What is the treatment for dysarthria and dysphagia?

Treatment of Dysarthria and Dysphagia

Speech-language therapy is the cornerstone of treatment for both dysarthria and dysphagia, with intensive, individualized interventions targeting the specific subsystems affected and compensatory strategies to maximize functional communication and safe swallowing. 1

Dysphagia Treatment

Initial Assessment and Safety Screening

• Complete a bedside swallow screening before any oral intake to identify patients at risk for aspiration 1
• If screening is abnormal, proceed immediately to comprehensive bedside swallow examination 1
• Refer all patients with suspected dysphagia to a speech-language pathologist for instrumental assessment (videofluoroscopic swallow study or fiberoptic endoscopic evaluation of swallowing) before implementing treatment, as clinical bedside evaluation alone misses over 70% of silent aspiration 2, 3
• Patients with reduced level of consciousness should remain NPO until consciousness improves due to extremely high aspiration risk 4, 2

Compensatory Strategies

• Implement postural maneuvers as first-line intervention, particularly chin-down (chin-to-chest) position, which eliminates aspiration in 77% of patients by opening the valleculae and preventing laryngeal penetration 2, 3
• Other effective postural techniques include head rotation, head tilt, and lying down position 2
• Heighten sensory input through temperature modifications, increased bolus volume (when safe), or tactile stimulation 1
• Use specific swallowing maneuvers such as effortful swallow to improve pharyngeal pressure generation 3

Diet Modifications

• Start with thickened liquids (nectar or honey consistency) rather than thin liquids, as these reduce aspiration risk visualized on videofluoroscopy 4
• Follow the International Dysphagia Diet Standardisation Initiative (IDDSI) framework for standardized texture modifications, progressing from safer to more difficult consistencies 4, 3
• Introduce unthickened water only at the end of rehabilitation after demonstrating control over thicker consistencies 4
• Adapt food textures to compensate for poor oral preparation and ease pharyngeal transport 3

Tube Feeding Considerations

• Implement tube feeding for patients unable to sustain sufficient oral caloric or fluid intake to meet nutritional needs 1
• Percutaneous endoscopic gastrostomy (PEG) feeding is preferred over nasogastric tube feeding based on limited evidence 1
• Consider early gastrostomy placement in patients with progressive weight decline or uncontrolled aspiration risk 2

Multidisciplinary Management

• Establish a multidisciplinary team including physician, speech-language pathologist, nurse, dietitian, and physical/occupational therapists, as this approach reduces aspiration pneumonia and trends toward decreased mortality 2
• Implement oral care interventions to reduce pneumonia risk in non-ventilated patients 3

Dysarthria Treatment

Direct Intervention Approaches

• Target the specific affected subsystem (articulation, resonance, phonation, respiration, or prosody) based on the type and severity of dysarthria 1
• For patients with flaccid or spastic dysarthria, expect more severe impairment requiring intensive direct intervention 5
• Patients with ataxic, hypokinetic, or unilateral upper motor neuron dysarthria typically have milder impairment 5

Compensatory and Augmentative Strategies

• Develop compensatory behaviors during the chronic phase to maximize functional communication 1
• Modify the environment to support communication effectiveness 1
• Train patients in augmentative/alternative communication devices when dysarthria persists despite direct intervention 1
• Early intervention prevents learning of ineffective or inappropriate compensatory behaviors 1

Timing and Intensity

• Provide treatment during the period of spontaneous recovery to maximize gains 1
• Continue intervention in the chronic phase to develop and refine compensatory strategies 1

Critical Pitfalls to Avoid

• Never assume absence of cough means safe swallowing, as silent aspiration occurs in over 70% of patients with aspiration detected on videofluoroscopy 2, 3
• Do not delay instrumental assessment in favor of prolonged bedside evaluation alone, as this leads to inadequate management 2
• Avoid implementing dietary modifications without instrumental confirmation of their effectiveness 2
• Do not use thickened liquids exclusively long-term, as this can lead to dehydration and decreased quality of life 4
• Recognize that dysarthria and dysphagia frequently co-occur (47.2% and 31.5% respectively in neuromuscular diseases), requiring evaluation of both systems 6
• Monitor for signs requiring urgent re-evaluation: recurrent pneumonia, progressive weight loss, worsening respiratory symptoms, and development of silent aspiration 2