Muscular dystrophy (MD) refers to a group of inherited muscle disorders caused by mutations in genes that generate proteins that play an essential role in muscle structure and function. The disease causes progressive weakness and wasting of muscles in different parts of the body, including the arms, legs, head, and neck.
In some types of muscular dystrophy, weakness in the facial and oral muscles that control the use of the tongue, lips, soft palate, cheeks, and diaphragm results in problems with speech quality (dysarthria) and voice quality (dysphonia).
Speech problems by MD type
- In patients with Duchenne muscular dystrophy (DMD), speech problems may precede muscle weakness. Some of the speech problems experienced by patients with DMD include late onset of speech, problems with finding words, and non-fluent speech.
- In facioscapulohumeral muscular dystrophy (FSHD), those diagnosed in their teens or early adult years do not generally experience problems with speech production except for nasalized speech. However, those with infantile FSHD have speech problems because of oral muscle weakness that, in some patients, is further complicated due to hearing loss. Speech issues in these patients include problems with consonant and vowel sounds, difficulties with inflection, intonation, and the proper spacing and pauses between words, as well as problems in producing high-pitched sounds.
- Patients with limb-girdle muscular dystrophy type 1A (LGMD 1A) also may have isolated bulbar weakness or weakness in the tongue and pharynx, which may lead to dysarthria and dysphagia.
- In oculopharyngeal muscular dystrophy (OPMD), tongue and pharyngeal weakness can cause dysarthria and dysphagia.
- In congenital and childhood myotonic dystrophy type 1 (DM1), patients have difficulties with bilabial consonants (consonants made with both lips like “b,” “m,” and “p”), interdental articulation (“th”), and hypernasal speech, because of weakness in the oral and facial muscles. In DM1, hypotonia (low muscle tone) causes monotony, hypernasality, hoarseness, shorter stretches of speech, a slow speech rate, and a decrease in volume and intelligibility. On the other hand, myotonia (delayed relaxation of voluntary muscles) causes irregularities in speech fluency and articulation.
Speech therapy methods
There are several ways by which speech problems can be treated under the directions of a speech therapist. These methods include:
- Exercises to help improve strength and coordination of the muscles in the throat, tongue, cheeks, mouth, diaphragm, soft palate, and lips, for clear and precise articulation and pronunciation;
- Voice training in which patients are taught how to talk slowly and articulate more carefully and clearly when speaking by exaggerated articulation, and controlled and modified breathing;
- Exercises to strengthen or relax the muscles that control the palate and the vocal cords to overcome breathy and hoarse speech;
- Expiratory and inspiratory muscle strength training that helps to breathe in and out in one breath and practice to speak with emphasis and proper flow between breaths;
- Vowel prolongation tasks that improve the duration and loudness of speech;
- Phonetic placement techniques (e.g., hands-on, descriptive, pictures) to work on the positioning of the mouth, tongue, lips, or jaw while speaking;
- Exaggerated articulation to emphasize phonetic placement and increase precision.
When speech intelligibility or efficiency is reduced, other communication strategies, including augmentative and alternative communication can be used to supplement natural speech. These include:
- Unaided modes such as manual signs, gestures, and fingerspelling;
- Aided methods such as line drawings, pictures, communication boards, tangible objects, and speech-generating devices;
- Augmentative supports like voice amplifiers and artificial phonation devices such as electrolarynx devices (battery-operated machines that produce sound), intraoral devices, and oral prosthetics to reduce hypernasality.
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