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operate holistically; no single part functions completely in de pen dently of other systems. This is
particularly true during communication. “With just a moment of thought it becomes apparent
that not one of these systems is in de pen dent of the others. The speech mechanism draws heavi ly
on some systems and less heavi ly on others, but either directly or indirectly, it is dependent upon
all of the systems of the body” (p. 30). Tetnowski (2003) comments on speech disorders and strict
localization philosophies: “If we knew all there was to know about human be hav iors, modern brain
imaging techniques would be the sole tool required to identify the symptoms, strengths, and weak-
nesses of our patients with neurogenically based communication disorders” (p. ix).
Principles of Dysarthria Therapy
Duffy (1995) suggests that the primary goals of therapy for motor speech disorders are restora-
tion, compensation, and adjustment. These general management goals ultimately help neurogenic
patients maximize the effectiveness and efficiency of communication. However, it is unlikely that
patients suffering from severe neuromuscular disorders, especially progressive ones such as ALS,
multiple sclerosis, and Parkinson’s disease, will ever have complete restoration of normal commu-
nication abilities. “It is crucial that clinicians and patients realize that full restoration of normal
speech is not a realistic treatment goal in most cases” (Duffy, 1995, p. 372).
Tanner (1999a, pp. 213–215) provides eight general dysarthria therapies for stroke patients.
These therapies are applicable to dysarthria arising from most neurological injuries.
- Slowing the rate of speech: In most activities, the faster an action is performed, the less pre-
cise it is, hence the old adage, “Haste makes waste.” This princi ple holds true for speaking. The
faster a person talks, the less precisely each sound is made. When the rate of speech exceeds
about 600 hundred words per minute, most persons become unintelligible. For many survivors
of strokes, reducing the rate of speech helps them adjust for muscle weakness or paralysis of the
speech system and allows them to relearn how to produce each sound clearly and precisely. In the
course of rehabilitation, the patient can begin to talk progressively faster once again. - Exaggerating individual sounds: Speech can often be improved significantly by exaggerating
individual sounds. Although the patient may find it difficult to get into this habit while talking,
after a while it becomes natu ral, and the greater the exaggeration, the clearer the speech becomes. - Clearly producing the final sounds of words: In normal speech, there is a tendency to produce
the first sound of a word more clearly than the sounds in the middle or at the end. When the
stroke survivor with dysarthria is encouraged to produce the final sounds of a word as clearly as
the first and middle sounds, speech improves, sometimes dramatically. - Opening the mouth more widely: A singer opens the mouth more widely to allow the voice
to radiate more effectively. For a stroke survivor with dysarthria, it is also sometimes helpful to
open the mouth more widely when speaking. This allows the patient to produce sounds more
clearly and reduce the tendency to muffle speech. It also reminds the patient to use slow speech
and to exaggerate each sound. - Speaking more loudly: Speech has to be loud enough to be understood. No matter how clearly
or precisely the sounds are made, speech will not be heard if it is too quiet. Sometimes having the
stroke survivor sit or stand with erect posture helps increase loudness. - Working on specific sounds: For many patients with dysarthria, the sounds that occur when
the tongue reaches the top of the mouth are the most difficult to make. Particularly troublesome
are the sounds produced at the top and front of the mouth, such as t, th, and d. As a result, the
speech- language clinician may want the patient to perform exercises to strengthen and improve
the movement of the tongue. These exercises are generally speech drills, but sometimes non-
speech activities are used, such as trying to touch the nose with the tongue or sticking the tongue
out as far as pos si ble. However, it is usually best to give the patient speech rather than nonspeech
exercises because speech exercises transfer more naturally to speaking situations.