Hi Heather

the term cortical dysarthria is one used by the Germn neurologist E Bay
back in the 1940's/50's and is synonymous with the pure anarthria of the
French neurologist Pierre Marie (early 1900's). Just to add to your
historical jargon list it's most likely that Liepmann and Kleist,
further German neurologists, in early 1900's were describing the same
thing, which they labelled melokinetic apraxia ande innervatory apraxia.
Others include it under the label of 'dysarthria clumsy hand syndrome'.
These terms linger on in the neurology books, with a lot of wishy washy
definitions and deliniation of one disorder from another!

Descriptively it is something midway between dysarthria and apraxia of
speech - you have the slowed, imprecise consonants, problems with
clusters, slight hypernasality, some dysprosody from the slowness and
alterations to stress patterns typical of spastic dysrathria, except the
movement deficit is not so laboured and slow and the problem is more of
fine motor control; it has elements of apraxia of speech in that speech
errors are lot less consistent than usually heard in dysarthria and
there may be some struggle/ articulatory groping. However, unlike
apraxia there isn't the automatic-propositional divide.

From the scan results you cite it sounds like there may be other
elements , or the label cortical dysarthria is not quite right - lesions
of the putamen and internal capsule can lead to dysarthria too , and
characteristically quiet voice, in severe cases a whisper or mute.
Unilateral upper motor neurone dysarthria has the same perceptual
features you describe - this would tie in well with the internal capsule
lesion site.

That any use? Do ask if further details required.

Nick
Speech and Language Sciences
George VI Building
University of Newcastle
Newcastle-Tyne NE1 7RU
Great Britain
Telephone: +44 191 222 56 03
Fax: +44 191 222 65 18
Email: <Nicholas.Miller@...>

>-----Original Message-----
>From: slt-north@yahoogroups.com
>[mailto:slt-north@yahoogroups.com] On Behalf Of heather rae
>Sent: 06 July 2005 16:21
>To: slt-north@yahoogroups.com
>Subject: [slt-north] Cortical dysarthria
>
>Dear All,
>
>This is a clinical question directed to those working with
>adults with neurological disorders. I am currently working
>with a 75 year old lady with a diagnosis from the consultant
>neurologist of "cortical dysarthria", a term which I have not
>come across before. She has a history of TIAs but was never
>admitted to hospital and has no limb weakness or visual field
>deficit, her speech is the only area impaired. She presents
>with very slow, non fluent speech with unusual prosody - not a
>monotone but prosody is definitely reduced. She has no
>slurring of speech and no muscle weakness, so her articulation
>is good. She has no difficulty with most language assessments,
>although she sometimes comments that words are hard to find.
>She does have difficulty with some phonological awareness
>tasks such as rhyme judgment and syllable segmentation. She
>has no cognitive difficulties. An MRI scan showed several
>hyperintense foci in the white matter of both cerebral
>hemispheres, with one larger focus near the left putamen and
>anterior internal capsule.
>
>I am writing to find out whether anyone has come across a
>similar patient, or anyone who has come across the term
>cortical dysarthria before, or anyone who has any ideas of
>what therapy techniques to try.
>So far in therapy I have been working on phonological
>awareness and prosody, mainly through reading aloud tasks. She
>has not made much progress.
>
>Thankyou very much for any suggestions,
>
>Heather Rae
>City Hospitals Sunderland
>
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