From diagnosis to therapy ‒ mixed hyperkinetic-hypokinetic dysarthria ‒ a comprehensive case study

Abstract

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.