Dysarthria refers to a group of neurogenic speech disorders characterized by “abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production” (Duffy, 2020, p. 3).

These changes are due to one or more sensorimotor problems, including weakness or paralysis; incoordination; involuntary movements; or excessive, reduced, or variable muscle tone (Duffy, 2020). Dysarthria can adversely affect intelligibility of speech and/or naturalness of speech. Dysarthria may also co-occur with other neurogenic language, cognitive, and swallowing disorders.

The predominant framework for differentially diagnosing dysarthria is based on a perceptual method of classification (Darley et al., 1969a, 1969b, 1975). This method primarily relies on the auditory perceptual attributes of speech that point to the underlying pathophysiology. The perceptual attributes are used to characterize the dysarthrias and, along with pathophysiological information, can help identify an underlying neurologic illness.

The primary types of dysarthria identified by perceptual attributes and the associated localization of pathophysiology (Duffy, 2020) are as follows:

• Flaccid—associated with disorders affecting the lower motor neuron pathways and motor units.
• Spastic—associated with bilateral disorders of the upper motor neuron system.
• Ataxic—associated with disorders of the cerebellar control circuit.
• Hypokinetic—associated with disorders of the basal ganglia control circuit.
• Hyperkinetic—associated with disorders of the basal ganglia control circuit.
• Unilateral upper motor neuron—associated with unilateral disorders of the upper motor neuron system.
• Mixed—various combinations of dysarthria types (e.g., spastic–ataxic, flaccid–spastic).
• Undetermined—Perceptual features are consistent with a dysarthria but do not clearly fit into any of the identified dysarthria types.

For perceptual attributes associated with specific types of dysarthria, please see Distinguishing Perceptual Characteristics and Physiologic Findings by Dysarthria Type.

Incidence is the number of new cases of a disorder or condition identified in a specific time period. Prevalence is the number of individuals who are living with the disorder or condition in a given time period. Dysarthria is present in many neurologic diseases. As such, its incidence and prevalence vary based upon the nature and course of the underlying condition; condition severity; and location of lesion, if present. Estimates of dysarthria prevalence in adults secondary to these neurologic conditions are as follows:

• Huntington’s disease: Estimates suggest that 78%–93% of people with Huntington’s disease have dysarthria (Novotný et al., 2016; Rusz et al., 2014).
• Multiple sclerosis: Between 40% and 51% of individuals with multiple sclerosis are diagnosed with dysarthria at some point during the course of their disease (Danesh-Sani et al., 2013; Hartelius et al., 2000; Yorkston et al., 2010).
• Neuromuscular disease (e.g., myasthenia gravis, amyotrophic lateral sclerosis, muscular dystrophy): Approximately 26%–62% of individuals with neuromuscular disease experience dysarthria during the course of their disease (Elliott et al., 2020; Knuijt et al., 2014; Traynor et al., 2000).
• Nonfluent variant primary progressive aphasia (nfvPPA): It is estimated that the prevalence of dysarthria in individuals with nfvPPA is approximately 18%–60% (Duffy et al., 2014; Poole et al., 2017).
• Parkinson’s disease: It is estimated that dysarthria affects approximately 44%–88% of individuals with Parkinson’s disease (Müller et al., 2001; Perez-Lloret et al., 2012; Rusz et al., 2022; Schalling et al., 2017; Steurer et al., 2022).
• Stroke: It is estimated that 22%–58% of individuals with acute stroke present with dysarthria (De Cock et al., 2021; Flowers et al., 2013; Safaz et al., 2016; Stipancic et al., 2019; Vidović et al., 2011).
• Traumatic brain injury: Approximately 30%–86% of individuals with acute to subacute traumatic brain injury experience dysarthria (Safaz et al., 2008; Stubbs et al., 2018).

Signs and symptoms of dysarthria include perceptual speech characteristics and physical signs that vary by dysarthria type (see Distinguishing Perceptual Characteristics and Physiologic Findings by Dysarthria Type). Dysarthria can alter speech intelligibility and/or speech naturalness by disrupting one or more of the five speech subsystems—respiration, phonation, articulation, resonance, and prosody.

Perceptual Speech Characteristics

Perceptual speech characteristics are grouped below by the subsystem that contributes most to the feature; however, subsystems associated with some characteristics can vary based on the individual. For example, reduced loudness may be a laryngeal problem for some individuals and a respiratory problem for others. In addition, due to the interactive nature of the speech subsystems, disruptions in one subsystem can have an impact on others. For example, impairments in respiration, phonation, articulation, and/or resonance may be responsible for prosodic deficits.

Respiration (Breathing)

• short phrases
• reduced loudness
• monoloudness
• excessive loudness variation
• loudness decay
• forced expiration/inspiration

Phonation (Laryngeal)

• pitch level (higher or lower than baseline)
• monopitch
• pitch breaks
• atypical voice quality (roughness, breathiness, strain; harshness, hoarseness, strain)
• diplophonia
• vocal flutter
• voice tremor
• reduced control of voice onset and offset
• devoicing
• audible inhalation/inhalatory stridor

Articulation

• imprecise consonants
• distorted vowels
• irregular articulatory breakdown
• articulatory blurring

Resonance (Velopharyngeal)

• hypernasality
• denasality or hyponasality (oral resonance on nasal consonants)
• audible nasal emission/nasal snort

Prosody

• atypical rate (faster or slower than baseline, limited control)
• short rushes of speech
• reduced stress
• excessive and equal stress
• prolonged intervals
• atypical silences
• atypical intonation

Physical Signs

Physical signs in the articulatory structures (e.g., head, jaw, lip, tongue) may include the following:

• muscle wasting
• abnormal muscle tone at rest
• fasciculations
• tremors
• weakness
• involuntary movements
• abnormal reflexes (e.g., hypo- or hyperactive gag reflex, jaw jerk, sucking or snout reflexes)
• decreased muscular range of motion
• mucosal membrane changes

Many neurologic illnesses, diseases, and disorders—both acquired and congenital—can cause dysarthria. Listed below are examples of some specific etiologies, grouped into broad categories (Duffy, 2020).

• Congenital—cerebral palsy, Chiari malformation, congenital suprabulbar palsy, syringomyelia, syringobulbia
• Degenerative diseases—amyotrophic lateral sclerosis, Parkinson’s disease, progressive supranuclear palsy, cerebellar degeneration, corticobasal degeneration, multiple system atrophy, Friedreich’s ataxia, Huntington’s disease, olivopontocerebellar atrophy, spinocerebellar ataxia, ataxia telangiectasia
• Demyelinating and inflammatory diseases—multiple sclerosis, encephalitis, Guillain-Barré and associated autoimmune syndromes, meningitis, multifocal leukoencephalopathy
• Infectious diseases—COVID-19, acquired immune deficiency syndrome (AIDS), Creutzfeldt-Jakob disease, herpes zoster, infectious encephalopathy, central nervous system tuberculosis, poliomyelitis
• Neoplastic diseases—central and peripheral nervous system tumors; cerebral, cerebellar, or brainstem tumors; paraneoplastic cerebellar degeneration
• Other neurologic conditions—hydrocephalus, Meige syndrome, myoclonic epilepsy, neuroacanthocytosis, radiation necrosis, sarcoidosis, seizure disorder, Tourette syndrome, chorea gravidarum
• Toxic/metabolic diseases—botulism, carbon monoxide poisoning, central pontine myelinolysis, heavy metal or chemical toxicity, hepatocerebral degeneration, hypothyroidism, hypoxic encephalopathy, lithium toxicity, Wilson’s disease
• Trauma—traumatic brain injury, chronic traumatic encephalopathy, neck trauma, neurosurgical/postoperative trauma, skull fracture
• Vascular diseases—stroke (hemorrhagic or nonhemorrhagic), moyamoya disease, anoxic or hypoxic encephalopathy, arteriovenous malformations

Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with dysarthria. The professional roles and activities in speech-language pathology include clinical services (diagnosis, assessment, planning, and treatment); counseling, education, administration, and research; and prevention and advocacy. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).

The following roles fall within the scope of practice for SLPs:

• Screen individuals who present with possible dysarthria and determine the need for further assessment and/or referral to other services.
• Conduct a comprehensive, culturally and linguistically responsive assessment of speech and communication in the context of the individual’s unique complaints and functional needs.
• Diagnose the presence of dysarthria and establish its severity, characteristics, and functional impact.
• Refer to, and collaborate with, other professionals to determine the etiology of dysarthria, if not already known, and to facilitate access to comprehensive services.
• Determine probable prognoses for improvement and progression of the dysarthria.
• Collaborate and consult with the patient, family, care partners, and interprofessional teams to make decisions about the management of dysarthria, facilitate program development, and/or provide expert testimony. See ASHA’s resources on focusing care on individuals and their care partners and interprofessional education/interprofessional practice (IPE/IPP).
• Develop culturally and linguistically responsive treatment plans, provide intervention and support services, document progress, and determine appropriate service delivery approaches and dismissal criteria (or discharge recommendations).
• Counsel people with dysarthria, their families, and their care partners regarding communication-related issues and provide education aimed at maximizing quality of life and/or preventing further decline and complications related to dysarthria.
• Provide information on prevention and maintenance to individuals and groups known to be at risk for etiologies associated with dysarthria, as well as to individuals working with those at risk.
• Advocate for individuals with dysarthria and their care partners at local, state, and national levels.
• Educate other professionals on dysarthria, the needs of persons with dysarthria, and the role of SLPs in meeting those needs.
• Remain informed of research in the area of dysarthria (including professional development) to help advance the knowledge base related to the nature and treatment of this disorder and use evidence-based practice to guide intervention.

As stated in the Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so. SLPs who diagnose and treat dysarthria must possess skills in the differential diagnosis and management of motor speech disorders. They must have specialized knowledge of the following:

• neuroanatomy and neural functions related to craniofacial, laryngeal, and respiratory musculature and how they interact during speech production
• how each subsystem (articulation, phonation, respiration, resonance, and prosody) can contribute to the perception of normal or abnormal speech
• the principles of speech motor control and motor learning
• appropriate evidence-based assessment and intervention techniques

Screening

Screening for dysarthria is pass/fail and identifies the need for further assessment. Screening may also result in referral for other examinations or services. It does not provide a diagnosis or a detailed description of the severity and characteristics of speech deficits associated with dysarthria.

Dysarthria Assessment

An SLP conducts the assessment of individuals with suspected dysarthria using both standardized and nonstandardized measures. See ASHA’s resource on assessment tools, techniques, and data sources for more information.

The goals of dysarthria assessment are to

• describe perceptual characteristics of the individual’s speech and relevant physiologic findings;
• describe speech subsystems affected (i.e., articulation, phonation, respiration, resonance, and prosody) and the severity of impairment for each;
• identify other systems and processes that may be affected (e.g., swallowing, language, cognition); and
• assess the impact of the dysarthria on speech intelligibility and naturalness, communicative efficiency and effectiveness, and social participation.

See Duffy (2020) and Freed (2020) for examples of dysarthria assessment procedures.

The severity of the disorder does not necessarily determine the degree of disability. Speech-related disability will depend on the communication needs of the individual, the perceived impact of the disorder, and the comprehensibility of their speech in salient contexts.

Consistent with the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016; WHO, 2001), the assessment identifies and describes

• impairments in body structure and function, including underlying strengths and weaknesses in speech production and verbal/nonverbal communication;
• the individual’s limitations in activity and participation, including functional status in communication, interpersonal interactions, self-care, and learning;
• contextual (environmental and personal) factors that serve as barriers to, or facilitators of, successful communication and life participation; and
• the impact of communication impairments on quality of life and functional limitations relative to the individual’s premorbid social roles and abilities and the impact on their community.

See Person-Centered Focus on Function: Dysarthria [PDF] for an example of assessment data consistent with the ICF.

Typical Components of the Dysarthria Assessment

The assessment section below is not prescriptive; it outlines the components of a comprehensive evaluation. Some components may not be applicable in all clinical settings.

Case History

Components of case history include the following:

• Medical diagnosis and history, including
• etiology of dysarthria, if known;
• onset and course of symptoms;
• associated deficits (e.g., language, cognitive communication, swallowing);
• medical procedures, hospitalizations, and prior treatments and their outcomes;
• other medical and rehabilitation specialty referrals and interventions and their outcomes; and
• medications and potential side effects/symptoms.
• Review of auditory, visual, motor, cognitive, language, literacy, and mental health status.
• Education, vocation, cultural and linguistic backgrounds, and social determinants of health. See ASHA’s resource on social determinants of health.
• Patient and family report, including
• awareness, observations, and perspectives;
• person-specific communication needs; and
• the impact of the presenting problem on activities, participation, and overall quality of life.
• Identification of facilitators of and barriers to communication, such as
• variation in effort for speaking in different contexts (e.g., when fatigued, at different times of day, relative to medication schedule);
• adaptability in different communication contexts (e.g., in noisy environments, with distractions, with multiple communication partners, with unfamiliar listeners, with personal protective equipment); and
• emotional adaptation (e.g., not wanting to communicate due to listener perception and resulted frustration).

Nonspeech Examination

This is an assessment of speed, strength, range, accuracy, coordination, and steadiness of nonspeech movements as well as an assessment of the speech subsystems using objective measures, as available. The following are typically included:

• completion of a cranial nerve exam to assess facial, oral, velopharyngeal, and laryngeal function and symmetry
• observation of dentition, appearance of oral mucosa, and secretion management
• observation of facial and neck muscle tone—at rest and during nonspeech activities (Clark & Solomon, 2012)
• assessment of sustained vowel prolongation—to determine if there is adequate pulmonary support and sufficient laryngeal valving for phonation
• assessment of alternating motion rates and sequential motion rates or diadochokinetic rates—to judge speed and regularity of jaw, lip, and tongue movement and, to a lesser extent, articulatory precision (see Kent et al., 1987)
• assessment of overall body posture and breathing pattern

Speech Production

A clinician uses auditory-perceptual approaches in addition to standardized assessments to evaluate speech production (Pernon et al., 2022). The type of speech sampling used in the auditory-perceptual assessment varies based on the areas that the clinician wants to evaluate. Speech sampling can include

• single-word, phrase-length, and sentence-length material of low semantic predictability that is unknown to the listener;
• words that provide a sampling of most of the phonemes; and/or
• connected speech (reading and/or spontaneous speech).

A speech production evaluation targets the following areas:

Phonation—the ability to voice phonemes using vocal fold vibrations in the larynx (Freed, 2020). Atypical vocal quality (e.g., breathy, harsh, strained) and difficulty changing loudness and pitch can indicate neuromotor damage to the phonatory system. See ASHA’s Practice Portal page on Voice Disorders.

Articulation—a combination of appropriate timing, direction, force, speed, and placement of the articulators (Freed, 2020). The following articulation tasks can also reveal diagnostic information:

• Stress testing—2 to 4 minutes of reading or speaking aloud to assess deterioration over time (can use spontaneous conversation, reading text aloud, or counting).
• Repetition of simple and complex multisyllabic words and sentences—to determine if apraxia of speech (AOS) is present and assess motor speech planning or programming. See ASHA’s Practice Portal page on Acquired Apraxia of Speech.

Prosody—use of variations in pitch, loudness, and duration to convey emotion, emphasis, and linguistic information (e.g., meaning, sentence type, syntactic boundaries); speech naturalness reflects prosodic adequacy. Targeted prosodic tasks include asking and answering questions, contrastive stress tasks, and reading statements using prosodic variation to express different emotions.

Speech intelligibility—the degree to which the listener (familiar or unfamiliar) understands the individual’s speech signal. Intelligibility and comprehensibility are typically reported as a percentage of words correctly identified by a listener.

• Comprehensibility—the degree to which the listener understands the spoken message, given other information or cues (e.g., topic, semantic context, gestures, facial expressions) to enhance communication. The speaker’s use of comprehensibility strategies or the stimulability/potential to adopt these strategies can also be assessed during these tasks.
• Efficiency—the rate at which intelligible or comprehensible speech is communicated, typically reported as the number of intelligible or comprehensible words per minute. Sentences are transcribed by a rater, and the number of correct words per minute is computed.

Additional areas of assessment may include the following:

• Language—assess receptive and expressive language skills in oral and written modalities to help distinguish between dysarthria and aphasia. All languages that the individual speaks should be assessed. See ASHA’s Practice Portal page on Aphasia.
• Cognitive-communication—identify aspects of verbal or nonverbal communication that may be affected by disruptions in cognition (e.g., attention, memory, organization, executive function, level of alertness).
• Swallowing—assess swallowing function. See ASHA’s Practice Portal page on Adult Dysphagia.
• Fluency—assess for stuttering and cluttering. See ASHA’s Practice Portal page on Fluency Disorders.

Assessment may result in the following outcomes:

• Diagnosis of dysarthria and classification of dysarthria type.
• Clinical description of the dominant auditory-perceptual speech characteristics and the severity of the disorder.
• Presence of comorbid conditions, including AOS, aphasia, cognitive-communication disorder, or swallowing disorder.
• Statement of prognosis and recommendations for intervention related to overall communication adequacy.
• Development of an intervention or management plan (in collaboration with the patient, care partner, and rehabilitation team), including augmentative and alternative communication, as appropriate. See ASHA’s Practice Portal page on Augmentative and Alternative Communication.
• Identification of relevant follow-up services, including support for individuals with dysarthria.
• Referral to other professionals as needed, such as a prosthodontist for palatal lift candidacy, a neurologist for diagnosis of an underlying etiology, a surgeon for implanting a diaphragmatic pacer, or a physical therapist or an occupational therapist for seating and positioning.

Differential Diagnosis

*See the Distinguishing Dysarthria From AOS and Distinguishing Dysarthria From Aphasia sections below for further details.

Please note that the chart above does not capture all the nuances of differential diagnosis of dysarthria. The information below may further clarify this subject.

Differentiating Among Dysarthria Types

Given the overlap in speech characteristics and other deficits across the dysarthrias, it may be difficult to determine dysarthria type (Fonville et al., 2008; Van der Graaff et al., 2009; Zyski & Weisiger, 1987). However, accurate differentiation supports treatment planning and can assist in the physician and medical team’s efforts to determine an underlying diagnosis if it is not known. See Distinguishing Perceptual Characteristics and Physiologic Findings by Dysarthria Type.

Distinguishing Dysarthria From AOS

Listed below are characteristics and comparisons often used to distinguish dysarthria from AOS. Some dysarthria types (e.g., ataxic, hyperkinetic, and unilateral upper motor neuron) share some characteristics with AOS and can be difficult to distinguish (Bislick et al., 2017; Duffy, 2020).

• Muscle weakness or spasticity is present in several dysarthria types; AOS does not present with muscle weakness or spasticity unless there is a concomitant dysarthria.
• Several subsystems can be affected in dysarthria—unlike AOS, which is predominated by articulatory and prosodic deficits.
• In contrast to AOS, dysarthric speech may present with more consistent error patterns and is generally not influenced by automaticity of speech production, stimulus modality, and linguistic variables (Duffy, 2020).
• Other apraxic speech characteristics, such as a larger variety of articulatory errors and groping for articulatory postures, are typically not seen in dysarthria.
• Poorer performance on sequential motion rates than on alternating motion rates in AOS may distinguish it from ataxic dysarthria (Duffy, 2020).

For more information about AOS, see ASHA's Practice Portal page on Acquired Apraxia of Speech.

Distinguishing Dysarthria From Aphasia

Aphasia affects language comprehension and expression; dysarthria affects only speech production. Dysarthria can significantly compromise speech intelligibility and speech naturalness; however, delays during speech and/or attempts by the speaker to revise content might indicate language expression problems associated with aphasia. In such cases, it may be necessary to assess written language expression and oral and written language comprehension to make a definitive diagnosis. If deficits are found in these modalities, it is likely that language problems are contributing to verbal expression difficulties (Duffy, 2020). For more information about aphasia, see ASHA’s Practice Portal page on Aphasia.

Cultural and Linguistic Factors

When selecting screening and assessment tests, the SLP considers the influence of cultural and linguistic factors on the individual’s communication style and the potential impact of impairment on function. Variations in dialect and accent are taken into consideration before marking phonemes in error if they were not part of the client’s repertoire or dialect prior to injury or disease.

The assessment is conducted in the language(s) used by the person with dysarthria, with the use of interpretation services as necessary. Some structural impairments may have a more significant impact on intelligibility of some languages than others (e.g., tonal languages, languages where aspiration of stops and nasality of vowels impact meaning). See ASHA’s Practice Portal pages on Cultural Responsiveness; Collaborating With Interpreters, Transliterators, and Translators; and Multilingual Service Delivery in Audiology and Speech-Language Pathology.

Appropriate accommodations and modifications must be made to the testing process to reconcile cultural and linguistic variations. Comprehensive documentation includes descriptions of these accommodations and modifications. Dynamic assessment is an alternative to standardized testing, when appropriate. See ASHA’s resource on dynamic assessment.

The clinician considers how changes in resonance and respiratory support impact the ability to produce a voice that is congruent with gender and gender expression. See ASHA’s Practice Portal page on Gender Affirming Voice and Communication.

Treatment is individualized to address the specific areas of need identified during assessment. It is provided in the language(s) used by the person with dysarthria—either by a bilingual SLP or with the use of trained interpreters, when necessary. See ASHA’s Practice Portal page on Collaborating With Interpreters, Transliterators, and Translators.

Consistent with the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework (World Health Organization, 2001), the goal of intervention is to help the individual achieve the highest level of independent function for participation in daily living.

Intervention is designed to

• capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication across partners, activities, and settings;
• optimize the retention of new motor skills by implementing principles of motor learning (Maas et al., 2008);
• facilitate the individual’s activity and participation by (a) teaching new skills and compensatory strategies to the individual with dysarthria and their partner(s) and (b) incorporating augmentative and alternative communication (AAC) strategies if appropriate; and
• modify contextual factors that serve as barriers to and enhance the factors that facilitate successful communication and participation, including development and use of appropriate accommodations.

See Person-Centered Focus on Function: Dysarthria [PDF] for an example of functional goals consistent with the ICF.

Treatment Approaches

Dysarthria treatment focuses on facilitating the efficiency, effectiveness, and naturalness of communication (Rosenbek & LaPointe, 1985; Yorkston et al., 2010) and supporting functional communication between the speaker and their listeners.

Restorative interventions maximize intelligibility by addressing the function of the speech production subsystems. Restorative approaches focus on improving

• speech intelligibility,
• prosody and naturalness, and
• efficiency.

Compensatory interventions maximize a person’s participation in activities by addressing functional communication. Compensatory approaches focus on the following goals:

• Improving comprehensibility by
• increasing the speaker’s use of communication strategies,
• improving listener skills and capacity, and
• altering the communication environment.
• Increasing effective use of AAC strategies (e.g., speech-generating devices, letter board).

Sometimes the goal of treatment is to preserve or maintain function or to slow further decline, such as when an individual has a progressive disease.

Considerations for Treatment Planning

Because dysarthria is a motor speech disorder, treatment planning considers the goal of the intervention and principles of motor learning and neuroplasticity. These principles impact how someone acquires, or learns, a motor pattern as well as how they retain and transfer those patterns (Maas et al., 2008). Principles of motor learning impact the structure of practice and feedback. Clinicians can modify practice by the amount and schedule of practice time and the variability and complexity of the targets during practice. For example, blocked, constant practice is associated with skill acquisition, whereas random, variable practice is associated with retention and transfer (Maas et al., 2008). Feedback can be modified in its frequency and focus, moving from frequent knowledge of performance feedback (e.g., “You put your lips together”) during skill acquisition to variable knowledge of results feedback (e.g., “That was correct”) during retention and transfer. Clinicians may also incorporate principles of neuroplasticity during treatment planning, including specificity of training, repetition, intensity, and salience (Ludlow et al., 2008). Clinicians consider each of these principles, their intersection with each other, and differences in their application between nonspeech and speech tasks when choosing interventions, selecting targets, and recommending dosage.

Individual client factors that may influence motor learning include

• the severity of the underlying subsystem impairment;
• the natural history and prognosis of the underlying neurologic disorder;
• the presence and severity of co-occurring conditions (e.g., aphasia, cognitive impairment, apraxia of speech);
• response to cueing, accuracy, and capacity to modify motor performance; and
• patient and care partner preferences and opportunities for supported practice.

It can be important to consider the sequence of targeted subsystems in restorative approaches. For example, respiration and phonation are usually targeted initially, but prosthetic management of velopharyngeal dysfunction may be needed first to achieve efficient and effective breathing and phonation for speech (Duffy, 2020; Yorkston et al., 2010).

Some treatments have benefits that extend to subsystems other than the one being targeted. For example, improving prosody can benefit naturalness and intelligibility (Patel, 2002; Yorkston et al., 2010), and increased loudness (vocal effort) may induce changes in articulation and resonance (Neel, 2009).

As dysarthria impacts functional communication between the individual and both familiar and unfamiliar communication partners, planning for compensatory strategies considers the individual’s level of independence in self-advocacy and ability to modify their environment. For example, a dysarthric speaker with no limitations in ambulation or the use of their hands will be able to access supportive tools such as a text-to-speech app independently, whereas someone with motor limitations may be more dependent on partner support.

Individual client factors that may influence compensatory strategies include

• the presence and severity of co-occurring conditions (e.g., aphasia, cognitive-communication impairment, apraxia of speech);
• the presence and severity of other motor limitations;
• insight into communication limitations and capacity to repair breakdowns;
• patient and care partner preference and capacity for support and modification; and
• social determinants of health (see ASHA’s resource on social determinants of health).

SLPs use their independent clinical judgment and the best available evidence in partnership with the client and their care partners when selecting treatment strategies. Research continues to add new understanding of the relationship between restorative strategies and compensatory strategies. ASHA members can use ASHA Evidence Maps and ASHA journals to integrate the principles of evidence-based practice and make an evidence-based clinical decision that is appropriate for their clients. Below are brief descriptions of treatment options for addressing dysarthria. This information is not prescriptive or exhaustive, and the inclusion of any specific treatment does not imply endorsement from ASHA.

Restorative Treatment Approaches

Restorative treatment approaches aim to restore function of the speech subsystems. The restorative treatment techniques below (e.g., Clark, 2014) might also be combined with compensatory treatment approaches. Certain treatment techniques may not be the best fit for every person with dysarthria or in all situations. Choosing the appropriate strategies will depend on the etiology of dysarthria, the differential diagnosis of dysarthria type, and the affected subsystems.

Respiration

• Postural adjustments (e.g., sitting upright to improve breath support for speech)
• Inspiratory muscle training to facilitate better efficiency of sustained or repeated inspirations
• slow and controlled inhalation and exhalation
• inspiratory training devices to tax the muscles beyond their typical use (i.e., overload)
• Phrase grouping
• optimal phrase length based on respiratory support and syntactic boundaries (i.e., for each breath, speak only the number of syllables that can be comfortably produced)
• Expiratory muscle strength training using a pressure threshold device (e.g., manometer) to overcome a preset threshold
• Using maximum vowel prolongation tasks to improve duration and loudness of speech

Resonance

• Velopharyngeal exercise to overload musculature, such as resistance training during speech using continuous positive air pressure (Kim et al., 2022).
• Visual feedback or biofeedback (e.g., dental mirror under the nose, nasometry) during speech with progressive difficulty.
• Speech pattern modification (e.g., overarticulation). See also ASHA’s Practice Portal page on Resonance Disorders.
• Prosthetic management in collaboration with other disciplines (e.g., dentists, prosthodontists), such as
• palatal lift prosthesis and
• nasal obturator to occlude nasal airflow.

Phonation

• Lee Silverman Voice Treatment or LSVT LOUD® (LSVT Global, Inc., n.d.; Ramig et al., 2018)—an intensive program that targets high phonatory effort to improve loudness. LSVT LOUD may also influence intelligibility (Levy et al., 2020) and/or voice quality (Moya-Galé et al., 2022).
• Pitch Limiting Voice Treatment (de Swart et al., 2003)—a program for increasing vocal loudness without increasing pitch.
• SPEAK OUT!® (Parkinson Voice Project, n.d.)—a standardized, comprehensive program developed for individuals diagnosed with Parkinson’s disease (PD) and related movement disorders. SPEAK OUT! is based on principles of motor learning and places high emphasis on maintaining speech and communication skills. SPEAK OUT! combines individual therapy with weekly speech and singing groups, daily home practice, and education for patients and their care partners. Individuals with PD and related movement disorders are trained to “speak with intent,” converting speech from an automatic function to an intentional act. This increases patient loudness (Behrman et al., 2020; Levitt, 2014; Watts, 2016) and improves their vocal intensity, vocal quality, articulation, and intonation over time (Behrman et al., 2022; Boutsen et al., 2018, 2023). Patients may also experience improved quality of life (Behrman et al., 2022; Levitt & Walker-Batson, 2018).
• Reduction of atypical phonatory function
• hypo-adduction (e.g., head turn, manual lateralization of the thyroid cartilage, surgical management)
• hyper-adduction (e.g., relaxation, massage)
• Laryngeal exercises
• adduction (e.g., effortful closure through cough, pulling upward on chair seat)
• pitch glides, pitch matching
• Coordination of respiration and phonation
• increased duration of inhalation prior to initiating speech
• initiating phonation at the top of inhalation

Articulation

• Phonetic placement to optimize the positioning of the mouth, tongue, lips, or jaw during speech
• demonstration, placement cues, photos, and videos for feedback of positioning
• minimal contrasts to emphasize sound contrasts that differentiate one phoneme from another
• complex phonetic sequencing to emphasize coarticulatory effects (e.g., multisyllabic words with consonant blends in varying positions)
• Exaggerated articulation (overarticulation) to emphasize phonetic placement and increase precision, sometimes called “clear speech”

Prosody

• Reduced speaking rate
• pacing strategies, including hand tapping or use of a pacing board or metronome
• delayed auditory feedback
• indirect strategies such as increased loudness and/or overarticulation
• Lexical stress
• visual cues (e.g., hand gestures) to signal variations in loudness, pitch, or duration
• contrastive stress tasks to promote naturalness and support comprehensibility, such as differentiating “night rate” from “nitrate”
• varying pitch and/or loudness to repair communication breakdowns
• Matching breaths to natural pauses in speech

Compensatory Treatment Approaches

Communication Strategies

A variety of communication strategies can be used by the individual with dysarthria (speaker) and their communication partner to enhance communication when speech intelligibility or efficiency is reduced. These strategies can be used before, during, or after other treatment approaches are implemented to improve or compensate for speech deficits (e.g., Duffy, 2020).

Speaker strategies include

• maintaining eye contact with the communication partner, as appropriate;
• preparing the communication partner by gaining their attention and introducing the topic of conversation before speaking;
• pointing and gesturing to help convey meaning;
• looking for signs regarding whether the communication partner understood the message; and
• effectively using conversational repair strategies (e.g., restating message in different words, using gestures to help clarify message).

Communication partner strategies include

• maintaining eye contact with the speaker, as appropriate;
• being an active listener and making every effort to understand the speaker’s message;
• asking for clarification by asking specific questions;
• providing feedback and encouragement; and
• optimizing the ability to hear the speaker and to see their visual communication cues (e.g., by wearing prescribed hearing aids and glasses during conversations).

Environmental Modification

Environmental modification involves identifying optimal parameters to enhance comprehensibility.

These parameters include

• reducing background noise (e.g., choose a quiet setting for conversations; turn off TV, radio, and fans);
• ensuring that the environment has adequate lighting;
• reducing the distance between the speaker and their communication partner; and
• using face-to-face seating for conversations.

Augmentative and Alternative Communication (AAC)

AAC involves supplementing or replacing natural speech and/or writing.

The two forms of AAC are

• unaided (e.g., manual signs, gestures, and finger spelling) and
• aided (e.g., line drawings, pictures, communication boards, tangible objects, speech-generating devices).

Speech supplementation, a form of AAC, uses additional cues to enhance the speaker’s spoken message. Supplementation strategies, which can be low-tech or computer-based, can include (Hanson et al., 2013) the following:

• Alphabet-based—The speaker indicates the first letter of a word on a letter board.
• Topic-based—The speaker indicates the topic of the spoken message using a communication display (e.g., written word, drawings, photographs) before speaking.
• Gestural—The speaker uses an easily understood gesture with the spoken word or phrase.

Other augmentative supports include voice amplifiers, artificial phonation devices (e.g., electrolarynx devices and intraoral devices), and oral prosthetics.

See ASHA’s Practice Portal page on Augmentative and Alternative Communication.

Medical/Surgical Intervention

SLPs may refer the individual to a medical specialist to assess the need for medical interventions. Medical or surgical interventions may be used in combination with behavioral interventions, as needed.

These interventions can include, for example,

• pharyngeal augmentation, pharyngeal flap, or palatal flap to treat velopharyngeal incompetency and improve resonance;
• laryngeal (vocal fold) augmentation (e.g., autologous fat or collagen), laryngoplasty, or recurrent laryngeal nerve sectioning to improve phonation;
• a diaphragmatic pacer for individuals with impaired/paralyzed diaphragm; and
• pharmacological management to relieve symptoms of the underlying neurologic condition (e.g., spasticity, tremor) associated with an underlying neurologic disease.

Factors Influencing Treatment Decisions

Not all individuals with dysarthria are candidates for treatment. Factors influencing decisions about treatment include the individual’s communication needs, their motivation regarding treatment, and the presence of other deficits or conditions that can hinder communication.

Management of dysarthria related to neurodegenerative disease requires consideration of present needs and those that may arise over the course of the disease. The goal of treatment is to maximize communication at each stage of the disease, not to reverse decline (Duffy, 2020). This may include additional strategies to conserve energy and minimize fatigue, as well as initiating AAC systems and voice banking as early as possible following a diagnosis.

SLPs may need to provide counseling and education to clients and their care partners about the various factors influencing treatment decisions. See ASHA’s Practice Portal page on Counseling in Audiology and Speech-Language Pathology.

Cultural and Linguistic Factors

Views of the natural aging process and acceptance of disability vary by culture. Cultural views and preferences may not be consistent with medical approaches typically used in the U.S. health care system. It is essential that the clinician be responsive to client/patient and care partner wishes when sharing potential treatment recommendations and outcomes. Clinical interactions should be approached with cultural humility.

Treatment goals should take into consideration all languages and the specific dialects spoken by the person receiving services and their different communicative environments. See ASHA’s Practice Portal pages on Cultural Responsiveness, Multilingual Service Delivery in Audiology and Speech-Language Pathology, and Collaborating With Interpreters, Transliterators, and Translators.

The clinician also considers how changes in resonance and respiratory support impact the ability to produce a voice that is congruent with gender and gender expression. See ASHA’s Practice Portal page on Gender Affirming Voice and Communication.

Service Delivery

In addition to determining the optimal treatment approach for an individual with dysarthria, the clinician considers service delivery variables—such as format, provider, dosage, timing, and setting—that may have an impact on treatment outcomes.

Format refers to the structure of the treatment session (e.g., group and/or individual). Individual treatment may be most appropriate for learning new techniques and strategies. Group treatment provides opportunities to practice techniques and strategies in a naturalistic setting and to receive feedback about their effectiveness in improving comprehensibility and overall communication. Telepractice may be appropriate for some individuals with dysarthria (Tenforde et al., 2020). See ASHA’s Practice Portal page on Telepractice for more information.

Provider refers to the person providing the treatment (e.g., SLP, trained volunteer, family member, care partner). In addition to skilled treatment provided by the SLP, care partners and other communication partners can be trained by the SLP to provide opportunities for practice, encourage the use of strategies such as AAC, and give feedback about performance in functional settings.

Dosage refers to the frequency, intensity, and duration of service. Dosage may vary depending on the individual’s type and severity of disease, energy level, motivation, and degree of community support. Individuals with dysarthria may benefit from frequent and intense practice consistent with the principles of motor learning to enhance retention of speech skills (Bislick et al., 2012; Kleim & Jones, 2008; Maas et al., 2008).

Timing refers to when intervention is initiated relative to the diagnosis. Early initiation of treatment may be beneficial for learning or relearning motor patterns; however, improvements in comprehensibility using communication strategies are possible at any point. Timing for introducing prosthetic management and/or AAC may vary with the setting, the individual’s preferences, and the severity and stage of disease.

Setting refers to the location of treatment (e.g., home, community-based). Individuals may benefit from a naturalistic treatment environment that incorporates a variety of communication partners to facilitate generalization and carryover of skills.

ASHA Resources

• Assessment Tools, Techniques, and Data Sources
• Distinguishing Perceptual Characteristics and Physiologic Findings by Dysarthria Type
• Dynamic Assessment
• Dysarthria (Consumer Page)
• Focusing Care on Individuals and Their Care Partners
• Interprofessional Education/Interprofessional Practice (IPE/IPP)
• Person-Centered Focus on Function: Dysarthria [PDF]
• Preferred Practice Patterns—Assessment for Motor Speech Disorders in Adults and Treatment of Motor Speech Disorders in Adults
• Social Determinants of Health

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

• Academy of Neurologic Communication Disorders and Sciences: Resources
• ALS Association: Speech Therapy Fact Sheet
• National Multiple Sclerosis Society
• Parkinson’s Foundation
• Parkinson Voice Project
• RCSLT: New Long COVID Guidance and Patient Handbook 
• Speech-to-Speech
• United States Society for Augmentative and Alternative Communication

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Acknowledgments

Content for ASHA’s Practice Portal is developed and updated through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Dysarthria in Adults page:

• Deanna Britton, PhD, CCC-SLP
• Heather M. Clark, PhD, CCC-SLP
• Joseph R. Duffy, PhD, CCC-SLP
• Nicole M. Etter, PhD, CCC-SLP
• Jessica E. Huber, PhD, CCC-SLP
• Raymond D. Kent, PhD
• Mili S. Kuruvilla-Dugdale, PhD
• Kaitlin L. Lansford, PhD
• Antje S. Mefferd, PhD, CCC-SLP
• Gemma Moya-Galé, PhD, CCC-SLP
• Amy T. Neel, PhD, CCC-SLP
• Donald Robin, PhD
• Nancy P. Solomon, PhD, CCC-SLP

ASHA seeks input from subject matter experts representing differing perspectives and backgrounds. At times a subject matter expert may request to have their name removed from our acknowledgment. We continue to appreciate their work.

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Dysarthria in adults [Practice portal]. https://www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/