevier Mosby. • Klefbeck, P. & Nedjad, J. (July 2003). Effect of Inspiratory Muscle Training in Patients with Multiple Sclerosis. Arch Phys Med Rehabil, 84, 994-999. • Lewis, S., Hutter, M., Lilly, D., Bourdette, D., Saunders, J. & Fausti, S. (November 2006). Frequency Modulation (FM) Technology as a Method for Improving Speech Perception in Noise for Individuals with Multiple Sclerosis. Journal of American Academic Audiology, 17, 605-616. • McHenry, M.A., 2003. The effect of pacing strategies on the variability of speech movement sequences in dysarthria. Journal of speech, language, and hearing research, 46, 702-710. • Miller, P.H., no date. Dysarthria in Multiple Sclerosis. National Multiple Sclerosis society: Clinical bulletin. Retrieved 2008-04-18 from www.nationalmssociety.org/PRC.asp References cont.

• Multiple Sclerosis- Mayo Clinic. Retrieved 2008-05-06, from http://www.mayoclinic.com/health/multiple-sclerosis/DS00188/DSECTION=1 • Multiple Sclerosis. Retrieved 2008-03-08, from http://www.fpnotebook.com/Neuro/Demyelinating/MltplSclrs.htm • National MS Society. Speech and Swallowing Disorders. Retrieved 2008-02-14, from www.nationalmssociety.org/sourcebook • Pitt, D., Werner, P. & Raine, C. (January 2000). Glutamate Excitotoxicity in a Model of Multiple Sclerosis. Nature America, 6(1), 67-71. • Putzer, M., Barry, W. & Moringlane, J. (June 2007). Effect of Deep Brain Stimulation on Different Speech Subsystems in Patients with Multiple Sclerosis. Journal of Voice, 6(6), 741-753. • Tjaden, K. & Wilding, G. (August 2004). Rate and Loudness Manipulations in Dysarthria: Acoustic and Perceptual Findings. Journal of Speech, Language, and Hearing Research, 47(2), 766-783. • Wiens, M., Reimer, M. & Guyn, L. (March 1999). Music Therapy as a Treatment for Improving Respiratory Muscle Strength in Patients with Advanced Multiple Sclerosis: A Pilot Study. Rehabilitation Nursing, 24(2), 74-80. • Young, E. Autoimmune disease risk for teachers revealed. New Scientist. Retrieved 2008-05-05, from http://www.newscientist.com/article/dn1106-autoimmune-disease- risk-for-teachers-revealed.html