From diagnosis to therapy ‒ mixed hyperkinetic-hypokinetic dysarthria ‒ a comprehensive case study
DOI:
https://doi.org/10.15584/ejcem.2026.1.3Keywords:
dysphagia, mixed dysarthria, movement disorder, neuroacanthocytosis, progressive dysarthria, speech therapyAbstract
Introduction and aim. Progressive dysarthria and dysphagia pose substantial diagnostic and therapeutic challenges. This case report aims to describe the assessment and intensive structured management of a patient with chronic, functionally limiting dysarthria and dysphagia.
Description of the case. The patient was a 38-year-old male with neuroacanthocytosis syndrome. Dysarthria diagnosis was established through auditory-perceptual profiling and acoustic analysis, confirming a mixed hyperkinetic-hypokinetic pattern. Clinical bedside evaluation of swallowing was done, which revealed severe oral dysphagia. Speech therapy was conducted using the hierarchy of motor speech treatment, targeting various motor speech bases. Additionally, severe oral phase dysphagia was managed using rehabilitative, compensatory, and modified diet approaches.
Results. Improvements were noted across all motor speech bases, supported by subjective reports and objective data. The patient's self-reported measures, as well as the improvement in voice quality (AVQI score decreased from 4 to 2.95), improved intelligibility (from 30 to 75%), and decreased speech rate (4.36 to 2.53 syllables/second) showed substantial improvement in dysarthria. Similarly, safe swallowing was achieved at IDDSI Levels 4–6 with compensatory strategies.
Conclusion. This case illustrates that even rare and chronic forms of dysarthria can respond positively to structured, intensive speech-language therapy, underscoring the importance of individualized, comprehensive intervention approaches.
Downloads
References
Nishio M, Niimi S. Relationship between speech and swallowing disorders in patients with neuromuscular disease. Folia Phoniatr Logop. 2004;56(5):291-304. doi:10.1159/000080066
Yorkston KM, Beukelman DR. Dysarthria: Tools for Clinical Decision-Making. ASHA Lead. 2004;9(9):4-21. doi:10.1044/LEADER.FTR2.09092004.4
Duffy JR. Motor Speech Disorders: Substrates, Differential Diagnosis, and Management. 3rd ed. Elsevier Health Sciences; 2012.
Ovsiowitz M. Dysphagia. In: Gut Instincts: A Clinician’s Handbook of Digestive and Liver Diseases. CRC Press; 2024:17-21. doi:10.1201/9781003524489-4
Wang BJ, Carter FL, Altman KW. Relationship between dysarthria and oral-oropharyngeal dysphagia: the present evidence. Ear Nose Throat J. Published online 2020. doi:10.1177/0145561320951647
Tjaden K. Speech and swallowing in Parkinson’s disease. Top Geriatr Rehabil. 2008;24(2):115-126. doi:10.1097/01.TGR.0000318899.87690.44
Jung HH, Danek A, Walker RH. Neuroacanthocytosis syndromes. Orphanet J rare Dis. 2011;6(68). doi:10.1186/1750-1172-6-68
Walterfang M, Evans A, Looi JCL, et al. The neuropsychiatry of neuroacanthocytosis syndromes. Neurosci Biobehav Rev. 2011;35(5):1275-1283. doi:10.1016/j.neubiorev.2011.01.001
Walker RH, Jung HH, Dobson-Stone C, et al. Neurologic phenotypes associated with acanthocytosis. Neurology. 2007;68(2):92-98. doi:10.1212/01.WNL.0000250356.78092.CC
Walker RH. Management of neuroacanthocytosis syndromes. Tremor Other Hyperkinet Mov (N Y). 2015;5:346. doi:10.7916/D8W66K48
Atkinson-Clement C, Letanneux A, Baille G, et al. Psychosocial Impact of Dysarthria: The Patient-Reported Outcome as Part of the Clinical Management. Neurodegener Dis. 2019;19(1):12-21. doi:10.1159/000499627
Chiaramonte R, Di Luciano C, Chiaramonte I, Serra A, Bonfiglio M. Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis. Acta Otorrinolaringol Esp. 2019;70(1):25-31. doi:10.1016/j.otorri.2017.12.002
Mitchell C, Bowen A, Tyson S, Butterfint Z, Conroy P. Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury. Cochrane Database Syst Rev. 2017;2017(1):CD002088. doi:10.1002/14651858.CD002088.pub3
Conway A, Walshe M. Management of non-progressive dysarthria: Practice patterns of speech and language therapists in the Republic of Ireland. Int J Lang Commun Disord. 2015;50(3):374-388. doi:10.1111/1460-6984.12143
MacKenzie C, Muir M, Allen C. Non-speech oro-motor exercise use in acquired dysarthria management: Regimes and rationales. Int J Lang Commun Disord. 2010;45(6):617-629. doi:10.3109/13682820903470577
Fox CM, Ramig LO. Vocal sound pressure level and self-perception of speech and voice in men and women with idiopathic Parkinson disease. Am J Speech-Language Pathol. 1997;6(2):85-94. doi:10.1044/1058-0360.0602.85
Connor N, Abbs J, Cole K, Gracco V. Parkinsonian deficits in serial multiarticulate movements for speech. Brain. 1989;112(4):997-1009. doi:10.1093/brain/112.4.997
Helm-Estabrooks N, Yorkston KM, Spencer KA, Duffy JR. Behavioral management of respiratory/phonatory dysfunction from dysarthria: a systematic review of the evidence. J Med Speech Lang Pathol. 2003;11(2):xiii.
Robertson SJ, Thomson F. Speech therapy in Parkinson’s Disease: A study of the efficacy and long term effects of intensive treatment. Int J Lang Commun Disord. 1984;19(3):213-224. doi:10.3109/13682828409029837
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053
World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice. World Health Organization website. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice. Published 2010. Accessed January 26, 2024.
Dunne-Platero K, Cloud C, Hilger A. Colorado Motor Speech Framework. Published online 2023. doi:10.17605/OSF.IO/PM936
Lippke BA, Dickey SE, Selmar JW, Soder AL. PAT-3: Photo Articulation Test—Third Edition. PRO-ED; 1997. https://www.proedinc.com/Products/8370/pat3-photo-articulation-testthird-edition. Accessed April 21, 2024.
Hirano M. Psycho-acoustic evaluation of voice. Clin Exam Voice Disord Hum Commun. Published online 1981:81-84. Accessed April 21, 2024.
Maryn Y, Weenink D. Objective dysphonia measures in the program praat: Smoothed cepstral peak prominence and acoustic voice quality index. J Voice. 2015;29(1):35-43. doi:10.1016/j.jvoice.2014.06.015
Enderby PM, Wood VA, Wade DT, Hewer RL. The Frenchay Aphasia Screening Test: A short, simple test for aphasia appropriate for non-specialists. Disabil Rehabil. 1986;8(4):166-170. doi:10.3109/03790798709166209
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. J Am Geriatr Soc. 2005;53(4):695-699. doi:10.1111/J.1532-5415.2005.53221.X
Lim HJ, Lai DKH, So BPH, et al. A Comprehensive Assessment Protocol for Swallowing (CAPS): Paving the Way towards Computer-Aided Dysphagia Screening. Int J Environ Res Public Health. 2023;20(4). doi:10.3390/IJERPH20042998
Cichero JAY, Lam P, Steele CM, et al. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia. 2017;32(2):293-314. doi:10.1007/S00455-016-9758-y
Rusz J, Megrelishvili M, Bonnet C, et al. A distinct variant of mixed dysarthria reflects parkinsonism and dystonia due to ephedrone abuse. J Neural Transm. 2014;121(6):655-664. doi:10.1007/S00702-014-1158-6
De Angelis EC, Mourão LF, Ferraz HB, Behlau MS, Pontes PAL, Andrade LAF. Effect of voice rehabilitation on oral communication of Parkinson’s disease patients. Acta Neurol Scand. 1997;96(4):199-205. doi:10.1111/J.1600-0404.1997.tb00269.x
Chiaramonte R, Vecchio M. A Systematic Review of Measures of Dysarthria Severity in Stroke Patients. PM R. 2021;13(3):314-324. doi:10.1002/pmrj.12469
Darley FL, Aronson AE, Brown JR. Differential diagnostic patterns of Dysarthria. J Speech Hear Res. 1969;12(2):246-269. doi:10.1044/JSHR.1202.246
Ludlow CL, Hoit J, Kent R, et al. Translating principles of neural plasticity into research on speech motor control recovery and rehabilitation. J Speech, Lang Hear Res. 2008;51(1). doi:10.1044/1092-4388(2008/019)
Spencer KA, Yorkston KM. Evidence for the treatment of respiratory/phonatory dysfunction from dysarthria. Perspect Neurophysiol Neurogenic Speech Lang Disord. 2002;12(4):4-16. doi:10.1044/nnsld12.4.4
Lester-Smith RA, Miller CH, Cherney LR. Behavioral therapy for tremor or dystonia affecting voice in speakers with hyperkinetic dysarthria: a systematic review. J Voice. 2023;37(4):561-573. doi:10.1016/j.jvoice.2021.03.026
Yorkston KM, Beukelman DR. Ataxic dysarthria: treatment sequences based on intelligibility and prosodic considerations. J Speech Hear Disord. 1981;46(4):398-404. doi:10.1044/JSHD.4604.398
Martens H, Van Nuffelen G, Dekens T, et al. The effect of intensive speech rate and intonation therapy on intelligibility in Parkinson’s disease. J Commun Disord. 2015;58:91-105. doi:10.1016/J.JCOMDIS.2015.10.004
Yorkston KM, Miller RM, Strand EA, Britton D. Management of Speech and Swallowing in Degenerative Diseases. Pro-Ed Inc.; 2013.
Patel R. Prosodic Control in Severe Dysarthria. J Speech, Lang Hear Res. 2002;45(5):858-870. doi:10.1044/1092-4388(2002/069)
Schmidt RA, Lee TD, Winstein C, Wulf G, Zelaznik HN. Motor Control and Learning: A Behavioral Emphasis. 6th ed. Champaign, IL: Human Kinetics; 2018.
Maas E, Robin DA, Hula SNA, et al. Principles of motor learning in treatment of motor speech disorders. Am J Speech-Language Pathol. 2008;17(3):277-298. doi:10.1044/1058-0360(2008/025).
O’Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N. Bedside Diagnosis of Dysphagia: A Systematic Review. J Hosp Med. 2015;10(4):256. doi:10.1002/jhm.2313
Ricci Maccarini A, Filippini A, Padovani D, Limarzi M, Loffredo M, Casolino D. Clinical non-instrumental evaluation of dysphagia. Acta Otorhinolaryngol Ital. 2007;27(6):299.
Lim SHB, Lieu PK, Phua SY, et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia. 2001;16(1):1-6. doi:10.1007/s004550000038
Peikert K, Dobson-Stone C, Rampoldi L, et al. VPS13A Disease. Encycl Mov Disord Three-Volume Set. Published online March 30, 2023:V1-217-V1-219. doi:10.1016/b978-0-12-374105-9.00396-8
Adult Dysphagia. American Speech-Language-Hearing Association website. https://www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia. Accessed April 25, 2024.
Robbins JA, Kays SA, Gangnon RE, et al. The Effects of Lingual Exercise in Stroke Patients With Dysphagia. Arch Phys Med Rehabil. 2007;88(2):150-158. doi:10.1016/j.apmr.2006.11.002
Sollazo A, Monaco L, Vecchio L Del, et al. Investigation of compensatory postures with videofluoromanometry in dysphagia patients. World J Gastroenterol. 2012;18(23):2973-2978. doi:10.3748/wjg.v18.i23.2973
Calvo I, Sunday KL, Macrae P, Humbert IA. Effects of chin-up posture on the sequence of swallowing events. Head Neck. 2017;39(5):947-959. doi:10.1002/hed.24713
Yorkston KM. The degenerative dysarthrias: A window into critical clinical and research issues. Folia Phoniatr Logop. 2007;59(3):107-117. doi:10.1159/000101769
Ford CN, Roy N, Bless DM. Muscle tension dysphonia and spasmodic dysphonia: The role of manual laryngeal tension reduction in diagnosis and management. Ann Otol Rhinol Laryngol. 1996;105(11):851-856. doi:10.1177/000348949610501102
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
