Management of Dysarthria
Assessment and Treatment Approaches
- The American Heart Association recommends that speech and language therapy should be individually tailored to target the specific physiological support systems affected, including respiration, phonation, articulation, and resonance 1, 2
- 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 3
- Assessment tools should include both auditory-perceptual measures, acoustic measures, and physiological measures 3
- 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 4
- Behavioral management should target physiological support for speech and global aspects of speech production, including loudness, rate, and prosody 2
- Voice therapy techniques include gentle phonation exercises and postural manipulations to improve voice production, although the source of this information is not preferred 5
- AAC devices and modalities should be used to supplement speech when intelligibility is severely compromised 2
- Environmental modifications, including listener education, should be implemented to improve communication effectiveness 2
- Communication partner training is effective in improving communication activities and participation 1, 6
- Treatment for dysarthria following stroke should begin as soon as possible during the rehabilitation process 1, 6
- Regular reassessment of communication abilities should document resolution, improvement, or worsening of symptoms after treatment, although the source of this information is not preferred 5
- Activities to facilitate social participation and promote psychosocial well-being should be incorporated into the treatment plan 2
- Delayed diagnosis of underlying conditions can lead to worse outcomes, although the source of this information is not preferred 5
- The psychosocial impact of motor speech disorders is often disproportionate to the severity of the physiological impairment 2
Mild to Moderate Dysarthria in the NIH Stroke Scale
Characteristics of Mild to Moderate Dysarthria
- Slurred speech that remains intelligible to the listener 7, 8
- Noticeable articulation difficulties but words can still be understood 7
- Patient can read provided word lists with impaired but comprehensible pronunciation 8
- Speech may sound thickened or imprecise but meaning is preserved 7
Clinical Assessment
- Assessment should be performed by having the patient read a standardized list of words 7, 8
- The examiner listens for articulation difficulties while maintaining intelligibility 8
- Thickened speech quality but words remain recognizable 7
Differential Scoring on NIH Stroke Scale
- Score 0: Normal articulation with no speech abnormalities 7
- Score 1: Mild to moderate slurring but speech remains intelligible 7, 8
- Score 2: Severe dysarthria where speech is unintelligible or patient is mute 7
- Score X: Used when patient is intubated or has a mechanical barrier to speech 8