Speech and language therapy for dysarthria due to non-

Speech and language therapy for dysarthria due to nonprogressive brain damage (Review)
Sellars C, Hughes T, Langhorne P
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2009, Issue 1
http://www.thecochranelibrary.com
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . .
ABSTRACT . . . . . . . . .
PLAIN LANGUAGE SUMMARY .
BACKGROUND . . . . . . .
OBJECTIVES . . . . . . . .
METHODS . . . . . . . . .
RESULTS . . . . . . . . . .
DISCUSSION . . . . . . . .
AUTHORS’ CONCLUSIONS . .
ACKNOWLEDGEMENTS
. . .
REFERENCES . . . . . . . .
CHARACTERISTICS OF STUDIES
DATA AND ANALYSES . . . . .
APPENDICES . . . . . . . .
WHAT’S NEW . . . . . . . .
HISTORY . . . . . . . . . .
CONTRIBUTIONS OF AUTHORS
DECLARATIONS OF INTEREST .
SOURCES OF SUPPORT . . . .
INDEX TERMS
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Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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i
[Intervention Review]
Speech and language therapy for dysarthria due to nonprogressive brain damage
Cameron Sellars1 , Thomas Hughes2 , Peter Langhorne3
1 Department of Speech and Language Therapy, Glasgow Royal Infirmary, Glasgow, UK. 2 Neurology and Rehabilitation, Rookwood
Hospital, Cardiff, UK. 3 Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK
Contact address: Cameron Sellars, Department of Speech and Language Therapy, Glasgow Royal Infirmary, Castle Street, Glasgow,
G4 0SF, UK. [email protected]
Editorial group: Cochrane Stroke Group.
Publication status and date: Edited (no change to conclusions), published in Issue 1, 2009.
Review content assessed as up-to-date: 3 February 2005.
Citation: Sellars C, Hughes T, Langhorne P. Speech and language therapy for dysarthria due to non-progressive brain damage. Cochrane
Database of Systematic Reviews 2005, Issue 3. Art. No.: CD002088. DOI: 10.1002/14651858.CD002088.pub2.
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
Background
Dysarthria is a common sequel of non-progressive brain damage (typically stroke and traumatic brain damage). Impairment-based
therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient
population.
Objectives
To determine the efficacy of speech and language therapy interventions for adults with dysarthria following non-progressive brain
damage.
Search methods
We searched the trials registers of the following Cochrane Groups: Stroke, Injuries, Movement Disorders and Infectious Diseases. We
also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The trials registers were last searched in
September 2004. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004), MEDLINE
(1966 to September 2004), EMBASE (1980 to September 2004), CINAHL (1983 to September 2004), PsycINFO (1974 to October
2004), and Linguistics and Language Behavior Abstracts (1983 to December 2004) were searched electronically. We handsearched
the International Journal of Language and Communication Disorders (1966 to 2005, Issue 1) and selected conference proceedings, and
scanned the reference lists of relevant articles. We approached colleagues and speech and language therapy training institutions to
identify other possible published and unpublished studies.
Selection criteria
Unconfounded randomised controlled trials (RCTs).
Data collection and analysis
One author assessed trial quality. Two co-authors were available to examine any potential trials for possible inclusion in the review.
Main results
No trials of the required standard were identified.
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
1
Authors’ conclusions
There is no evidence of the quality required by this review to support or refute the effectiveness of speech and language therapy
interventions for dysarthria following non-progressive brain damage. Despite the recent commencement of a RCT of optimised speech
and language therapy for communication difficulties after stroke, there continues to be an urgent need for good quality research in this
area.
PLAIN LANGUAGE SUMMARY
Speech and language therapy for dysarthria due to non-progressive brain damage
Speech and language therapy treatments for people with dysarthria have not been tested in large clinical trials. Dysarthria is a speech
problem which can be caused by a number of brain disorders including conditions such as stroke and head injury. Typical features
of dysarthria include slurring of speech and quiet voice volume. Psychological distress is often experienced by people with dysarthria.
Speech and language therapists employ a range of treatments to help people with dysarthria. There are no large clinical trials which
have tested whether these treatments are effective.
BACKGROUND
Dysarthria has been defined as a “neurologic motor speech impairment that is characterized by slow, weak, imprecise, and/or
uncoordinated movements of the speech musculature and may involve respiration, phonation, resonance, and/or oral articulation.”
(Yorkston 1996). It can be a feature of developmental and acquired
neurological conditions, both of the peripheral and central nervous systems. This review will focus on dysarthria resulting from
non-progressive diseases of the central nervous system acquired
in adulthood. These are, principally, stroke and traumatic brain
injury but could include meningitis, encephalitis, and post-surgical meningioma and acoustic neuroma. The rationale for the
inclusion of multiple pathologies arises from the likelihood that,
to date, studies of treatment benefit have been small, limited in
number, and have included patients with a number of diagnoses
(Yorkston 1996).
Estimates of the prevalence of dysarthria following traumatic brain
injury vary from 10% to 60% in different series (Sarno 1986;
Yorkston 1989). Frequencies of between 20% and 30% have been
reported for stroke (Arboix 1990; Melo 1992; Warlow 1996).
Traditionally, speech and language therapists (SLTs; the abbreviation SLT is also used for speech and language therapy) have managed dysarthria by assisting in differential diagnosis, treating the
speech problem, and preventing secondary complications by facilitating participation in normal activities of life (Yorkston 1996).
Differential diagnosis will not be considered in this review. Management strategies otherwise undertaken by SLTs include the following.
(1) Attempted normalisation of muscle tone and/or increasing
strength and movement precision and co-ordination (Netsell
1984).
(2) Behavioural compensation, e.g., reducing rate of speech beyond an already slower rate to promote improved intelligibility
(Yorkston 1987).
(3) Elimination of maladaptive responses such as increasing rate
of speech in order to reduce a speaking rate wrongly perceived as
being too slow (Yorkston 1987).
(4) Provision of prosthetic devices such as the palatal lift or training appliance to compensate for hypernasality in speech (Tudor
1974).
(5) Provision of assistive devices. These can range from very lowtech aids such as an alphabet board to a highly sophisticated computerised system. They may be intended to facilitate a single function such as improving rate of speech with a pacing board (Crow
1989) or to replace speech completely (McNamara 1983).
(6) Reducing the handicap by altering the environment, listener
training, and promoting positive attitudes in those regularly communicating with the dysarthric individual (Berry 1983).
The settings in which such interventions take place are varied
and may include hospital, specialised rehabilitation unit, or the
patient’s home. The treatments may involve single individuals,
groups of patients, vary in intensity, and be subject to review and
maintenance therapy.
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
2
OBJECTIVES
We hypothesised that speech and language therapy interventions
would be effective for adults with dysarthria following non-progressive acquired brain damage.
METHODS
Criteria for considering studies for this review
Types of studies
These were limited to those described as unconfounded randomised controlled trials (RCTs), even where the method of randomisation was not fully specified. In the event of uncertainty
about allocation concealment, study authors were to be contacted
for clarification.
Types of participants
All adults (over 16 years of age at onset of the cerebral injury) who
had become dysarthric following acquired brain damage (i.e., principally stroke and traumatic brain injury but also including conditions such as meningitis, encephalitis, and post-surgical meningioma and acoustic neuroma). Patients at any stage after injury
onset were considered for inclusion with the provision that the
stage would be recorded for sensitivity analysis.
Types of interventions
We included interventions which are delivered, determined, directed, or facilitated by a SLT. For the purposes of this review, the
term SLT is used to refer to those individuals holding a professional qualification recognised by the Royal College of Speech and
Language Therapists, UK, or belonging to a body of similar professional standing elsewhere in the world. Possible interventions
included:
(1) articulation, voice, and prosody training;
(2) behavioural interventions;
(3) the use of sign language as a supplement or alternative to
speech;
(4) prosthetic devices;
(5) assistive communication devices;
(6) listener training programmes;
(7) listener advice.
The above list was not considered to be exhaustive, and a broadbased search strategy was designed accordingly. The following possible study designs were considered.
(1) SLT intervention compared with no SLT intervention (i.e.,
SLT versus nil).
(2) SLT intervention compared with an alternative SLT intervention (i.e., SLT A versus SLT B).
(3) SLT intervention compared with an intervention undertaken
by non-SLT personnel, e.g., delivered by volunteers (i.e., SLT versus non-SLT).
Types of outcome measures
The primary outcome measure considered was the Frenchay
Dysarthria Assessment. Secondary outcome measures included
other standardised measures of articulation (range, speed, strength,
and co-ordination); perceptual measures of voice and prosody
(e.g., Vocal Profile Analysis); physiological measures (e.g., airflow
studies); acoustic measures (e.g., fundamental frequency, pitch
perturbation (jitter), amplitude perturbation (shimmer), etc. as
measured by, e.g., computerised sound spectrography); measures
of intelligibility and listener acceptability; mood scales (e.g., Hospital Anxiety and Depression Scale, Wakefield Self-assessment Depression Inventory, Beck Questionnaire, etc.); subjective health
scales (e.g., Euroquol, SF-36, Nottingham Health Profile); patient
satisfaction as addressed by e.g., questionnaire survey; carer outcomes; and resource use (cost of provision of services, devices, etc.).
No restriction was placed on timing of outcome measures relative
to completion of treatment. Where possible, outcomes were to be
specified in relation to the underlying pathology (stroke, traumatic
brain injury, etc.).
Search methods for identification of studies
See: ’Specalized register’ section in Cochrane Stroke Group
We searched the trials registers of the following Cochrane
Groups for relevant trials: Stroke, Injuries, Movement Disorders,
and Infectious Diseases. We also searched the trials register of
the Cochrane Rehabilitation and Related Therapies Field. The
Cochrane Movement Disorders Group was contacted for an updated search of its trials register but did not respond to this request.
The trials registers were last searched in September 2004.
(1) In addition, we searched the following electronic bibliographic
databases.
• The Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library Issue 2, 2004)
• MEDLINE (1966 to September 2004)
• EMBASE (1980 to September 2004)
• CINAHL (1983 to September 2004)
• PsycLIT (1974 to 2000; searching continued on the
PsycINFO database as below)
• PsycINFO (1999 to October 2004)
• Linguistics and Language Behaviour Abstracts (1983 to
December 2004)
We developed intervention-based search strategies in consultation
with the Review Group Trials Search Co-ordinators to avoid un-
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
3
necessary duplication of effort. The search strategies for MEDLINE (Appendix 1) and CENTRAL (Appendix 2) were developed
and were modified for other databases.
(2) We handsearched the International Journal of Language and
Communication Disorders (known as the British Journal of Disorders
of Communication (1966 to 1991) and the European Journal of
Disorders of Communication (1992 to 1997)) for the years 1966 to
2005 (Issue 1).
(3) We approached universities and colleges in the UK where SLTs
are trained to identify recent and ongoing research into dysarthria.
(4) We checked conference proceedings identified in electronic
and other searching by direct reference to the literature. We handsearched titles and abstracts for possible randomised trials.
(5) We checked reference lists of all relevant articles identified for
possible randomised trials.
(6) We approached colleagues and researchers to identify other
possible published and unpublished studies.
No language restriction was imposed on the studies, and we sought
translations where necessary.
Data collection and analysis
Two authors (CS and TH) were available to assess independently
the eligibility and quality of any trials for possible consideration.
Any differences would be resolved by discussion or by reference to
the third independent author (PL).
No formal methodological scoring system was used, but trials were
assessed for methodological quality with attention paid to whether
there was protection from the following types of bias:
(1) selection bias, i.e., true random sequencing, and true concealment up to time of allocation;
(2) exclusion bias, i.e., withdrawal after trial entry;
(3) detection bias, i.e., unmasked assessment of outcome.
Descriptive information for each trial (with respect to methodological quality, participants, interventions, and outcomes) was to
be recorded in the ’Characteristics of included studies’ table. Data
for all prespecified outcomes were to be tabulated, where possible. Where trials were judged sufficiently similar with respect to
their descriptive characteristics, an attempt was to be made to synthesise the data using standard statistics: odds ratios for dichotomous outcomes and standardised mean differences for continuous outcomes. Results were to be subjected to a random-effects
meta-analysis. Ninety-five per cent confidence intervals were to
be generated throughout the review where possible. Subgroups
for dysarthria due to stroke and traumatic brain injury were to
be identified before trials were analysed together and were to be
subjected to analysis in relation to the primary outcome measure
using heterogeneity chi-squared statistics. Heterogeneity was to be
determined using the I2 statistic (I2 greater than or equal to 50%:
moderate heterogeneity; I2 greater than or equal to 75%: extreme
heterogeneity). If heterogeneity was found to be present, possible
causes would be considered.
Where appropriate, sensitivity analysis was to be performed to assess the effect of differences in methodological quality, intervention type, and patient characteristics. Where trials other than those
studying the effect of SLT versus no SLT were included (i.e., SLT
A versus SLT B and SLT versus non-SLT), all analyses were to be
separately undertaken. If statistical combination of different studies proved impossible, a narrative account of the included trials
would be given.
RESULTS
Description of studies
See: Characteristics of excluded studies; Characteristics of ongoing
studies.
Literature searching has generated in excess of 10,000 titles. These
were examined, and where a title clearly identified a study as not
being relevant to this review, it was rejected. Abstracts of the remaining titles, where available, were checked for possible inclusion
in the review. These totalled in excess of 2000. Studies clearly indicating in their title or in the published abstract that a methodology
other than RCT (e.g., single-case treatment design) was used were
rejected. Over 100 studies were consulted in the original (where
the language of the publication was not English, informed opinion
was sought from a native speaker as to the methodological status
of the study). Sixteen studies were considered for inclusion but rejected from the review. Six studies could be clearly excluded on at
least one criterion (Fukusako 1989; Ince 1973; Light 2001; Pilon
1998; Robertson 2001; Yorkston 1981), while the remaining 10
were rejected on at least two criteria (Braverman 1999; Cohen
1992; Cohen 1993; Crow 1989; Enderby 1990; Huffman 1978;
Keenan 1993; Main 1997; Ray 2002; Yorkston 1990). Of studies
identified in the literature search and subsequently excluded, 10
included 10 or fewer participants. No studies meeting the stated
criteria for inclusion were identified.
Risk of bias in included studies
No studies were found for inclusion.
Effects of interventions
No studies were available for analysis.
DISCUSSION
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
4
Dysarthria is a common event after stroke and traumatic brain
injury, and may also be a feature of other non-progressive conditions. It is clear from the published literature that speech and
language therapists in the UK, and their counterparts elsewhere
in the world, devote substantial time and energy to the management of dysarthria. While a research agenda is not lacking, this
has been directed in no small part to descriptive studies (Kent
1998) and to consideration of analysis procedures (Kent 1999).
The research effort targeting treatment efficacy and effectiveness
has been small-scale and has often favoured single-case or small
N design. This picture is not dissimilar to that found in other
areas related to communication disorders following non-progressive brain damage such as aphasia (Greener 1999). Meta-analysis
of single-case studies has been undertaken for SLT management
of aphasia (Robey 1999), but such an endeavour is beyond the
remit and the stated methods of this review and, in any case, will
increase the risk of bias, including publication bias.
The lack of large-scale clinically controlled trials is likely to be the
result of the diversity of conditions underlying dysarthria, simple
practical problems (such as attending for therapy) in achieving
compliance in a therapy regime, and a lack of adequate funding for
larger-scale research endeavours. It is encouraging to note, however, that concerted efforts are being made to develop a greater
awareness among clinicians of the need for a firm evidence base
for practice (Hanson 2004; Yorkston 2001a; Yorkston 2001b;
Yorkston 2003). The Clinical Sciences and Disorders Clinical Trials and Research Group (CSDRG), for example, receives funding
from an institute of the US National Institutes of Health and aims
to promote the conduct of RCTs in the communication-impaired
population (Baum 1999). A substantial RCT of optimised SLT
for communication difficulties after stroke (including dysarthria)
is currently underway in the UK (ACT NoW 2004).
AUTHORS’ CONCLUSIONS
Implications for practice
Therapies and management strategies for dysarthria following
non-progressive brain damage as undertaken by speech and language therapists cannot presently be supported or refuted by good
quality evidence from randomised controlled trials (RCTs). Patients, carers, clinicians, service providers and other interested parties will have to consider other sources of evidence, such as case
studies and expert opinion.
Implications for research
Despite the recent commencement of a RCT of optimised speech
and language therapy (SLT) for communication difficulties after
stroke, there remains an urgent need for RCTs to compare SLT interventions for dysarthria following non-progressive brain damage
with no treatment, or if this is ethically unacceptable, to compare
alternative SLT interventions. Funding bodies may wish to consider the need to re-align their priorities to accommodate an area
of rehabilitation that has to date received scant attention, while
speech and language therapists will have to face the challenge of
devising research questions that go some way to addressing the
complexities of the condition of concern and of the rehabilitation
approaches presently undertaken by them.
ACKNOWLEDGEMENTS
The significant contribution of Brenda Thomas, Trials Search Coordinator of the Cochrane Stroke Group, and of Irene Stirling, librarian at Strathclyde University Library, in devising search strategies and in running searches is gratefully acknowledged.
REFERENCES
References to studies excluded from this review
Braverman 1999 {published data only}
Braverman SE, Spector J, Warden DL, Wilson BC, Ellis
TE, Bamdad MJ, et al.A multidisciplinary TBI inpatient
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as part of a randomized controlled trial. Brain Injury 1999;
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Cohen 1992 {published data only}
Cohen NS. The effect of singing instruction on the speech
production of neurologically impaired persons. Journal of
Music Therapy 1999;29(2):87–102.
Cohen 1993 {published data only}
Cohen NS, Masse R. The application of singing and
rhythmic instruction as a therapeutic intervention for
persons with neurogenic communication disorders. Journal
of Music Therapy 1993;30(2):81–99.
Crow 1989 {published data only}
Crow E, Enderby P. The effects of an alphabet chart on the
speaking rate and intelligibility of speakers with dysarthria.
In: Yorkston KM, Beukelman DR editor(s). Recent advances
in clinical dysarthria. Boston: College-Hill, 1989:99–108.
Enderby 1990 {published data only}
Enderby P, Crow E. Long-term recovery patterns of severe
dysarthria following head injury. British Journal of Disorders
of Communication 1990;25:341–54.
Fukusako 1989 {published data only}
Fukusako Y, Endo K, Konno K, Hasegawa K, Tatsumi IF,
Masaki S, et al.Changes in the speech of spastic dysarthric
patients after treatment based on perceptual analysis.
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
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5
Annual Bulletin of the Research Institute of Logopedics and
Phoniatrics (RILP) 1989;23:119–40.
Huffman 1978 {published data only}
Huffman AL. Biofeedback treatment of orofacial
dysfunction: a preliminary study. American Journal of
Occupational Therapy 1978;32(3):149–54.
Ince 1973 {published data only}
Ince LP, Rosenberg DN. Modification of articulation in
dysarthria. Archives of Physical Medicine and Rehabilitation
1973;54:233–6.
Keenan 1993 {published data only}
Keenan JE, Barnhart KS. Development of yes/no systems
in individuals with severe traumatic brain injuries.
Augmentative and Alternative Communication 1993;9:
184–90.
Light 2001 {published data only}
Light J, Edelman SB, Alba A. The dental prosthesis used for
intraoral muscle therapy in the rehabilitation of the stroke
patient. New York State Dental Journal 2001;67(5):22–7.
Main 1997 {published and unpublished data}
Kelly S, Main A, Manley G, McLean C. Electropalatography
and the linguagraph system. Medical Engineering and Physics
2000;22(1):47–58.
Main A. The use of electropalatography in the treatment of
acquired dysarthria. Unpublished dissertation, University
of Kent at Canterbury 1998.
Main A, Kelly S, Manley G. Teaching the tongue and
looking at listening. Bulletin of the Royal College of Speech
and Language Therapists 1997;November:8–9.
Main A, Kelly S, Manley G. The treatment of a severe ataxic
dysarthria, using electropalatography. Single case study.
http://medical.kent.ac.uk/research/EPG/Cb/CB.html.
Main A, Kelly S, Manley G. The use of palatography in
acquired dysarthria. Proceedings of the Second European
Symposium on Electropalatography. Edinburgh, UK, 1997.
∗
Main A, Kelly S, Manley G, MorganBarry R, Pring T.
The use of electropalatography in the treatment of acquired
dysarthria: a clinical trial. Unpublished manuscript 1997.
Main A, Manley G, Kelly S, Sansom W, Walker J, Stanfield
S, et al.The use of eletropalatography in the treatment of
acquired dysarthria. http://medical.kent.ac.uk/research/
EPG/LORS_Trial/Trial_summary.htm.
Pilon 1998 {published data only}
Pilon MA, McIntosh KW, Thaut MH. Auditory vs visual
speech timing cues as external rate control to enhance verbal
intelligibility in mixed spastic-ataxic dysarthric speakers: a
pilot study. Brain Injury 1998;12(9):793–803.
Ray 2002 {published data only}
Ray J. Orofacial myofunctional therapy in dysarthria: a
study on speech intelligibility. International Journal of
Orofacial Myology 2002;28:39–48.
Robertson 2001 {published data only}
Robertson S. The efficacy of oro-facial and articulation
exercises in dysarthria following stroke. International
Journal of Language and Communication Disorders 2001;36
(Suppl):292–7.
Yorkston 1981 {published data only}
Yorkston KM, Beukelman DR. Ataxic dysarthria:
treatment sequences based on intelligibility and prosodic
considerations. Journal of Speech and Hearing Disorders
1981;46:398–404.
Yorkston 1990 {published data only}
Yorkston KM, Hammen VL, Beukelman DR, Traynor
CD. The effect of rate control on the intelligibility and
naturalness of dysarthric speech. Journal of Speech and
Hearing Disorders 1990;55:550–60.
References to ongoing studies
ACT NoW 2004 {unpublished data only}
Bowen A. Assessing the effectiveness of communication
therapy in the North West - the ACT NoW study.
Unpublished 2004.
Additional references
Arboix 1990
Arboix A, Marti-Vilalta JL, Garcia JH. Clinical study of 227
patients with lacunar infarcts. Stroke 1990;21:842–7.
Baum 1999
Baum HM, Logemann JA, Stenzel BA. Initiating a clinical
trials group in an increasingly managed care environment:
successes and problems in establishing collaboration.
Medical Care Research and Review 1999;56(Suppl 2):
139–52.
Berry 1983
Berry WR, Sanders SB. Environmental education: the
universal management approach for adults with dysarthria.
In: Berry WR editor(s). Clinical dysarthria. San Diego, CA:
College-Hill Press, 1983:203–16.
Greener 1999
Greener J, Enderby P, Whurr R. Speech and language
therapy for aphasia following stroke. Cochrane Database of
Systematic Reviews 1999, Issue 4. [Art. No.: CD000425.
DOI: 10.1002/14651858.CD000425]
Hanson 2004
Hanson EK, Yorkston KM, Beukelman DR. Speech
supplementation techniques for dysarthria: a systematic
review. Journal of Medical Speech-Language Pathology 2004;
12(2):ix–xxix.
Kent 1998
Kent RD, Kent JF, Duffy J, Weismer G. The dysarthrias:
speech-voice profiles, related dysfunctions, and
neuropathology. Journal of Medical Speech-Language
Pathology 1998;6(4):165–211.
Kent 1999
Kent RD, Duffy J, Kent JF, Vorperian HK, Thomas JE.
Quantification of motor speech abilities in stroke: timeenergy analyses of syllable and word repetition. Journal of
Medical Speech-Language Pathology 1999;7(2):83–90.
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
6
McNamara 1983
McNamara R de P. A conceptual holistic approach to
dysarthria treatment. In: Berry WR editor(s). Clinical
dysarthria. San Diego, CA: College-Hill Press, 1983:
191–201.
Melo 1992
Melo TP, Bogousslavsky J, van Melle G, Regli F. Pure motor
stroke: a reappraisal. Neurology 1992;42:789–98.
Netsell 1984
Netsell R. Physiological studies of dysarthria and their
relevance to treatment. In: Rosenbek JC editor(s). Seminars
in language. New York: Thieme-Stratton, 1984:279–92.
Robey 1999
Robey RR, Schultz MC, Crawford AB, Sinner CA. Singlesubject clinical-outcome research: designs, data, effect sizes,
and analyses. Aphasiology 1999;13(6):445–73.
Sarno 1986
Sarno MT, Buonaguro A, Levita E. Characteristics of verbal
impairment in closed head injured patients. Archives of
Physical Medicine and Rehabilitation 1986;67:400–5.
Tudor 1974
Tudor C, Selley WG. A palatal training appliance and a
visual aid for use in the treatment of hypernasal speech.
British Journal of Disorders of Communication 1974;9:
117–22.
Warlow 1996
Warlow CP, Dennis MS, van Gijn J, Hankey GJ, Sandercock
PAG, Bamford JG, et al.Stroke: a practical guide to
management. Oxford: Blackwell Scientific, 1996.
Yorkston 1987
Yorkston KM, Beukelman DR, Bell KR. Clinical
management of dysarthric speakers. London: Taylor &
Francis, 1987.
Yorkston 1989
Yorkston KM, Honsinger MJ, Mitsuda PM, Hammen
V. The relationship between speech and swallowing
disorders in head-injured patients. Journal of Head Trauma
Rehabilitation 1989;4:1–16.
Yorkston 1996
Yorkston KM. Treatment efficacy: dysarthria. Journal of
Speech and Hearing Disorders 1996;39:S46–S57.
Yorkston 2001a
Yorkston KM, Spencer K, Duffy J, Beukelman D, Golper
LA, Miller R. Evidence-based medicine and practice
guidelines: application to the field of speech-language
pathology. Journal of Medical Speech-Language Pathology
2001;9(4):243–56.
Yorkston 2001b
Yorkston KM, Spencer K, Duffy J, Beukelman D, Golper
LA, Miller R, et al.Evidence-based practice guidelines
for dysarthria: management of velopharyngeal function.
Journal of Medical Speech-Language Pathology 2001;9(4):
257–74.
Yorkston 2003
Yorkston KM, Spencer KA, Duffy JR. Behavioral
management of respiratory/phonatory dysfunction from
dysarthria: a systematic review of the evidence. Journal of
Medical Speech-Language Pathology 2003;11(2):xiii–xxxviii.
References to other published versions of this review
Sellars 2000
Sellars C. [Determining the availability of good quality
evidence for the effectiveness of speech and language
therapy interventions for dysarthria post–stroke (Abstract)].
Proceedings of the Consensus Conference on Stroke
Treatment and Service Delivery. Edinburgh, UK: Royal
College of Physicians of Edinburgh, 2000.
Sellars 2001
Sellars C, Legg L, Langhorne P, Pollock A. Determining the
availability of good quality evidence for the effectiveness of
speech and language therapy interventions for dysarthria
post-stroke (Abstract). Cerebrovascular Diseases 2001;11
(Suppl 4):43.
Sellars 2002
Sellars C, Hughes T, Langhorne P. Speech and language
therapy for dysarthria due to nonprogressive brain damage:
a systematic Cochrane review. Clinical Rehabilitation 2002;
16(1):61–8.
∗
Indicates the major publication for the study
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
7
CHARACTERISTICS OF STUDIES
Characteristics of excluded studies [ordered by study ID]
Study
Reason for exclusion
Braverman 1999
Randomised controlled trial but included patients with communication problems other than dysarthria
Employed non-SLT interventions
Cohen 1992
Not a randomised controlled trial but a multiple single-case study design
Included patients with communication problems other than dysarthria
Employed non-SLT interventions
Cohen 1993
Randomised controlled trial but included patients with dysarthria resulting from developmental and progressive
causes
Employed non-SLT interventions
Crow 1989
Not a randomised controlled trial, but a small group before and after study
Employed mainly patients with progressive conditions
Enderby 1990
Not a randomised controlled trial, but a small group retrospective study
Patients had communication problems other than dysarthria
Fukusako 1989
Not a randomised controlled trial, but a before and after study
Huffman 1978
Not a randomised controlled trial, but paired comparison
Employed non-SLT interventions
Therapy not specific to dysarthria
Ince 1973
Not a randomised controlled trial, but a small group before and after study
Keenan 1993
Not a randomised controlled trial, but a before and after study
Unclear if patients were simply dysarthric
Light 2001
Not a randomised controlled trial, but a small group before and after study
Main 1997
Randomised controlled crossover trial but included patients with dysarthria resulting from progressive causes
Patients had communication problems other than dysarthria
Pilon 1998
Not a randomised controlled trial, but a small group single system design with baseline reversal (ABACAD) study
Ray 2002
Not a randomised controlled trial, but a small group before and after study
Some patients were non-native speakers of English (the medium of therapy)
Robertson 2001
Not a randomised controlled trial, but a small group before and after study
Yorkston 1981
Not a randomised controlled trial, but a small group before and after study
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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(Continued)
Yorkston 1990
Not a randomised controlled trial, but a small group before and after study
Included patients with dysarthria resulting from developmental and progressive causes
SLT: speech and language therapy
Characteristics of ongoing studies [ordered by study ID]
ACT NoW 2004
Trial name or title
Assessing the effectiveness of communication therapy in the North West - the ACT NoW study
Methods
Participants
Adults admitted to hospital with a stroke and with communication impaired due to aphasia or dysarthria.
They must be considered by SLT to be able to engage in therapy and likely to benefit from therapy. Inclusion
is to be subject to informed consent by the patient or their carer. A number of exclusion criteria apply
Interventions
(1) Experimental (health technology currently being assessed). This will include optimised duration and
frequency of therapy (maximum 3-5 times weekly for a maximum of 12 weeks); optimised range of clinical
assessments to direct therapy, including the Frenchay Dysarthria Profile; and optimised range of therapy
techniques as appropriate, including impairment-based therapy, functional therapy, training with others and
Alternative or Augmentative Communication.
(2) Control (attention control of similar frequency and duration to the experimental intervention with a
trained volunteer)
Outcomes
Primary outcome measures:
(1) Communicative Effectiveness Index (CETI)
(2) Therapy Outcome Measure (TOM).
Secondary outcome measures will assess patients’ quality of life and carers’ well-being and will be determined
following the pilot RCT
Starting date
Contact information
Dr Audrey Bowen, Lecturer in Psychology (Speech & Language Therapy), Human Communication and
Deafness, Faculty of Education, University of Manchester, Oxford Road, Manchester M13 9PL, UK
Email: [email protected]
Phone: +44 161 275 3401
Fax: +44 161 275 3373
Notes
The investigators propose also to undertake an economic analysis and a qualitative exploration of the experience
and effectiveness of SLT from the perspectives of users and carers
RCT: randomised controlled trial
SLT: speech and language therapy/therapist
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
9
DATA AND ANALYSES
This review has no analyses.
APPENDICES
Appendix 1. MEDLINE search strategy
MEDLINE (Ovid) 1966 to September 2004 Search Strategy
1. Dysarthria/rh,th [Rehabilitation, Therapy]
2. Articulation disorders/rh,th [Rehabilitation, Therapy]
3. Speech disorders/rh,th [Rehabilitation, Therapy]
4. Voice disorders/rh,th [Rehabilitation, Therapy]
5. Communication disorders/rh,th [Rehabilitation, Therapy]
6. Dystonia/rh,th [Rehabilitation, Therapy]
7. 1 or 2 or 3 or 4 or 5 or 6
8. dysarthria/ or articulation disorders/
9. speech disorders/ or voice disorders/ or communication disorders/
10. (dysarth$ or dysphon$ or anarth$ or dyspros$ or aphon$).tw.
11. ((speech or articulat$ or phonat$ or voice or vocal or prosod$ or intonat$ or respirat$ or communicat$) and (disorder$ or
impairment$ or problem$ or difficult$)).tw.
12. exp mouth/ or exp larynx/ or exp laryngeal muscles/ or palatal muscles/ or (mouth or tongue or lingual or palat$ or laryn$ or
orofacial or oro-facial).tw.
13. movement disorders/ or ataxia/ or dystonia/ or hyperkinesis/ or hypokinesia/ or muscle hypotonia/ or exp muscular diseases/
14. (atax$ or dyston$ or hyperkin$ or hypokin$ or hypoton$ or flaccid$ or spastic$).tw.
15. 13 or 14
16. 12 and 15
17. 8 or 9 or 10 or 11 or 16
18. exp “rehabilitation of speech and language disorders”/ or rehabilitation/
19. speech-language pathology/
20. speech intelligibility/
21. exp speech production measurement/
22. larynx, artificial/ or “prostheses and implants”/
23. (speech or language or voice or vocal or phonat$ or articulat$ or prosod$ or communicat$ or respirat$ or breath$).tw.
24. (therap$ or train$ or rehabilitat$ or management or assist$ or measure$ or assess$ or remedia$ or augment$ or recover$).tw.
25. 23 and 24
26. remedial teaching/
27. computer-assisted instruction/
28. prosthe$.tw.
29. 18 or 19 or 20 or 21 or 22 or 25 or 26 or 27 or 28
30. 17 and 29
31. 7 or 30
32. exp cerebrovascular disorders/
33. (stroke$ or cerebrovasc$ or cerebral vascular or poststroke).tw.
34. (cerebral or cerebellar or brain$ or vertebrobasilar).tw.
35. (infarct$ or ischaemi$ or ischemi$ or thrombo$ or emboli$ or apoplexy).tw.
36. 34 and 35
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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37. (cerebral or brain or subarachnoid).tw.
38. (haemorrhage or hemorrhage or haematoma or hematoma or bleed$ or aneurysm$).tw.
39. 37 and 38
40. 32 or 33 or 36 or 39
41. 31 and 40
42. exp brain injuries/
43. head injuries/
44. head injuries, closed/
45. skull fractures/
46. brain damage, chronic/
47. exp brain stem/in
48. exp cerebellum/in
49. (head or brain$ or cerebral or cranial or craniocerebral or skull).tw.
50. (injur$ or trauma$).tw.
51. 49 and 50
52. neuroma, acoustic/su
53. meningioma/su
54. neuroma, acoustic/ or meningioma/
55. surgery/ or neurosurgery/ or surgical procedures, operative/ or neurosurgical procedures, operative/ or craniotomy/
56. 54 and 55
57. (acoustic neuroma$ or meningioma$).tw.
58. (surg$ or neurosurg$ or postoperat$).tw.
59. 57 and 58
60. exp meningitis/ or encephalitis/
61. (meningit$ or encephalit$).tw.
62. exp brain neoplasms/
63. ((brain or cereb$) and (neoplasm$ or lesion$ or tumor$ or tumour$)).tw.
64. 62 and 63
65. (benign or non malignant or non-malignant).tw.
66. 64 and 65
67. 42 or 43 or 44 or 45 or 46 or 47 or 48 or 51 or 52 or 53 or 56 or 59 or 60 or 61 or 66
68. 31 and 67
69. 68 not 41
Appendix 2. CENTRAL search strategy
The Cochrane Central Register of Controlled Trials (CENTRAL) Search Strategy
#1 DYSARTHRIA*:ME
#2 ARTICULATION-DISORDERS*:ME
#3 SPEECH-DISORDERS*:ME
#4 VOICE-DISORDERS*:ME
#5 COMMUNICATION-DISORDERS*:ME
#6 ((((DYSARTH* or DYSPHON*) or ANARTH*) or DYSPROS*) or APHON*)
#7 ((((((((SPEECH or ARTICULAT*) or PHONAT*) or VOICE) or VOCAL) or PROSOD*) or INTONAT*) or RESPIRAT*) or
COMMUNICAT*)
#8 (((DISORDER* or IMPAIRMENT*) or PROBLEM*) or DIFFICULT*)
#9 (#7 and #8)
#10 MOUTH*2:ME
#11 LARYNX*1:ME
#12 LARYNGEAL-MUSCLES*:ME
#13 PALATAL-MUSCLES*:ME
#14 ((((((MOUTH or TONGUE) or LINGUAL) or PALAT*) or LARYN*) or OROFACIAL) or ORO-FACIAL)
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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#15 ((((#10 or #11) or #12) or #13) or #14)
#16 MOVEMENT-DISORDERS*:ME
#17 ATAXIA*:ME
#18 DYSTONIA*:ME
#19 HYPERKINESIS*:ME
#20 HYPOKINESIA*:ME
#21 MUSCLE-HYPOTONIA*:ME
#22 MUSCULAR-DISEASES*1:ME
#23 ((((((#16 or #17) or #18) or #19) or #20) or #21) or #22)
#24 ((((((ATAX* or DYSTON*) or HYPERKIN*) or HYPOKIN*) or HYPOTON*) or FLACCID*) or SPASTIC*)
#25 (#23 or #24)
#26 (#15 and #25)
#27 (((((((#1 or #2) or #3) or #4) or #5) or #6) or #9) or #26)
#28 REHABILITATION-OF-SPEECH-AND-LANGUAGE-DISORD*:ME
#29 REHABILITATION*:ME
#30 SPEECH-LANGUAGE-PATHOLOGY*:ME
#31 SPEECH-INTELLIGIBILITY*:ME
#32 SPEECH-PRODUCTION-MEASUREMENT*:ME
#33 LARYNX-ARTIFICIAL*:ME
#34 PROSTHESES-AND-IMPLANTS:ME
#35 REMEDIAL-TEACHING*:ME
#36 COMPUTER-ASSISTED-INSTRUCTION*:ME
#37 PROSTHE*
#38 (((((((((SPEECH or LANGUAGE) or VOICE) or VOCAL) or PHONAT*) or ARTICULAT*) or PROSOD*) or COMMUNICAT*) or RESPIRAT*) or BREATH*)
#39 (((((((((THERAP* or TRAIN*) or REHABILITAT*) or MANAGEMENT) or ASSIST*) or MEASURE*) or ASSESS*) or
REMEDIA*) or AUGMENT*) or RECOVER*)
#40 (#38 and #39)
#41 ((((((((((#28 or #29) or #30) or #31) or #32) or #33) or #34) or #35) or #36) or #37) or #40)
#42 (#27 and #41)
WHAT’S NEW
Last assessed as up-to-date: 3 February 2005.
Date
Event
Description
2 October 2008
Amended
Converted to new review format.
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
12
HISTORY
Protocol first published: Issue 1, 2000
Review first published: Issue 2, 2001
Date
Event
Description
4 February 2005
New search has been performed
All literature searches for this review have been updated. No new trials for
inclusion have been uncovered by these searches
CONTRIBUTIONS OF AUTHORS
This review was carried out by the principal author (Cameron Sellars). The co-authors were available for independent assessment of
any trials identified and have had the opportunity to comment on the final text before publication.
DECLARATIONS OF INTEREST
None known
SOURCES OF SUPPORT
Internal sources
• No sources of support supplied
External sources
• Chest Heart & Stroke Scotland, UK.
• Health Foundation, UK.
• New Opportunities Fund, UK.
INDEX TERMS
Medical Subject Headings (MeSH)
∗
Language Therapy; ∗ Speech Therapy; Brain Injury, Chronic [complications]; Dysarthria [etiology; ∗ therapy]; Stroke [complications]
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
13
MeSH check words
Adult; Humans
Speech and language therapy for dysarthria due to non-progressive brain damage (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
14
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