See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/352837299

Dysarthria and Dysphagia in Amyotrophic Lateral Sclerosis: A Case Study -

Research & Reviews: A Journal of Neuroscience

Article · December 2020

CITATIONS READS

0 635

2 authors, including:

Girish K S
J.S.S. Institute of Speech & Hearing Dharwad
21 PUBLICATIONS 12 CITATIONS

SEE PROFILE

All content following this page was uploaded by Girish K S on 30 June 2021.

The user has requested enhancement of the downloaded file.

 Research & Reviews: A Journal of Neuroscience
ISSN: 2277-6427 (Online), ISSN: 2348-7925 (Print)
Volume 10, Issue 3
www.stmjournals.com

Dysarthria and Dysphagia in Amyotrophic Lateral

Sclerosis: A Case Study
Theaja Kuriakose1,*, Girish K.S.2
1
Reader, Department of Speech Language Pathology, JSS Institute of Speech and Hearing, Kelageri,
Dharwad, India
2
Lecturer, Department of Speech Language Pathology, JSS Institute of Speech and Hearing, Kelageri,
Dharwad, India

Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease affecting the
bulbar, limb and respiratory muscles. ALS is generally characterized by progressive
degeneration of both upper motor neuron (UMN) and lower motor neuron (LMN) dysfunction
leading to a ‘mixed’ spastic-flaccid dysarthria. To date, only a few studies have been
published regarding the nature of speech characteristics and dysphagia during the
developmental course of ALS. The present study highlighted the nature of speech impairment
and swallowing difficulties in a 36-year-old male who was diagnosed as having ALS with
bulbar signs. Speech evaluation indicated the presence of flaccid spastic mixed dysarthria.
His speech was characterized by hypernasality, imprecise consonants, distorted vowels,
harshness, short phrases, mono-pitch, mono-loudness, silent pauses, prolonged phonemes,
slow rate of speech, leading to poor speech intelligibility. Also, the swallowing assessment
revealed a moderate degree of dysphagia because of the “bulbar onset” of ALS. Knowledge of
speech, language and swallowing characteristics in individuals with ALS is crucial, as it helps
the professionals and the caregivers to give a better service. This knowledge is often used for
rehabilitation, employment, participation in the community, and to inform the role of family
members in the betterment of the patient.

Keywords: amyotrophic lateral sclerosis (ALS), degeneration, dysarthria, dysphagia, motor

neurons

*Author for Correspondence E-mail: thejakuriakose@gmail.com

INTRODUCTION sporadic disease and 45–55 years for familial

Amyotrophic lateral sclerosis (ALS) is a motor
neuron disease. It is an idiopathic, fatal disease
of insidious onset, characterized by
progressive degeneration of motor units in the
human nervous system. ALS is also known as
‘Lou Gehrig’s disease’, ‘Charcot disease’ and
‘Lou Gehrig disease’ [1]. Though uncommon,
ALS is not a rare disease and is seen among all
ethnic and socioeconomic groups around the
world [2]. Worldwide, ALS has an incidence
of 2.08, 1.80 and 0.60; with a prevalence of
5.40, 3.40 and 2.34 in 100,000 European,
American, and Asian populations, respectively
[3]. However, the frequency of ALS cases in
India is 5 in 100,000 population [4].
The peak incidence of ALS is observed among
individuals in the age range of 55–63 years for
disease [5]. Though it can also affect young
adults, ALS is rare before the age of 40 years
[6] and very few studies reported young
individuals with ALS [7]. ALS impacts males
and females differently where males are
affected more than females with a ratio of 3:2
[8].
ALS is generally characterized by progressive
degeneration of motor nerve cells in the brain
(upper motor neurons or UMN) and spinal
cord (lower motor neurons or LMN).When the
motor neurons can no longer send impulses to
the muscles, the muscles begin to waste away
(atrophy), causing motor weakness. UMN
damage leads to spasticity, weakness, brisk
gag reflex and brisk deep tendon reflexes in
the limbs. Whereas LMN damage leads to

RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved Page 12
Dysarthria and Dysphagia in Amyotrophic Lateral Sclerosis: A Case Study
Girish
fasciculation, weak cough, absent gag reflex
and weakness in the limbs, and later dysphagia
[7, 9–11].
Despite the motor weakness, ALS does not
show any sensory abnormalities [12] that is,
vision, hearing, sense of taste, smell, and touch
stay intact. Language and cognition are also
considered to be intact in ALS, but studies
have reported that 1–3% of sporadic ALS
involve overt dementia as a feature [13]. On
the other hand, 80% of the individuals with
ALS commonly possess complex speech
impairments which significantly hamper their
daily communication [14].
Over the last three decades, very few studies
have discussed the speech characteristics in
ALS. The phonetic impairments underlying
reduced speech intelligibility in 25 English
speaking individuals with ALS was studied.
The results revealed that the most disrupted
phonetic features involved phonatory function
(voicing contrast), velopharyngeal valving,
place and manner of articulation for lingual
consonants and regulation of tongue height for
vowels [15]. Similar studies were conducted
by various authors on English speaking
individuals with ALS and the results revealed
a significant deterioration in speech
intelligibility, diadochokinetic rate, pulmonary
capacity, speaking rate, and highly variable
phonatory measures such as jitter, shimmer
and signal to noise ratio [16–18]. Increase in
fundamental frequency (only in males) was
also reported in individuals with ALS [19].
Also, the variability of frequency stability
during sustained vowel sound prolongation
and a standard deviation of F0 were
significantly increased in individuals with
ALS.
Darley [20] reported that individuals with ALS
have a defective articulation of both consonant
and vowels, often rendering the speech
unintelligible, extremely slow production of
words in short phrases, marked hypernasality
coupled with severe harshness and strained
voice. In a study of 30 individuals with ALS,
Orsini et al. & Ingre et al. [5, 6] reported that
these individuals had imprecise consonants,
hypernasality, harsh voice quality, slow rate,
RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved
Kuriakose and
mono-pitch, short phrases and distorted
vowels in their study.
Prosodic abnormalities are also reported in an
individual with ALS. Motor speech analysis in
individuals with ALS revealed a significantly
lower rate of speech (2.2 syllables/second
diadochokinetic rate [3.1 ± 218.1]) [19].
Individuals with ALS having mixed flaccid
spastic dysarthria exhibited prolonged
intervals between phonemes, prolonged
phonemes and inappropriate silences [9, 10].
These prosodic problems can be due to the
weakness of the subsystems of speech
production. Recently, the tongue and jaw
movements were investigated in a longitudinal
study on 33 English speaking individuals with
ALS (mean age: 62.65±6.87 years) and the
kinematic measurements revealed a reduction
in the tongue movement size and speed [21].
Besides speech problems, one of the most
common problems of ALS is dysphagia or
swallowing difficulty [22]. Swallowing is a
complex function, which requires coordination
between various phases and any dysfunction in
any of the phases of swallowing would lead to
dysphagia or disordered swallowing. Studies
reported that most of the individuals with ALS
suffer from mild or moderate dysphagia within
the first two years after the incidence [23, 24].
The symptoms include inability to form and
hold bolus in the mouth, difficulty in
mastication, bolus residue in the oral cavity,
delayed swallow reflex, nasal penetration,
cough before or during the swallow, reduced
laryngeal elevation, throat clearing, gurgled
voice quality after the swallow and multiple
swallow for a single bolus [25].
Knowledge of speech, language and
swallowing characteristics in individuals with
ALS is very important and it helps the
professionals and the caregivers to give a
better service to ALS patients. This knowledge
is often used for rehabilitation, employment,
participation in the community and to inform
the role of family members in the betterment
of the patient. In India, very few studies have
been carried out regarding the nature of speech
impairment and swallowing problems in
people with ALS. A review of the literature
indicates that ALS in young adults is rare [6].
Page 13
Research & Reviews: A Journal of Neuroscience
Volume 10, Issue 3
ISSN: 2277-6427 (Online), ISSN: 2348-7925 (Print)
Hence the present study was aimed to
investigate the nature of speech impairment
and dysphagia in a young adult diagnosed with
ALS.
METHOD
A 36-year-old male working as a mobile shop
owner was referred to the Department of
Speech Language Pathology, JSS Institute of
Speech and Hearing, Dharwad, India from a
neurologist in July 2020 with the complaint of
unclear speech and difficulty in swallowing.
Detailed history revealed that, in June 2019,
the patient reported a high-grade fever for 8
days; later his friends informed him that they
are observing a change in his speech.
However, it was very subtle, and he neglected
it. These speech problems gradually
progressed. After two months of the above
symptoms, he also developed difficulty in
swallowing both solid and liquid food. These
symptoms also gradually progressed. The
patient consulted a neurologist on 2019 Oct 1,
where nerve conduction study (NCS) was
done and diagnosed a case of anterior horn cell
disease involving bulbar segments. His
computed tomography (CT) scan reports
revealed a few small T2/FLAIR hyper-intense
foci in bilateral fronto-parietal white matter,
few enlarged upper jugular lymph nodes and
no abnormal mass lesions. Later he consulted
another neurologist and the reports revealed
RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved
signs of both UMN and LMN damage such as
left lower limb weakness, weak cough, facial
and tongue weakness with fasciculation and
dysphagia. The patient was diagnosed with
ALS by that neurologist.
The patient reported that he had not
experienced any speech difficulties prior to
this incidence. Speech and language
evaluation revealed no indication of language
impairment, but he exhibited severe
impairment in all the speech subsystems
indicating presence of severe dysarthria. He
did not have any mask like face, rigidity of
speech musculature and involuntary
movements of upper or lower limbs. Frenchay
Dysarthria Assessment (FDA) test was carried
out to rate and examine the speech
subsystems. Henningsson’s four-point rating
scale [26] was used to assess the nasality,
speech understandability and acceptability.
Praat software (version 5.3) was used to
extract fundamental frequency and formant
frequencies. Sydney Swallow Questionnaire
was used to assess the severity of swallowing
problem.
RESULTS
The results of FDA revealed apparent masseter
muscle weakness. Figure 1 shows the FDA
results.
Page 14
Dysarthria and Dysphagia in Amyotrophic Lateral Sclerosis: A Case Study Kuriakose and
Girish

Fig. 1: Results of Components of FDA.

Fig. 2: Formants of vowels /a/, /i/ and /u/.

The patient took frequent breath intake
indicating poor respiratory control. He could
sustain ‘ah’ for about 8–9 sec. His cough was
weak. His lips were slightly drooping, and the
movement was consistently poor—there was a
reduction in speed and range during retraction
and pursing of the lips.
At rest, the jaw appeared to be relaxed in a
normal position; however, in speech task
minimal deviation was noticed. Tongue
examination revealed severe weakness. He
was unable to attempt tongue elevation and
lateral movements. His tongue protrusion was
found to be limited and unable to manage
more than two movements. Alternating motion
rate (AMR) and sequential motion rate (SMR)
showed reduced speed and accuracy of
movements. The rate obtained for AMR and
SMR were 1.75 and 0.36, respectively.

RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved Page 15
Research & Reviews: A Journal of Neuroscience
Volume 10, Issue 3
ISSN: 2277-6427 (Online), ISSN: 2348-7925 (Print)
The palatal movement revealed minimal
movements over repetitions of ‘ah-ah-ah’.
There were significant hypernasality and nasal
air emission. Henningsson’s four-point rating
scale of nasality [26] was administered and the
patient had a score of four indicating severe
hypernasality.
The articulatory assessment revealed the
presence of imprecise consonant production
and vowel distortions. All classes of sounds
were affected. There were severe distortions
for lingua-palatal and velar sounds followed
by bilabials and labiodentals. Glottal sounds
and inter-dental sounds were least affected.
Vowel articulation revealed mild distortion for
the vowel /a/. The vowel /u/ was more affected
followed by the vowel /i/. Acoustic analysis
revealed higher F1, F2 and F3 and breakdown
of formant structure. Figure 2 and Table 1
shows the formant frequencies of vowels /a/,
/i/ and /u/.
Table 1: Formant Frequencies of Vowels /a/,
/i/ and /u/.
Vowels Formant 1 Formant 2 Formant 3
/a/ 804 Hz 1259 Hz 2771 Hz
/i/ 514 Hz 1643 Hz 2806 Hz
/u/ 569 Hz 1108 Hz 2756 Hz
Henningsson’s four-point rating scale [26] was
used to assess the speech understandability
and acceptability. The patient obtained a score
of four in speech understandability which
indicated that the speech was hard to
understand most or all the time. His speech
acceptability indicated deviation of speech to a
severe degree. Voice evaluation revealed
hypernasality, breathiness and reduction in
loudness. His fundamental frequency was
found to be 148 Hz.
Prosodic aspects of speech were also found to
be affected. The perceptual evaluation
indicated that he had monopitch and
monoloudness in connected speech. Speech
examination also revealed short phrases,
inappropriate silences, prolonged phonemes
and prolonged intervals between phonemes.
His rate of speech was found to be 1–2
syllables per second indicating a slow rate of
speech.
RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved
Swallowing assessment revealed that the
patient experienced chocking occasionally and
reported drooling. He was intaking a pureed
diet at the time of diagnosis. Sydney swallow
questionnaire was used to assess the severity
of the swallowing problem. The results
indicated that he was having moderate
difficulty in swallowing soft, hard and dry
food. He always needed to swallow more than
once for the food to go down. The impression
obtained from the evaluation showed the
presence of dysphagia. However, we could not
carry out an instrumental evaluation.
Speech evaluation indicated that the patient
demonstrated some of the speech
characteristics of more than one type of
dysarthria indicating it to be a mixed type of
dysarthria. He had severe hypernasality, nasal
air emission (a characteristic feature of flaccid
dysarthria), strained and harsh voice quality,
short phrase, slow rate of speech (spastic
component), and imprecise consonant,
monopitch and monoloudness (characteristic
features that are common to both flaccid and
spastic dysarthria). Hence the provisional
diagnosis of the patient was flaccid-spastic
mixed dysarthria.
DISCUSSION
Motor neuron diseases are a group of disorders
that involve the degeneration of motor
neurons. ALS is the most common motor
neuron disease. ALS can affect bulbar, limb
and respiratory muscles. ALS is a disease of
both UMNs and LMNs, but its initial
manifestation may be confined to the LMNs.
Thus, ALS may produce flaccid dysarthria
secondary to cranial nerve involvement [27].
About 80% of the affected individuals with
ALS develop dysarthria at some point during
the disease course [28]. The type of dysarthria
that appears in individuals with ALS depends
on which motor neurons are affected by the
disorder. In the study of 30 subjects with ALS,
Darley et al. [9, 10] found that the subjects’
speech errors reflected the combined
characteristics of flaccid and spastic
dysarthria.
The present study also showed clusters of
abnormal speech characteristics of both flaccid
and spastic dysarthria. He had severe
Page 16
Dysarthria and Dysphagia in Amyotrophic Lateral Sclerosis: A Case Study
Girish
hypernasality, nasal air emission and poor
respiratory control (a characteristic feature of
flaccid dysarthria), strained and harsh voice
quality, slow rate of speech and distorted
vowels (spastic component) and imprecise
consonants, short phrases, monopitch and
monoloudness (characteristic features that are
common to both flaccid and spastic
dysarthria). These findings agreed with the
previous findings [9, 10, 20]. Darley et al. [9,
10] also reported that ALS with mixed flaccid–
spastic dysarthria exhibit three features that
are not found in pure flaccid or spastic
dysarthria. They were prolonged intervals,
prolonged phonemes and inappropriate
silences. These three features were also
evident in our case indicating that our case had
flaccid–spastic mixed dysarthria. Results of
the intelligibility rating scale revealed poor
speech intelligibility, which can also be seen
in flaccid–spastic mixed dysarthria [9, 10, 20].
Several studies [15, 16, 29, 30] shed light on
the articulatory abnormalities that contribute to
reduced intelligibility in ALS. The most
prominent abnormalities are related to
velopharyngeal function, lingual functions,
syllable shapes, voicing contrasts and
regulation of tongue height for vowels. In the
present case, there were imprecise consonants
and vowel distortions. Linguapalatal and velar
sounds were severely affected followed by
bilabials and labiodentals. Glottal sounds and
interdental sounds were least affected. The
reason for this articulatory deficit can be a
weakness in the speech mechanism and
reduced range and speed of movements of
articulators.
Individuals with ALS can have weaknesses in
limbs and oral speech mechanisms [7, 9–11].
The neurological findings of the patient
revealed left lower limb weakness, facial and
tongue weakness with fasciculation which was
in agreement with the previous literature.
There were marked reduction in the range and
speed of movements of the structures such as
lips, tongue and soft palate indicating
weaknesses in the oral peripheral mechanism.
These abnormalities directly correlate with
measures of speech function including
RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved
Kuriakose and
intelligibility. The presence of resonatory
incompetence, which was characterized by the
presence of hypernasality, nasal air emissions,
short phrases, and imprecise consonants in our
case, indicated the presence of velopharyngeal
valve weakness, leading to excessive nasal
resonance.
Voice problems are reported for individuals
with ALS [16–18]. In specific, studies have
reported an increased fundamental frequency
in their case [19]. In the present study, the
patient also obtained a higher fundamental
frequency of about 148 Hz and increased
formant frequencies. Other voice problems
identified in the present case were harsh and
strained voice quality. Researchers also
reported the presence of harsh voice quality in
an individual with mixed flaccid–spastic
dysarthria due to ALS [9, 10]. The probable
reason what they reported in their cases was
due to turbulence during the speech from
saliva that has accumulated in the pyriform
sinuses and on the vocal folds because of
reduced frequency of swallowing or
inadequate clearing of secretions. The same
may be the reason in the present case as well
because on examination it was noted that the
present case also experienced moderate
difficulty in swallowing.
Prosodic abnormalities were evident in our
case. Speech evaluation revealed the presence
of prolonged intervals, prolonged phonemes,
inappropriate silences, reduced rate of speech,
short phrases and reduced variation in pitch
and intensity. These findings were supported
by the findings of Darley et al. [9] who
reported individual with ALS exhibiting three
features such as prolonged intervals,
prolonged phonemes and inappropriate
silences which are not found in pure flaccid or
spastic dysarthria. Researchers found that the
individuals with ALS experience a slow rate of
speech and reduction in DDK rate [19, 21].
The probable reasons for these prosodic
abnormalities are weakness and reduction in
the speed and range of articulators. Short
phrases in the present case reflect the effect of
the air wastage through the velopharyngeal
Page 17
Research & Reviews: A Journal of Neuroscience
Volume 10, Issue 3
ISSN: 2277-6427 (Online), ISSN: 2348-7925 (Print)
port. Another reason for short phrases could be
the weakness of the respiratory musculatures.
Other than speech problems, one of the most
common problems of ALS is dysphagia or
swallowing difficulty [22, 25]. Swallowing
assessment revealed that the patient in the
present case has moderate dysphagia,
supporting the previous literature. Previous
investigations reported that the individuals
with ALS suffer from mild or moderate
dysphagia within the first two years after the
incidence [23, 24]. In the present study, speech
or swallowing problems were the initial
symptoms noticed in the patient which can be
because of the“bulbar onset” of ALS. A recent
study reported that the bulbar onset of ALS
can have speech and swallowing problems as
initial symptoms [21]. Literature indicated that
one-fourth of the population with ALS have
primary bulbar involvement with articulatory,
palate–pharyngeal, or/and laryngeal
symptoms. Our case also exhibited these
symptoms which may indicate ALS of bulbar
origin.
CONCLUSION
ALS is generally characterized by progressive
degeneration of UMN and LMN. Combined
involvement of UMN and LMN dysfunction
produces a ‘mixed’ spastic–flaccid dysarthria.
The present case was diagnosed with ALS by
a neurologist and his speech evaluation
indicated the presence of flaccid–spastic
mixed dysarthria. His speech was
characterized by hypernasality, imprecise
consonants, distorted vowels, harshness, short
phrases, monopitch, monoloudness, silent
pauses, prolonged phonemes and slow rate of
speech. The presence of the above
characteristics leads to poor speech
intelligibility. The present case report sheds
light on the speech characteristics of
individuals with ALS which further helps the
speech-language pathologist on assessment
and management of individuals with ALS.
ACKNOWLEDGEMENT
The authors would like to thank the Principal,
JSS Institute of Speech and Hearing, Dharwad,
India for providing us the set up to carry out
the present study. The authors would also like
to thank Mr. Aravind. C and Dr. Amulya. P.
Rao for proofreading our research article.
RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved
REFERENCES
1. Carpenter RJ, McDonald TJ, Howard FM.
The otolaryngologic presentation of
amyotrophic lateral sclerosis. Otolaryngol.
1978; 86(3): ORL-479.
2. Das K, Nag C, Ghosh M. Familial,
environmental, and occupational risk
factors in development of amyotrophic
lateral sclerosis. N Am J Med Sci. 2012;
4(8): 350p.
3. Chiò A, Logroscino G, Traynor BJ,
Collins J, Simeone JC, Goldstein LA,
White LA. Global epidemiology of
amyotrophic lateral sclerosis: A systematic
review of the published
literature. Neuroepidemiology. 2013;
41(2): 118–130p.
4. Foundation for Research on Rare Diseases
and Disorders. Amyotrophic Lateral
Sclerosis. India: Foundation for Research
on Rare Diseases and Disorders; 2015.
Available from: http://www.
rarediseasesindia.org/als.
5. Orsini M, Oliveira AB, Nascimento OJ,
Reis CH, Leite MA, de Souza JA, Pupe C,
de Souza OG, Bastos VH, de Freitas MR,
Teixeira S. Amyotrophic lateral sclerosis:
new perspectives and update. Neurol Int.
2015; 7(2): 5885p.
6. Ingre C, Roos PM, Piehl F, Kamel F, Fang
F. Risk factors for amyotrophic lateral
sclerosis. Clin Epidemiol. 2015; 7: 181p.
7. Nusrat K, Mahmood S, Marsia S,
Mahmood K. Elaborate Tongue
Fasciculations Going Down to the Neck:
A Rare Case of Sporadic, Young-onset
Amyotrophic Lateral Sclerosis with
Bulbar Symptoms, from Pakistan. Cureus.
2019; 11(5): e4600.
8. Manjaly ZR, Scott KM, Abhinav K,
Wijesekera L, Ganesalingam J, Goldstein
LH, Janssen A, Dougherty A, Willey E,
Stanton BR, Turner MR. The sex ratio in
amyotrophic lateral sclerosis: A
population based study. Amyotroph
Lateral Scler. 2010; 11(5): 439–442p.
9. Darley FL, Aronson AE, Brown JR.
Clusters of deviant speech dimensions in
the dysarthrias. J Speech Hear Res. 1969;
12(3): 462–496p.
Page 18
Dysarthria and Dysphagia in Amyotrophic Lateral Sclerosis: A Case Study
Girish
10. Darley FL, Aronson AE, Brown JR.
Differential diagnostic patterns of
dysarthria. J Speech Hear Res. 1969;
12(2): 246–269p.
11. Duffy JR, Peach RK, Strand EA.
Progressive apraxia of speech as a sign of
motor neuron disease. Am J Speech Lang
Pathol. 2007; 16: 198–208p.
12. Adams RD, Victor M. Principles of
neurology, 3rded. New York: McGraw-
Hill; 1986. 889–894p.
13. Strong MJ, Grace GM, Orange JB, Leeper
HA. Cognition, language, and speech in
amyotrophic lateral sclerosis: A review. J
Clin Exp Neuropsychol. 1996; 18(2): 291–
303p.
14. Beukelman DR, Garrett KL, Yorkston
KM, editors. Augmentative
communication strategies for adults with
acute or chronic medical conditions.
Baltimore, MD: Paul H. Brookes
Publishing Company; 2007. 287–316p.
15. Kent RD, Kent JF, Weismer G, Sufit RL,
Rosenbek JC, Martin RE, Brooks BR.
Impairment of speech intelligibility in men
with amyotrophic lateral sclerosis. J
Speech Hear Disord. 1990; 55(4): 721–
728p.
16. Kent RD, Sufit RL, Rosenbek JC, Kent JF,
Weismer G, Martin RE, Brooks BR.
Speech deterioration in amyotrophic
lateral sclerosis: A case study. J Speech
Lang Hear Res. 1991; 34(6): 1269–1275p.
17. Mulligan M, Carpenter J, Riddel J,
Delaney MK, Badger G, Krusinski P,
Tandan R. Intelligibility and the acoustic
characteristics of speech in amyotrophic
lateral sclerosis (ALS). J Speech Lang
Hear Res. 1994; 37(3): 496–503p.
18. Ball LJ, Beukelman DR, Pattee GL.
Timing of speech deterioration in people
with amyotrophic lateral sclerosis. J Med
Speech Lang Pathol. 2002; 10(4): 231–
236p.
19. Lundy DS, Roy S, Xue JW, Casiano RR,
Jassir D. Spastic/spasmodic vs. tremulous
vocal quality: Motor speech profile
analysis. J Voice. 2004; 18(1): 146–152p.
20. Darley FL, Aronson A, Brown J. Motor
speech disorders. Philadelphia: WB
Saunders; 1975.
RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved
Kuriakose and
21. Shellikeri S, Green JR, Kulkarni M, Rong
P, Martino R, Zinman L, Yunusova Y.
Speech movement measures as markers of
bulbar disease in amyotrophic lateral
sclerosis. J Speech Lang Hear Res. 2016;
59(5): 887–899p.
22. McCarthy JE. A manual for people living
with ALS. Canada: Amyotrophic Lateral
Sclerosis Society of Canada; 2005.
23. Fattori B, Grosso M, Bongioanni P, Nacci
A, Cristofani R, AlSharif A, Licitra R,
Matteucci F, Rossi B, Rubello D, Ursino
F. Assessment of swallowing by
oropharyngoesophageal scintigraphy in
patients with amyotrophic lateral sclerosis.
Dysphagia. 2006; 21(4): 280–286p.
24. Luchesi KF, Kitamura S, Mourão LF.
Higher risk of complications in
odynophagia-associated dysphagia in
amyotrophic lateral sclerosis. Arq
Neuropsiquiatr. 2014; 72(3): 203–207p.
25. Jani MP, Gore GB. Swallowing
characteristics in amyotrophic lateral
sclerosis. Neuro Rehabilitation. 2016;
39(2): 273–276p.
26. Henningsson G, Kuehn DP, Sell D,
Sweeney T, Trost-Cardamone JE,
Whitehill TL. Universal parameters for
reporting speech outcomes in individuals
with cleft palate. The Cleft Palate
Craniofac J. 2008; 45(1): 1–7p.
27. Duffy JR. Motor speech disorders:
Substrates, differential diagnosis, and
management. St. Louis: Mosby
Incorporated; 2013.
28. Tomik B, Guiloff RJ. Dysarthria in
amyotrophic lateral sclerosis: A review.
Amyotroph Lateral Scler. 2010; 11(1–2):
4–15p.
29. Kent RD. Laryngeal dysfunction in
neurological disease: Amyotrophic lateral
sclerosis, Parkinson disease, and stroke. J
Med Speech-Lang Pathol. 1994; 2: 157–
175p.
30. Klasner ER, Yorkston KM, Strand EA.
Patterns of perceptual features in speakers
with ALS: A preliminary study of
prominence and intelligibility
considerations. J Med Speech Lang
Pathol. 1999; 7(2): 117–125p.
Page 19
 Research & Reviews: A Journal of Neuroscience
Volume 10, Issue 3
ISSN: 2277-6427 (Online), ISSN: 2348-7925 (Print)

Cite this Article

Theaja Kuriakose, Girish K.S. Dysarthria
and Dysphagia in Amyotrophic Lateral
Sclerosis: A Case Study. Research &
Reviews: A Journal of Neuroscience. 2020;
10(3): 12–19p.

RRJoNS (2020) 12-19 © STM Journals 2020. All Rights Reserved Page 20

View publication stats