Breaking Down Dysarthria: Insights from a Speech Therapist

Using your voice and words to communicate is one of the most personal ways to connect with those around you. However, it can be discouraging when the speech isn’t clear to the listener. 

Dysarthria is one of the most common areas I work with as an adult speech therapist. 

Dysarthria is a motor speech disorder caused by weakness, paralysis, or incoordination of the muscles needed for speech, resulting in changes in speech that is produced too fast or too slow, sounds slurred or mumbled, and/or unintelligible to a listener. 

In this blog, we will learn:

1. Causes for dysarthria

2. A deeper look into the assessment

3. The goal of speech therapy when the diagnosis is dysarthria

Causes and Evaluation for Dysarthria

Dysarthria can be caused by a variety of neurological disorders that can be congenital (from birth), such as cerebral palsy, degenerative diseases like ALS, Parkinson’s, MS, neurological trauma such as traumatic brain injuries or seizures, and strokes. 

There are 5 main areas that we assess when evaluating and treating dysarthria. 

• Respiration: Breath support for speech

  • If respiration is affected, speech may sound quiet, be produced in short phrases, and the individual may run out of air frequently while speaking. 

• Phonation: Sounds produced by the vibration of the vocal folds

  • If phonation is affected, speech may be produced at a higher or lower pitch than baseline and/or harsh or hoarse vocal quality. 

• Articulation: Speech sounds are formed by tongue, lips, and mouth coordination. 

  • Speech may sound slurred, mumbled, or unclear if articulation is affected. 

• Prosody: The intonation, stress, rhythm, and loudness of speech

  • If prosody is affected, speech may be produced faster or slower than normal, and atypical stress or silence may occur when produced. 

• Resonance is the intensity and quality of the vocal tone. Too much sound comes through the nasal cavity, or not enough sound comes out of the nasal cavity. 

  • If resonance is affected, speech may sound like the person's nose is blocked or that too much sound is coming out of the nose. 

A Deeper Look into the Assessment

A speech therapist will diagnose dysarthria through a comprehensive assessment of the 5 areas listed above to determine the specific deficits. This assessment likely will include:

• Gathering a case history related to when the dysarthria started and the cause

• A cranial nerve exam assesses any abnormalities in movement and sensation in the nerves, specifically the face. 

• Simple breathing tasks include taking deep breaths and holding ‘ah’ for an extended time. 

• Articulation assessment of specific sounds in isolation, syllables, and connected speech. 

• Assessment of rate and rhythm of speech to identify irregularities

• Overall intelligibility assessment to determine how well listeners can understand you. 

• Patient-reported outcome Measures (PROMS) may be used to identify patients' thoughts and feelings about speech impairment. 

The Goal of Speech Therapy when the Diagnosis is Dysarthria

The overall goal of speech therapy when working with someone with dysarthria is to improve their ability to communicate in everyday life. This may look different depending on the severity and symptoms of the condition. 

For someone with more severe dysarthria, an Augmentative and alternative communication device may be implemented to help supplement verbal communication. This could be a high-tech device like an iPad or a simple paper communication board. For someone with moderate or mild dysarthria, we would begin by targeting the specific of the 5 areas that are affected by dysarthria through specific strategies. 

Here are some basic examples of what treatment strategies may be used:

• Respiration: Focus on breathing deeply and fully to have enough air to produce speech. 

• Phonation: Adjusting head positions to change pitch

• Resonance: Increasing loudness so more air comes through the mouth and not the nose

• Articulation: exaggerating speech, focusing on specific tongue and lip placements to make sounds

• Prosody: Slowing rate of speech and targeting adding stress on specific sounds/syllables

Dysarthria poses significant challenges to individuals striving to communicate effectively, often affecting various aspects of speech production. As a speech therapist specializing in adult dysarthria, I understand the frustration and barriers faced by those grappling with this condition. By understanding the causes, evaluation process, and therapeutic interventions outlined above, we shed light on improving communication skills and overall quality of life. Individuals can regain confidence and clarity in their speech through targeted strategies addressing respiration, phonation, articulation, prosody, and resonance.