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Midwest Voice Conference : Neurological Diseases Associated with Voice Disorders

By Stephanie Ciccarelli

August 14, 2008

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Dr. Arlene Barr

Do You Know Who Has Had a Stroke or Has Parkinson's Disease?

In Dr. Arlene Barr's lecture, she discussed how neurological diseases are related to voice disorders, featuring Stroke and Parkinson's Disease, among others.

Learn more about how neurological disorders affect speech at VOX Daily.

Diseases Associated with Voice Disorders

๏ Stroke
๏ Parkinson's Disease
๏ Essential Tremor
๏ Spasmodic Dysphonia
๏ Amyotrophic Lateral Sclerosis
๏ Myasthenia Gravis

We'll be focusing on Stroke and Parkinson's Disease in this article.


๏ After a stroke the can be cortical impairment of comprehension (receptive aphasia) and articulation (expressive aphasia).
๏ Production of sound can be affected by impairment of subcortical structures that are coordinated by the cortex. These structures include:
- brainstem structures
- the phrenic nerve which innervates the diaphragm
๏ Cortex - left: production of speech, right: prosody (inflection, intonation, and timing)
๏ Corticobulbar tracts: communication between the cortex and brainstem
๏ Cerebellum and basal ganglia - modulate motor control of speech

Components of Voice Production and Their Roles

See if you can connect the dots! CN is for "central nerve".

Component: Diaphragm, lungs
Nerves: Phrenic (C 3-5)
Role: Source Generation

Component: Vocal Folds
Nerves: CN: X
Role: Pitch, phonation

Component: Supraglottis, pharynx, oral and nasal cavities
Nerves: CN: VII, X
Role: Shape, resonance

Component: Lips, cheeks, mandible (jaw), tongue
Nerves: V, VII, XII
Role: Articulation

When you think about it, there's a lot that goes into speech production and phonation, and you can see from the information above just how complex voice production is.

Impact on Stroke on Speech

๏ Vascular disease of either the cortex or brainstem can have a direct effect on speech
๏ Indirect complications of stroke include: intubation, ventilation, aspiration risk, nasogastric nutrition, pneumonia, and medication side effects

Treatment of Speech Disorders Associated with Stroke

๏ Rehabilitation is handled by the speech pathologist
๏ Laryngeal paralysis or vocal fold paralysis due to a CNS lesion can require surgical intervention

Let's take a look now at how Dr. Barr explains Parkinson's Disease and its affects on the voice.

Parkinson's Disease

๏ A progressive disorder of the substantia nigra in the brainstem
๏ Typical symptoms include: pill-rolling tremor, rigidity, shuffling gait, poor balance, stooped posture, slowness of movement (bradykinesia)
๏ Approximately 70% - 80% have speech problems
๏ Greater than 30% find the speech problems very disabling

Speech Manifestations in Parkinson's Disease

๏ Related to bradykinesia
๏ Soft, breathy, monotone voice, can have a tremor or stuttering-like quality
๏ Poor articulation, difficulty in initiating speech
๏ Vocal fold adduction is weak
๏ Vocal folds appear thin and bowed due to vocalis muscle atrophy
๏ Articulation is sluggish
๏ Voice is strained and can sound like spasmodic dysphonia

Treatment of Speech Disorders in Parkinson's Disease

๏ Dopaminergic medications
๏ Speech therapy
๏ Injection laryngoplasty
๏ Botulinum toxin (Botox) injection of laryngeal muscles in patients with hyperkinetic dysphonia (vocal rigidity predominates over hypokinesia)

About Arlene Barr, MD

Associate Professor of Clinical Neurology
University of Illinois at Chicago
Department of Neurology

Dr. Barr is a part-time Associate Professor in Clinical Neurology at the University of Illinois at Chicago since her retirement in 2004. She specializes in electromyography, peripheral neuropathy, and movement disorders. Throughout her career at UIC, she has held various academic positions, which included Director of Electrodiagnostic Laboratory from 1991-2004 and Co-Director of Clinical Neurophysiology Fellowship, Department of Neurology from 1994-2004. Also, she has been named one of America's Best Doctors in 2006 and 2007.

Any comments?

Best wishes,


Related Topics: Chicago, Dr. Arlene Barr, Midwest Voice Conference, Neurological Diseases, Parkinson's Disease, Stroke, Voice Disorders


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