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Communication

Dysarthria is impairment of speech production.

  • caused by weakness and paralysis of the lips, facial muscles, tongue, larynx, and pharynx resulting from affected trigeminal, facial, glossopharyngeal, vagus, accessory and hypoglossal cranial nerves
  • weakness of the muscles of respiration will also impact on speech volume
  • impairment of speech production may begin with slurring, hoarseness or weak voice
  • this may progress to total loss of speech (anarthria) (MND Australia 2014)

MND Australia 2014

Management

Dysarthria requires a coordinated, multidisciplinary approach and regular review

  • early referral to a speech pathologist
  • advice on strategies for communication
  • assessment and provision of communication aids and training in their use
  • the speech pathologist will work with an occupational therapist who can advise on seating, positioning, wrist supports, switches, pointers, mobile arm supports and tables, access to communication aids, computers and environmental controls

Emotional response

Difficulties with communication can lead to decreased social interaction and feelings of isolation loss of control, lowered self-esteem and increased vulnerability.

  • speech may become difficult or impossible to understand
  • opinions may be not sought or ignored
  • others may assume deafness or assume intellectual impairment

Additionally, communication aids can cause frustration for both the communication partner and the person with MND.

Depression may be present but can be masked by the progression of the disease and physical changes, and exacerbated by communication difficulties.

Communication support strategies

  • take time to create a relaxed atmosphere
  • encourage the person with MND to slow down speech and carefully articulate words
  • positioning face-to-face, watch lips, eyes, gestures, reduce background noise
  • avoid interruptions or trying to finish sentences
  • encourage writing of key words to augment verbal communication
  • ascertain the individual's own preferred means of communication
  • establish gestures or signals for 'yes' and 'no'
  • ask questions which only need a 'yes/no' answer

Augmentative and assistive communication devices

  • writing, alphabet board, communication chart, perspex eye-gaze frame (ETRAN board)
  • hands-free telephone, telephone typewriter (TTY), call bell, personal alarm
  • laser head pointer, computer software, tablets, eye-tracking devices, Lightwriter

Dysarthria management algorithm (Tomik and Guiloff 2010)

(reproduced with permission)

TomikandGuiloff2010DysarthriaManagement_20100605133853_Resized_20100605133939.jpg

 

Referral Pathways

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Or to search using additional criteria visit Referral Pathways.


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