8 Diagnosing Dysarthria in Adults In English, a stress-timed language, correct application of word stress is of particular importance, as it is phonemic, i.e. word meaning can change with a shift in word stress, e.g. upset (the verb /ʌpˈset/ vs. the noun /ˈʌpset/). It has to be noted, though, that some words can have two correct stress patterns. Function words, such as auxiliary verbs, pronouns, or prepositions, also bear different or no stress, depending on their position and function. At the phrase level, stressed syllables carrying a rhythmic accent are considered to also carry a pitch accent if they begin a tone unit (except for low-pitch intonation at the beginning of a phrase). A pitch accent usually falls on the initial syllable of the final rhythmic unit in the fall-rise contour. Other than that, rhythmically accented syllables do not have any intonation prominence. English differentiates between syllables in four different prosodic situations: (1) unstressed syllables; (2) stressed syllables given rhythmic prominence; (3) stressed syllables given rhythmic and intonation prominence (pitch accent); and, finally, (4) nuclear stressed syllables, which are prominent rhythmically and intonationally. The latter tone units are also usually the most salient, meaning-wise. Should any preceding segments within a phrase be given a stronger pitch accent, it only adds more markedness to the melody and meaning of the utterance. Accentuation at the phrase-level, then, may also be of intonational significance. The most salient tone unit, carrying the maximum information load and receiving the pitch accent, is referred to as the nucleus. The only obligatory element of any utterance, the nucleus is also usually its final element, and sometimes the only one. Cf. e.g., the imperative: (1) Come! Stressed syllables are found in any other tone units comprising the head and body of an utterance, before the nucleus, while unstressed syllables comprise the utterance’s pre-head and tail. Cf.: (2) I’d rather have a cup of tea. When the penultimate tone unit has a fall-high contour and the ultimate is low-rise, they both constitute a nucleus, cf.: (3) I like tea. Since dysarthric changes in the melody of speech are of particular interest here, it is always worth evaluating the patient’s speech at the utterance level, to assess whether intonation patterns remain natural or if they have become
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