Dystonia is a movement disorder characterized by spontaneous, involuntary movements occurring in isolation or in combination with other disorders. This movement disorder is impacted by several clinical characteristics, such as age of onset, body distribution, and etiology. Etiologies include acquired, nervous system pathology, or inherited. Oromandibular dystonia, an idiopathic focal type of dystonia, impacts one area of the body including the jaw, tongue, or lips. It can lead to hyperkinetic dysarthria affecting speech intelligibility through disrupted articulatory coordination, hypernasality, and disrupted fluency, as well as a variety of consequences in communication participation. Treatment is not permanent but there are a variety of treatment interventions that can be used as compensatory strategies to manage the symptoms. This includes botulinum toxins (injection to contract muscles and reduce symptoms), and sensory tricks, which include the incorporation of a physical position to temporarily alleviate dystonic symptoms in the affected area. Patient A was given a sensory trick using a tongue depressor, to impede dystonic movement during speech production by enforcing a spread lip posture. Patient A was also given buccal muscle and neck strengthening exercises to increase endurance and relaxation exercises to calm her physiologically and to reduce her anxiety regarding speaking. Phrasing strategies such as a slow pace with frequent pauses and light articulatory contact with words that require lip rounding were also used to reduce the interruptions during speech production in order to achieve better speech intelligibility. Following 18 weeks of treatment, the amount of dystonic movement while speaking has decreased, intelligibility is 90% or higher, and her fluency has improved in almost all areas. Speaking rate has increased to a more average speed with improved intonation and loudness. Currently, Patient A is in the process of being fitted for an orthodontic appliance as a more permanent solution to help stabilize her jaw without the use of the tongue depressor. She is receiving dual sessions with speech-language pathology and orofacial orthodontist so that her speech may be assessed during the orthodontic appliance trials.
Learning Objectives:
At the completion of this activity, participants should be able to:
to describe oromandibular dystonia as a focal dystonia of movement disorder and its medical and surgical treatment
to state how oromandibular dystonia can impact speech and reduce speech intelligibility
to understand how sensory tricks may be used as treatment strategies in conjunction with muscle relaxation and muscle endurance training to improve speech intelligibility