Dysarthria

1. Speaker-oriented treatment

Respiration (nonspeech respiratory exercises, such as blowing into a glass manometer to improve respiratory support and subglottal air pressure.).

Phonation (increase the utterance length per breath group and to obtain loudness levels that are appropriate to the social context. Patients with unilateral or bilateral vocal fold weakness would benefit from effort closure techniques)

Resonance (many believe that patients do not benefit from behavioral interventions)

Articulation (strength training, relaxation, stretching, and instrumental biofeedback. Traditional approaches can also be applied)

Rate (There are many ways to reduce rate, including prosthetic devices such as delayed auditory feedback (DAF), or natural methods, such as hand or finger tapping in pace with syllable production, using visual feedback from a screen, or rhythmic cueing).

Prosody and naturalness (working at the level of the breath group, including chunking utterances into natural syntactic units, and contrastive stress tasks)

2. Speaker-oriented for specific

a. Flaccid (examples include pushing/pulling exercises).

b. Spastic (relaxation exercises as well as stretching exercises)

c. Ataxic (modifying rate and prosody)

d. Hypokinetic (Lee silverman voice treatment).

e. Hyperkinetic (primarily surgical and pharmacological.)

f. Unilateral upper motor neuron (no formal reports of treatment)

g. Mixed (targeting the different dysarthrias present, however one must be conscious of contraindicated treatments)

3. Communication-oriented treatment

Apraxia of Speech

It is important to distinguish between the different types of Apraxia namely: Acquired versus developmental apraxia.

Therapy for developmental apraxia includes 1) traditional articulation training procedures and 2) special training techniques.

Therapy for DAS :

Adapted cueing technique, melodic intonation therapy, the prompt system (which uses prompts for restructuring oral muscular phonetic targets), total communication, touch cue system, and STP which is signed target phoneme approach. These methods use imitation, auditory-visual stimulation, phonetic placement, and motor repetition, as strategies to aid the patient.

Developmental AOS: acquisition of as normal volitional speech as physiological limitations will allow, emphasizing movement sequence, Generating tasks according to the phonetic principles, Limiting the number of stimuli presented to the patient

Acquired AOS: concentrated drill work, Imitation of sustained vowels and consonants followed by the production of simple syllable shapes, Movement patterns and sequences of sounds, Avoidance of auditory discrimination drills, Slow rate, self-monitoring, the use of core vocabulary words and carrier phrases

Therapy for both include: using mirror work and imitation of tongue and lip movements, Imitation of sustained vowels with exaggerated lip movements, Imitation of visible consonants, The use of diphthongs paired with consonants to introduce stress and intonation patterns, Imitation of CVC shapes

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References

Duffy, J. R. (2019). Motor speech disorders e-book: Substrates, differential diagnosis, and management. Elsevier Health Sciences.

Pannbacker, M. (1988). Management strategies for developmental apraxia of speech: A review of literature. Journal of Communication Disorders, 21(5), 363-371.

Knollman-Porter, K. (2008). Acquired apraxia of speech: a review. Topics in stroke rehabilitation, 15(5), 484-493.