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The primary source of treatment and assistance for people with speech disorders will be from a speech and language therapist, who will usually be based at a local hospital or rehabilitation unit. They may also be accessed via your GP or local community clinic. The therapist’s aim will usually be to make speech as understandable as possible. They will begin by making a detailed assessment of the person’s speech and will then decide what can be done to improve things for them.

Speech and language therapy assessment
Assessment is very important. Firstly, it can help the doctors in their diagnosis of the person’s neurological disorder because certain patterns of speech impairment are characteristic of certain diseases. Secondly, the assessment provides a yardstick with which to measure any change. Thirdly, an assessment enables the therapist to identify the person’s strengths and weaknesses, which is vital for planning the best way to treat them.

The most important aspect of assessment is talking and listening to the patient. The speech and language therapist has a highly trained ear and just by listening to someone speak he or she will develop a good idea as to what might be going wrong. In addition, they can get a clear idea as to the level of speech intelligibility, i.e. the degree to which others can understand their speech. Intelligibility gives the therapist an indication of the disability the person is experiencing, that is the impact the dysarthria or dyspraxia is having on their everyday lives. The therapist will ask the person and their family about how well they can communicate in different situations. They will also want to talk to them about how their lifestyle is being affected. Some people find their speech difficulty harder to cope with than others do. This often depends on lifestyle, personality and expectations. The other important aspect of the speech and language therapist’s assessment will be to evaluate how the actual mechanism of speech production has been affected. Such an assessment will often be tape-recorded.

Minimising the effects of dysarthria
As with other aspects of neurological disability, speech symptoms are often not fully reversible, and so the aim of speech and language therapy for people with dysarthria will rarely be to regain ‘normal’ speech. Instead, the speech and language therapist aims to minimise the effects of the dysarthria.

The approach the speech and language therapist takes will often depend on the nature of the neurological disease and the severity of the dysarthria. In addition, the motivation of the person, the support they have from others and their concentration and memory abilities will all be considered.

Speech difficulties resulting either from rapidly progressive neurological diseases or the later stages of slowly progressing neurological diseases are unlikely to benefit a great deal from speech exercises. When working with people in this situation, the speech and language therapist will be far more likely to advise them and their families on how to cope with their dysarthria. Their main aim here will be to help them adapt to and compensate for speech difficulties. This might involve reducing background noise, encouraging the use of shorter phrases or spelling out difficult words.

The therapist will also advise the family on how they can help the person to communicate. They may be able to lend the person an amplifier to make their speech louder. Where appropriate, communication aids may be introduced. These range from high-tech machines that can be used with just the blink of an eye to a simple alphabet chart for spelling out words. The speech and language therapist will work closely with the occupational therapist to ensure the person can use the appropriate aid as well as possible.

Dysarthria can be so severe that speech is either impossible or almost unintelligible. This level of severity may be found at an early stage in the recovery process, but if the person’s speech has remained severely affected for many months it is unlikely that any major change will take place. It may also be found in the latter stages of some progressive disorders, such as motor neurone disease. The therapist tends to work within the capabilities that the patient has got, primarily aiming to help them adapt to their limitations and use their abilities to the full.

If some limited speech is possible, some of the same strategies as those used for people with progressive disorders will also be introduced. For example, spelling out key words can be helpful since letter names are short and relatively easy to say. Most importantly, devices to help communication can be provided. An alphabet chart can be invaluable. The person may be able to point out the letters themselves or the listener can use it to run through the alphabet until the person indicates that they have reached the right letter. Spelling the whole word or simply indicating the first letter can be very helpful in aiding understanding. More sophisticated machines that can store whole phrases and produce synthesised speech are also available (see Figure 2 on page 18 of printed booklet or the pdf version). To be successful in people with progressive disorders, these communication aids or strategies need to be introduced early.

For people with moderate dysarthria, speech is usually good enough to be the main form of communication, but it can nevertheless be difficult to understand. The speech and language therapist’s approach, in addition to encouraging the sorts of methods described above, is more likely to be aimed at improving the intelligibility of the person’s speech. This may be achieved by improving underlying impairments, such as breath control or articulation, or by teaching the person to make better use of the abilities they have, for example by slowing down their rate of speech. By improving intelligibility the impact of dysarthria on their life will hopefully be reduced.

Some people experience only mild dysarthria, whereby speech is more or less fully intelligible, but may be perceived by the speaker and listeners as unnatural or unacceptable. It must be remembered that even mild speech impairments such as slow or laboured speech and reduced intonation can be very handicapping for some people. The speech and language therapist will work with these people to try and make their speech sound more natural.

Because the effect of dysarthria on a person’s lifestyle is often tied up with the environment they live or work in, the speech and language therapist may need to work with the people they talk to most. The therapist will also work on building up the person’s self-confidence and may include them in a group with people with similar difficulties or set tasks for them to achieve in their own community. Nevertheless, adjusting to disabilities and handicaps is the most difficult stage for many people.

The psychological impact of any disability can be devastating. Although the speech and language therapist will do their best to offer support to the person and their family, it may be that more specialised help is required in the form of counselling. Unfortunately, very little counselling is available within the NHS, but some charities may be able to provide help. Charities can provide people with invaluable support in lots of other ways too.