Speech therapy for children with dysarthria

Cerebral Palsy Alliance offers a specialised service where our speech pathologists work with children and their families to determine whether speech therapy for dysarthria is a good choice.

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Fees will apply for assessment and intervention with a speech pathologist and will depend on the provider and the number of sessions needed. Check with the provider whether fees will also apply for development of a home program, report writing or therapist travel.

Ask the speech pathologist if you are eligible for funding to assist with fees. People with a disability living in Australia may be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Therapy to treat dysarthria will involve the child attending two to three sessions each week with a speech pathologist – for at least six weeks. Parents are expected to attend the sessions so they can learn to carry out a daily home program between the sessions. The home program is essential for children to get the intensive levels of practice they need to improve their speech.

Because of the time involved, participating in dysarthria therapy requires a substantial commitment from families, for both the therapy sessions and the home program. Once therapy is completed, the child will need to continue with their home program on an ongoing basis to maintain their new speaking skills.

Dysarthria occurs when a child with cerebral palsy has difficulty coordinating the muscles they use for speaking and the coordination of their breathing as they talk. It is usually more common, and the person’s speech is more difficult to understand, when the child has severe cerebral palsy.

Children with cerebral palsy can be taught strategies that help improve their speech. Their therapy will focus on improving different components of their speech. The exercises they practice can help them:

• Slow down their rate of speech
• Pause to take a breath at appropriate times in a word or a sentence
• Breathe deeply to increase the length of the speech they can produce using one breath
• Produce clearer voice quality
• Maintain even and appropriate vocal pitch
• Produce accurate speech sounds

As a child’s speech becomes clearer, their intervention will gradually incorporate words and sentences that are longer and more difficult.

The child’s speech pathologist will also consider whether they would benefit from other communication supports, such as alternative and augmentative communication (AAC). For children who are not able to communicate effectively using speech alone, these can supplement and even replace speech.

Examples of alternative and augmentative communication methods include:

• Picture and alphabet boards
• Speech generating devices
• Sign language such as Key Word Sign which is typically used by people with disabilities

These options may be used as a short or long term strategy for a child’s communication, depending on how well they are able to communicate using speech. Alternative and augmentative communication may be the most helpful long term option for some children to enable them to participate in conversations at home, school and in other environments.

• Dysarthria therapy is most suited for children aged three-years-old to 18-years-old with cerebral palsy who have moderate to severe dysarthria and are able to follow instructions. A speech pathologist can offer suggestions for other ways to improve the communication of children who are under three years of age
• To help a child remain motivated with their practice, exciting and interesting activities and toys, including iPad applications, can be useful in speech therapy and home sessions.

A thorough assessment by a speech pathologist is really important to identify the child’s specific communication difficulties. This will help set goals for therapy and ensure the exercises they select are suitable for the child’s ability level. The assessment will also determine how well the child can understand and follow instructions during their therapy. Assessments include:

• Diagnostic Evaluation of Articulation and Phonology (DEAP) - measures and diagnoses a person’s speech errors and disorders
• Goldman-Fristoe Test of Articulation – measures the accuracy of speech sounds

The purpose of using an outcome measure is to determine whether this intervention meets the individual’s needs and goals.

The speech pathologist, together with the child with cerebral palsy and their family, will decide on the most suitable measures to use. One outcome measure that is commonly used is:

• Goal Attainment Scaling (GAS) – this measures the extent to which the child’s goals are achieved. This can also be used to measure change in a child’s ability to be understood in everyday environments.

We searched the medical and allied health literature looking for research published between 1995 and 2015 evaluating the outcomes when children and adolescents with cerebral palsy participated in speech therapy for their dysarthria.

The search was to find the best available research on whether speech therapy for dysarthria improves speech clarity and the ability to participate in everyday communication (this is known as functional communication).

The best available evidence was one systematic review of randomised controlled trials (RCTs)¹. As this systematic review did not locate any RCTs to include, we then searched the literature for lower levels of evidence on this topic. This search revealed four small Level 4 studies^2-5. They included 47 children with cerebral palsy aged five-years-old to 18-years-old. Collectively the studies were classified as low quality of evidence. This is because they were small, low level, and had some inconsistency in the type of therapy and outcome measures used.

Overall, it appears that intensive speech therapy for dysarthria may be effective for helping children with cerebral palsy to be better understood by others they communicate with. Children are more likely to maintain their skills if they continue to practice³, but younger children can maintain their skills up to 12 weeks after an intensive therapy block². Families of children with dysarthria are encouraged to contact a speech pathologist to discuss creating an individualised speech therapy program.

Intensive dysarthria therapy appears to be effective for children with cerebral palsy

Each of the studies used intensive speech therapy, for instance, attending two to five sessions a week for five to six weeks. The studies concluded that these children’s speech was easier to understand after the therapy. For two of the studies^2-3 children’s single words and sentences were more easily understood by people who were used to (familiar listeners) and people who were not used to (unfamiliar listeners) listening to children with dysarthria. A third study found improvements only for single words but not when the children were speaking in sentences⁴.

Changes in intelligibility may be sustained for six weeks and possibly up to 12 weeks

Three studies tested children six to seven weeks after their dysarthria therapy finished. One of these studies found that improvements in intelligibility were not retained after therapy⁴, however the other two larger studies found the improvement was sustained^2-3. One of the studies assessed children 12 weeks after therapy and found that improvements in intelligibility remained³.

The effect of dysarthria therapy on functional communication is unknown

One study³ looked at whether children’s functional communication, or communication participation in everyday life increased. The results are inconclusive. Although their communication participation improved, the improvement was not correlated with increases in intelligibility and therefore may have been due to different factors in the children’s lives.