Motor Speech Disorders 119- Setting standards: Sometimes just having the patient try harder to produce speech clearly will
result in significant improvement. One way of doing this is to set up a number system that re-
flects the patient’s increased efforts. A scale of 1 to 10 works best. On this scale, 5 represents the
normal, easy, effortless way people usually speak. Number 1 is unintelligible speech produced in
a slurred, distorted manner. Number 10 represents per... fect... ly... ar... tic... u... la...
ted... sp... ee... ch in which every sound is made with maximum precision. Setting the goal
at 8 or 9 and praising the patient for trying to reach it results in more precise speech, as well as
providing a way of mea sur ing and rewarding improvement. - Other therapies: Voice, respiratory support, nasalization, and speech rhythm are other areas
that may need improvement. The patient with a stroke may be given exercises designed to have
the voice box produce voice or improve the quality of the sound. Several therapies are available
to patients with dysarthria who need to learn how to reduce nasal resonance or to improve the
rhythm of speech.
There is a parallel between the neuromuscular therapies provided by physical therapists
and speech- language pathologists. Of course, a major difference between speech and physical
therapy is that the physical therapist often can physically adjust body parts. The speech- language
pathologist often finds it impossible to physically move the patient’s speech muscles. Therefore,
creative methods of strengthening, coordinating, and positioning these muscles must be found.
Nevertheless, although each dysarthria requires attention to its par tic u lar neuromuscular defi-
ciency, and although therapy goals and objectives must address unique aspects of f laccidity,
spasticity, ataxia, and so forth, the previously mentioned general therapies can be helpful for most
patients with any type of dysarthria.
The goals of compensation can involve prosthetic devices, medi cations, therapies, and alterna-
tive means of communication. Duffy (1995, 2012) also notes that adjustment for many patients
involves ending or changing careers and making significant lifestyle changes. Unfortunately, not
all patients are candidates for rehabilitation, and the goals of treatment may change from overcom-
ing the disorder to accepting it and its implications.
In most patients with neurogenic communication disorders, psychological adjustment involves
the grief response and accepting unwanted changes associated with loss of self, person, and object
(Tanner, 2003d). Some progressive disorders create special conditions, so that passing through the
stages of grieving may be impeded by exacerbation and remission of the physical symptoms. For
example, some patients may return to denial and bargaining during periods of remission, and their
progression to ac cep tance may be delayed.
Case Study 6-1: A High School Wrestler With Ataxic Dysarthria
Freddy didn’t care that varsity wrestling was not a glamorous sport like football or basketball.
Whereas hundreds of students and townspeople attended football and basketball games, only a
handful came to the wrestling matches. Even the “Mat Maids,” cheerleaders for the team, some-
times forgot the games. It didn’t matter to Freddy because he loved the sport. Tragically, during one
of the tournament games, an opponent put Freddy in a hold, pinching a blood vessel and forever
changing his life.
Freddy’s wrestling team had made the tournament, and for the first time, the high school
bleachers were full of spectators. Freddy’s parents were sitting in the front row, and he waved to
them as he approached the mat. His opponent for the first round was no one special, and Freddy’s
coach told him that this would be an easy win. After the usual squaring off, the contest began. On