An Inside Look At Treating Dysarthria

Dysathria patient at TTUHSC

Communication is our lifeline.  It is the way in which we connect with others. There are three main areas that make up communication:

● Cognition: you need to know what you want to say.
● Language: you need to find the words to say it.
● Speech: you need to turn those words into sound.

When a person has difficulty with the physical ability to turn words into sounds, it is called dysarthria.

Dysarthria is a motor speech disorder in which the muscles we use for verbal communication are weakened or you have trouble controlling the movement of those muscles. It is most often caused by brain damage due to stroke, tumors, head trauma or degenerative neurological diseases.

The signs of dysarthria include slow or slurred speech, an inability to speak louder than a whisper, uneven or abnormal speech patterns and difficulty moving your tongue or facial muscles.

While dysarthria is considered a chronic condition, some patients can expect to make a great deal of improvement depending on the initial cause of their disorder. Patients who’ve experienced a stroke or head trauma often see substantial improvements in their speech. Others with degenerative disorders can expect the condition to progress with their disease. According to James Dembowski, CCC-SLP, Ph.D., continued therapy and treatment is especially important for these patients.

Dembowski is an associate professor and clinical instructor at Texas Tech University Health Sciences Center (TTUHSC) in Speech-Language Pathology. He has dedicated his career to helping patients with speech motor control deficits from dysarthria improve their communication skills.

“It is our job as speech-language pathologists to figure out if patients are experiencing a language problem,” he says.

Patients with dysarthria face a multitude of challenges. A patient who loses their ability to speak and use their voice also loses a part of their core identity. “How you view yourself is very much tied to your personal voice and speech patterns. Psychologically, I think it’s a big challenge for patients when they lose those patterns and have to adapt to a new way of communicating,” says Dembowski.

Treating Dysarthria

Speech-language pathologists help these patients regain their speech or find other ways of communicating so they can reconnect to their world and loved ones. “There's certainly a place for us to help people learn to adjust and accommodate, whether they are improving or experiencing increasing losses,” says Dembowski.

Treatments for dysarthria are largely based on behavioral therapy. Patients are taught how to adapt and learn ways to communicate that accommodate their deficits. “Our first choice if a person has any functional speech, is to try to get them to adapt their speech. And that mostly means slower, clearer and louder. And if that doesn't work, we start adding things that supplement the speech with gestures, writing and alphabet boards and other communicative devices, in addition to speech,” says Dembowski.

These tips and tools can include slowing down speech. Patients often cannot communicate at what used to be their normal rate, so speech-language pathologists help them to be more slow and careful about their speech.

“We also teach them to change their volume levels,” he explains.“Patients with dysarthria  may have voice issues that require them to breathe a little more deeply and to push a little harder with their muscles to get good volume out so that they can be heard.”

These changes can help patients become clearer and louder.
 
Many of the neurological disorders that cause dysarthria are progressive. Patients with Parkinson’s disease change over the course of the disease and are often unintelligible toward the end stages. Working with these patients requires a deep understanding, compassion and even psychological preparation. Treatment strategies need to adjust as these diseases progress. In the end stages of neurological diseases, for example, more high-tech options become useful. These typically include augmentative electronic communication devices.

Developments in the Field

Famed physicist and author Stephen Hawking lost the ability to speak because of complications from amyotrophic lateral sclerosis (ALS). He was able to communicate through a computer-assisted device, although for many years, Hawking’s voice was not his own. The synthetic voice was based on the programmer who helped develop one of the first text-to-speech translation devices. So while Hawking regained his ability to communicate through speech, he relinquished the characteristics that made his voice distinctly his.

“It used to be if you had one of these devices, you picked a voice. Males picked a voice that was labeled male, and it was more or less low pitched. Females picked a voice that said female, and that was it,” explains Dembowski. Today, dysarthria patients have a chance to preserve their voices thanks to advances in the field.

AI and machine-learning company VOCALiD developed a solution to help people preserve their voice and their identity. If someone knows they are at risk of losing their speech, VOCALiD can collect recordings of their voice that could electronically generate their speech in the future. When the patient reaches the point at which they can no longer talk, they have a synthesized voice that is very similar sounding to their own.

“It’s not just picking a generic male or female voice anymore,” says Dembowski. Now they can get an electronic voice that actually sounds something like their voice before they lost their speech.”

Computer-assisted devices can be very expensive, but dysarthria patients today no longer need to purchase separate expensive equipment. Technological advances have lowered barriers to access.  For example, today’s software programs can run on tablets.

“That's a tremendous advance. Before these new programs, if somebody wanted one of these high-tech speech synthesis devices they had to get it from a company that specialized in that. And they were very expensive, thousands of dollars. The process usually involved a lot of back and forth with insurance companies or state agencies that helped patients cover the costs. What's happening now is many people already own tablets, or they can buy one for only a few hundred dollars,” says Dembowski.

Dysarthria Treatment Options at TTUHSC

TTUHSC offers many different options for dysarthria treatment, including one-on-one therapy at its Speech-Language Clinic. This clinic provides a much-needed community service, as well as practical training opportunities for students.

TTUHSC offers several other dysarthria treatment options and programs, including the STAR Program. Dembowski says this community outreach program provides aphasia and stroke recovery care and support to patients and caregivers at no cost.

STAR gives patients the opportunity to practice conversations and communication in a small group setting, and in a safe environment with others who understand the issues they are facing. Meetings are facilitated by speech-language pathology graduate students and a speech-language pathologist. STAR also holds meetings for caregivers that not only educate participants about new ways to communicate with their loved ones, but the group also offers much needed psychosocial support.

Dembowski adds that TTUHSC’s speech-language pathology program also offers its expertise to the local prison system. Several of his colleagues consult with the prison’s health care workers to offer possible strategies for treating dysarthria and other speech-related conditions.
“The whole prison population is aging. And they have patients who have suffered various forms of violence that affect their speech and language along with patients who have the same normal range of diseases that anybody outside the prison system has,” he explains.  

Training Future Speech-Language Pathologists

The STAR Program and onsite clinic give TTUHSC students an invaluable opportunity to learn more about treating dysarthria and plenty of hands-on experience working with patients who have language and speech problems.

These firsthand experiences also help students understand what communication strategies are the best fit and most helpful for each patient. To successfully treat dysarthria, students and clinicians must have a thorough understanding of what constitutes intelligible speech production. They need to understand what underlies speech that is well understood versus speech that is distorted and not understood. This also involves an understanding of the problems a listener will have.

To achieve this, speech-language pathologists learn about motor control, acoustics and the neurological problems that produce distorted speech. Once they have a good handle on what is going wrong, they can then select the best strategies to help their patients.

Dembowski also explains the importance of understanding the underlying medical condition that led to dysarthria. Treatment strategies will be very different for patients who are likely to improve, such as a stroke recovery patient, versus patients who have a progressive disease.

“You have to be a perceptive enough clinician to say, ‘I think this person is going to improve and I can teach them some things to help them be clearer and better understood while they get better.’ You also have to know when a patient is only going to get worse. In those cases, you can help prepare them for what's to come by teaching them strategies in advance of the disease. They will need to know how to use the kinds of tools they're going to need down the line, even if they don't have to use them now,” explains Dembowski.

Clinicians also need to understand the patient’s communication needs. What does this patient want and need in their life? Who do they need to talk to? Strategies and skills may be very different for a patient who has dependable caregivers versus someone who lives alone. One patient may live far from their grandchildren and want to speak with them over the phone, while another may want to be better understood in face-to-face social situations. A large part of treating dysarthria is personalizing the approach, and that means understanding which communication strategies are most beneficial to that patient.

Clinicians also must consider the large role environment plays in communication. For example, a noisy atmosphere will make it much harder for dysarthria patients to be understood.

The Path to Successfully Treating Dysarthria

Clinicians and students interested in becoming speech-language pathologists will need to earn a graduate degree, such as the Master of Speech-Language Pathology offered by TTUHSC.  Through coursework and clinical experience,  students will become experts in prevention strategies, identification, evaluation, treatment and rehabilitation for patients with swallowing, speech and communication disorders. They’ll also work one-on-one with patients at the university clinic, through programs within the larger Lubbock, Texas, community, and at externship sites around the country.

After earning a master’s, speech-language pathologists must obtain certification from the American Speech-Language-Hearing Association (ASHA). Part of this certification involves an exam and completing a year-long clinical fellowship. Most states also have individual licensing requirements.

Good communication depends on the speaker and the listener. Patients with dysarthria face overwhelming challenges at times, but there are strategies to help them overcome these barriers and potentially even improve their communication skills. For those living with dysarthria, seeking out a trained speech-language pathologist can be a great help. As Dembowski explained, speech-language pathologists can help patients learn to slow down, use their breathing to their advantage and learn new ways to communicate.

If you would like to learn more about TTUHSC’s Master of Science in Speech-Language Pathology program, please visit the program page. You can also email the SHP Office of Admissions and Student Affairs at health.professions@ttuhsc.edu or call 806-743-3220 to learn more.

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