Anarthria

Anarthria is the most severe degree of dysarthria, leading to almost complete absence of sound and voice reactions. The severity varies from complete inability to pronounce speech sounds to the presence of separate vocalizations, vowel sounds, syllables. Also, patients have difficulty chewing, swallowing, there is no facial expression, hypersalivation is expressed. Cerebral lesions are diagnosed using tomographic methods (MRI, CT), the speech status is clarified as part of a speech therapy examination. Complex treatment: medical correction of neurological disorders, neurorehabilitation, logotherapy.

ICD 10

R47.1 Dysarthria and anarthria

General information

Anarthria (Greek. “anarthros” – unintelligible, inarticulate) is a gross innervation insufficiency of the speech apparatus, characterized by paresis or complete paralysis of the speech motor muscles and loss of articulate speech. According to the classification proposed by the French neurologist J. Tardieu in 1968, anarthria corresponds to dysarthria of the fourth degree of severity. In the clinic of cerebral palsy, anarthria is 5 times less common than dysarthric syndrome of mild, moderate or severe degree. Pathology is diagnosed in both children and the elderly, the population frequency has no gender differences.

Causes of anarthria

A speech defect is formed in conditions of severe organic brain damage. This lesion can be either congenital or acquired sooner or later. Anarthria in children is most often associated with cerebral palsy (CP). In their perinatal history, they usually have indications of intrauterine infections, Rh conflict, birth trauma, blue asphyxia at birth, prolonged neonatal jaundice. Less often, speech pathology is associated with muscular dystrophy (Facio-Londe syndrome) and other genetic pathologies.

Severe dysarthria or anarthria in adults develops as a result of neurological diseases accompanied by bulbar or pseudobulbar paralysis. The most common causes are:

• CVA (hemorrhage, thrombosis);
• head injuries;
• tumors of the medulla oblongata, cerebellum;
• multiple sclerosis;
• Parkinson’s disease;
• amyotrophic lateral sclerosis;
• syringobulbia;
• myasthenia gravis;
• neuroinfections;
• poisoning with neurotropic poisons, etc.

Pathogenesis

Anarthria develops as a result of bilateral paresis or paralysis of the speech muscles: lips, tongue, soft palate, pharynx, larynx. This is preceded by focal lesions of the medulla oblongata, Varolian bridge, cerebellum, basal nuclei, conducting nerve pathways (pyramidal, extrapyramidal). Due to spastic paresis, hyperkinesis, ataxia and apraxia, control over the speech muscles is lost, arbitrary motor realization of speech becomes impossible.

Along with disorders of articulatory praxis, the work of the phonatory and respiratory departments of the speech analyzer is disrupted, therefore, along with pronouncing difficulties, there is a disorder of voice formation and breathing. Innervation of mimic, masticatory, pharyngeal muscles also suffers, which causes a complex pathological symptom complex in anarthria.

Classification

Depending on the clinical manifestations of anarthria and its severity, three variants of speech pathology are distinguished:

1. The absence of any sound-voice reaction.
2. The presence of separate vocalizations in the patient.
3. The presence of minimal sound and syllabic activity.

Symptoms of anarthria

The mental development of children with severe congenital disorder of innervation of the speech apparatus is significantly behind the norm. Almost everyone has no history of babbling, the first vocal reactions appear at the age of 3-4 years and later. They are separate vowel sounds or similar syllabic complexes. The voice is deaf, intermittent, without modulations. Articulation-phonatory-respiratory asinergia, chanted rhythm of speech are noted. In severe anarthria, pronouncing and vocal activity is completely absent.

The peculiarities of the mental sphere in anarthria demonstrate the rapid depletion of arbitrary auditory-verbal and visual attention. Intelligence may not be impaired or reduced. The patients understand the addressed speech. Due to gross violations of the phonemic system, schoolchildren have difficulty learning to read, motor difficulties hinder the mastery of writing.

The patient’s face is masked, amimic, hypersalivation is pronounced. It is difficult to chew food of a solid consistency, choking occurs when swallowing. The severity of speech dysfunction correlates with the severity of motor disorders: anarthria is usually accompanied by double hemiplegia. Many children do not have walking skills, cannot use their hands, turn over on their own in bed, sit without fixation. There are pronounced hyperkinesis, episyndrome is often diagnosed.

Complications

The consequence of anarthria is social isolation, lack of speech contacts, depressive disorders. Immobilized patients are deeply disabled, unable to self-care. With improper care, they often form bedsores, there is stagnant and aspiration pneumonia. Muscle spasticity leads to the formation of secondary orthopedic complications: articular contractures, spinal deformities, hip dislocation.

Diagnostics

A team of specialists is engaged in the management of patients with anarthria: a speech pathologist, a clinical psychologist, a neurologist, a rehabilitologist. In order to compile a complete picture of the disorder and develop a plan of treatment and rehabilitation measures,:

1. Clinical examination. In the anamnesis of children, perinatal pathology is traced, in adults – cerebrovascular catastrophes, demyelinating diseases of the central nervous system, infections, intoxication. There are various disorders of the motor sphere: paresis, paralysis, muscle tone disorders, ataxia, hyperkinesis. Often anarthria is accompanied by nystagmus, dysphagia, increased tendon and pathological reflexes.
2. Neuroimaging. Visualization methods are prescribed to determine the etiology of speech disorders. By means of MRI of the brain, CT scanning, foci of cerebral ischemia, hemorrhages, atrophic processes, volumetric formations, hematomas, etc. are detected. In order to exclude hydrocephalus, echoencephalography is performed.
3. Electrophysiological diagnostics. Registration of electrical activity of brain neurons (electroencephalography) and conduction of nervous tissue (electroneuromyography) are aimed at assessing the functional state and interaction of various parts of the nervous system.
4. Speech therapy examination. During special tests, a gross violation of oral, articulatory, phonatory, respiratory praxis, a sharp decrease or absence of sound-vocal activity, dysphonia is revealed. The understanding of the reversed speech is not broken. Auditory attention is unstable.

Treatment of anarthria

Therapy of the leading syndrome

Treatment and rehabilitation tactics are developed by an interdisciplinary group of specialists (neurologists, speech therapists, rehabilitologists) taking into account etiology, age, concomitant disorders. When anarthria is carried out:

• Pharmacological therapy. It helps to improve cerebral blood flow, normalize muscle tone and conduction of nerve impulses. For drug courses, cerebroprotectors, metabolic drugs, angioprotectors, myospasmolytics, vitamins are used. With pronounced spasticity, botulinum toxin injections are used.
• Physical therapy. Ozokerite applications are prescribed for the jaw area. Electrical stimulation of articulation muscles and limb musculature is performed. Repeated courses of general massage, physical therapy, acupuncture are shown. Modern, well-proven rehabilitation technologies for children with cerebral palsy include classes in a verticizer, an Adele suit, Bobat therapy, orthosis, hippotherapy.
• Psychotherapy. In patients with a lack of speech, it is extremely important to form a motivational readiness for correctional work, to develop an emotional interest in restoring speech. For this purpose, methods of rational psychotherapy, game therapy are used. Neuropsychological correction is being performed.

Speech therapy correction

The primary tasks of logotherapy are the normalization of speech motor skills and oral praxis, the formation of phonemic differentiations, lexico-grammatical categories. If swallowing is difficult, the speech therapist also selects the optimal consistency and volume of food, teaches relatives safe feeding techniques for the patient. The structure of classes in anarthria necessarily includes:

• passive and active articulation gymnastics;
• differentiated speech therapy massage of the facial and lingual muscles (manual, vibration, probe);
• breathing exercises;
• orthophonic exercises (combining articulation, breathing and voice exercises);
• elements of phonetic and speech therapy rhythmics;
• kinesiotaping of articulatory muscles;
• sensory stimulation;
• techniques for training auditory attention.

As a rule, the maximum result that can be achieved in this contingent of patients is the formation of arbitrary mimic, gesture, voice reactions, the possibility of pronouncing individual syllables and words. Sometimes patients learn to read and communicate using a split alphabet.

Forecast

The effectiveness of rehabilitation work in anarthria depends on the timing of the start of rehabilitation, the regularity of therapy, the causes of speech disorder, the patient’s age, and motivational readiness. Children with cerebral palsy demonstrate some positive dynamics. With the systematic conduct of correctional speech therapy work, their vocal and sound activity increases, arbitrary verbal reactions appear. At the same time, the pronunciation capabilities remain at the babbling level, and without constant speech therapy, skills are quickly lost. With progressive neurodegeneration, the prognosis for speech recovery is disappointing.

Prevention

Since congenital anarthria is closely related to intrauterine pathologies and injuries, its prevention is the perinatal protection of fetal and newborn health. Women are recommended to conduct pre-pregnancy training, early registration for pregnancy, compliance with the recommendations of an obstetrician-gynecologist, passing the necessary screenings. In order to avoid birth injuries of the baby, it is necessary to decide in advance on the method of delivery. Prevention of anarthria in adults requires reduction of risk factors for neurological diseases (thrombosis, intoxication, infections, injuries, etc.).