The Development And Application Of The Dysarthria Assessment Tool

Dysarthria is a speech disorder that results from the damage of central or peripheral nervous system.The disorder can cause abnormalities in speech respiration,phonation,resonance,articulation,prosody,and intelligibility.In the context of Mandarin Chinese,there is a lack of assessment tools for dysarthria that are in line with Chinese characteristics and can reflect the above speech dimensions comprehensively.To this end,the study developed the Dysarthria Assessment Tool(DAT),which is applicable to the context of Mandarin Chinese,developed the classification standard of dysarthria according to ICF,and analyzed the speech characteristics and severity of various types of dysarthria patients using the DAT.The details of the study are as follows:1.The Development of the Dysarthria Assessment ToolFirstly,the principles,framework and contents of the DAT were determined based on ASHA's diagnostic criteria for dysarthria,international research results of dysarthria and the assessment and intervention experience of clinicians.In addition,experts in relevant fields were invited to review the effectiveness of the initial version of DAT,and pre-experiments were conducted with normal adults and patients with various types of dysarthria.Thus,a comprehensive,accurate,practical,intuitive,economical and targeted DAT has been compiled,including 9 sections of reflexes,respiration,laryngeal,soft palate,jaw,lips,tongue,prosody and intelligibility.Secondly,the assessment results of 50 patients with different types of dysarthria were collected to analyze and evaluate the psychometric characteristics of the DAT.The results show that the DAT has good feasibility(missing data < 5%),acceptability(no floor and ceiling effects),internal consistency reliability(> 0.7),inter-rater reliability(> 0.9),retest reliability(> 0.9),content validity(> 0.9)and internal validity(0.5-0.7),and can be applied to clinical assessment and scientific research of dysarthria.Finally,the DAT was used to assess the speech functions of 80 normal adults to compare the influence of gender and age on DAT assessment results of normal adults.It is found that gender has little influence on DAT assessment results,while age has a large influence on it.Based on these,the reference standard of DAT has been established,and the severity standard of dysarthria has been formulated according to ICF.2.The Application of the Dysarthria Assessment ToolThe DAT was used to assess 23 spastic / 33 hypokinetic / 9 flaccid / 37 mixed dysarthria patients and their matched normal adults to analyze the various types of dysarthria of Mandarin-speakers.The speech characteristics and the severity of various types of dysarthria were analyzed and compared.The study finds that patients with spastic,hypokinetic,or mixed dysarthria are disordered in all 9 sections of the DAT.In patients with flaccid dysarthria of facial nerve palsy,only the function of lips is impaired,and the damage does not involve other sections.The speech characteristics of spastic patients shows that the disorder in the laryngeal is the most severe.The disorder in the lips,tongue,prosody and intelligibility of spastic patients is also severe,while the disorder in reflexes,respiration,soft palate and jaw is less severe.Hypokinetic patients have the most severe disorder in the laryngeal and tongue.The disorder in the lips,prosody and intelligibility of hypokinetic patients is also severe,while the disorder in reflexes,respiration,soft palate,and jaw is less severe.Although the lips function of patients with facial nerve palsy is damaged,the disorder in lips is not obvious in speech.Mixed patients have the most severe disorder in laryngeal.The disorder in tongue,prosody and intelligibility injuries of mixed patients is also severe,while disorder in reflexes,soft palate and jaw injuries is less severe than other dimensions,and the speech performance between different patients of mixed dysarthria is heterogeneous.Using the DAT is easy to distinguish spastic / hypokinetic / mixed dysarthria patients from normal adults.But in patients with facial nerve palsy of flaccid dysarthria,the differentiation is not obvious from normal adults.Comparing the DAT scores and the severity of various dysarthria,it was found that disorder in patients with mixed dysarthria is most severe in all the sections and overall,followed by disorder in patients with spastic dysarthria,followed by disorder in patients with hypokinetic dysarthria,and the disorder in facial nerve palsy(except the lip plate)is least severe.The innovation of this study lies in :(1)the development of an assessment tool for dysarthria that are in accordance with Chinese language and cultural characteristics;(2)the provision of speech assessment materials in line with the characteristics of Mandarin Chinese;(2)the enrichment of inland and abroad basic researches on various types of dysarthria.