Darley Et Al-1969-Journal of Speech, Language, and Hearing Research

DIFFERENTIAL DIAGNOSTIC
PATTERNS OF DYSARTHRIA
FREDERIC L. DARLEY, ARNOLD E. ARONSON, and JOE R. BROWN
Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Thirty-second speech samples were studied of at least 30 patients in each of 7 dis-

crete neurologic groups, each patient unequivocally diagnosed as being a representa-
tive of his diagnostic group. Three judges independently rated each of these samples
on each of 38 dimensions of speech and voice using a 7-point scale of severity.
Computer analysis based on the means of the three ratings on each patient on each
dimension yielded results leading to these conclusions: (1) Speech indeed follows
neuroanatomy and neurophysiology. There are multiple types or patterns of dysar-
thria, each mirroring a different kind of abnormality of motor functioning. (2) These
patterns of dysarthria can be differentiated; they sound different. They consist of
definitive groupings of certain dimensions of speech and voice, deviant to distinctive
degrees. (3) Five types of dysarthria were delineated: flaccid dysarthria (in bulbar
palsy), spastic dysarthria (in pseudobulbar palsy), ataxic dysarthria (in cerebellar
disorders ), hypokinetic dysarthria (in parkinsonism ), and hyperkinetic dysarthria (in
dystonia and chorea). Also, a mixed dysarthria combining elements of flaccid and
spastic dysarthrias was identified in amyotrophic lateral sclerosis. (4) Observed oc-
currence of a single dimension uniquely in a given neurologic disease and distinctive
co-occurrence of several dimensions can aid diagnostically in identification of neuro-
logic disorders.
Dysarthria is a collective name for a group of speech disorders resulting from
disturbances in muscular control over the speech mechanism due to damage of
the central or peripheral nervous system. It designates problems in oral com-
munication due to paralysis, weakness, or incoordination of the speech muscu-
lature. It differentiates such problems from disorders of higher centers related
to the faulty programming of movements and sequences of movements (apraxia
of speech) and to the inefficient processing of linguistic units (aphasia).
M o d e m usage of the term "dysarthria" b y speech pathologists and neurolo-
gists makes it both more comprehensive and more specific than the persistent
medical dictionary definition: "imperfect articulation in speech" (Dorland,
1965). Peacher (1950) has pointed out that the term "is now being used to
cover all motor disturbances of speech exclusive of the symbolic and integrative
functions" (p. 252). Greene (1964) prefers to use the term suggested b y
Peacher (1949), dysarthrophonia, for
in the more severe cases of paralysis, ataxia, and hypermotoricity, the palatal, pharyn-
geal, laryngeal and respiratory muscles may be involved . . . . It reminds us, as speech
therapists, not to concentrate upon one aspect of defective speech to the neglect of
another, but to treat the problem of respiration, voice and speaking as a holistic entity
(p. 9,9,9.).
246
Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
This report will use the traditional term "dysarthria" but will use it to en-
compass coexisting motor disorders of respiration, phonation, articulation,
resonance, and prosody (those variations in time, pitch, and loudness which
summate to produce emphasis and interest in speech). However, the term will
be restricted-again in accordance with modem usage-to speech dysfunctions
that are neurogenic.
Textbooks that discuss dysarthria often lack specificity, sometimes describ-
ing the speech associated with certain neurologic disorders simply as "dysar-
thric" or using relatively inexact terms like "slurred," "thick," "indistinct," "un-
clear," "clumsy," or "cerebral palsied.'" More descriptive adjectives used are
"forced," "slow," "'nasal," "labored," "explosive," "drawling," and "jerky." Some-
times the authors use more quaint and colorful expressions, reporting that the
patient's speech is "slobbery," that he speaks as though "with a foreign body in
his mouth" or more exactly, in a culinary way, with "hot potato speech," or as
though with "mush in the mouth" or "with mouth full of mashed potatoes."
Other authors detail more fully what we may expect to hear in the speech
of patients with certain neurologic diseases. Some take an important step for-
ward in emphasizing the differential characteristics of various dysarthrias.
Wechsler (1963), for example, in telling the neurologist how to test for dysar-
thria, says:
The scanning, staccato speech which is observed in multiple sclerosis, the quivering,
explosive articulation betraying a cerebellar component, the tremulous, slurring speech
of general paresis, the slow speech of striatal rigidities, the paralytic, nasal speech of
bulbar paralysis, the explosive, barely understood speech of spastic supranuclear
bulbar or pseudobulbar palsy can frequently be brought out either in conversation or
by means of test phrases (pp. 13-14).
Grewel (1957) even suggests that the various dysarthrias may have a "localiz-
ing value." He says,
In many cases dysarthria is discernible at an early stage in neurological disorders,

sometimes even suggesting a tentative diagnosis to the phonetically trained ear, when
neurological examination still shows no convincing neurological symptoms (p. 329).
In daffy encounters with dysarthric patients on neurology and speech pathol-

ogy services we early came to agree with Grewel that it is proper to speak of
dysarthrias (plural) rather than of dysarthria (singular) and that the dysar-
thrias are clinically differentiable. Our report reviews a study of the motor
speech problems of seven neurologic groups and delineates the distinctive pat-
terns of speech phenomena which characterize them.
PROCEDURE
Speech samples were collected from a total of 212 patients, each unequivo-
cally diagnosed as representing a given neurologie category. Seven groups
were studied: pseudobulbar palsy, bulbar palsy, amyotrophic lateral sclerosis,
cerebellar lesions, parkinsonism, dystonia, and choreoathetosis.
DARLEYET AL.: Diagnostic Patterns of Dysarthria 247

Patients were examined in the neurology sections of the Mayo Clinic. Their
records were reviewed by one of the authors (J. R. Brown) to determine that
each patient selected for the study presented symptoms and signs only of the
type characteristic of the given disorder. Thirty patients of each type (32 in
the case of parkinsonism) were selected, all with some speech involvement and
representing a wide range of severity of speech involvement.
For the tape-recorded speech samples most patients read a standard para-
graph of simple expository prose containing all English phonemes (the "Grand-
father" passage). In some cases a sample of conversational speech was used,
and in a very few cases it was necessary to use sentences repeated by the
patients after the examiner. Thirty-second samples were dubbed from these
tapes to make listening tapes. Each patient was identified by number with
from 4 to 15 patients grouped on a single tape for ease in playback and
listening.
Scaling Method
Each speech sample was rated by a group of three judges (the authors) on a
series of dimensions. In preliminary discussions a number of dimensions of
speech and voice were specified which were considered to be pertinent to a
phenomenological study of dysarthria; a description of each dimension was
formulated reflecting the judges' agreement as to what phenomenon each
dimension represented. During the listening part of the study the judges
identified other dimensions which they considered pertinent, and these were
added to the series. Each time a dimension was added it was of course neces-
sary to re-listen to all samples previously rated in order that every subject be
rated on every dimension.
The final series consisted of 38 dimensions, each of which has been given a
short descriptive name. 1 A description of each dimension is presented in the
Appendix. The 38 dimensions may be grouped for convenience into seven
categories (although it is recognized that a given dimension might reasonably
be placed in some other category).
Four dimensions pertain to pitch characteristics (No. 1-4 in the Appendix):
pitch level, pitch breaks, monopitch, and voice tremor.
Five dimensions pertain to loudness (No. 5-9 in the Appendix): monoloud-
hess, excess loudness variation, loudness decay, alternating loudness, and
loudness level (overall). (Ratings of overall loudness level were possible on
only a limited selection of patients in each group since reference loudness levels
were not available for all. Therefore data on this dimension have been omit-
ted.)
Nine dimensions (No. 10-18 in the Appendix) pertain to vocal quality, in-
eluding both laryngeal and resonatory dysfunction: harsh voice, hoarse (wet)
1Each time the dimension name appears in the text it will be in italics. The terminology
for physiologic and neuromuscular features has also been standardized; in the text such fea-
tures will be in s~_Axa,cAPrrAx.s.
2,48 Journalof Speech and Hearing Research 12 246-269 1969

voice, breathy voice (continuous), breathy voice (transient), strained-strangled
voice, voice stoppages, hypernasality, hyponasality, and nasa/emission.
Three dimensions pertain to respiration ( No. 19-21 in the Appendix) : forced
inspiration-expiration, audible inspiration, and grunt at end of expiration.
Ten dimensions pertain to prosody (No. 22-31 in the Appendix): rate,
phrases short, increase of rate in segments, increase of rate overall, reduced
stress, variable rate, intervals prolonged, inappropriate silences, short rushes
of speech, and excess and equal stress.
Five dimensions pertain to articulation (No. 32-36 in the Appendix): im-
precise consonants, phonemes prolonged, phonemes repeated, irregular articu-
Iatory breakdown, and vowels distorted.
Two are "overall" or general impression dimensions (No. 37-38 in the Appen-
dix): intelligibility and bizarreness.
Each patient's performance with regard to each dimension was rated through
the use of a seven-point equal-appearing intervals scale of severity, 1 repre-
senting normal speech and 7 representing very severe deviation from normal.
A series of speech samples would be played through, the three judges concen-
trating on only one dimension at a time and recording independently their
severity rating of each patient with regard to that dimension. After listening to
all the samples on that tape, the judges then listened to the series again, this
time rating each patient on the next dimension. In this way attention was
focused upon one dimension at a time in a series of speech samples rather than
spread over multiple dimensions simultaneously.
Obviously not all possible speech deviations are found in all neurologic dis-
orders. The following economy was adopted: each time the judges started to
listen to a group of speech samples obtained from patients representing a new
disorder, they first listened to samples of at least 10 patients within that neuro-
logic group to determine which dimensions were present. If all three judges
agreed that a given dimension was not present in any of the 10 patients, that
dimension was "screened out" for that disorder and was not rated thereafter.
If, however, during later ratings of samples representing that disorder the
judges felt that a given screened-out dimension was indeed present, that dimen-
sion was reinserted, although this occurrence was infrequent. The judges,
therefore, listened to all dimensions in all disorders but did detailed rating
using the seven-point scale on only those dimensions judged to be relevant to
the given disorder on the basis of preliminary listening.
Reliability
Both temporal reliability and interobserver reliability in the making of these
judgments were measured. To determine the stability of the judgments, the
speech samples of at least 30 patients were scaled twice on each of the 38
dimensions. The first 30 patients on whom ratings could be made in two ses-
sions were used, regardless of their neurologic group.

With regard to temporal reliability, on 9 dimensions the three judges agreed
with themselves on two independent ratings within one scale value 95% of the
time; on 15 other dimensions, from 90 to 94% of the time; on 11 other dimen-
sions, from 85 to 8 9 ~ of the time; and on 2 dimensions, from 80 to 84% of the
time. On 35 of the dimensions, then, they agreed with themselves within one
scale value at least 85% of the time.
With regard to interobserver reliability, a comparison was made of the rat-
ings by the three judges of 150 patients on 37 of the dimensions-a total of
5550 sets of three ratings. On 84% of the sets the three judges agreed that the
sample was either normal or not normal. Considering instead the range of
values within the sets of three ratings, the judges again agreed perfectly or
within one scale value on 84% of the sets.
Although this level of reliability was considered to be generally satisfactory,
to increase the stability of the measures the mean of the three ratings was used
in all statistical treatments. Mean ratings of all speech dimensions of all pa-
tients in the seven neurologic groups were transferred to punch cards and
were subjected to computer analyses of various types.
The results of the investigation will be presented in three sections. First, the
speech deviations found to be characteristic of each of the seven neurologic
groups will be presented. Second, the differential incidence of the various di-
mensions across the seven groups will be discussed. Finally, a second article
will review the coappearance of certain dimensions in the seven groups and
will present a neurophysiologic rationale for the existence of these diagnostic
"clusters."
CHARACTERISTICS OF N E U R O L O G I C GROUPS
Bulbar Palsy
All 30 patients in this group displayed evidence of a lower motor neuron
lesion implicating motor units of the cranial nerves involved in speech (V,
VII, IX-X, XII). In some patients the lesion was presumably in the cell bodies
in cranial nerve nuclei (for example, a patient with residuals of a viral infec-
tion); in others damage may have been to peripheral nerve fibers; and in sev-
eral patients the difllculty was impaired transmission across the myoneural
junction (patients with myasthenia gravis). All displayed the signs of hypore-
flexia and muscle flaccidity. Some also showed atrophy characteristic of lower
motor neuron impairment. The locus of the weakness varied depending on the
cranial nerve(s) involved-velopharyngeal port, tongue, lips, mandible, or
larynx, or more than one of these.
In Table 1 are given the dimensions of speech judged to be most deviant
in the bulbar palsy group, constituting the features of what may be called
"flaccid dysarthria." "Mean" refers to the sum of the means of the scale values
assigned by the three judges to each patient in the group, divided by the
number of patients (30) in the group. Probably most interesting are those
250 Journalof Speech and Hearing Research 12 246-269 1969

TABLE 1. Dimensions of speech judged most deviant in bulbar palsy group.
Rank Dimension Mean

1 Hypernasality 3.61
2 Imprecise Consonants 2.91
3 Breathy Voice (Continuous) 2.28
4 Monopitch 2.09
5 Nasal Emission 1.93
6 Audible Inspiration 1.92
7 Harsh Voice 1.90
8 Phrases Short 1.83
9 Monoloudness 1.68
dimensions with a mean scale value of 2.0 and above, but also listed are dimen-
sions with mean scale values between 1.5 and 2.0; these appear beneath the
broken line in each group.
In this group of patients hypernasa/ity is the most evident deviation, with
associated nasa/ emission being less prominent. Second most prominent is
imprecise consonants. Breathy voice implies poor adduction of vocal folds,
while audible inspiration suggests inadequate abduction of the folds. Both
monopitch and monoloudness appear. Phrases short may well be related to
air wastage at the glottis (breathy voice), at the velopharyngeal port (hyper-
nasality, nasal emission), and in the processes of oral valving (imprecise con-
sonants). Harsh voice is less prominent than breathy voice.
Correlations were calculated between the mean scale values for all indi-
vidual dimensions and the mean scale values for the two "overall" or general
impression dimensions. The purpose was to estimate the degree to which the
individual dimensions contributed to the judges' general evaluations of intelli-
gibility (understandability of speech) and bizarreness (degree to which
speech calls attention to itself because of its unusual, peculiar, or bizarre
characteristics). In groups of the size used and with data representing judges'
ratings, correlations of 0.46 and above are conservatively interpreted to be
significantly different from zero at the 0.05 level. Only correlations of this
magnitude are reported.
Significant correlations in the case of the bulbar palsy group are given in
Table 2. The same six dimensions-two pertaining to articulation, two to reso-
TABLE 2. Correlations between individual dimensions and the two overall dimensions in
the bulbar palsy group.
Intelligibility Bizarreness
Dimension r Dimension r
Imprecise Consonants 0.92 Imprecise Consonants 0.84
Vowels Distorted 0.71 Hypernasality 0.65
Hypernasality 0.55 Nasal Emission 0.63
Nasal Emission 0.55 Phrases Short 0.63
Slow Rate 0.53 Vowels Distorted 0.58
Phrases Short 0.51 Slow Rate 0.52
DAaLVYET AL.: Diagnostic Patterns of Dysarthria 251

nance, and two to prosody-are seen to make the most significant contribu-
tions to both general impression dimensions, with misarticulation making by
far the greatest contribution to both.
Pseudobulbar Palsy
The 30 patients constituting the pseudobulbar group presented upper motor
neuron disorder, presumed to involve combined damage to the pyramidal sys-
tem and to a portion of the extrapyramidal system since these arise from the
same motor cortex areas. Because the paralysis that results from bilateral
upper motor neuron lesions bears certain clinical resemblances to bulbar palsy
but presents certain differences, it is designated as false or pseudobulbar paral-
ysis. On the basis of present knowledge, loss of skilled movement in pseudo-
bulbar palsy is attributed to damage to the pyramidal system, while the phe-
nomena of spasticity and hyperreflexia are attributed to damage to a portion
of the extrapyramidal system.
Since motor nuclei of cranial nerves receive upper motor neuron supply from
both cerebral hemispheres, enduring impairment of movement of the muscles
innervated by them does not generally result from a unilateral lesion. How-
ever, the bilateral supranuclear supply to tongue and lips is inadequate; a
unilateral lesion will produce weakness of one side of the mouth and tongue.
Upper motor neuron lesions produce both negative and positive symptoms.
Negative symptoms (losses of function) include paralysis or paresis. Positive
symptoms (evidences of overactivity) include spasticity (increased resistance
of muscle on palpation or on passive movement) and hyperreflexia (the suck-
ing reflex, an increased jaw jerk, the Babinski sign, and other exaggerated re-
sponses). The behavioral picture is one of reduction, weakening, or loss of
voluntary movements; weakness is diffuse, involving movement patterns rather
than individual muscles.
Tongue and lips, though of normal size and clearly not atrophied, move
slowly and with limited range, and rapid alternating movements are markedly
slowed and performed efforffully. The soft palate moves little and slowly on
phonation but responds refexly when stimulated with a tongue depressor.
Swallowing is difficult and choking is common. Impaired emotional control
leads to short outbursts of laughing or crying, often without affect. Etiology
may be multiple strokes, brain injury sustained in accidents, cerebral palsy of
infancy, extensive brain tumors, encephalitis, multiple sclerosis, or progressive
degeneration of the brain.
The speech deviations most prominent in pseudobulbar palsy may be desig-
nated "spastic dysarthria." The general pattern is quite different from that
noted in bulbar palsy (Table 3).
Imprecise consonants is the foremost deviation, on the average more deviant
than in bulbar palsy by one full scale value. Monopitch and monoloudness ap-
pear with reduced stress. Phonatory changes include harsh voice and strained-
strangled voice (as though the voice were being squeezed through the glottis),
252 1ournalof Speech and Hearing Research 12 246-269 1969

TABLE 3. Prominent speech deviations in pseudobulbar palsy group.
Rank Dimension Mean
2 Monopitch 3.72
3 Reduced Stress 3.32
4 Harsh Voice 3.23
5 Monoloudness 2.98
6 Low Pitch 2.82
7 Slow Rate 2.66
9 Strained-Strangled Voice 2.49
11 Vowels Distorted 1.77
12 Pitch Breaks 1.60
13 Breathy Voice ( Continuous ) 1.54
14 Excess and Equal Stress 1.50
low pitch, and pitch breaks. But breathy voice is also heard. S/ow rate with
short phrases and excess and equal stress reflect the sluggish activity of the
speech mechanism. Hypernasality is present b u t to a lesser degree ( b y one
scale value) than in bulbar palsy.
As shown in the correlations in Table 4, articulatory deviations and prosodic
alterations contribute importantly to the judges' ratings of intelligibility, while
these together with phonatory problems largely account for the judgments of
bizarreness.
the pseudobulbar palsy group.
Reduced Stress 0.78 Reduced Stress 0.79
Vowels Distorted 0.74 Monopitch 0.74
Monopitch 0.74 Monoloudness 0.73
Monoloudness 0.73 Vowels Distorted 0.68
Phrases Short 0.54 Phrases Short 0.64
Hypernasality 0.47 Strained-Strangled Voice 0.59
Slow Rate 0.58
Hypernasality 0.53
Phonemes Prolonged 0.49
Harsh Voice 0.46
Amyotrophic Lateral Sclerosis

In amyotrophic lateral sclerosis there is progressive degeneration of both
upper and lower motor neurons. The resulting upper and lower motor neuron
signs vary from patient to patient depending on the location and proportion of
damage to upper and lower motor neuron systems. One would expect the
DABLEY ET AL.: Diagnostic Patterns o[ Dysarthria 253

speech of patients with this disease to have both bulbar (flaccid dysarthria)
and pseudobulbar (spastic dysarthria) characteristics, truly a "mixed dysar-
thria."
Table 5 gives the dimensions of speech deviation found in the 30 patients
studied in this group.
TABLE5. Dimensions deviant in amyotrophic lateral sclerosis group.

Rank Dimension Mean
3 Harsh Voice 3.00
4 Slow Rate 2.89
5 Monopitch 2.77
8 Low Pitch 2.59
9 Monoloudness 2.51
11 Intervals Prolonged 2.21
13 Phonemes Prolonged 1.90
15 Breathy Voice ( Continuous ) 1.82
16 Audible Inspiration 1.65
17 Inappropriate Silences 1.61
18 Nasal Emission 1.51
Imprecise consonants ranks first, as it did in pseudobulbar palsy, but the

rated severity is greater than in either pseudobulbar or bulbar palsy. Hyper-
nasality, which ranked first in bulbar palsy, ranks second with a mean scale
value below that assigned in bulbar palsy but above that assigned in pseudo-
bulbar palsy. Slow rate is more prominent here than in pseudobulbar palsy.
Breathy voice (continuous) is less prominent than in bulbar palsy but more
prominent than in pseudobulbar palsy.
Table 6 summarizes the relationships between the speech phenomena of
amyotrophic lateral sclerosis, pseudobulbar palsy, and bulbar palsy. The 18
characteristics of amyotrophic lateral sclerosis with mean scale values of 1.5
and above are shown in order of decreasing prominence. Thirteen of these
also appeared in the pseudobulbar palsy group, and nine of them appeared in
the bulbar palsy group. Their relative ranks in those two disorders are shown.
It can be seen that seven dimensions were common to all three groups, six
were common to amyotrophic lateral sclerosis and pseudobulbar palsy, two
were common to amyotrophic lateral sclerosis and bulbar palsy, and three
were unique to amyotrophic lateral sclerosis. These three were intervals pro-
longed (No. 11 in importance in amyotrophic lateral sclerosis), phonemes pro-
longed (No. 13 in that list ), and inappropriate silences (No. 17). These mainly
prosodic dimensions may be the result of the summation and interaction of the
254 1ournalof Speech and Hearing Research 12 246-269 1969

TABLE 6. Interrelationships between scaled speech deviations in amyot~ophic lateral scle-
rosis (ALS), pseudobulbar palsy (PBP), and bulbar palsy ( BUL ).
Rank of Dimension in
Dimension ALS PBP BUL
Imprecise Consonants 1 1 2
Hypernasality 2 8 1
Harsh Voice 3 4 7
Slow Rate 4 7 -
Monopitch 5 2 4
Phrases Short 6 10 8
Vowels Distorted 7 11 -
Low Pitch 8 6 -
Monoloudness 9 5 9
Excess and Equal Stress 10 14 -
Intervals Prolonged 11 - -
Reduced Stress 12 3 -
Phonemes Prolonged 13 - -
Strained-Strangled Voice 14 9 -
Breathy Voice ( Continuous ) 15 13 3
Audible Inspiration 16 - 6
Inappropriate Silences 17 - -
Nasal Emission 18 - 5
many problems that characterize amyotrophic lateral sclerosis, blending as it

does the problems found in pseudobulbar and bulbar palsy.
Fourteen of the individual dimensions deviant in amyotrophic lateral sclero-
sis correlated significantly with the judges" judgments of intelligibility and 16
dimensions correlated significantly with judgments of bizarreness (Table 7).
Articulatory deviations contributed importantly to judgments of both intelli-
gibility and bizarreness. As might be expected, the dimensions hypernasaIity,
intervals prolonged, and slow rate were more highly correlated with bizarre-
ness than with intelligibility, while pitch breaks was surprisingly correlated
with intelligibility and not with bizarreness.
Cerebellar Disorders
Speech musculature, as well as muscles of the body and the extremities, dis-
plays impairment of the regulatory effects of the cerebellum on the accuracy
of movements that originate elsewhere. Any efficient movement must involve
accurate T~MI~'G SO that each component of the movement is called into play
at the exact proper moment. The FORCE Of the movement and each of its com-
ponents must be accurately graded, being neither too strong nor too weak. Ac-
curate metering of the X~ANGE (distance) of the movement is essential to pre-
vent overreaching or underreaching the desired point. Unerring accuracy of
DmECTmN must be maintained. In ataxia due to cerebellar disorders there are
errors in the TIMING, roacE, RANGE, and DmECTmN Of whole movements and of
individual parts of movements. General body equilibrium and gait may be
ataxic without speech being involved. Affected muscles are hypotonic and
feel flabby; voluntary movements are slow, and irregularity of their speed and
DAaLEY ET AL.: Diagnostic Patterns of Dysarthria 255

amyotrophie lateral sclerosis group.
Vowels Distorted 0.86 Vowels Distorted 0.82
Monoloudness 0.58 Hypernasality 0.68
Low Pitch 0.58 Low Pitch 0.60
Pitch Breaks 0.56 Monoloudness 0.60
Hypernasality 0.56 Slow Rate 0.60
Monopitch 0.54 Intervals Prolonged 0.60
Strained-Strangled Voice 0.53 Strained-Strangled Voice 0.57
Excess Loudness Variations 0.52 Monopitch 0.54
Intervals Prolonged 0.52 Phonemes Prolonged 0.53
Inappropriate Silences 0.51 Excess Loudness Variations 0.52
Slow Rate 0.50 Loudness Decay 0.48
Harsh Voice 0.46 Harsh Voice 0.46
Nasal Emission 0.46
Inappropriate Silences 0.46
force makes them jerky. Alternate motions are performed slowly, with irregu-
lar and often excessive excursions, and the timing is dysrhythmic. Finger move-
ments are slow and clumsy; larger arm movements are jerky, irregular, and
inaccurate. Tremor m a y be evident during a movement, and often increases
markedly toward the termination of movement. The gait is wide-based with
staggering to either side.
W h e n the causative l e s i o n - w h e t h e r tumor, progressive degeneration,
trauma, multiple sclerosis, toxicity from alcoholic excess, strokes, or congenital
conditions-involves both sides of the cerebellum and ataxia of both upper
extremities is observed, ataxic speech is generally noted as well. Errors in
timing, force, range, and direction affect muscular activity in respiration,
phonation, and articulation.
A group of 30 patients presented signs and symptoms of disorders of cere-
bellar systems. The dimensions constituting the "ataxic dysarthria" of this
group are given in Table 8. As it did in the first three groups reviewed above,
imprecise consonants appears prominently, but a new articulatory feature is
TABLE 8. Dimensions constituting "ataxie dysarthria" of group with cerebellar disorders.

Rank Dimension Mean
3 Irregular Articulatory Breakdown 2.59
5 Harsh Voice 2.10
8 Monopitch 1.74
9 Monoloudness 1.62
10 Slow Rate 1.59
256 Iournal of Speech and Hearing Research 12 246-269 1969

apparent: irregular articulatory breakdown; errors appear inconsistently, with
the sudden telescoping of a syllable or even several syllables. Also distinc-
tively prominent here is excess and equal stress, noted in milder degree in
amyotrophic lateral sclerosis and pseudobulbar palsy. This dimension corre-
sponds to the feature of measured, "scanning" speech described by Charcot
(1877) as characteristic of the dilapidated speech of patients with advanced
disseminated sclerosis (today's multiple sclerosis). Phonemes prolonged, inter-
vals prolonged, and slow rate appear, seemingly integral aspects of the total
prosodic alteration involved in equalization and increase of stress.
The relationships found between individual dimensions and overall dimen-
sions are shown in Table 9. In both cases articulatory phenomena appear to
the group with cerebellar disorders.
Irregular Articulatory Imprecise Consonants 0.65
Breakdown 0.80 Phonemes Prolonged 0.60
Imprecise Consonants 0.77 Nasal Emission 0.56
Monopitch 0.58 Monopitch 0.54
Nasal Emission 0.52 Strained-Strangled Voice 0.53
Monoloudness 0.50 Low Pitch 0.52
Inappropriate Silences 0.46 Slow Rate 0.50
Intervals Prolonged 0.46
have contributed more to the judges' impressions. Prosodic features added

importantly to the bizarreness of the speech rather than decreased its intelli-
gibility.
Parkinsonism
Disorders of the extrapyramidal system result in alteration of movement,
either to reduce it (hypokinesia) or to increase it (hyperkinesia). The former
result is observed in parkinsonism, the latter in the two neurologic groups that
follow. Common causes of all these movement disorders are encephalitis, de-
generation of nerve cells due to aging or arteriosclerotic changes, repeated
small injuries of the head, birth injuries and congenital diseases, exposure to
certain toxins, and certain tranquilizing drugs.
Positive symptoms in parkinsonism include rigidity of muscles and tremor
at rest; the primary negative symptom is paucity of movement, involving
SLOWNESS, limited R A N G E OF M O V E M E N T , and limited F O R C E OF C O N T R A C T I O N .
Facies are masked; blinking is infrequent; smiling is rare. Movements initiated
may become arrested, requiring several trials to get started. Gait is slow and
shuffling, and turning is done all in one piece. Alternating movements are
REDUCED IN RANGE and tend to become progressively smaller. Though slow at
DARLEYET AL." Diagnostic Patterns of Dysarthria 257

times, alternating movements may be very LIMITED IN RANGE and very FAST.
There is no true paralysis of voluntary movements, but there is marked loss of
the automatic aspect of movement. These problems will affect speech per-
formance as they do any other motor performance.
The 32 patients in the parkinsonism group presented phenomena constitut-
ing what may be called '~hypokinetic dysarthria" (Table 10). All four of the
neurologic groups previously reviewed displayed monopitch and monoloud-
TABLE 10. Phenomena constituting "hypokinetie dysarthria" in parkinsonism group.

Rank Dimension Mean
1 Monopitch 4.64
3 Monoloudness 4.26
6 Short Rushes 2.22
7 Harsh Voice 2.08
8 Breathy Voice (Continuous) 2.04
9 Low Pitch 1.76
10 Variable Rate 1.74
hess, but the severity of these dimensions is decidedly greater in parkinsonism;

together with reduced stress they comprise the most striking phenomena. Re-
lated prosodic changes distinctively present here are inappropriate silences,
short rushes of speech, and variable rate. It will be seen that this is the only
type of dysarthria in which rate is not characteristically slow; it is typically
quite variable and, considering the group as a whole, is rated as slightly fast
(mean scale value of 1.34) rather than on the slow side. Imprecise consonants
is prominent, apparently being the result of reduced excursion of the articu-
lators rather than simply the rate of articulation. Both harsh voice and breathy
voice are heard.
Correlations of individual dimensions with general impression dimensions
are shown in Table 11.
the parkinsonism group.
Short Rushes 0.79 Reduced Stress 0.84
Reduced Stress 0.78 Variable Rate 0.66
Variable Rate 0.73 Short Rushes 0.64
Monoloudness 0.60 Monoloudness 0.61
Fast Rate 0.55 Inappropriate Silences 0.54
Phonemes Repeated 0.48 Monopitch 0.46
Inappropriate Silences 0.47
258 ]ournal of Speech and Hearing Research 12 246-269 1969

Dystonia
Dystonia is a movement disorder which may be designated a slow hyper-
kinesia. Muscle contractions build up slowly, produce a prolonged distorted
posture, and gradually subside. Muscles of the trunk, neck, head, and proximal
part of the limbs are predominantly affected. The disorder may be focal, as in
tongue or face dystonia, or more generalized, as in dystonia musculorum
deformans. Intermittent sustained spasms of the face produce closing of the
eyes, grimacing, or pursing of the lips; the mouth may close in a spasm or open
widely, and the tongue may twist and turn in the mouth or may protrude.
Muscles of the neck may go into spasm, elevating the larynx. Patients may
learn tricks that will temporarily inhibit such movements, for example, press-
ing the chin or the back of the head or whistling.
The dimensions of "hyperkinetic dysarthria" rated in the 30 patients of the
dystonia group are given in Table 12. Interference with articulation is pre-
dominant, followed by alterations of phonation of a hypertonic sort and then
TABLE 12. Dimensions of "hyperkinetic dysarthria" rated in dystonia group.

Rank Dimension Mean
3 Harsh Voice 2.40
4 Irregular Articulatory Breakdown 2.28
5.5 Strained,Strangled Voice 2.14
5.5 Monopitch 2.14
7 Monoloudness 2.01
m m m m m ~
8.5 Inappropriate Silences 1.72

8.5 Phrases Short 1.72
12 Excess Loudness Variations 1.63
14 Voice Stoppages 1.60
15 Slow Rate 1.52
by a large number of prosodic changes. Several of these prosodic characteris-

tics have been encountered in the earlier neurologic groups: intervals pro-
tonged and phonemes prolonged in amyotrophie lateral sclerosis and cere-
bellar disorders; inappropriate silences in amyotrophic lateral sclerosis and
parkinsonism; and reduced stress in pseudobulbar palsy, amyotrophic lateral
sclerosis, and parkinsonism. In dystonia all of these dimensions appear together
with one not heretofore noted, excess loudness variations. Slow rate is noted
but not to the degree noted in pseudobulbar palsy and amyotrophic lateral
sclerosis.
Relatively few of these deviations were significantly related to the general
impression dimensions (Table 13).
DABLEYET AlL.: Diagnostic Patterns oJ Dysarthria 259

the dystonia group.
InteUigibilittj Bizarreness
Vowels Distorted 0.71 Monoloudness 0.61
Monoloudness 0.58 Intervals Prolonged 0.59
Vowels Distorted 0.57
Phonemes Prolonged 0.55
Excess Loudness Variations 0.46
Chorea
Chorea exemplifies quick hyperkinesia, its irregular movements being un-

sustained, random, unpatterned, and rapid. Hypotonia and incoordination are
often associated with choreie movements.
The patient with chorea is continuously in motion, displaying a finger jerk,
a foot twitch, a shoulder shrug, a facial grimace in quick succession. The
tongue may suddenly move to one side or quickly protrude and retract like a
frog catching a fly. A movement started as a choreic jerk may be continued as
an apparently purposeful movement. During walking, the arms and legs are
jerked and flung arrhythmically, a foot being lifted too high or being stomped
down too hard. Sudden contractions of diaphragm, thoracic muscles, laryngeal
muscles, tongue, and lips interfere with ongoing speech processes.
Table 14 gives the speech dimensions of the "nyperkinetic dysarthria" of the
30 patients with chorea. Here it can be seen that all of the ongoing motor
speech processes are interrupted. As one listens to the speech samples, one
gets the impression that some dimensions are the direct result of the movement
TABLE 14. Speech dimensions of "hyperkinetic dysarthria" in the chorea group.

Rank Dimension Mean
3 Variable Rate 2.29
4 Monopiteh 2.23
5 Harsh Voice 2.20
8 Excess Loudness Variations 2.04
10 Monoloudness 1.84
12.5 Excess and Equal Stress 1.62
12.5 Irregular Articulatory Breakdown 1.62
14.5 Hypernasality 1.56
14.5 Reduced Stress 1.56

disorder-imprecise consonants, variable rate, harsh voice, vowels distorted,
excess loudness variations, and irregular articulatory breakdown, for example.
But these patients appear to be moving tentatively through the speaking act
momentarily expecting interruption; some dimensions seem to be the result
of anticipatory and compensatory behavior-intervals prolonged, inappropriate
silences, phonemes prolonged, and excess and equal stress.
Table 15 gives the correlations between individual dimensions and the gen-
eral impression dimensions.
the chorea group.
Dirnen~on r Dimen~on r
Strained-Strangled Voice 0.77 Strained-Strangled Voice 0.68
Monopitch 0.69 Monopitch 0.56
Harsh Voice 0.62 Monoloudness 0.56
Inappropriate Silences 0.59 Inappropriate Silences 0.56
Reduced Stress 0.58 Excess Loudness Variations 0.53
Nasal Emission 0.57 Harsh Voice 0.49
Monoloudness 0.55 Reduced Stress 0.49
Excess Loudness Variations 0.54
Voice Stoppages 0.53
Hypernasality 0.49
Pitch Breaks 0.48
CROSS-GROUP ANALYSIS
The above sections have described the groupings of dimensions which one
can expect to find deviant in samples of patients with seven different neuro-
logic disorders. The speech phenomena of the neurologic groups differ in
fundamental ways. The dimensions listed under each disorder constitute the
detail concerning the phenomena of the dysarthrias which textbooks largely
lack.
Viewing the data from a different position, one can further visualize the
various neurologie groups by considering the numbers of patients within the
groups who are judged to be deviant with regard to the 38 dimensions. Table
16 summarizes these differential frequencies. It can be seen that imprecise con-
sonants was rated in all or practically all of the patients in all seven groups.
Monopitch and monoloudness are frequently observed in all groups, as is
harsh voice. On the other hand, some dimensions appear in only a few patients
of only one group: forced inspiration-expiration in chorea, increase of rate in
segments and increase of rate overall in parkinsonism. Hyponasality was rated
in no patient in any group.
A more convenient way to study the differential prominence of the various
dimensions in the seven neurologic groups is to compare the mean scale values
for given dimensions across groups. Table 17 shows the relative rank (from
DAaLEYET AL.: Diagnostic Patterns of Dysarthria 261

TABLE 16. Number of deviant patients (mean scale value above 1.00) on each of 38 di-
mensions of speech and voice by neurologic group. Abbreviations: B U L - - b u l b a r palsy;
PBP : pseudobulbar palsy; ALS -- amyotrophic lateral sclerosis; CLR : cerebellar disor-
ders; PKN : parkinsonism; DTN : dystonia; CHO "- chorea. * "- data omitted because not
available for total samples.
Dimension Neurologic Group

BUL PBP ALS CLR PKN DTN CHO
No. Abbreviation N : 30 N = 30 N = 30 N : 30 N = 32 N : 30 N = 30
1 Pitch Level 18 26 24 14 26 21 16
2 Pitch Breaks 5 9 8 7 0 6 3
3 Monopitch 24 29 29 20 31 25 19
4 Voice Tremor 0 9 5 5 0 10 7
5 Monoloudness 18 27 28 18 32 21 16
6 Excess Loudness Variation 0 10 10 10 0 9 20
7 Loudness Decay 4 0 5 0 13 0 0
8 Alternating Loudness 6 0 0 0 11 7 0
9 Loudness (Overall) * * * * * * *
10 Harsh Voice 23 29 28 21 21 27 25
11 Hoarse (Wet) Voice 4 0 6 0 0 0 0
12 Breathy Voice (Continuous) 27 14 14 0 19 4 0
13 Breathy Voice (Transient) 0 9 0 0 8 4 7
14 Strained-Strangled Voice 0 20 18 8 0 17 13
15 Voice Stoppages 0 5 0 0 0 11 5
16 Hypernasality 25 20 22 10 8 11 13
17 Hyponasality 0 0 0 0 0 0 0
18 Nasal Emission 16 9 15 2 0 0 1
19 Forced Inspiration-Expiration 0 0 0 0 0 0 6
20 Audible Inspiration 20 14 23 0 0 14 10
21 Grunt at End of Expiration 0 3 1 0 0 1 0
22 Rate 18 25 25 24 28 23 27
23 Phrases Short 17 23 22 0 16 11 12
24 Increase of Rate in Segments 0 0 0 0 4 0 0
25 Increase of Rate Overall 0 0 0 0 4 0 0
26 Reduced Stress 0 28 24 0 32 16 15
27 Variable Rate 0 0 0 7 16 8 16
28 Intervals Prolonged 0 0 20 15 0 16 23
29 Inappropriate Silences 0 0 7 8 25 15 24
30 Short Rushes of Speech 0 0 0 0 19 0 8
31 Excess and Equal Stress 0 15 17 22 0 15 17
32 Imprecise Consonants 28 30 30 28 32 30 27
33 Phonemes Prolonged 0 18 21 24 8 20 17
34 Phonemes Repeated 0 0 0 0 14 5 0
35 Irregular Articulatory
Breakdown 0 13 0 28 0 24 19
36 Vowels Distorted 11 17 24 25 0 24 23
37 Intelligibility (Overall) 25 27 25 24 25 28 26
38 Bizarreness (Overall) 30 30 30 30 32 30 30
m o s t d e v i a n t to l e a s t d e v i a n t ) of t h e n e u r o l o g i c g r o u p s w i t h r e g a r d to e a c h of
t h e 38 d i m e n s i o n s . F o r t h e 33 d i m e n s i o n s i n w h i c h a t l e a s t 3 g r o u p m e a n s w e r e
r e p r e s e n t e d , a n a l y s i s of v a r i a n c e w a s a p p l i e d to d e t e r m i n e w h e t h e r t h e differ-
e n c e s b e t w e e n t h e m e a n s w e r e s t a t i s t i c a l l y significant. I n t h e c a s e of 13 d i m e n -
sions t h e d i f f e r e n c e s w e r e s i g n i f i c a n t b e y o n d t h e 1 % level of c o n f i d e n c e ; i n 3
d i m e n s i o n s , at t h e 1 % level; i n 4 d i m e n s i o n s , b e t w e e n t h e 1 % a n d 5 % levels;
i n 1 d i m e n s i o n , a t t h e 5 % level; a n d i n 12 d i m e n s i o n s t h e d i f f e r e n c e s w e r e n o t
significant.
262 Journal of S p e e c h and Hearing Research 12 246-269 1969

.~ .~ o .~.-~,
~ _0_ ~ . ,... V V
e',!. . t'-:.. ~ . . . " ~ . . . . . ~..
~ ~..~ ~ " ~
~ ~.~ ~
~ ~162
t,--~.~.,~ II II o I1~ I1~ lie I1~o II

to..e'!."~.'~.0qc'2... :~. ~. c'2.0 f t . o . ~.
g ~r'tO,1,"~,,--~..-I .0,1 ~ ~ r.-.I ~
~ ~~
9 . . ~ o . ~ . . , "~. ~.e,!.~ " ~. ,~. , ~.

~ ~.~ ~,~ ~,---~eq,.--~eq,...~ .o,1 ,--~,--~,---~ ~ ~
~ ~
9.~ ~ ~ ~ ,--~,-.-~o,.1,-~o~1~,.-.~-~ .o,1 ,-..~-..~-.~--.~oq ~1
II II
~ ~ ~ . ~ ~ ~ ~
. . . . . . . . "~.~.~.~.~. ~. . .
= ~---
9.~ ~
~._. ~ ~
a~"~s~~176176 "~" .
~.~ o~ .= o, ---
~ o= ~.~ ~
,-~ oq t'O ~'~ It.O r 1-.- oO O~ 0 ,-.~ eq oO ' ~ tO r 1"-- oO ~ 0
263

9- 1 4 ~ - 4 I,,,,,,,4 ~ ~-4~-'4
c~c~ o-I-zc~ .oc5 . ~247

VV V V~ ~
~-4
~.o ~ oo~
0
I
II II II II II II II II II II II t-.. c'o
~
,-.~ ~Xl e,)
r,o l
II II II II II II II II t--. ,'-~ 0
~..4 o,1 c o
II r II II ,-.~ ~0 O0 , . . ~ II 0 0 ~ t..- II O,l cO t'--. 0,1

,~ ~ ~.,-!.~.~.,~ ~.~.~.~ ~ . .-. . ~
I
o
o~co
II II II II
~4~4
I
~ ~ ~
,<
c.o
IIII
eqeq
e,l I
o~o~
o0~D
c,i c,i
I
0 ~ ~,.9,o. ~'c'o~ ~.
0
v
~ '~ ~""~ ~ ~<: o
~o ~ o.~~. ~o o o~
O,10,10,10,10q r CO r CO CO CO CO CO CO
2,04

These data answer such a clinical question as "If one hears in a patient's
speech a pronounced hypernasality or excess and equal stress or strained-
strangled voice, of what disorder is each of these most characteristicN' Table
17 shows that hypernasality (dimension 16) is most prominent in bulbar palsy,
next in amyotrophic lateral sclerosis, then in pseudobulbar palsy, consider-
ably less in chorea, dystonia, and cerebellar disorders, and to a minimal
degree in parkinsonism. Excess and equal stress is most prominent in eerebel-
lar disorders, to a lesser degree in amyotrophic lateral sclerosis, and to a con-
siderably lesser degree in chorea, pseudobulbar palsy, and dystonia; it is
not observed in bulbar palsy and parkinsonism. Strained-strangled voice is
most evident in pseudobulbar palsy, next most evident in dystonia, fairly evi-
dent in amyotrophic lateral sclerosis, and evident to lesser degrees in chorea
and cerebellar disorders; it is not noted in bulbar palsy and parkinsonism.
Table 18 summarizes Table 17 and indicates how unusual or how common
TABLE 18. Summary of occurrence of dimensions with mean scale values of 1.5 or above
in seven neurologic groups.
Occurred in All Seven Groups

Monopitch
Monoloudness
Harsh Voice
Imprecise Consonants
Occurred in Five Groups
Phrases Short: ALS, PBP, BUL, CHO, DTN
Reduced Stress: PKN, PBP, ALS, DTN, CHO
Vowels Distorted: ALS, DTN, CLR, CHO, PBP
Occurred in Four Groups
Breathy Voice (Continuous): BUL, PKN, ALS, PBP
Strained-Strangled Voice: PBP, DTN, ALS, CHO
Hypernasality: BUL, ALS, PBP, CHO
Slow Rate: ALS, PBP, CLR, DTN
Intervals Prolonged: CHO, ALS, CLR, DTN
Inappropriate Silences: PKN, CHO, DTN, ALS
Excess and Equal Stress: CLR, ALS, CHO, PBP
Phonemes Prolonged: CLR, ALS, CHO, DTN
Occurred in Three Groups
Low Pitch: PBP, ALS, PKN
Irregular Articulatory Breakdown: CLR, DTN, CHO
Occurred in Two Groups
Excess Loudness Variation: CHO, DTN
Nasal Emission: BUL, ALS
Audible Inspiration: BUL, ALS
Variable Rate: CHO, PKN
Occurred in Only One Group
Pitch Breaks: PBP
Voice Stoppages: DTN
Short Rushes of Speech: PKN
Occurred in Lesser Degree in Only One Group
(Mean Scale Value Less Than 1.5 )
Forced Inspiration-Expiration: CHO ( 1.42 )
Fast Rate: PKN (1.34)
Increase of Rate in Segments: PKN (1.07)
Increase of Rate Overall: PKN (1.07)

the various dimensions are in the seven neurologic groups. Four dimensions
with mean scale values of 1.5 and above are found in all seven groups, three
in five groups, eight in four groups, two in three groups, four in two groups,
and three in only one group. Four other dimensions with mean scale values of
less than 1.5 are found in only one group. When a dimension is observed in
only a single group, even though it may be rather mild in severity in a given
patient, it may turn out to be a useful diagnostic sign, as Grewel (1957) says,
"of localizing value." When dimensions are found in several groups, their ap-
pearance together with other dimensions must be studied in order to arrive
at a conclusion as to the neurologic group probably represented. The phenome-
non of "clusters" of dimensions will be discussed in a second paper.
CONCLUSIONS
Thirty-second speech samples were studied of at least 30 patients in each of
seven discrete neurologic groups, each patient unequivocally diagnosed as be-
ing a representative of his diagnostic group. Three judges independently rated
each of these samples on each of 38 dimensions of speech and voice using a
seven-point scale of severity. Computer analysis based on the means of the
three ratings on each patient on each dimension yielded results which lead
to the following conclusions:
1. Speech indeed follows neuroanatomy and neurophysiology. There are
multiple types or patterns of dysarthria, each of which mirrors a different kind
of abnormality of motor functioning.
2. These patterns of dysarthria can be differentiated; they sound different.
They consist of definitive groupings of certain dimensions of speech and voice
which are deviant to distinctive degrees.
3. Five types of dysarthria have been delineated: flaccid dysarthria (in
bulbar palsy), spastic dysarthria (in pseudobulbar palsy), ataxic dysarthria
(in cerebellar disorders), hypokinetic dysarthria (in parkinsonism), and hy-
perkinetic dysarthria (in dystonia and chorea). In addition, a mixed dys-
arthria combining the elements of flaccid and spastic dysarthrias has been
identified in amyotrophic lateral sclerosis.
4. The observed occurrence of a single dimension unique in a given neuro-
logic disease and the distinctive co-occurrence of several dimensions can be
used as diagnostic aids in the identification of neurologic disorders.
ACKNOWLEDGMENT
The assistance of Lila R. Elveback, of the Mayo Clinic Section on Medical Statistics,
Epidemiology, and Population Genetics, is gratefully acknowledged.
REFERENCES
Cm,~acoT, J. M., Lectures on the Diseases o~ the Nervous System. (Translated by G. Siger-
son.) London: The New Sydenham Society (1877).

Dorland's Illustrated Medical Dictiona~ ( 24th ed.). philadelphia: Saunders (1965).
GREENE,M,cFtG.C~rC. L., The Voice and Its Disorders (2nd ed. ). Philadelphia: Lippincott
(1964).
Gea~wr_a.,F., Classification of dysarthrias. Acta Psychiat. Scand., 39., 325-337 (1957).
Pm~cx-ma,W. G., The neurological evaluation of delayed speech. 1. Speech Hearing Dis., 14,
344-352 ( 1949).
Pmccmma, W. C., The etiology and differential diagnosis of dysarthria. I. Speech Hearing
Dis., 15, 252-265 (1950).
WECHSLF~e,,I. S., Clinical Neurology: With an Introduction to the Histortj of Neurologv
(9th ed. ). Philadelphia: Saunders (1963).
APPENDIX
DIMENSIONS U S E D IN T H I S S T U D Y
No. A bbrevi at io n Description

1 Pitch level Pitch of voice sounds consistently too
low or too high for individual's age
and sex.
2 Pitch breaks Pitch of voice shows sudden and uncon-
trolled variation (falsetto breaks).
3 Monopitch Voice is characterized by a monopitch
or monotone. Voice lacks normal pitch
and inflectional changes. It tends to
stay at one pitch level.
4 Voice tremor Voice shows shakiness or tremulousness.
5 Monoloudness Voice shows monotony of loudness. It
lacks normal variations in loudness.
6 Excess loudness variation Voice shows sudden, uncontrolled altera-
tions in loudness, sometimes becoming
too loud, sometimes too weak.
7 Loudness decay There is progressive diminution or de-
cay of loudness.
8 Alternating loudness There are alternating changes in loud-
ness.
9 Loudness (overall) Voice is insufficiently or excessively loud.
10 Harsh voice Voice is harsh, rough, and raspy.
11 Hoarse (wet) voice Wet, "liquid sounding" hoarseness.
12 Breathy voice (continuous) Continuously breathy, weak, and thin.
13 Breathy voice (transient) Breathiness is transient, periodic, inter-
mittent.
14 Strained-strangled voice Voice (phonation) sounds strained or
strangled (an apparently efforfful
squeezing of voice through glottis).
DABLEYET AL.: Diagnostic Patterns of D~lsarthria 267

No. Abbreviation Description
15 Voice stoppages There are sudden stoppages of voiced
air stream (as ff some obstacle along
vocal tract momentarily impedes flow
of air).
16 Hypernasality Voice sounds excessively nasal. Excessive
amount of air is resonated by nasal
cavities.
17 Hyponasality Voice is denasal.
18 Nasal emission There is nasal emission of air stream.
19 Forced inspiration-expiration Speech is interrupted by sudden, forced
inspiration and expiration sighs.
20 Audible inspiration Audible, breathy inspiration.
21 Grunt at end of expiration Grunt at end of expiration.
22 Rate Rate of actual speech is abnormally slow
or rapid.
23 Phrases short Phrases are short (possibly due to fact
that inspirations occur more often
than normal). Speaker may sound as
ff he has run out of air. He may pro-
duce a gasp at the end of a phrase.
24 Increase of rate in segments Rate increases progressively within given
segments of connected speech.
25 Increase of rate overall Rate increases progressively from begin-
ning to end of sample.
26 Reduced stress Speech shows reduction of proper stress
or emphasis patterns.
27 Variable rate Rate alternately changes from slow to
fast.
28 Intervals prolonged Prolongation of interword or intersylla-
ble intervals.
29 Inappropriate silences There are inappropriate silent intervals.
30 Short rushes of speech There are short rushes of speech sepa-
rated by pauses.
31 Excess and equal stress Excess stress on usually unstressed parts
of speech, e.g. (1) monosyllabic
words and (2) unstressed syllables of
polysyllabic words.
32 Imprecise consonants Consonant sounds lack precision. They
show slurring, inadequate sharpness,
distortions, and lack of crispness.
There is clumsiness in going from one
consonant sound to another.
33 Phonemes prolonged There are prolongations of phonemes.
34 Phonemes repeated There are repetitions of phonemes.
268 ]ournalof Speech and Hearing Research 12 246-269 1969

No. Abbreviation Description
35 Irregular articulatory Intermittent nonsytematie breakdown in
breakdown accuracy of articulation.
36 Vowels distorted Vowel sounds are distorted throughout
their total duration.
37 Intelligibility (overall) Rating of overall intelligibility or under-
standabflity of speech.
38 Bizarreness (overall) Rating of degree to which overall speech
calls attention to itself because of its
unusual, peculiar, or bizarre charac-
teristics.
Received October 4, 1968.


Darley Et Al-1969-Journal of Speech, Language, and Hearing Research

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Darley Et Al-1969-Journal of Speech, Language, and Hearing Research

Uploaded by

Copyright:

Available Formats

DIFFERENTIAL DIAGNOSTIC

FREDERIC L. DARLEY, ARNOLD E. ARONSON, and JOE R. BROWN

Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Thirty-second speech samples were studied of at least 30 patients in each of 7 dis-

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

In many cases dysarthria is discernible at an early stage in neurological disorders,

In daffy encounters with dysarthric patients on neurology and speech pathol-

DARLEYET AL.: Diagnostic Patterns of Dysarthria 247

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

2,48 Journalof Speech and Hearing Research 12 246-269 1969

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

DARLEYET AL.: Diagnostic Patterns of Dysarthria 249

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

250 Journalof Speech and Hearing Research 12 246-269 1969

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

Rank Dimension Mean

DAaLVYET AL.: Diagnostic Patterns of Dysarthria 251

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

252 1ournalof Speech and Hearing Research 12 246-269 1969

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

Amyotrophic Lateral Sclerosis

DABLEY ET AL.: Diagnostic Patterns o[ Dysarthria 253

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

TABLE5. Dimensions deviant in amyotrophic lateral sclerosis group.

Imprecise consonants ranks first, as it did in pseudobulbar palsy, but the

254 1ournalof Speech and Hearing Research 12 246-269 1969

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

many problems that characterize amyotrophic lateral sclerosis, blending as it

DAaLEY ET AL.: Diagnostic Patterns of Dysarthria 255

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

TABLE 8. Dimensions constituting "ataxie dysarthria" of group with cerebellar disorders.

256 Iournal of Speech and Hearing Research 12 246-269 1969

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

have contributed more to the judges' impressions. Prosodic features added

DARLEYET AL." Diagnostic Patterns of Dysarthria 257

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

TABLE 10. Phenomena constituting "hypokinetie dysarthria" in parkinsonism group.

hess, but the severity of these dimensions is decidedly greater in parkinsonism;

258 ]ournal of Speech and Hearing Research 12 246-269 1969

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

TABLE 12. Dimensions of "hyperkinetic dysarthria" rated in dystonia group.

8.5 Inappropriate Silences 1.72

by a large number of prosodic changes. Several of these prosodic characteris-

DABLEYET AlL.: Diagnostic Patterns oJ Dysarthria 259

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

Chorea exemplifies quick hyperkinesia, its irregular movements being un-

TABLE 14. Speech dimensions of "hyperkinetic dysarthria" in the chorea group.

260 ]ournal of Speech and Hearing Research 12 246-269 1969

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

DAaLEYET AL.: Diagnostic Patterns of Dysarthria 261

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

Dimension Neurologic Group

262 Journal of S p e e c h and Hearing Research 12 246-269 1969

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

e',!. . t'-:.. ~ . . . " ~ . . . . . ~..

t,--~.~.,~ II II o I1~ I1~ lie I1~o II

9 . . ~ o . ~ . . , "~. ~.e,!.~ " ~. ,~. , ~.

9.~ ~ ~ ~ ,--~,-.-~o,.1,-~o~1~,.-.~-~ .o,1 ,-..~-..~-.~--.~oq ~1

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

c~c~ o-I-zc~ .oc5 . ~247

II r II II ,-.~ ~0 O0 , . . ~ II 0 0 ~ t..- II O,l cO t'--. 0,1

Downloaded From: http://jslhr.pubs.asha.org/ by a ReadCube User on 05/02/2016

Occurred in All Seven Groups