Motor neuron disease (MND) refers to a heterogeneous group of conditions characterized by degeneration. Lower Motor Neurons (those that have a cell bodies in the cranial nerve nuclei or in the anterior horn of the spinal cord and synapse directly on muscle)andUpper Motor Neurons (those that have cell bodies in the brain and synapse on lower motor neuron. Amyotrophic lateral sclerosis(ALD) is one of the multiple degenerative motor neuron diseases.
As there is depth of studies focusing on speech,language,cognition and swallowing.The need of current study is to profile the speech, language,cognition and swallowing in a detailed manner using both subjective and objective evaluation.
The aim of the study is to profile the speech and language characteristics in Motor Neuron Disease.
The subject was a 65 year old male who presented to the outpatient clinic with the chief complaint of a slurring of speech since 2 years.Medical assessment includes Electroneedle myography and Computerized Tomography scan.Assessment of speech subsystems (articulation, intelligibility, Diadochokinesis, rate of speech, nature of articulation) and Phonation – MPD (Maximum Phonation Duration/time),S/Z ratio was done. Respiration assessment includes, types of breathing, pattern of breathing, length of utterance in one breathe. Reflex-Gag reflex, voice - loudness variation, pitch variation were noted .Frenchey Dysarthric Assessment was administered. The detailed evaluation of informal language assessment (reading, writing, cognition and right hemisphere function test) was carried out.Evaluation of dysarthria was carried out. Oral Mechanism/Cranial nerve examination- cranial nerves are CN VII –Facial , CN V- Trigeminal, CN IX and X –Glossopharyngeal, Vagus ,CN XI – Accessory and CN XII – Hypoglossal assessment done. Swallowing assessement was carried using MMSA – Manipal Manual for Swallowing Assessment consisting four subscales, 1. Assessment of structure, 2. Assessment of function, 3. Assessment of phases of swallowing and 4 Tolerence of consistencies and Augmentative Alternative Communication related to speech and language was done with the therapy goals.
The speech evaluation results show slow speech.The oral peripheral mechanism examination significant findings were Lip - puckering of lips affected, lip strength is inadequate. Speech intelligibility was also found to be significantly compromised. Reduced MPD and increased shimmer were found in analysis of phonatory system. FDA results shows mixed dysarthria.
Detailed evaluation of all domains is inevitable for proper intervention of an individual with motor neuron disease (MND).Proper evaluation helps in differential diagnosis otherwise that leads to misdiagnosis. Motor neuron disease (MND) refer to an heterogeneous group of conditions characterized by degeneration of upper motor neurons (UMN) and lower motor neurons . Hence augmentative and alternative communication is better management option for the motor neuron disease (MND) patients as its degenerative condition. The detailed evaluation of Augmentative and alternative communication (AAC) has been carried out .Goals taken focuses on s all subsystems of speech and have to be worked simultaneously in order to get better prognosis of an individual with motor neuron disease (MND).
Audience Take Away:
The current study helps the practicing clinicians in:
• Understanding the clinical manifestations of MND
• Helps in assessment and management of MND