What is the best approach to manage dysarthria?

Management of Dysarthria

Speech-language therapy should be the primary approach for managing dysarthria, with treatment individually tailored to target the specific physiological support systems affected, including respiration, phonation, articulation, and resonance. 1

Assessment Process

• A comprehensive evaluation by a speech-language pathologist (SLP) 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
• The Frenchay Dysarthria Assessment is recommended to quantitatively evaluate respiration, phonation, resonation, articulation, and prosody 1
• Diagnostic laryngoscopy should be performed before prescribing voice therapy and results should be documented and communicated to the SLP 2
• Assessment should occur as early as possible, as treatment outcomes are superior when begun in the acute stage of recovery 3

Treatment Approaches

Speech and Language Therapy

• Clinicians should advocate voice therapy for patients with dysarthria from causes amenable to voice therapy 2
• Treatment should focus on developing compensatory strategies for communication 3
• Specific therapeutic techniques include:
  • Direct intervention targeting affected subsystems (articulation, resonance, phonation, respiration, or prosody) 3
  • Voice therapy techniques including gentle phonation exercises and postural manipulations to improve voice production 1
  • Speech rate modifications using pacing boards, alphabet board supplementation, visual and auditory feedback, cueing strategies, and delayed auditory feedback 4

Communication Partner Training

• The SLP should educate rehabilitation staff and family/caregivers in techniques to enhance communication with patients who have dysarthria 1, 3
• Communication partner training is effective in improving communication activities and participation 1
• Environmental modifications should be implemented to improve communication effectiveness 1

Augmentative and Alternative Communication (AAC)

• AAC devices and modalities should be used to supplement speech when intelligibility is severely compromised 1
• For patients with severe dysarthria, AAC systems should be considered early in the treatment process 5

Special Considerations by Etiology

Post-Stroke Dysarthria

• Approximately 20% of stroke patients present with dysarthria, with varying types and characteristics depending on lesion site and severity 2
• Treatment should begin as soon as possible during the rehabilitation process 2
• Patients with progressive symptoms within 48 hours of onset should be immediately sent to an emergency department with capacity for advanced stroke care 3

Parkinson's Disease Dysarthria

• Characterized by monotony of pitch and loudness, reduced stress, variable rate, imprecise consonants, and breathy/harsh voice 6
• Intensive programs focused on vocal loudness have shown substantial beneficial effects 6
• For appropriate candidates with Parkinson's disease, botulinum toxin injections should be offered for treatment of dysarthria caused by laryngeal dystonia 2

Other Neurological Conditions

• Different types of dysarthria (flaccid, spastic, ataxic, hyperkinetic, hypokinetic, or mixed) require specific treatment approaches based on the underlying neuropathology 7
• For progressive conditions like ALS, management goals should focus on optimizing communication effectiveness for as long as possible 8

Monitoring and Follow-up

• Regular reassessment of communication abilities should document resolution, improvement, or worsening of symptoms after treatment 1
• Activities to facilitate social participation and promote psychosocial well-being should be incorporated into the treatment plan 1
• The psychosocial impact of dysarthria is often disproportionate to the severity of the physiological impairment and should be addressed 3

Common Pitfalls and Caveats

• Avoid prescribing medications (antireflux medications, corticosteroids, antibiotics) for isolated dysphonia without visualization of the larynx 2
• Distinguish between dysarthria (motor speech disorder) and aphasia (language disorder) when assessing communication difficulties 9
• Don't delay referral to an SLP, as early treatment is key to maximizing recovery 3
• Avoid focusing solely on speech production without addressing psychosocial impact and quality of life 1