Long-term recovery patterns of severe dysarthria following head injury.
This study gives detailed information regarding the changes of bulbar dysfunction in a long-term follow-up of four severely brain-damaged young persons. There are similarities in the pathology and symptomatology of the four and all made measurable improvements albeit these did not start for some considerable time following injury. Few gains in bulbar function were noted in the first 18 months. One subject began to improve after 24 months, another after 30 months with the most substantial changes for all subjects being seen by 48 months post-injury. Further small improvements continued to be recorded up until the end of the study. The four subjects with severe dysarthria and profound physical disability following head injury were monitored for 7 years. All were assessed using the Frenchay Dysarthria Assessment (FDA) at regular intervals. The gains were not so significant that any became independent oral speakers. Although the subjects remain severely dysarthric and all use communication aids, the improvements are seen to have functional relevance. The timing of the maximum improvement was noted to follow the cessation of specific remediation of bulbar function. The results of this study raise interesting questions with regard to neurological recovery and rehabilitation management. It is possible to speculate that oral/motor therapy should be implemented at a later stage with severely head-injured patients in an attempt to exploit and extend returning function.