Lost for words: developing treatment for dysarthria

by Margo White / 17 March, 2012
Speech therapists turn to helping listeners rather than the speech-impaired.

The late author and commentator Christopher Hitchens wrote last year about what it was like to lose his voice after oesophageal cancer ravaged his vocal cords.

“Deprivation of the ability to speak is more like an attack of impotence, or the amputation of part of the personality. To a great degree, in public and private, I ‘was’ my voice.”

People who suffer neurological damage can have an intact voice box, but might have difficulty controlling or co-ordinating the muscles required to speak. Their speech can become slurred and difficult to understand.

This is called dysarthria; although people who have it may have lost the ability to clearly articulate what they want to say, their ability to think in grammatically correct sentences remains intact.

“The ability to communicate lies at the heart of what it is to be human,” says speech-language therapist and researcher Stephanie Borrie. “To be able to express your thoughts and feelings and respond to people is fundamental to virtually all aspects of life, so the impact of a speech disorder can be devastating.”

The traditional approach to treating such speech impairments is to train the patients to speak better. The Lee Silverman Voice Treatment Programme, for instance, aimed at people with Parkinson’s disease, encourages people to “think loud” and increase the volume of their speech.

It has had considerable success, but the programme requires intensive training and may not be suitable for many – either because it’s too expensive or hard to access, or because the disease might be too advanced for such an intervention to be effective.

Borrie, however, is investigating a novel approach to what is becoming an increasingly common communication problem. Rather than focusing on the patient with dysarthria, her research examines the potential for treatments to target the partners and caregivers of patients, essentially training them to better understand dysarthric speech.

The 27-year-old first read about this listener-focused approach while she was working at Whangarei Hospital, where she was frustrated by the limitations of what she could offer some of her patients.

Dysarthria, she notes, is often associated with fatigue, and/or a range of physical, cognitive and memory deficits that can make it difficult for the patient to learn something new. “I would see the patient and they would be exhausted, or struggling with side effects of medication.

There would be all sorts of issues that would affect their ability to benefit from speech treatment.” At the time, Julie Liss of Arizona State University was investigating how listeners process different types and severities of dysarthria, with the aim of developing a dysarthria-specific intervention model that incorporates the listener. As Borrie notes, speech intelligibility isn’t exclusively the preserve of the speaker, but is also about the ability of the listener to recover the message.

Inspired by Liss’s ideas, Borrie returned to the University of Canterbury’s Department of Communication Disorders to complete her PhD with primary supervisor Megan McAuliffe. Her research established strong empirical evidence that listeners could significantly improve their ability to understand dysarthric speech, reporting a 20% gain following a single training session.

Her research also examined the cognitive-perceptual mechanisms (including speech properties such as sounds and intonation patterns) that underlie improved understanding. Her work has been published in the Journal of Speech,
Language, and Hearing Research and Language and Cognitive Processes in the US.

At the time of writing Borrie was, thanks to a postdoctoral fellowship from the New Zealand Neurological Foundation, about to board a plane for Phoenix, Arizona, where she will spend two years at the state university’s Department of Speech and Hearing Sciences, and the Mayo Clinic at nearby Scottsdale.

She will work with Liss on the development of this novel treatment for those affected by dysarthria. She agrees that in many instances people may learn to understand the idiosyncratic speech patterns of their loved ones or their patients on their own, but it usually takes time. “And what if we could intensively train a person so that instead of taking three to four months to adapt, we could train them to do so in a week? For people who have had a stroke or Parkinson’s disease, this time can be critical.”

If it stacks up as a therapeutic tool, it would be both economic and efficient. “And it empowers the family. Most of the time people really want to be part of the rehabilitation process, they want to help their spouse or their loved one improve. To be able to say, ‘Here’s something you can do’ … well, I think it would be wonderful.”


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