Becoming a speech pathologist offers the opportunity to address a variety of disorders and injuries that affect your patients’ daily lives and communication skills. Dysarthria is one of the more common speech disorders you’ll encounter in this profession, and it’s an ailment that has the potential to severely impact a patient’s quality of life. Successful treatment of dysarthria means you’ve been able to help your clients regain their ability to make themselves heard again, and with it, regain a sense of autonomy.
But what is dysarthria and how can you treat it as a speech pathologist? Let’s go over the different types of dysarthria, what causes it, and the available methods for helping your patients clearly communicate once again.
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What Is Dysarthria?
If you haven’t come across this literal tongue-twister of a disorder, you may be wondering “What is dysarthria and dysphagia?” Dysarthria is a motor-speech disorder, where permanent brain and/or nerve damage impacts speech-related muscles. It’s often accompanied by dysphagia, which is an impairment that affects the ability to swallow. These issues show up together frequently, since the muscles and nerves for both skills being are closely located and related in the body and brain.
Individuals with dysarthria know what they want to say, but the muscles responsible for getting the words out won’t respond correctly due to damage. These muscles either go limp and loose or become tight and rigid, causing symptoms such as:
- Slurred or indistinct speech
- Slow speech or rapid, incomprehensible speech
- Uncontrollable vocal volume (e.g., only being able to whisper or shout)
- Uneven vocal patterns
- Stiff facial muscular movement
What causes dysarthria to develop? Some causes for dysarthria include brain tumor or injury, stroke, nervous system disorders such as cerebral palsy or Guillain-Barre syndrome, certain medications such as seizure medicines. It may appear suddenly, as with brain trauma, or gradually, with progressive neurological disorders.
Dysarthria affects both adults and children, though it’s often misidentified in kids as childhood apraxia of speech, as 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 accurate assessment and diagnosis.
Those who share their experience with dysarthria often feel that they’ve lost an integral part of their personality. As a speech-language pathologist, your primary job will be helping your patients regain or hold onto speech skills using compensatory methods. At times you’ll also be called on to support dysphagia-related 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.
Types of Dysarthria
Different types of dysarthria result in varying symptoms and courses of treatment—some are accompanied by intellectual challenges, while others may present with additional speech issues like aphasia or ataxia. Knowing which types of dysarthria your patient is experiencing helps you create the best possible treatment plan.
Common types of dysarthria include:
- Ataxic dysarthria—This condition 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—This type of dysarthria can happen after 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, and a stiff gait. They may also have swallowing difficulties.
- Hyperkinetic dysarthria—Hyperkinetic dysarthria results from diseases that attack the basal ganglia, such as Huntington’s Disease. You will notice excessive movement, strained or strangled-sounding speech, variations in volume, and changes in the rate of speaking.
- Hypokinetic dysarthria—Like its hyperkinetic counterpart, hypokinetic dysarthria also results from diseases that affect the basal ganglia, usually Parkinson’s Disease. In this case, individuals speak in short rushes with a lower volume, and at times with monopitch or monovolume. Out of all types of dysarthria, this is the only one that causes an increase in the rate of speech. You may also notice a resting tremor. Unfortunately, this form of dysarthria often comes with cognitive impairment, at times influencing treatment progress.
- Spastic dysarthria—This 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—This impairment most often results from stroke or neurosurgery, although tumors and traumatic brain injury are other possible causes. These patients are often easier to understand than other speech patients because only one side of the face is affected. This form of dysarthria is often only short-term.
- Mixed dysarthria—Essentially, mixed dysarthria is any combination of the above types of dysarthria. This condition tends to result from multiple strokes or diseases such as ALS, Wilson’s, and multiple sclerosis (MS). Mixed dysarthria occurs more frequently than single or “pure”, and you’ll notice symptoms from multiple categories. As such, you’ll need to tailor your treatment plan to address multiple types of dysarthria at once.
Treatment for Dysarthria
Treatment options vary among the types of dysarthria, though many therapies overlap. Some of the most common dysarthria speech and language therapy treatments include:
- Teaching the patient how to speak more slowly—this is because the brain is used to communicating verbally at a certain speed, but the muscles are no longer able to respond to that speed.
- Coaching your patient to move their tongue and lips often when not speaking, to encourage muscular redevelopment.
- Focusing on using their breath efficiently—either using more breath if their dysarthria has caused a reduction in power and volume or encouraging less breath for the reverse.
- Helping the patient learn to select alternative words and monosyllabic speech.
- Encouraging the patient to spell or over-articulate their words when they aren’t understood.
- Creating personalized communication cues for the patient and their caregiver. For example, you may have the patient start their conversation with the word “lunch,” which triggers the caregiver with a clue of what is coming next.
It’s helpful to have your patient’s family or caregiver present for some therapy sessions, as it’s important for them to learn and support the communication methods their loved one is learning so as to better understand them. For those with severe or progressive forms of dysarthria, you may also be training your patient to use augmentative and alternative communication. This includes all the types of communication that don’t involve speaking, such as writing, facial expressions, hand gestures, drawing, using photos, or even a speech-generating device.
Can Dysarthria Be Cured?
Though many dysarthria patients enjoy successful rehabilitation, it’s important to understand that depending on the severity and types of dysarthria your patient may have, they may never fully regain their pre-condition communication abilities. With treating dysarthria, your goal often isn’t to bring the damaged part of the brain back to health, but instead to find compensatory methods for the person to communicate.
That said, some types of dysarthria are easier to reverse, such as those caused by medications or by a very mild stroke.
Specializing in Treatment of Dysarthria
Though currently, you won’t find any industry certifications specific to dysarthria, there are a handful of other ways to enhance your ability to treat these patients, especially if you’re interested in deep-diving into specific neurological disorders.
One option is to pursue a Lee Silverman Voice Treatment (LSVT) LOUD certification. The LSVT LOUD Certification training focuses on training SLP’s to work specifically with Parkinson’s patients, for whom dysarthria is often a symptom. ASHA offers continuing education credits for those taking LSVT courses, and they are now available fully online.
Because dysarthria is a neurological disorder, you may also want to consider pursuing board certification from the Academy of Neurologic Communication Disorders and Sciences (ANCDS). This certification tells patients and other medical personnel that you have advanced clinical expertise in these types of disorders and cements your reputation as a best-in-class practitioner.
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 options for specializing your treatment of dysarthria patients include:
- 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 several 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.
Frequently Asked Questions About Dysarthria
Can dysarthria come and go?
Dysarthria doesn’t typically appear and then disappear, though improvement can wax and wane depending on how much the patient progresses in strengthening and controlling their facial nerves and muscles. Some causes of dysarthria, such as certain medications, may cause the condition to come and go if the patient goes back and forth on their use of the medicine.
Can anxiety cause dysarthria?
In short, no—anxiety is not a diagnosable cause for clinical dysarthria. It is extremely rare for anxiety to cause any kind of slurred speech or other verbal impairment. In the few cases that it does mimic these symptoms, they’re still wildly different than clinically diagnosed dysarthria, as the cause isn’t an actual issue with the facial muscles or nerves.
What type of dysarthria is associated with ALS?
Patients with amyotrophic lateral sclerosis (ALS) most often suffer mixed dysarthria—typically flaccid dysarthria, caused by damage to their peripheral nervous system, and spastic dysarthria, caused by damage in their motor cortex region. Symptoms of these types of dysarthria combined include slow speech, inarticulate constant pronunciation, and nasally vocalization.
Does dysarthria go away?
Dysarthria may go away with speech-language therapy, especially if it was caused by a treatable trauma, medication, or mild stroke. Some causes of dysarthria make it less likely that it will go away permanently, including degenerative neurological diseases and severe strokes.
What is apraxia and dysarthria?
Apraxia and dysarthria are both motor speech disorders. Apraxia is a brain and nervous system disorder that specifically causes an inability for patients to be able to put words together correctly. They may struggle to find the “right” word or speak words within a sentence in the wrong order, but they have no issues with their facial or vocal muscles forming and speaking verbal communication. Dysarthria, on the other hand, affects the facial muscles’ ability to form said words, rather than the brain’s ability to put words together. Dysarthria patients are physically impaired from being able to form and vocalize speech.
Be the Difference in a Dysarthria Patient’s Life
Speech-language pathologists are the key to helping dysarthria patients communicate with their loved ones again. It’s an incredibly rewarding career, and it starts with a robust education in speech-language disorders and treatment, as well as state certification to earn your clinical license.
Learn more about how to become a speech-language pathologist, including information on certification requirements, accredited SLP master’s programs, and more.