Evaluation of Baclofen on Speech Production in Post-Stroke Laryngeal Tension Dysphonia and Spastic Dysarthria: A Case Report

Lau Tsui Nam Trier; Joon Sin Ser; San San Tay

Authors

Lau Tsui Nam Trier Rehabilitation Medicine, SingHealth Residency, Changi General Hospital, Singapore
Joon Sin Ser Rehabilitation Medicine, SingHealth Residency, Changi General Hospital, Singapore https://orcid.org/0009-0005-2241-6634
San San Tay Department of Rehabilitation Medicine, Changi General Hospital, Singapore https://orcid.org/0000-0002-6623-6265

Keywords:

baclofen, dysarthria, tension, dysphonia, stroke

Abstract

Objectives: Communication deficits following stroke are prevalent and often debilitating. While conventional speech rehabilitative strategies by speech-language pathologists remain the mainstay of therapy, pharmacological adjuncts that facilitate oromotor and phonatory function may further enhance recovery. This case report describes the use of oral baclofen as an adjunct to conventional speech therapy in a post-stroke patient with severe dysarthria. It also illustrates how the Frenchay Dysarthria Assessment (FDA) can sensitively capture functional changes beyond standard bedside evaluation.

Case description: A 64-year-old English-speaking male with no significant comorbidities presented with a right middle cerebral artery (MCA) infarct which occurred in the context of cerebral amyloid angiopathy for which he underwent successful thrombectomy. He suffered from severe motor speech impairment, including dysphonia and dysarthria. Nasoendoscopy revealed normal vocal cord structure and movement, suggesting laryngeal tension dysphonia. During the initial 10 days of conventional speech-language therapy without baclofen, there was minimal improvement in his speech production as assessed by the same speech-language pathologist using the Perceptual Dysarthria evaluation. Given the persistent oromotor and laryngeal muscle hypertonicity, oral baclofen was introduced to address suspected spastic contributions to the dysarthria and dysphonia.

Results: Over one month, the patient completed 22 structured speech therapy sessions. Following baclofen initiation, the FDA, administered before and after treatment, demonstrated noticeable improvements in multiple domains: lip seal function, lip spread in speech, jaw function in speech, palatal muscle function in speech, and tongue muscle function in protrusion, lateral movement, and speech. Speech intelligibility also improved.

Conclusions: This case highlights the potential of oral baclofen as an adjunctive agent in modestly improving speech production, articulation clarity, and intelligibility post-stroke, and underscores the clinical utility of the Frenchay Dysarthria Assessment in detecting oromotor improvements. Further studies are needed to determine the reproducibility and efficacy

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