DYSARTHRIA

Additional information that may be helpful can be found at:

➢ http://www.asha.org/public/speech/disorders/dysarthria/

Definition: ​Dysarthria is a motor speech disorder. This results from

impaired movement of muscles that are involved in the production of
speech. These muscles may include: lips, tongue, vocal folds and/or
diaphragm.

An individual with dysarthria may display characteristics such as:

➢ ”Slurred”, “choppy”, or mumbled speech
➢ Slow rate of speech production
➢ Limited muscle movement
➢ Change in voice quality
➢ Abnormal pitch and rhythm when speaking
Tips for individuals assisting with dysarthria residents:
➢ Reduce background noise as much as possible
➢ Pay attention to the speaker -- use eye contact when they are
speaking
➢ Let the speaker know when you are having a difficult time
understanding them
○ Ask them to repeat what he/she said, ​don’t assume what
he/she said
➢ BE PATIENT​ --allow them time to respond, so they don’t feel rush or
anxious which can ultimately affect their ability to communicate
➢ Talk normally. Many people with dysarthria understand others without
difficulty, so there’s no need to slow down or speak loudly
Informal Therapy Options:
➢ Stretching
➢ Naming opposites activities--stimulation of speech
○ Example: “opposite of ​on, hello, girl, hot, bad, etc.​”
➢ Alphabet chart- ​Evidence has shown that using an alphabet chart can
greatly enhance intelligibility. Not just by spelling out entire words, but
by just pointing to the initial letter/sound of a word often cues in the
listener to the word you are trying to pronounce
➢ Gestures/Visual chart
○ Make it easier to communicate with another person
➢ http://www.icommunicatetherapy.com/adult-communication-difficulties
-2/adult-acquired-communication-difficulties/stroke-cva/dysarthria/
➢ Oral Motor Exercises:
○ Lee Silverman Voice Treatment
○ http://www.asha.org/public/speech/disorders/dysarthria/
○ Gives indirect therapy options
➢ Simple exercises may include:
○ Loudness range
○ Pitch range
○ Pitch control
■ https://www.youtube.com/watch?v=pZhhRjYkSAo
○ Voice timing

➢ Articulatory-Kinematic Treatments
○ Integral stimulation
■ “Watch me, listen to me, say it with me”
● Possibly create a worksheet that has simple
phrases working up to more complex
phrases/sentences
○ Possible use shapes to break apart the words,
emphasizing on the pauses between each
word
 ○ Example: Ride a bike...every time you use a
different word pause and go to a different
shape
■ Maximal support, will gradually fade cues
○ Prompts for restructuring Oral Muscular Phonetic Targets
■ Cues provided to pt. Through oral-facial prompts
(​provided by trained clinicians)
○ Sound production treatment
■ https://www.youtube.com/watch?v=DdA1_PADaHw
➢ Activity: ​Reading an article out loud emphasizing on certain words!
○ Possibly using shapes to help break apart the word
Apps on Ipad/Andriod
➢ Sensory Speak Up/Sensory Speak Up Too
○ Visual representation of objects
○ App is used to encourage player to be vocal and make sound
■ The louder the players voice is the bigger the animal or
pattern becomes
○ The visual response can be adjusted easily to meet the needs
of the players stage in rehabilitation

➢ Verbal Me
○ Easy-to-use AAC and choice board app
➢ Bla | Bla | Bla
○ Helps individuals with muscle movement of the mouth

➢ Breathe2Relax
○ Helps with diaphragmatic breathing to help improve voice,
volume and speech
○ Coaches ​deep ​diaphragm breathing
○ Offers an assistance for residents by having a “Show me how”
which can be used for explanation and visual representation of
the breathing exercise
 Lee Silverman Voice Treatment Concepts
DAILY TASK # 1
● 4 days a week: 50-60 minute sessions
● Focus on:
○ Deep breathes
○ Open mouth
○ Improved articulation
○ Reduced rate
● Model to change behavior
● Minimize clinical explanations
● PUSH ​the patient
● SHAPING “Ah”: ​Change behavior through model- no explanations
○ “Do what I do”
○ Hands on visual cues
○ Push/Pull
○ Open mouth- over exaggerating
○ Relax shoulders
○ Modal pitch- may be slightly higher
● STABILIZE “AH”
○ Best “Ah” of the day, then practice
○ 15 successive times (minimum)
■ This ultimately builds: loudness, quality, duration, and
stimulating high effort
○ DO NOT: ​“As loud as you can”
○ DO: ​Loud “Ah” with good quality voice
○ First 10 minutes of session: short durations = more repetitions
○ NEED TO ESTABLISH GOOD ​“Ah”
■ In first week so patient know how to do this
● CONSIDERATIONS
○ No louder than 90dB/30cm for “Ah”
○ No louder than 80-85dB for speech
○ 15 second(s) “Ah” at 80 dB is better than 30 seconds at 60dB
 DAILY TASK #2
(Maximum Fundamental Frequency Range)

● Stimulate High/Low first:

1. Say “Ah” and go high/low
a. Listen and observe
2. Cue for loudness/effort
a. Second time: ​“LOUD HIGH/LOW”
3. As high as the resident can with the best quality, and same thing with
low
● Model: “​Do what I do”
● Glide-stairstep: ​“Do this”
● Keyboard
● Open mouth
● Head up
● Stabilize HI/LO:
1. After shaping, once the resident has the best HI/LO of the day then
practice 15 times ​BOTH ​high and low
● Hold each highest and lowest for 5 seconds
● Starts at “Ah” voice: ​This is their NEW NORMAL
● DON’T ​dwell on range, rather the exercise of the pitch change
 DAILY TASK #3
(Maximum Functional Speech Loudness- “Functional
Phrases”)
● Patient generates 10 phrases/sentences used in his/her everyday life
● Read articles/paragraphs using loud “Ah” voice
● REPEAT ​each phrase fives times achieving loudness
● NEVER CHANGE PHRASES
● Pause between phrases/reading each as a separate utterances- ​not
as a list
● Encourage “HOOK” taking therapy outside of treatment room
Generate 10 phrases/sentences used in residents everyday life:

1. ____________________________.
2. ____________________________.
3. ____________________________.
4. ____________________________.
5. ____________________________.
6. ____________________________.
7. ____________________________.
8. ____________________________.
9. ____________________________.
10. ____________________________.
(Hierarchical Speech Loudness Tasks-*Should
consist of ½ of Session Time)

1. Gradually increase complexity-words

a. Conversation!
2. Avoid word lists-consider trying:
a. Recipes, poetry, stock report, classifieds, famous quotes
3. METHOD:
a. Read using residents loud “Ah” voice
b. Think loud/think shout
c. “Top of breath”
d. A list of 40 phrases is repeated at least 5 times during last 30
minutes of session
4. SHAPE: ​Good quality loudness in speech hierarchy tasks
5. MODEL: ​Loudness, open mouth, intonation, rate with one cue,
BE LOUD
6. Stop, interrupt, redirect to practice
7. Monitor body positioning
 (General Breakdown of Treatment Session)

1.Daily tasks: 25-30 minutes

a.“Ah”: 12-15 minutes
b.High/Low’s: 10-12 minutes
c. Phrases: 5-10 minutes
2.Hierarchy: 25-30 minutes
a.Structured reading: 20-25 minutes
b.Off the cuff: 5-10 minutes
c. Homework and carry out: 5 minutes
3.OTHER HELPFUL HINTS:
a. Recognize effort and loudness on a scale
of 1-10