Non-progressive Dysarthria Research Articles

Communication-oriented group therapy for non-progressive dysarthria: A randomised controlled trial in an inpatient setting

Purpose To examine the effectiveness of communication-oriented group therapy for non-progressive dysarthria regarding functional speech and communicative participation. Method Prospective two-arm randomised controlled trial, targeting communication-oriented dysarthria group therapy (DGT). A non-specific social group program served as the control condition/group (CG). Participants’ speech was assessed immediately before and after completing the respective three week program, using a standardised diagnostic test (objective outcome measure). Participants rated the extent of their communication participation immediately before and after group therapy, as well as three months after program completion (subjective outcome measure). Result Fifty-six persons aged 40–88 years with mild to severe dysarthria (median duration 29 days) from an inpatient facility participated. Prior to the intervention, self-rated communication participation correlated with severity of dysarthria. Immediately after the intervention, DGT participants achieved significantly higher scores than the CG on both outcome measures. After three months, the difference between groups in the subjective outcome measure was no longer significant. Conclusion Participation in DGT resulted in improved speech and better communication participation. Results suggest that three weeks may be too short to ensure maintenance of treatment gains. Also, reduced opportunity for social interaction due to COVID-19 restrictions may have influenced the results.

Neuroanatomical regions associated with non-progressive dysarthria post-stroke: a systematic review

BackgroundDysarthria is a common and persisting sequela to stroke. It can have a negative influence on psychological wellbeing, and quality of life. This systematic review aimed to describe and identify the neuroanatomical regions associated with non-progressive dysarthria following stroke.MethodsA systematic search of PubMed, Ovid Medline, CINAHL, Cochrane, Scopus, and ScienceDirect was conducted to identify all relevant articles published in peer-reviewed journals up to December 2021. Following data extraction, the National Institutes of Health (NIH) quality assessment tools were used to evaluate the methodological quality of the included studies.ResultsOut of 2186 papers found in the literature related to dysarthria post-stroke, 24 met the inclusion criteria. Eligible articles assessed 1150 post-stroke subjects. Out of them, 420 subjects had dysarthria from isolated lesions. Regarding dysarthric subjects with ischemic strokes, 153 sustained supratentorial infarctions, while 267 had infratentorial infarctions. The majority had pontine infarctions (n = 142), followed by infarctions in the corona radiata (n = 104), and the cerebellum (n = 64).ConclusionThis systematic review is the first step toward establishing a neuroanatomical model of dysarthria throughout the whole brain. Our findings have many implications for clinical practice and provide a framework for implementing guidelines for early detection and management of dysarthria post-stroke.

Feasibility of a Telerehabilitation Adaptation of the Be Clear Speech Treatment Program for Non-Progressive Dysarthria.

This study evaluated the feasibility and outcomes of a telerehabilitation adaptation of the Be Clear speech treatment program for adults with non-progressive dysarthria to determine clinical delivery viability and future research directions. Treatment effects on speech clarity, intelligibility, communication effectiveness, and participation, as well as psychosocial outcomes in 15 participants with non-progressive dysarthria, were explored. Intervention involved daily 1-h online sessions (4 days per week for 4 weeks, totalling 16 sessions) and daily home practice. Outcome measures were obtained at baseline (PRE), post-treatment (POST), and 12 weeks following treatment (FUP). Feasibility measures targeting participant satisfaction, treatment adherence and fidelity, and technical viability were also employed. The programme was feasible concerning technical viability and implementation, treatment adherence and fidelity. High levels of participant satisfaction were reported. Increases in overall ratings of communication participation and effectiveness were identified at POST and FUP. Reductions in speech rate were identified at FUP. Improvements in aspects of lingual and laryngeal function were also noted after treatment. Over time, improvements relating to the negative impact of dysarthria were identified. Naïve listeners perceived negligible changes in speech clarity following treatment. Online delivery of the Be Clear speech treatment program was feasible, and some positive speech benefits were observed. Due to the small sample size included in this research, statistically significant findings related to speech outcomes must be interpreted with caution. An adequately powered randomised controlled trial of Be Clear online is warranted to evaluate treatment efficacy.

Assessment of non-progressive dysarthria: practice and attitude of speech and language therapists in Lebanon

BackgroundNon-progressive dysarthria is an acquired motor speech disorder resulting from neurological diseases such as stroke and traumatic brain injury. The evidence base for the assessment of non-progressive dysarthria remains limited with professional practices relying mainly on therapists’ clinical experience. Limited information on the assessment practices of Lebanese speech and language therapists (SLTs) is available. Such information is crucial for the development of adequate therapy services for clients with non-progressive dysarthria. This study aims to explore the assessment practices and attitudes of Lebanese SLTs working with adults with non-progressive dysarthria and to investigate their adherence to the framework of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF).MethodsA cross-sectional study was conducted in Lebanon between March and May 2021. Data was collected through an online survey that included information on socio-demographic characteristics, practices, and attitudes of SLTs who assess adults with non-progressive dysarthria.ResultsA total of 50 Lebanese SLTs responded to the survey. The majority of SLTs (78%) assessed clients with non-progressive dysarthria across all ICF domains. SLTs reported dissatisfaction with the available assessment tools (64%) and reliance on informal tools (84%). In addition, 68% of the SLTs suggested the crucial need for the development of Arabic formal assessments that can quantitatively evaluate dysarthria and determine severity. The survey also showed that the respondents demonstrated a preference for the use of impairment-based tools.ConclusionIt can be concluded that the assessment practices of Lebanese SLTs, generally, follow the international trend and the recommended professional guidelines. Further research initiatives should be held to develop Arabic formal assessment tools for non-progressive dysarthria.

A survey of speech-language pathology treatment for non-progressive dysarthria in Australia

AbstractAim:To identify management practices of Australian speech-language pathologists (SLPs) in the treatment of non-progressive dysarthria using a subsystem approach, and to explore SLPs’ consideration and implementation of the theoretical underpinnings of non-progressive dysarthria management.Method:A 39-item online survey was distributed to Australian SLPs, with 80 responses suitable for data analysis.Results:Practices of SLPs were variable for the management of the speech subsystems. The Lee Silverman Voice Treatment (LSVT®) was the most commonly used manualised treatment program, and was employed by 63.77% of respondents. Almost all SLPs (>88%) provided strategies to improve functional communication. There was no clear preference for low tech alternative and augmentative communication (AAC) devices. Speech generating devices were the most commonly employed high tech device. Almost two-thirds of respondents used non-speech oral motor exercises (NSOMEs) in treatment. SLPs had varied frequencies and models of service delivery for intervention. SLPs valued interventions targeting the activity and participation domains of the ICF, however this was restricted by the treatment context and resources available. The majority of SLPs (92.06%) were aware of the principles of motor learning, however many were unsure regarding the specifics of implementation.Conclusion:There is a clear need for further research into the efficacy of treatment techniques to guide decision-making.

What are the usual assessment practices in adult non-progressive dysarthria rehabilitation? A survey of Australian dysarthria practice patterns

This aim of this study was to identify assessment practices for non-progressive dysarthria used by Australian speech-language pathologists (SLPs) and to describe these practices within the framework of the World Health Organization’s International Classification of Functioning Disability, and Health (ICF). A 23-item online survey was distributed to Australian SLPs, with 56 responses suitable for data analysis. The majority of SLPs prescribed ‘high importance’ to the assessment of impairment to speech function (96%, n = 54), activity limitations (91%, n = 51) and participation in society (91%, n = 51) in non-progressive dysarthria. However, reported assessment selection for non-progressive dysarthria focused largely on impairment and intelligibility, with assessments addressing participation restrictions being under-utilised. There was also a preference for informal assessment tools across all ICF domains. Over half (69%, n = 37) indicated that current assessment tools for non-progressive dysarthria generally do not meet their needs, with key issues being time-factors and inadequate sensitivity. There was variability in the use of outcome measures for non-progressive dysarthria, with workplace setting, time constraints and a perceived lack of relevance being the most commonly reported barriers to implementation.

Changes to articulation following LSVT® and traditional dysarthria therapy in non-progressive dysarthria

The present study aimed to evaluate the effects of the Lee Silverman Voice Treatment (LSVT®) on acoustic and perceptual measures of articulation in non-progressive dysarthria in comparison to traditional dysarthria therapy. The study involved 26 individuals with non-progressive dysarthria who were randomly allocated to receive either LSVT® or traditional dysarthria therapy (TRAD), both of which were administered for 16 hourly sessions over 4 weeks. Participants' speech samples were collected over a total of six testing sessions during three assessment phases: (1) prior to treatment, (2) immediately post-treatment, and (3) 6 months post-treatment (FU). Speech samples were analysed perceptually to determine articulatory precision and intelligibility as well as acoustically using vowel space (and vowel formant measures) and first moment differences. Results revealed short and long-term significant increases in vowel space area following LSVT®. Significantly increased intelligibility was also found at FU in the LSVT® group. No significant differences between groups for any variables were found. The study reveals that LSVT® may be a suitable treatment option for improving vowel articulation and subsequent intelligibility in some individuals with non-progressive dysarthria.

Effectiveness of Lee Silverman Voice Treatment (LSVT)® on hypernasality in non‐progressive dysarthria: the need for further research

Hypernasality is a common feature of non-progressive dysarthria. However, limited research has investigated the effectiveness of treatments for this impairment. Preliminary research has revealed positive effects on nasalance when using increased loudness in certain non-progressive dysarthric speakers. However, the long-term effects of loud speech on nasalance as part of a structured intervention such as Lee Silverman Voice Treatment (LSVT) are yet to be investigated in this population. The study aimed to investigate the short- and long-term effects of LSVT on hypernasality (perceptual ratings and degree of nasalance) in non-progressive dysarthria; and secondly, to evaluate the effects of traditional dysarthria therapy on these same measures, in comparison with the effects of LSVT. Ten non-progressive dysarthric speakers with varying levels of hypernasality (taken from a larger research study) were randomly allocated to receive LSVT((R)) (n = 5) or individually tailored traditional dysarthria therapy (n = 5). Both treatments were administered four times weekly for 4 weeks (that is, 16 x 1-hour sessions). Participants were assessed twice before treatment, twice immediately post-treatment, and twice at follow-up 6 months post-treatment using a perceptual rating task performed by two independent speech pathologists, and the Nasometer. Changes to individual mean nasalance scores were compared against clinically significant criterion and perceptual ratings were analysed descriptively. Three out of five participants demonstrated reductions in perceived hypernasality immediately following LSVT, but these changes were maintained at follow-up for only one participant. Two of these three participants demonstrated a corresponding reduction in mean nasalance. Limited changes in perceived hypernasality and nasalance scores were found following traditional dysarthria therapy, with only one participant exhibiting reduced nasalance at follow-up. Due to the small sample size in the present research and variability between participants, further exploration into the effects of LSVT on nasality with a larger population with different dysarthria types is essential.

Effectiveness of Lee Silverman Voice Treatment (LSVT)® on hypernasality in non-progressive dysarthria: the need for further research

Effectiveness of Lee Silverman Voice Treatment (LSVT)® on hypernasality in non-progressive dysarthria: the need for further research

Hypoglossal-vertebral entrapment syndrome

A 54-year-old man presented with nonprogressive dysarthria due to isolated right hypoglossal nerve (HN) palsy. The cranial MRI reveals an ectatic right vertebral artery impinging on the cisternal segment of HN (figure). Figure Cranial MRI revealing an ectatic …

Spastic Quadriparesis, Dysarthria, and Dysphagia following Cervical Hyperextension: A Traumatic Pontomedullary Syndrome

A 44-year-old man developed a clinical syndrome characterized by nonprogressive spastic quadriparesis, dysarthria, and dysphagia following a severe cervical hyperextension injury. These clinical features, coupled with normal neuroimaging studies, are consistent with a stretch injury of the corticospinal and corticobulbar tracts at the pontomedullary junction.