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The Source® for Dysarthria Second Edition
Ages: Birth-Adult   Grades: Birth-Adult         

This new edition provides a refresher on the neurology of dysarthria as well as current information and lots of helpful tools for assessment, treatment planning, and treatment techniques.

Outcomes

  • Distinguish the types of dysarthria and make appropriate treatment decisions
  • Achieve client goals for respiration, phonation, resonance, articulation, and prosody

 

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The approach is organized around a perceptual framework, meaning it is based on using your listening skills to help make decisions about diagnosis and treatment (in contrast to using instrumental assessment).  The information helps you:

  • understand the interrelationships among respiration, phonation, resonance, articulation, and prosody
  • determine possible causes for the observed symptoms
  • incorporate long-term goals of intelligibility, comprehensibility, efficiency, and naturalness   

The author explains the intricacies of dysarthria evaluation and gives guidelines for a differential diagnosis.  A description of each type of dysarthria includes:

  • possible medical diagnoses
  • associated neurological symptoms and reflexes
  • typical patient complaints
  • tasks to help distinguish the particular type of dysarthria

Updates in this edition include the latest information on:

  • oral-motor exercises—what they do or don't do for improved speech intelligibility
  • instrumentation
  • measuring outcomes of intelligibility, comprehensibility, and efficiency
  • treatment activities for comprehensibility and efficiency
  • coding and billing for treatment
  • dysarthria in children

The book comes with a FREE CD of 120 printable pages (in PDF format) of hands-on therapy tools: 

  • Perceptual Dysarthria Evaluation (adult and pediatric forms) 
  • informal evaluation forms for respiration, phonation, resonance, articulation, and prosody
  • case history form
  • 80 pages of word and sentence lists, reading passages, exercises, and activities to develop respiration, phonation, resonance, articulation, and prosody
  • educational handouts
  • activities for improving intelligibility and comprehensibility

 

Copyright © 2010

Components
168-page book plus a CD of an additional 120 printable pages in PDF format (printable evaluation tools and therapy activities)

This book by Nancy Swigert is easy to follow, practical, and full of great therapy ideas.  The checklists make assessments effortless and the treatment ideas are both fun and functional.  This is my "go to" Source for clients and their families.  Nancy Swigert's work motivates me to be the best clinician I can be.  I am never disappointed with the Source products. 

Cheryl Moyer-Rafferty, SLP
New Milford, CT

  • Effective speech treatment for individuals with dysarthria has been documented through group treatment studies, single-subject studies, and case reports.  Study outcomes measure improvements in:  
    • increased muscle strength and control 
    • improved respiration and phonation for adequate voice 
    • improved consonant precision and intelligibility (ASHA, 2008; Yorkston et al., 2001)
  • Speech production adequacy can improve, often with a focus on the physiological systems of speech (Hanson, Yorkston, & Beukelman, 2004).
  • Speech supplementation strategies (e.g., letter cues, topic cues, gestures) may be useful for speakers with severe or profound dysarthria (Hanson, Yorkston, & Beukelman, 2004).
  • Visibile letter cues improve intelligibility of dysarthric speech (Kentner & Miller, 2009).
  • Listener skills, attitudes, and experiences affect the range of intelligibility for speakers with severe dysarthria. Listeners must be trained as active participants in the communication process (Hanson, Yorkston, & Beukelman, 2004).
  • ASHA's National Outcomes Measurement System (NOMS) shows that outpatient speech therapy services [for dysarthria] are associated with improved intelligibility and communication functioning (ASHA, 2008).

The Source for Dysarthria Second Edition incorporates these principles and is also based on expert professional practice.

References

American Speech-Language-Hearing Association (ASHA). (2008). Treatment efficacy summaries: Dysarthria. Retrieved April 15, 2009, from http://www.asha.org/public/EfficacySummaries.htm

Hanson, E.K., Yorkston, K.M., & Beukelman, D.R. (2004). Speech supplementation techniques for dysarthria: A systematic review. Journal of Medical Speech-Language Pathology, 12(2), ix-xxix.

Kentner, J., & Miller, M. Effects of visible vs. concealed alphabet cues on speech intelligibility in dysarthria. (2009, May). International Journal of Therapy and Rehabilitation, 16(5), 272-279.

Yorkston, K.M., Spencer, K.A., Duffy, J.R., Beukelman, D.R., Golper, L.A., Miller, R.M., et al. (2001). Evidence-based medicine and practice guidelines: Application to the field of speech-language pathology. Journal of Medical Speech-Language Pathology, 9(4), 243-256.

    Author(s)

    Nancy B. Swigert

    Biography

    Nancy B. Swigert, M.A., CCC-SLP, BRS-S, received her master's degree from the University of Tennessee, Knoxville.  She is a board-recognized specialist in swallowing and swallowing disorders.  She is the director of Speech-Language Pathology & Respiratory Care at Central Baptist Hospital in Lexington, Kentucky.  For 26 years prior to that, she was president/founder of Swigert & Associates, Inc., a private practice serving the Central Kentucky area.

    Nancy has authored several publications for LinguiSystems, including The Source for Dysphagia Third Edition, The Source for Pediatric Dysphagia Second Edition, The Source for Children's Voice Disorders, The Source for Reading Fluency, and The Early Intervention Kit.  Nancy is also the author of the LinguiSystems CE course, Changing Behavior to Change the Child's Voice.  In addition, Nancy lectures extensively at the state, regional, and national level on sensorimotor speech disorders and coding and reimbursement.

    Nancy currently serves on the Specialty Board for Swallowing and Swallowing Disorders.  She is the former president of the Kentucky Speech-Language-Hearing Association, the Council of State Association Presidents, the American Speech-Language-Hearing Foundation, and the American Speech-Language-Hearing Association (1998).

    Introduction

    Speech-language pathologists face many challenges when working with patients who present with a dysarthria.

    • There is no such thing as a dysarthria.  There are many different subtypes of dysarthria.
    • Some dysarthrias are caused by an acute event and respond fairly well to treatment, whereas other dysarthrias are related to degenerative diseases and require an entirely different type of intervention.
    • We still lack a significant number of efficacy studies to prove that how we treat patients with dysarthria really works.
    • There are techniques that may help the patient with dysarthria compensate for decreased intelligibility, but it is very difficult to get the patient to use the techniques on a consistent basis.

    Dysarthria is often accompanied by cognitive-communicative deficits that make it difficult for the patient to fully participate in treatment.  If you were in graduate school long ago (with me!), you likely studied Darley, Aronson, and Brown's text (Motor Speech Disorders, 1975), with its classification system of different dysarthrias.  If you're newer to the field, you found similar perceptually-based descriptions in newer texts by Duffy (2005) and McNeil (2009).  Those are excellent texts if you're searching for more detailed information.  It is a challenge to develop skill in differentiating among the types of dysarthria; however, this is an important skill since the treatment varies in relation to the type of dysarthria and its etiology.  The charts in this book will help you with differential diagnosis and treatment planning.

    The Source for Dysarthria was first published in 1997 as a tool to help you improve the services you provide to patients with dysarthria.  After 13 years, it was time for a comprehensive review and update of the book.  Like the original edition, The Source for Dysarthria Second Edition provides a refresher on the neurology of dysarthria as well as tips and techniques for assessing dysarthria and planning treatment.  It is based on a perceptual framework, meaning it is based on refining our listening skills and helping us make decisions about diagnosis and treatment as a result of what we hear rather than on the results of an instrumental assessment (since most of us don't have access to instrumentation when working with patients).  The book will also help you relate perceptual symptoms to specific physiologic causes.

    The Source for Dysarthria Second Edition includes evidence that has emerged since 1997.  In particular, we know a lot more about what oral-motor exercises do or don't do for improved speech intelligibility.  The ambiguity of that research is reflected in this edition.  I also expanded the information on instrumentation since it has improved and is more readily available.  Because of the continued pressure from payers for cost-effective results, with a focus on function, I also added a chapter on Intelligibility, Comprehensibility, and Efficiency to help you put it all together.  Finally, although the physiology, evaluation strategies, and treatment techniques apply to adults and children, I've also added a new chapter on dysarthria in children with evidence to support that population.

    I hope you find this book useful in two ways.  When you encounter an interesting and challenging client, please take The Source for Dysarthria Second Edition from your shelf and look through the chapters on neurology, evaluation, and treatment planning to help you make decisions about the patient's care.  Second, since there are many activities on the enclosed CD for you to use with patients, I hope you will print these pages and take them into your therapy sessions on a regular basis.  They include goals and treatment objectives, descriptions of activities to achieve those treatment objectives, and patient handouts.  New to this edition are activities for comprehensibility and efficiency, which are also included on the CD.

    It takes great skill on the part of a speech-language pathologist to accurately evaluate a patient with dysarthria, make an appropriate diagnosis, plan the kind of intervention needed, establish a prognosis, and choose treatment objectives and activities that will help the patient achieve the goals you have set.  I hope The Source for Dysarthria Second Edition will help you refine your skills in each of those areas.

    Nancy