Question
What are some basic management approaches for dysarthria?
Answer
Prosthetic Management
Prosthetic management is the use of any device. It could be a high-tech device, a low-tech device, or it could even be a piece of paper in some cases. It could be a palatal lift prosthesis that helps lift a weak, flaccid velum for better velopharyngeal closure. It could be an AAC device to replace speech or to supplement speech. Boards or books can be used to help people who have communication break down or need a choice when they are in a noisy environment and can't be heard. Pacing boards are used to help a person externally cue themselves to slow their rate. Wearable devices include voice amplifiers like the Chattervox, delayed auditory feedback devices like the SpeechEasy, and the device that was developed in my lab called the SpeechVive is for people with Parkinson's disease.
Behavioral Management
Behavioral management can be speaker-oriented. We want to help the speaker either improve their function or teach them how to compensate better. As an SLP, I need to be communication-oriented as well. For example, working with listeners, common care partners, common communication partners or the environment. We want to allow people to ask for things or request in ways that don't entirely depend on verbal communication.
Counseling and Support
Counseling and support is always part of our behavioral management and is one of the most important things that SLPs bring to the medical model. It allows us the time to talk to patients about their dysarthria, their disease, the prognosis, what might be coming for them in the short term and the long term and how they can really maintain their communication. It allows us to make that deep connection with our patients.
Severe Patients
Understanding the categories of severity level for dysarthria can help to plan therapy. The severe patient is someone who really can’t communicate verbally. In therapy, we want to primarily establish a means of communication which will most likely be alternative communication. When we're making AAC plans and selecting devices or input methods, we want to think about whether the person will degenerate or are they likely to get better. We also want to plan for a device that we can morph around their changing needs.
We want to do some patient and family education so they understand what's happening and how it's likely to change. We want to observe their environment and set up some ways for them to interact better. That may mean changing their room a bit. For example, adding switches allow people to request or call from one room to another. This is helpful for a person who can’t raise the intensity of their voice to yell for help. There are call buttons that can be worn so that if the person falls, they can contact someone right away to help them rather than waiting for somebody to walk by.
Moderate Patients
Moderate patients use speech for communication but they have intelligibility problems. Their intelligibility problems could be significant or a little more moderate but the goal is to maximize their intelligibility. We can do that by working on compensatory strategies like slowing the rate of speech. We know that makes people easier to understand and a bit more intelligible. Prosthetic devices can also maximize intelligibility at this point.
Mild Patients
Individuals with mild dysarthria are still intelligible and we can help them maximize their communication. For example, they might be less efficient or find speaking fatiguing. But, we can help with efficiency and creating natural voice. We can find ways to help them participate more and reduce some of the withdrawal that is occurring as the disorder gets worse.
Please refer to the SpeechPathology.com course, Dysarthria - Back to the Basics: Treatment, for more in-depth information on basic treatment techniques for adults with a variety of types of dysarthria.