Cerebellar dizartriya — the violation of the proiznositelny party of the speech caused by damage of a cerebellum. It is shown by loss of smoothness, rhythm of the expressional speech, its slowness and intermittence. It is observed against the background of symptoms of a cerebellar ataxy. In diagnostics data of logopedic inspection, the neurologic status, neurovisualization researches (brain MCKT, MPT), if necessary — the genetic analysis are used. Logopedic correction is carried out against the background of etiopatogenetichesky treatment of causal pathology, neurometabolic medicamentous support and the general rehabilitation actions (LFK, massage, work with the psychologist).
The cerebellum makes the regulating impact on the motive sphere, supports a muscular tone, provides balance deduction, coordination and synchronization of movements. The regulating influences extend to mimic muscles, articulation muscles and vocal chords. The cerebellar dizartriya arises at violation of the regulating function of a cerebellum, is followed by other symptoms of its defeat united in clinical neurology by the concept "cerebellar ataxy". The isolated cerebellar dizartriya is observed seldom, more often it is combined with other forms of a dizartriya, other neurologic symptoms.
Reasons of a cerebellar dizartriya
Basis of pathology defeat of hemispheres makes, a worm of a cerebellum, violation of its communications with other departments of TsNS. Vascular frustration, toxic influences, atrophic, infectious and tumoral processes act as Etiofaktorami. All etiologichesky factors subdivide into the following main groups:
- Vascular. Occlusion of cerebellar arteries leads to development of an ischemic stroke of tserebellyarny fabrics. The hemorrhagic stroke (hemorrhage in cerebellar fabrics) is possible at violation of integrity of one of the specified arteries. In an ischemic zone there is a hypoxia and insufficient intake of nutrients, in the field of hemorrhage — a sdavleniye of cages the streamed blood with secondary dismetabolichesky changes.
- Traumatic. Dysfunction of a cerebellum turns out to be consequence of direct damage of its fabrics at a craniocereberal trauma, neurosurgical intervention, again — at a sdavleniye of cerebellar structures and the carrying-out highways the formed post-traumatic hematoma. At children tserebellyarny damage is possible at an intra cranial patrimonial trauma.
- Infectious. Damage of a cerebellum can be observed when forming in it of abscess, the inflammatory centers at encephalitis, an encephalomeningitis. Virus tserebellit can act as a complication of chicken pox, enteroviral infection, epidemic parotitis. Infectious and inflammatory changes lead to dysfunction of tserebellyarny neurons with development of a dizartriya.
- Toxic. Sharp intoxications, poisonings are the reason of defeat of tissues of cerebellum. The progressing cerebellar dysfunction is noted at chronic toxic influences in case of alcoholism, polydrug addiction, toxicomania.
- Neoplastic. Cerebellum tumors (a gemangioblastoma, a gangliotsitoma, a medulloblastoma) destroy and squeeze its neurons, leading to their dysfunction. Ekstratserebellyarny new growths of a back cranial pole cause a compression or sprout cerebellar fabrics. Besides, the cerebellar dizartriya can turn out to be consequence of paraneoplastic process at an extra cerebral malignant tumor.
- Degenerate. Dystrophic and atrophic processes in a cerebellum are characteristic of multiple sclerosis. Genetically determined degenerate changes are defined at an olivopontotserebellyarny degeneration, Fridreykh's ataxy, Pierre-Mari's ataxy.
Damages of a cerebellum lead to decrease in its regulating function, a diskoordination and desynchronization of the muscular contractions providing implementation of motive acts. Disorder of the coordinated muscle work of the articulation device leads to the slowed-down, faltering (chanted) character of the speech. Speech violations are aggravated with the tolchkoobrazny breath caused by an ataxy of respiratory muscles. Because of loss of harmony of motive acts (dismetriya) the accuracy, speed and amplitude of articulation movements decreases, there are difficulties at implementation of necessary articulation way.
The accompanying hypotonia of muscles of language and lips is the reason of a firm pronunciation of soft consonants. Voice their incomplete smykaniye turns out to be consequence of hypotonia of muscles that is shown by devocalization of ringing sounds, decrease in force of a fonation by the end of the phrase. Hypotonia of a soft palate is followed by its sagging causing a voice nasalization. The cerebellar dizartriya develops against the background of the similar diskoordinatorny disorders of skeletal muscles causing violation of any movements of extremities.
Symptoms of a cerebellar dizartriya
As basic manifestation the speech disprosodiya — disorder of rhythm, smoothness of pronunciation, lack of speech accents (accents) acts. The cerebellar dizartriya is characterized by tolchkoobrazny type of a speech stream, inconstancy of force of a voice that forms the so-called chanted speech. Devocalization ringing and a firm pronunciation of soft sounds is typical. The majority of phonemes are said nazalizirovanno. Because of muscular hypotonia the speech greased, muffled. Trembling of a voice at a fonation of lingering vowels is possible.
The speech is slowed down, difficult to the patient, demands constant search of articulation ways. In the course of the conversation the patient is intense, speaks with effort, speech production is followed by the increased sweating, vasomotorial reactions (pallor or hyperaemia of the person). The expressional speech tires the patient, difficulties of a fonation force it to abstain from active statements. The lowered tone of mimic muscles causes lack of a mimicry, hypotonia of chewing muscles results in difficulties of a chewing of firm food. Patients complain of instability when walking, an incoordination, handwriting change. The volume of any and passive movements is kept.
The cerebellar dizartriya complicates the expressional speech, does it unclear to people around. Restriction of communicative opportunities, awareness of speech defect adversely is reflected in a psychoemotional condition of the patient. Neurotic frustration develop: morbid depression, depressive neurosis. Hypotonia and a diskoordination of muscles of a throat is followed by swallowing violation — a dysphagy. At a popyorkhivaniye hit of food in airways with threat of asphyxia, aspiration pneumonia is possible.
Paramount diagnostic value has establishment of cerebellar character of a dizartriya and definition of its etiology. If necessary consultations of adjacent experts are held: neurosurgeon, oncologist, infectiologist, traumatologist. Have the major diagnostic importance:
- Consultation of the neurologist. In the neurologic status symptoms of a cerebellar ataxy are defined: shaky gait with broad statement of legs, a dismetriya, , an intentsionny tremor, a dizartriya, a makrografiya. There is no improvement of coordination, characteristic of a vestibular ataxy, at visual control. Hypotonia of muscles of extremities and the person at safety of volume of movements is found.
- Consultation of the logopedist. Diagnostics of oral speech reveals its slowness, not articulateness, intermittence with frustration of a rhythm, a typical skandirovannost. Hypotonia of the muscles participating in an articulation is noted. Internal speech, slukhorechevy memory of a sokhranna. During diagnostics of a written language the makrografiya is defined.
- MRT, brain MSKT. Neurovisualization is necessary for establishment of nature of organic defeat owing to which there was a cerebellar dizartriya. Allows to diagnose zones of ischemia, a hematoma, a tumor of a cerebellum and adjacent structures, degenerate changes, the inflammatory centers.
- Research of tserebrospinalny liquid. It is made at the assumption of an infectious and inflammatory etiology of defeat. The analysis is carried out after receiving a sample by method of a lyumbalny puncture. Studying of cellular structure gives the chance to find inflammatory changes, carrying out IFA, PTsR-diagnostics — to reveal the activator.
- Consultation of the geneticist. It is necessary at suspicion of genetically determined disease. For the purpose of definition of nature of inheritance the genealogical research is carried out. Concerning separate diseases DNA diagnostics is possible.
Differential diagnostics is carried out with other speech disturbance: motor aphasia, bulbarny and cortical dizartriya. Afferent motor aphasia differs in frustration of an articulation of separate sounds, a cerebellar dizartriya — a disritmichnost of a speech stream in general. The cortical dizartriya is characterized by frustration of a praksis with safety of coordination of movements, proceeds with a hypertrophy of articulation muscles more often. The Bulbarny dizartriya is followed by simplification of an articulation, atrophic changes of language, a dysphonia.
Treatment of a cerebellar dizartriya
Successful correction of speech defect is inseparably linked with effective therapy of the main pathology and active carrying out complex rehabilitation. Selection of methods of treatment is defined by a disease etiology, extensiveness and localization of defeat, the all-somatic status of the patient. The main components of therapy are:
- Etiopatogenetichesky treatment. It is directed to elimination of causal pathology and its consequences. Can include neurosurgical operation on removal of a tumor or hematoma, thrombolytic or antikoagulyantny therapy of a stroke, antibacterial, antiviral treatment of infectious defeats, desintoxication. In case of hereditary cerebellar degenerations etiopatogenetichesky therapy is difficult.
- Logopedic correction. Occupations with the logopedist are appointed for restoration of smoothness of the speech. The training of the articulation device by means of special gymnastics is carried out. Occupations included logopedic massage. In process of recovery of the speech pass to work on its expressiveness.
- Rehabilitation actions. Are made in a complex under observation of a reabilitolog, the neurologist. Include physiotherapy exercises with coordination restoration, massage, psychological consultation exercises. Medicamentous support neurotyre-tread, neurometabolic to pharmaceuticals is in parallel carried out.
Forecast and prevention
At successful treatment of a causal disease and correct logopedic work the cerebellar dizartriya can regress completely. Expressiveness of residual dysfunction depends on extent of defeat of cerebellar fabrics. The forecast at the progressing hereditary diseases, malignant tumoral processes is most adverse. To preventive actions the prevention of injuries and infections, maintaining a healthy lifestyle treat without alcohol intake, narcotic substances, timely correction of tserebrovaskulyarny violations, genetic consultation of couples planning pregnancy. In pediatric practice the adequate choice of a way of a rodorazresheniye acts as an important preventive measure.