What are the steps for managing dysarthria?

Management of Dysarthria

Speech and language therapy is the cornerstone of dysarthria management and should be individually tailored to target the specific physiological support systems affected, including respiration, phonation, articulation, and resonance. 1

Assessment Phase

• Comprehensive evaluation should identify the presence, type, and severity of dysarthria by assessing all components of the motor speech system: respiration, phonation, resonance, articulation, prosody, and overall intelligibility 1
• Assessment tools should include both auditory-perceptual measures (rating articulation precision), acoustic measures (identifying fundamental frequency), and physiological measures (determining airway resistance) 1
• The Frenchay Dysarthria Assessment is recommended to identify presence and severity of dysarthria by evaluating respiration, phonation, resonation, articulation, and prosody via quantitative tasks and rating scales 1
• Laryngoscopy should be performed when symptoms persist beyond 4 weeks or when serious underlying conditions are suspected 2

Treatment Approaches

Behavioral Interventions

• Behavioral management should target:

  • Physiological support for speech (respiration, phonation, articulation, resonance) 1
  • Global aspects of speech production (loudness, rate, prosody) 1
  • Specific articulation exercises to improve precision of consonants 1, 3

• Voice therapy techniques include:

  • Gentle phonation exercises 2
  • Postural manipulations to improve voice production 2
  • Rate control strategies to improve intelligibility 1, 3

Augmentative and Alternative Communication (AAC)

• AAC devices and modalities should be used to supplement speech when intelligibility is severely compromised 1
• Selection of appropriate AAC should be based on the severity of dysarthria and individual patient needs 3

Environmental Modifications

• Environmental modifications, including listener education, should be implemented to improve communication effectiveness 1
• Communication partner training is effective in improving communication activities and participation 1

Special Considerations

• For dysarthria related to Parkinson's disease:

  • Intensive programs focusing on vocal loudness have shown substantial beneficial effects 4
  • Levodopa therapy may improve articulation, voice quality, and pitch variation in some patients 4

• For dysarthria following stroke:

  • Treatment should begin as soon as possible during the rehabilitation process 1
  • Computerized treatment may be considered to supplement treatment provided by a speech-language pathologist 1

Monitoring and Follow-up

• Regular reassessment of communication abilities should document resolution, improvement, or worsening of symptoms after treatment 2
• Retest reliability of communication measures is important for tracking progress 5
• Activities to facilitate social participation and promote psychosocial well-being should be incorporated into the treatment plan 1

Potential Pitfalls

• Delayed diagnosis of underlying conditions can lead to worse outcomes 2
• The psychosocial impact of motor speech disorders is often disproportionate to the severity of the physiological impairment 1
• Professional voice users may require more urgent evaluation due to occupational impact 2
• Bilateral surgical procedures for conditions like Parkinson's disease typically worsen speech production 4