What is the treatment for dysphasia (difficulty speaking)?

Treatment of Dysphasia (Difficulty Speaking)

The treatment for dysphasia depends critically on whether you are dealing with aphasia (language disorder from brain injury/stroke) versus dysphonia (voice disorder), as these require fundamentally different approaches: aphasia requires intensive speech-language therapy focused on language rehabilitation, while dysphonia requires laryngoscopy-guided voice therapy or surgical intervention. 1, 2

Critical First Step: Clarify the Diagnosis

• Perform laryngoscopy within 4 weeks if the patient has altered voice quality, pitch, loudness, or vocal effort (dysphonia), especially if symptoms persist beyond 4 weeks or if serious underlying cause is suspected 1
• Do NOT prescribe antibiotics, corticosteroids, or antireflux medications before visualizing the larynx 1
• Refer to speech-language pathology immediately for comprehensive assessment including comprehension, speech, reading, writing, gestures, and functional communication impact 2

For Aphasia (Language Disorder Post-Stroke)

Timing and Intensity

• Initiate therapy within the first 4 weeks post-stroke with sessions of at least 45 minutes, five days per week during the first months 2
• Acute phase (≤6 weeks): 30-45 minute sessions, 2-3 days per week 2
• Chronic aphasia (>6 months): Intensive therapy of at least 10 hours/week of specialist-directed therapy (individual or group) for 3 weeks, plus 5+ hours/week of self-directed training 2, 3
• Greatest language recovery occurs with 20-50 total hours of therapy delivered at 2-4 hours/week or 9+ hours/week, 3-5+ days per week 3

Therapeutic Content

• Focus on production and/or comprehension of words, phrases, and discourse including reading and writing 2
• Use mixed receptive-expressive therapy that is functionally tailored with prescribed home practice 3
• Incorporate non-verbal strategies: gestures, drawings, writing, and augmentative/alternative communication (AAC) devices 2, 4
• Include technology: tablets, iPads, computer-guided therapies 2
• Add group therapy and conversation groups as part of comprehensive treatment 2

Communication Partner Training

• Train family members and caregivers in communication strategies 2
• Educate all healthcare providers working with the patient about aphasia and communication support methods 2
• Provide information in aphasia-accessible formats to patient and family 2

For Dysphonia (Voice Disorder)

After Laryngoscopy Confirms Diagnosis

• Advocate for voice therapy for conditions amenable to behavioral intervention, but only after laryngoscopy documents findings and communicates results to the speech-language pathologist 1
• Offer botulinum toxin injections for spasmodic dysphonia and laryngeal dystonia 1
• Advocate for surgery when indicated: suspected malignancy, symptomatic benign vocal fold lesions not responding to conservative management, or glottic insufficiency 1

Voice Therapy Techniques (for functional dysphonia)

• Symptomatic voice exercises: gargling with firm sound, pretend snoring, slow easy onset with prolonged speech sounds, phonation on inhalation with relaxed body 1
• Playful pre-linguistic sounds: blow raspberries while voicing, phonate with rising/falling scales, siren quietly down scale using nasal sounds 1
• Physical maneuvers: circumlaryngeal massage with concurrent vocalization, postural manipulations (phonating while bending over or looking at ceiling) 1
• Attention redirection: bubble blowing with vocalization, large body movements while making sounds, walking while communicating 1
• Psychological component: communication counseling addressing predisposing/precipitating/perpetuating factors, identify avoidance patterns, address social anxiety 1
• Refer to mental health professionals for structured psychotherapy (CBT) if long-standing anxiety, comorbid depression, or medicolegal issues present 1

For Functional Neurological Disorder (FND)

• Diagnose based on positive clinical features of internal inconsistency, not by exclusion 1
• Address illness beliefs, self-directed attention, and abnormal movement patterns through education, symptomatic treatment, and cognitive behavioral therapy 1
• Avoid reinforcing disability: discourage excessive dependence on communication aids when possible 1

Common Pitfalls to Avoid

• Do NOT obtain CT or MRI before visualizing the larynx in patients with primary voice complaints 1
• Do NOT routinely prescribe antibiotics for dysphonia 1
• Do NOT prescribe antireflux medications for isolated dysphonia based on symptoms alone without laryngoscopy 1
• Do NOT confuse dysphasia (language disorder) with dysphonia (voice disorder) - they require completely different treatment pathways 1, 2, 5

Outcome Monitoring

• Document resolution, improvement, or worsening of symptoms and quality of life changes after treatment 1
• Reassess functional communication, activities, participation, and quality of life throughout treatment 2