Download Dysarthria Handouts

Optimizing Communicative Effectiveness and
Comprehensibility in Dysarthria
Allyson Dykstra, SLP(C), PhD
School of Communication Sciences and Disorders, UWO
Enhancing Comprehensibility: Speaker Strategies
Adapted from Vogel & Miller, 1991; Yorkston, Strand, & Kennedy, 1996; Yorkston, Strand & Miller, 1995
1.
Provide your communication partner context for what you are saying
Knowing the topic of conversation makes a big difference in understanding speech that is distorted. If
your speech is difficult to understand, provide the context by writing or spelling the topic of your
message.
2.
Don’t shift topics abruptly
If your speech is difficult to understand, your partners may get lost if you change from one topic to
another without a transition. Let people know that you are changing topics and what the new topic is.
3.
Use turn-taking signals
Conversations tend to go very quickly. If your speech is slow, you may need to use clear signals that
you want a turn (e.g., eye gaze, breathing pattern, body movement, gesture or verbal interjection).
Choose one or two that work for you and make sure listeners are aware of them.
4.
Get your listener’s attention
If your speech is difficult to understand, it is even more important that listeners pay full attention.
Before you begin a message, alert your communication partner by saying his/her name.
5.
Use predictable types of sentences
Simple, grammatically predictable sentences are generally easier to understand than longer,
grammatically complicated sentences.
6.
Use predicable wording
If your speech is difficult to understand, avoid unusual idioms or slang expressions. Be direct.
7.
Watch the tone of your voice
We communicate a lot of information by changing the tone of our voice. If you have difficulty
expressing subtle changes in meaning with your intonation, you’ll need to express sarcasm or humour
in other ways.
8.
Rephrase your message
If listeners have not understood you even after you have repeated the message, try communicating the
thought using different words. But use a signal to let them know.
9.
Accompany speech with simple gestures when appropriate
At times, speech may be supplemented by simple gestures. For example, “Stop and turn around where
you are”.
10.
Take advantage of situational cues
Your surroundings may help you give a listener extra cues. For example, you might point to objects in
the room in order to introduce a topic.
11.
Make the environment as “friendly” as possible
Avoid carrying out important conversations in noisy places or in places where your communication
partner cannot watch you speak (e.g., dimly lit room, over distance)
12.
Avoid communicating over long distances
Trying to speak to someone who is across the room or in another room is difficult. If you need to call
attention to yourself, a buzzer, beeper, or baby monitor might be useful.
Enhancing Comprehensibility: Partner Strategies
Adapted from Vogel & Miller, 1991; Yorkston, Strand, & Kennedy, 1996; Yorkston, Strand & Miller, 1995
1.
Make sure you know the general topic of the conversation
Knowing the topic of conversation makes a big difference in understanding speech that is distorted.
Encourage speakers with dysarthria to introduce topics.
2.
Watch for turn taking signals
Some speakers with dysarthria for whom speech is slow have a difficult time getting a turn in
conversation. Watch carefully for your partner’s signals or decide in advance on some turn-taking
signals.
3.
Give your undivided attention
Speech that is slow and/or distorted is more difficult to understand and therefore requires undivided
attention.
4.
Choose the time and place for communication
Most of us can talk all day without getting tired. Talking may be very difficult and fatiguing for the
speaker with dysarthria. Avoid important conversations when the speaker is tired. Mealtimes may no
longer be the best time for conversation.
5.
Watch the speaker
A lot of information is obtained while watching a speaker. When speech is slow and/or distorted, it is
even more important to look at the speaker’s face.
6.
Piece together the cues
Some people describe the task of understanding slow and distorted speech as a process of piecing
together a series of cues. Take advantage of whatever cues are available to you (e.g., speech, gestures,
physical surroundings)
7.
Make the environment work for you
Maximize your ability to understand the speaker with dysarthria by making sure that you have enough
light, that the light is on the speaker’s face, and that all extraneous noise is eliminated/reduced.
8.
Avoid communication over long distances
Make sure to always be in the same room when you initiate conversation. It is difficult for many
speakers with dysarthria to speak loudly enough to be heard in another room.
9.
Make sure your hearing is as good as possible
Assessing Communicative Effectiveness
Communication Effectiveness Index - Modified (CETI-M)
(from Yorkston, K.M., Beukelman, D.R., Strand, E.A., & Bell, K.R. (1999). Management of motor speech disorders in children and adults,
(2nd ed.). Austin, TX: Pro-Ed.)
Please evaluate how effectively you communicate in these situations. Read the item describing each of the situations and
decide how successful you communicate.
If you think that communication is very effective, circle the 7. If communication doesn’t occur at all, circle the 1. Circle
any number on the scale that best describes communication in that situation.
Question #1. Having a conversation with familiar persons in a quiet environment.
1
2
3
4
5
6
7
Not at all effective
Very effective
Question #2. Having a conversation with strangers in a quiet environment.
1
2
3
4
5
Not at all effective
6
7
Very effective
Question #3. Having a conversation with a familiar person over the phone.
1
2
3
4
5
Not at all effective
6
7
Very effective
Question #4. Having a conversation with young children.
1
2
3
4
Not at all effective
6
7
Very effective
Question #5. Having a conversation with a stranger over the phone.
1
2
3
4
5
Not at all effective
6
7
Very effective
Question #6. Having a conversation while traveling in a car.
1
2
3
4
Not at all effective
5
6
7
Very effective
Question #7. Having a conversation with someone at a distance.
1
2
3
4
5
Not at all effective
6
7
Very effective
Question #8. Having a conversation with someone in a noisy environment.
1
2
3
4
5
Not at all effective
6
7
Very effective
Question #9. Speaking or having a conversation before a group.
1
2
3
4
5
Not at all effective
6
7
Very effective
Question #10. Having a long conversation with someone (over an hour).
1
2
3
4
5
Not at all effective
6
7
Very effective
5
Understanding the psychological, social, and
emotional impacts of dysarthria
Probe Questions for the Client
Adapted from: “Dysarthria: A Breakdown in Interpersonal Communication,” by R. Lubinski (1991), in Treating
Disordered Speech Motor Control (pg. 159), by D. Vogel and M. Cannito (Eds.), Austin: TX:PRO-ED.
Definition of the Problem
 What concerns you about your speech?
 What kind of sounds or words give you the most difficulty?
 In what situations do you feel you have the most difficulty talking?
Impact of the Problem
 How do you feel when you have difficulty being understood?
 How do others react when you have difficulty being understood?
 Do you ever avoid a situation or a person because of your speech problem?
If yes,
o What is this situation {person}?
o Why do you think this happens?
 How has your speech problem affected your interaction with your family?
 How has your speech problem affected your social life (employment and so on)?
 Do you think you have less opportunity to talk now than previously?
If yes,
o Why?
o How can you change this?
Motivation to Improve
 Why would you like to improve your speech?
 What would you like to improve?
 What have you done on your own to improve your speech?
 What techniques did you find helped you talk better?
 Have you attended speech therapy sessions before this?
If so,
o Where were they held?
o What were the goals?
o What were the results?
 How will your family work to help you improve your speech?
 How will we know when speech therapy has been successful?
 What do you think is my role in the speech therapy situation?
Assessing Quality of Life in Communication Disorders
ASHA Quality of Communication Life (QCL) Scale
Paul, D., Frattali, C., Holland, A., Thompson, C., Caperton, C., & Slater, S. (2005). Quality of
communication life scale (ASHA QCL). Rockville, MD: ASHA.
Voice-Related Quality of Life (V-RQOL)
Hogikyan, N.D., Sethuraman, G. (1999). Validation of an instrument to measure voice-related quality
of life (V-RQOL). Journal of Voice, 13(4), 557-569.
Voice Activity and Participation Profile (VAPP)
Ma, E., & Yiu, E. (2001). Voice activity and participation profile: assessing the impact of voice
disorders on daily activities. Journal of Speech, Language, and Hearing Research, 44, 511-524.
Assessing Speech Intelligibility
Speech Intelligibility Test (www.madonna.org)
$250 USD for software
(assesses intelligibility at the single word, carrier phrase & sentence levels)