See our Stroke Home Page for a full list of information relating to Stroke, Dysarthria, Aphasia, and startegies for improving communication.
Dysarthria and dysphonia
Dysarthria is a motor speech disorder caused by a neurological injury or disease and it can affect one or more of the speech mechanisms – respiration, phonation, resonance, prosody, articulation. The disorder occurs because the part of the brain that controls speech production is damaged, and the link from the brain to the muscles of speech is affected. Injury or disease to the speech muscles may also cause dysarthric like symptoms.
Dysphonia is a hoarseness, weakness or loss of voice. Following a stroke, disease, or trauma to the larynx (the “voice box”), there can be a paralysis of the vocal folds (often called the vocal chords) and weakness of the muscles relating to phonation (making sounds). Voice is powered by air from the lungs, the air passes through the larynx which contains the vocal folds. The vocal folds are 2 folds of muscle that meet together many times per second (approximately 125 per second for men and 210 times for woman) when we want to produce voice. The meeting together of the vocal folds creates the voice which resonates in the back of the throat (pharynx), oral and nasal cavities, and is then shaped into words by the speech muscles, the tongue, lips, facial muscles etc.
Dysarthria and/or dysphonia often occurs following a stroke and can affect a persons ability to speak, or speak clearly and easily. However, through therapy and the use of simple strategies an individual can improve their chances of being understood. For instance, having an awareness of your breathing (to improve volume), using shorter sentences, and emphasizing key words can make differences to intelligibility (how easily you are understood). Using simple communication aids can also give the listener cues and enhance intelligibility. A qualified speech and language pathologist / therapist can provide therapy exercises, help you develop strategies, and give you advice on assistive communication options.
Types of dysarthria
- Ataxic dysarthria can cause poor coordination of the speech muscles meaning that speech and volume is slow, erratic and irregular. Speech maybe explosive and extra stress may be put on syllables.
- Flaccid dysarthria can cause a breathy voice that is often nasal in quality (because of poor control of the soft palate). There is often an obvious paralysis or weakness of the facial muscles.
- Spastic dysarthria can cause a very slow, indistinct, monotone voice, and at times it may seem strained with some sounds being difficult to articulate.
- Hyperkinetic dysarthria presents with a harsh, strained voice.
- Hypokinetic dysarthria presents with a hoarse voice and low volume.
- A Mixed dysarthria can have a mix of the symptoms mentioned above, and will depend on the type of neuron damage as to whether speech is more harsh or breathy.
Muscle Exercises Following a Diagnosis of Dysarthria
There are a wide variety of exercises and approaches, and their use will depend on the severity and location of the brain lesion or the type of disorder causing dysarthria (e.g. cerebral palsy, traumatic brain injury, stroke etc). For instance, with flaccid dysarthria, muscle strengthening exercises may be appropriate, but for dysarthria that presents with increased muscle tone and poor coordination, relaxation exercises may need to be performed.
Breathing exercises may also be helpful, as poor breath control will affect volume and sentence length. Our lungs are the “bellows”, the power source that creates the energy for speech, and our breath has to be powerful enough to produce speech and it also has to be timed correctly.
Compensatory strategies may include, slowing speech (this is probably the most obvious way to become more intelligible), shortening sentence length between breathes, or producing each word, or syllable individually, rather than in a stream of connected speech.
Gesture or visuals
Individuals with speech difficulties can add gesture to their speech to give the listener another cue to help them understand. Have a book or sheet of pictures of common words, or an alphabet chart handy if you cannot make yourself understood. This can help cue people into what you are saying by putting them in the context of your conversation. See our Downloads Section for some printable Picture and Alphabet charts.
Evidence has shown that using an alphabet chart can greatly enhance intelligibility. Not just by spelling out entire words, but by just pointing to the initial letter/sound of a word often cues in the listener to the word you are trying to pronounce. See our Downloads Section for some printable Picture and Alphabet charts.
To see an icommunicate video about using Picture and Alphabet Charts to facilitate communication following a Stroke or Brain Injury, go to our Video Section.
Hi-tech Augmentative / Assistive communication aids
Depending on the degree of your dysarthria, it may be beneficial to use a hi-tech communication device. There are a range of these machines that offer speech output, either by typing your message or accessing visual symbols on a screen via touch or scanning. Lo-tech options such as an E-tram frame and partner assisted scanning can also work well for communication. More recently many individuals have used ipads with communication apps. To read more about assistive communication options go to our Downloads Section, or Assistive Communication Section.
For more information about communication difficulties, and ideas and strategies to help communication, see our Resources, or for specific fact-sheets and picture charts with helpful hints about Stroke and improving communication go to the Downloads Section.
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