Long-term treatment of severe dysarthria: a case study

Intervention for dysarthria associated with acquired brain injury in children and adolescents

BACKGROUND

The term 'acquired brain injury' (ABI) incorporates a range of aetiologies including cerebrovascular accident, brain tumour and traumatic brain injury. ABI is a common cause of disability in the paediatric population, and dysarthria is a common and often persistent sequelae associated with ABI in children.

OBJECTIVES

To assess the efficacy of intervention delivered by Speech and Language Pathologists/Therapists targeting dysarthric speech in children resulting from acquired brain injury.

SEARCH STRATEGY

We searched CENTRAL (Issue 4, 2006), MEDLINE (1966 to 02/2007), CINAHL (1982 to 02/2007), EMBASE (1980 to 02/2007), ERIC (1965 to 02/2007), Linguistics Abstracts Online (1985 to 02/07), PsycINFO (1872 to 02/2007). Additional references were also sought from reference lists studies.

SELECTION CRITERIA

The review considered randomised controlled trials (RCTs) and quasi-experimental design studies of children aged 3-16 years with acquired dysarthria grouped by aetiology (e.g., brain tumour, traumatic brain injury, cerebrovascular accident).

DATA COLLECTION AND ANALYSIS

Each author independently assessed the titles and abstracts for relevance (100% inter-rater reliability) and the full text version of all potentially relevant articles was obtained. No studies met inclusion criteria.

MAIN RESULTS

Of 2091 titles and abstracts identified, full text versions of only three (Morgan 2007; Murdoch 1999; Netsell 2001) were obtained. 2088 were excluded, largely on the basis of not including dysarthria, being diagnostic or descriptive papers, and for concerning adults rather than children. Morgan 2007 and Murdoch 1999 were excluded for not employing RCT or quasi-randomised methodology; Netsell 2001 on the basis of being a theoretical review paper, rather than an intervention study. Five references were identified and obtained from the bibliography of the Murdoch 1999 paper. All were excluded due to including populations without ABI, adults with dysarthria, or inappropriate design. Thus, no studies met inclusion criteria.

AUTHORS' CONCLUSIONS

The review demonstrates a critical lack of studies, let alone RCTs, addressing treatment efficacy for dysarthria in children with ABI. Possible reasons to explain this lack of data include i) a lack of understanding of the characteristics or natural history of dysarthria associated with this population; ii) the lack of a diagnostic classification system for children precluding the development of well targeted intervention programs; and iii) the heterogeneity of both the aetiologies and resultant possible dysarthria types of paediatric ABI. Efforts should first be directed at modest well-controlled studies to identify likely efficacious treatments that may then be trialed in multi-centre collaborations using quasi-randomised or RCT methodology.

The effect of pacing strategies on the variability of speech movement sequences in dysarthria

There are many potential sources of variability in speech production, particularly in individuals with dysarthria. The degree and time course of stabilization of the speech production system during recovery from a neurological insult is not constant across individuals. Another source of variability in speech production is speaking rate. Although individuals with no neurological impairments typically show increased variability at reduced speaking rates, this phenomenon has not been explored extensively in individuals with dysarthria. Because rate control strategies are commonly used in dysarthria treatment, it is of clinical importance to know if individuals with dysarthria produce less variable speech with rate reduction. Six individuals with mild dysarthria, 6 with moderate-to-severe dysarthria, and 6 matched normal controls repeated an utterance in four speaking rate conditions: habitual, fast, breaks between words, and stretched. Data were analyzed using the spatiotemporal index (STI), a composite measure of spatial and temporal variability across token repetitions. The normal controls consistently demonstrated the least variability, regardless of rate condition. Both groups with dysarthria were the least variable in the stretched condition and the most variable in the fast condition. The STI values of the group with moderate-to-severe dysarthria were significantly different from both the individuals with mild dysarthria and the normal controls. There were no significant differences between the group with mild dysarthria and the normal controls. In general, slowing the speaking rate in individuals with dysarthria reduces spatiotemporal variability; however, the effect of reduced spatiotemporal variability on intelligibility requires further investigation.

Speech aeromechanics and the dysarthrias: implications for children with traumatic brain injury

BACKGROUND

In addition to cognitive, linguistic, neurobehavioral, and physical challenges, children and adolescents with traumatic brain injury can have a dysarthria that compromises intelligibility and speaking effort.

OBJECTIVE

The focus of this article is on an aeromechanical approach to understanding, evaluating, and treating the moderate-severe dysarthrias in these children.

Effects of abdominal trussing on breathing and speech in men with cervical spinal cord injury

Abdominal trussing constitutes an inward fixation of the abdominal wall. In the context of speech habilitation/rehabilitation, it is sometimes used to supplant, in part, the function of a paralyzed or paretic abdominal wall. A paralyzed or paretic abdominal wall may be found in individuals with cervical spinal cord injury or in individuals with other neurologic disorders, such as muscular dystrophy. This research was designed to study the effects of trussing as a dinical treatment. A study was designed to systematically and precisely place the abdominal wall at one position (50% inward) to study the effects of trussing (as compared to an untrussed condition) on lung volume and oral reading in three men with cervical spinal cord injury (C5-C6). Results showed that abdominal trussing increased vital capacity, realized via an increase of inspiratory capacity, presumably by optimization of the function of the diaphragm. With the increase in inspiratory capacity, longer utterance duration for oral reading was observed. With increased utterance duration, more syllables were produced per utterance, and pauses occurred at appropriate linguistic locations. Oral reading samples for trussed and untrussed conditions were submitted to preference judgment by a group of 10 judges. For two of the three men studied, oral reading during trussing was preferred because of longer phrases and pauses taken at suitable linguistic boundaries. The findings from this study support clinical impressions that abdominal trussing may be useful in improving speech in individuals with a paralyzed or paretic abdomen whose breathing function for speech is diminished.

Treatment efficacy: dysarthria

The dysarthrias form a group of diverse, chronic motor speech disorders. The disorders of Parkinson's disease, stroke, traumatic brain injury, amyotrophic lateral sclerosis, and cerebral palsy are reviewed because they represent important clinical diagnoses in which dysarthria is a frequent and debilitating symptom. The roles played by speech-language pathologists include participation in differential diagnosis, provision of speech treatment, staging of treatment, and timely education so that clients and families can make informed decisions about communication alternatives. Both scientific and clinical evidence is presented that suggests that individuals with dysarthria benefit from the services of speech-language pathologists. Group-treatment studies, single-subject studies, and case reports illustrate the effectiveness of various types of speech treatment. Research into the effectiveness of augmentative and alternative communication systems for individuals with cerebral palsy is also presented.