Bradley, Kimberley Anne Mathieson; (1997) Respiratory therapy for speech in multiple sclerosis. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The dysarthria of multiple sclerosis is known to worsen as the disease progresses (Darley, Brown and Goldstein 1972). Thus as activities of daily life and opportunities for activity for the person with multiple sclerosis are curtailed by increasing disability, the capacity of their respiratory system is also diminished both by disease and lack of demand on the system (Olgiati, Hofstetter and Bailey 1988). It is a hypothesis of this paper and others that disuse creates a discrepancy between the functional ability that is neurologically available and that which is characteristically used (Olgiati et al., 1988; Olgiati et al.l986). It is this functional overlay that may be the target of speech therapy (Farmakides and Boone 1960). Five subjects with MS and dysarthria affecting intelligibility were involved in a multiple baseline therapy study to establish the efficacy of respiratory exercises in improving functional speech performance. Intervention effects were demonstrated by introducing the therapy to different subjects at successive points in time. Therapy exercises targeted the respiratory system alone with no phonatory or articulatory components. Various measures including laryngographic analysis, clinical motor speech tasks and standardised dysarthria profiles were found to be unsuitable as baseline or repeat measures to show improvement in speech. Intelligibility was chosen as a global and objective repeat measure of functional speech performance and was established for each subject using the Yorkston Beukelman Test of the Intelligibility of Dysarthric Speech. Findings cautiously suggest that certain subjects can benefit from respiratory muscle exercises that improve speech performance as measured by intelligibility. A component of the dysarthria of MS may not be due to neuro-motor dysfunction but to atrophy based on fatigue and disuse of the system. This study suggests that this atrophy may be reversible. The objective measurement of intelligibility and the clinical use of a multiple baseline research format are also discussed.

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