Dysarthria: Living with this communication disorder after stroke or brain injury

Dysarthria is a type of communication disorder, often caused by brain injury or stroke, that result in problems in the muscles used for speaking, including the lips, tongue, throat, vocal cords and diaphragm. What is a common reaction to those living with dysarthria? “I Don’t Understand You.”

What is the definition of dysarthria?

Dysarthria does not affect your ability to find the words you want to say, nor to understand others, nor ability to remember, nor to think. It is the outward communication that is impacted.

The Journal of Communication Disorders suggests that between 10% to 65% of individuals with TBI (traumatic brain injury) may experience dysarthria.

Your doctor or clinician may use one of these terms to describe your particular type of dysarthria:

• Flaccid dysarthria is associated with lower motor neuron impairment in your brain.
• Spastic dysarthria is associated with damaged upper motor neurons linked to the motor areas of the cerebral cortex.
• Ataxic dysarthria is primarily caused by cerebellar dysfunction.
• Hyperkinetic dysarthria and hypokinetic dysarthria are related to disorders of motor activity descending from the cortex to the spine.
• Mixed dysarthria is combinations of the above dysarthrias.

Dysarthria is different from aphasia in that it is a motor speech disorder impacting speech; language comprehension skills are typically not affected as they are with aphasia.

What causes dysarthria?

Damage to your brain causes this disorder, whether it occurs at birth or after a neurological illness or injury. The following can cause dysarthria:

• Stroke
• Brain injury
• Multiple sclerosis
• Parkinson’s disease
• Cerebral palsy
• Amyotrophic lateral sclerosis, or ALS
• Muscular dystrophy
• Huntington’s disease

How does dysarthria affect my speech?

If you have dysarthria, your voice may sound different and you may have difficulty speaking clearly. Other people may find your voice hard to understand. There are several systems involved in speaking. They are articulation, phonation, resonance, respiration, and prosody and all of them can be affected. 

Here are some symptoms, depending on which system is affected:

• Articulation: Your speech sounds slurred or imprecise.
• Phonation: Your voice quality sounds different. It may sound quiet, strained, strangled, breathy, hoarse, or harsh.
• Resonance: Your voice may sound nasal or hyponasal.
• Respiration: You may have difficulty getting good breath support while speaking, resulting in a quiet voice, talking on inhalation, or only getting a few words out before needing to breathe again.
• Prosody (intonation): Your voice may sound monotone, speaking rate may be too fast or too slow, or you may have uneven stress on words or rhythm of your speech.

What are the emotional and psychological side effects?

Dysarthria can cause affected individuals to lose confidence when talking. As a consequence, you might avoid social interactions and become even more isolated. But try not to do this.

A study published in The Journal | Disability and Rehabilitation found that “dysarthria can negatively impact speakers’ lives. Findings suggested that the experience of living with dysarthria is highly individual, but with common perspectives – six key themes emerged from interviews: ‘dysarthria as only part of the picture,’ ‘communication has changed,’ ‘people treat me differently,’ results in negative emotions,’ ‘barriers to communication’ and ‘life is different now.”

As one individual with dysarthria said: “Dysarthria is imprisoning, limiting my life to the people and places that I know. I would no more engage in a new friendship or relationship than fly. Dysarthria has robbed me of the confidence to try.”

How is dysarthria treated?

Given how dysarthria can impact daily life, getting speech-language therapy after stroke or brain injury is critical. Therapy can encourage individuals to use speech more effectively, increase the range and consistency of sound production, and learn strategies for improving intelligibility and communicative effectiveness.

One example of intensive speech therapy for dysarthria associated with Parkinson’s disease is called LSVT LOUD. It focuses on helping individuals increase speech intelligibility. Another example of speech therapy is working on strategies to improve speech intelligibility, such as slowing down, speaking more loudly, and increasing articulatory precision.

The Speaking category of Tasks in the Constant Therapy app are designed to help improve word retrieval, motor planning, and speaking skills. But you can target speech goals with any of the 15 Constant Therapy speaking tasks.  At the word level, you can choose from tasks like Repeat numbers, Name pictures, and Imitate words.

If you are practicing speech intelligibility at the sentence level, you can choose from tasks like Read active sentences aloud, Remember and say numbers, or Imitate passive sentences. Constant Therapy shows a loudness gauge so that you monitor how loud you are speaking.  You can get feedback by listening to your recording, and try again if needed.

Tips for talking to someone who has dysarthria

• Talk to them in a quiet area with good lighting.
• Communicate face to face if possible. Watch them as they talk. Face-to-face is much easier than talking from another room or on the phone.
• Pay attention to them when they talk.
• Let them know when you have trouble understanding. Don’t pretend to understand them.
• If you still don’t understand them, ask yes or no questions. Or, ask them to point or write down what they are saying.

References

• Handbook of Clinical Neurology – Disorders of Communication: Dysarthria
• Journal | Disability and Rehabilitation, The impact of stroke-related dysarthria on social participation and implications for rehabilitation
• NIH: Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury
• Journal of Communication Disorders | Dysarthria associated with traumatic brain injury: speaking rate and emphatic stress
• American Stroke Association