Case Study: A 74-year old with Dysarthria

Summary:

Mr. R, a retired 74 year old adult who still goes to work for a few hours each day, lives with his wife. His wife is diagnosed with Dementia and has a caretaker at home. He has 3 children who are married and settled. Elder daughter stays in the same city and his other 2 children live abroad.

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Patient Info:

Name: Mr R.

Age: 74 years old

Gender: Male

Diagnosis: Mild Dysarthria Post CVA

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Background:

In January 2024, he had a Cerebral Vascular Accident. He was left with the following impairments:

• Facial weakness

• Slurring of speech

He was diagnosed with Mild Dysarthria post CVA

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Team:

Speech-language pathologist, Patient, Neurologist, Nurse, and Family.

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Treatment Plan:

The following were the goals for Mr. R to improve his speech:

 

• Oral motor strengthening exercises

• Exercises to improve his breath support (MPD)

• Exercises to improve his speech intelligibility through an open mouth approach and by reducing his rate of speech.

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Intervention:

 

He was started off with sessions thrice a week and then reduced to twice and later once a week.

 

1. Oral motor strengthening - he was taught a few exercises for lip deviation, to improve his intra oral breath pressure (IOBP) by puffing his cheeks, and worked on improving his tongue and jaw’s rate of motion.

2. We worked on increasing his phonation duration to improve his breath capacity which is required for his speech.

3. We also worked on improving his speech intelligibility through open mouth approach and by reducing his rate of speech in conversation, reading and narration tasks in both English and Telugu languages.

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Outcomes:

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After 12 sessions Mr. R had a lot of improvement in his speech.

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• He was able to phonate for a maximum of 13-15 seconds and a minimum of 9 seconds on multiple trials.

• His lip deviation got better with stretching exercises.

• He can minimally build up unilateral intra oral breath pressure (IOBP) and his rate of tongue and jaw movements had improved with regular practice.

• Mr. R was able to inhale and elevate the 600cc ball pretty well but could hold his breath for just a second, and occasionally he could inhale and elevate the 900cc ball.

• Using a spirometer helped him to improve his breath support in speech. Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis.

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• ​He was able to reduce and maintain his rate of speech during reading and picture description activities in English and Telugu. He needs occasional prompts to maintain speech rate during conversations and topic discussions in both languages. 

• Open mouth approach was implemented to improve his speech intelligibility. 

• Mr. R performs prayers and recites mantras everyday and he had a concern that not all the words were clear. He had more difficulty in reducing the speech rate while reciting mantras, as they have a rhythm and flow to it and is a bit challenging to control the rate. But he was able to overcome it with regular practice and felt his speech clarity had improved.

• He did need occasional prompts to take frequent breaths in between. It also helped when he was asked to break down multisyllabic words into shorter syllables in order to pronounce each sound clearly.

• He has minimal distortions while producing /s/ sound in word and phrase level because of the missing lower incisors. 

• Compensatory strategy was tried for the production of /s/ by altering the tongue position which helps in producing an approximates the /s/ sound.

• His rate of speech was faster in Telugu, his mother tongue for which he needed more prompts.

• His speech intelligibility in the first session was 3 (Speech can be understood with concentration and effort especially by sympathetic listener, requires a minimum of 2-3 repetitions) and now it has improved to 1-2 (Speech can be understood with a little effort, occasionally need to ask for repetition and also sometimes speech can be understood without difficulty, however feel the speech is not normal).

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Testimonial Video:

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Recommendations:

He continues to follow all the treatment approaches and exercises to improve his speech intelligibility.

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