Dysarthria is one of the more common speech disorders you’ll encounter in this profession. This is a motor-speech disorder, where permanent brain and/or nerve damage impacts speech-related muscles. These muscles either go limp and loose or become tight and rigid, causing slurred or indistinct speech.
Individuals know what they want to say, but the muscles responsible for getting the words out won’t respond correctly due to damage.
Empowering Those Who Have Lost a Part of Themselves
Those who share their experience with dysarthria often feel that they’ve lost an integral part of their personality.
In her guest blog post, stroke victim Annette shares that in the past she was “a bit of a social butterfly…and a talker!” Post stroke, however, she prefers to be alone or in places that feel familiar.
“If I stay home and keep quiet I can pretend that I’m ‘normal’. I hate my new voice. It’s not mine. Why put myself through the embarrassment of watching people straining to hear or understand me? Why put myself through the mental fatigue of constantly having to repeat myself?”
As a speech-language pathologist, your primary job will be helping these individuals regain or hold onto speech skills using compensatory methods. At times you’ll also be called on to support swallowing issues that develop alongside speech issues.
You’ll probably be one of multiple professionals working to help patients improve their quality of life, and especially improve their ability to communicate with loved ones.
Knowing which type of dysarthria your patient is experiencing helps you create the best possible plan of treatment. Sometimes dysarthrias come alongside intellectual impairment or other speech issues such as aphasia or apraxia, so you’ll need to be a bit of a sleuth in order to work out just what issues need to be addressed.
- Ataxic Dysarthria usually results from strokes or degenerative diseases. Your patient may exhibit classic, drunk-like symptoms: slurred speech, sudden increases in volume, and overall lack of coordination.
- Flaccid Dysarthria can result from strokes, congenital disorders, ALS, cerebral palsy, tumors, MNS, or other traumas to the brain. Your patient might have low muscle tone and their speech can be breathy or nasal. Other signs include a jaw that tends to droop or hang open a stiff gait. They may also have swallowing difficulties.
- Hyperkinetic Dysarthria results from diseases like Huntington’s Disease, which attack the basal galangia. You will notice excessive movement, strained or strangled sounding speech, variations in volume, and changes in the rate of speaking. You or your patient may discover that certain “sensory tricks” or adjustments to posture help to limit the involuntary movements and improve speech.
- Hypokinetic Dysarthria also results from diseases that affect the basal ganglia, usually Parkinson’s Disease, but in this case individuals speak in short rushes with a lower volume, and at times with monopitch or monovolume. You may notice a resting tremor. This is the only form a dysarthria where you will see an increase in the rate of speech. Unfortunately this form of dysarthria often comes with cognitive impairment, at times influencing treatment progress.
- Spastic Dysarthria is most often triggered by a stroke, although other events such as tumors, cerebral palsy, encephalitis and primary lateral sclerosis may also cause it. You will notice spasticity, slow speech, harsh voice, weakness, and hyperactive reflexes. Depending on the root cause, the individual may show cognitive decline.
- Unilateral Upper Motor Neuron Dysarthria most often results from stroke or neurosurgery, although tumors and traumatic brain injury are other possible causes. These patients are often easier to understand that other speech patients, because one side of the face is affected. This form of dysarthria is often only short-term.
- Mixed Dysarthria tends to result from multiple strokes or diseases such as ALS, Wilson’s, and MS. Essentially a mixed dysarthria is any combination of the above. You are very likely to encounter individuals facing mixed dysarthria, since they occur more frequently than single or “pure” dysarthrias. In this case you’ll notice symptoms from multiple categories, and will need to adjust treatments to respond accordingly.
Treating Dysarthia: Look at it Like a Lost Limb
When someone loses a limb, that body function is gone. You can use a prosthetic, but nothing you do will bring the limb back. In these cases, therapy focuses on training the other muscles of the body to make up for the lost limb. A right-handed person will now need to learn to write with their left hand, for example.
With dysarthria your goal isn’t to bring the damaged part of the brain back to health, but instead to find compensatory methods for the person to communicate. Some of the ways you can do this include:
- Teaching the patient how to speak more slowly…the brain is used to communicating verbally at a certain speed, but the muscles are no longer able to respond to that speed.
- Helping the patient learn to select alternative words and monosyllabic speech.
- Encouraging the patient to spelling or over articulate when they aren’t understood.
- Creating personalized communication cues for patient and their caregiver. For example, you may have the patient start their conversation with the word “lunch”, which triggers the caregiver with a context for what is coming next.
For those with severe or progressive forms of dysarthria, you will also be training your patient to use augmentative and alternative communication.
Dysarthria in Children
Dysarthria in children is often misidentified as childhood apraxia of speech. One reason for this is that they may only show weakness in speech associated muscles, without any other evident weakness (unlike what is common in adults). In addition, young children don’t always understand or fully cooperate with the activities necessary for assessment.
Similar to adults with dysarthria, children often have difficulty controlling the volume and pitch of their speech, and may demonstrate slow or slurred speech. Root causes include:
- Brain injury
- Cerebral palsy
- Muscular dystrophy
- Guillain-Barre syndrome
- Lyme disease
- Huntington’s disease
- Myasthenia gravis
A Vacuum of Research
One of the things many clinicians find frustrating about dysarthria is the limited amount of ongoing, large-scale research into rehabilitation methods.
If you have any interest in research, this might be an area for you to consider focusing on.
“We urgently need better quality trials with bigger numbers of patients to find out more about dysarthria treatments and consider patients’ views on interventions and how we measure change,” writes SLP Claire Mitchell. Mitchell co-authored the current Cochrane review on dysarthria among victims of stroke and non-progressive brain injuries.
At this time, she encourages therapists follow standard clinical guidelines, but believes that further research could improve treatment methods. By developing a focus on researching dysarthria you could have a part in adjusting the clinical guidelines SLP’s follow in order to better serve all patients with the condition.
Specializing in Treatment of Dysarthria
You won’t find any industry certifications specific to Dysarthria, but because it is a neurological disorder you may want to consider pursuing board certification from the Academy of Neurologic Communication Disorders and Sciences (ANCDS).
In order to be eligible for this certification, you’ll need to fulfill the following requirements:
- Be a fully certified CCC-SLP
- Have five years of clinical experience with neurologic communication disorders
- Submit your CV or resume with three letters of recommendation from health care professionals familiar with your skills
- Complete the Board Certification Candidacy Application and pay applicable fees
The certification process involves submitting two case studies, giving an oral presentation, and taking part in a discussion following your presentation. The reviewers will then give you a “Pass” or notify you that your work “Does not meet standards”.
Additional Ways to Specialize Your Focus
There are a handful of other ways to enhance your ability to treat those with dysarthria. Once you have taken the steps necessary to become a speech-language therapist with your Certificate of Clinical Competence, you may want to consider one or more of the following options:
- LSVT LOUD Certification: The Lee Silverman Voice Treatment training focuses on training SLP’s to work with Parkinson’s patients. ASHA offers continuing education credits for those taking LSVT courses, and they are now available fully online.
- ASHA Continuing Education Webinars and E-Workshops: ASHA offers online workshops for both assessing and treating dysarthria.
- com Continuing Education Courses: This site offers continuing education credits for a number of courses, including ones related specifically to dysarthria. You can take an unlimited number of courses for an annual fee.
- The PROMPT Method: This therapy method is used with patients facing motor speech disorders, like dysarthria. ASHA offers CEU’s for this training.
Consider also reading blogs and watching YouTube posts by those with dysarthria so you can better understand their experience from the inside out. The more you understand dysarthria from the viewpoint of the patient, the better you will be able to empathize with their journey and implement treatment methods in a way that honors the difficulty but also continues to challenge them.