When we think of the major muscles in our body, we might imagine biceps, triceps, and deltoids. But there are actually many smaller muscles in our face, lips, tongue, lungs, and throat that we use every day to speak.
When these muscles are damaged, weakened, or paralyzed, as is the case with dysarthria, it can make it difficult to correctly pronounce words, clearly communicate thoughts, and speak easily. Dysarthria commonly causes slurred or slow speech, as well as a variety of other problems that make it difficult for the person to be understood by others.
Whether you're a parent, caregiver, spouse, or family member, it can be frustrating to watch a loved one struggle to communicate with dysarthria. However, there are effective treatments available, as well as many ways to get involved and help someone manage their communication obstacles.
As with all speech and language challenges, educating yourself on dysarthria is the best way to make informed treatment decisions. For that reason, we’ve put together this informational guide to answer common questions about dysarthria, identify signs and symptoms, and explain how dysarthria is typically evaluated, diagnosed and treated.
What is dysarthria?
Dysarthria is a motor-speech disorder that weakens the muscles used in speech production. This makes it difficult to coordinate and control these muscles, which can lead to a range of communication challenges. Dysarthria is often the result of damage to parts of the brain that are responsible for these muscles' movements.
This disorder can affect many aspects of your speech. For example, a person’s speech may become slow, mumbled, or slurred. They may lose the ability to pronounce sounds and words correctly. They may be unable to control the volume of their voice or the quality and pace at which they talk. Finally, because dysarthria involves muscle weakness, some individuals may drool excessively when speaking or have problems retrieving enough air in their lungs.
There are actually several types of dysarthria depending on where damage has occurred in the brain, the severity of this damage, and which muscles have been affected. There are also mixed dysarthrias that include features of more than one type. Identifying which dysarthria you have requires the trained expertise of a doctor or speech-language pathologist.
Spastic dysarthria: This type of dysarthria often results from damage to the central nervous system, which includes your brain and spinal cord. People with spastic dysarthria may have general speech problems in addition to muscle weakness and some abnormal reflexes.
Flaccid dysarthria: This occurs when there is damage to the peripheral nervous system: the nerves that connect the brain and spinal cord to the body. People with flaccid dysarthria often have trouble pronouncing consonants.
Ataxic dysarthria: There is a part of the brain called the cerebellum that receives sensory information that helps the body regulate its movements. Damage to the cerebellum can cause ataxic dysarthria, with one of the hallmark symptoms being slurred speech.
Hypokinetic dysarthria: The brain’s extrapyramidal system coordinates our subconscious muscle movements. When it’s not working properly, it can cause a wide range of speech, voice, and swallowing symptoms.
Hyperkinetic dysarthria: The basal ganglia is a part of the brain that has a role in various functions and motor movements. Damage to the basal ganglia can cause a wide range of symptoms.
How does dysarthria differ from apraxia of speech and aphasia?
While dysarthria, aphasia, and apraxia can all affect speech production and communication abilities, there are notable differences. A correct diagnosis is important to make the most informed treatment decisions.
Apraxia of speech: Your brain sends messages to your mouth instructing your muscles how and when to make sounds. Apraxia happens when these signals are disrupted. While acquired apraxia of speech can happen as a result of brain injury, it is not necessarily due to muscle weakness like dysarthria. Apraxia makes it difficult for people to communicate intelligibly and formulate coherent sounds, phrases, and sentences.
Aphasia: While both dysarthria and aphasia can happen after a stroke (and even present at the same time), dysarthria more commonly affects a person’s speech, while aphasia affects their ability to understand language. Generally, a person with dysarthria has difficulty making the sounds involved in speech production because of muscle weakness. People with aphasia have limited ability to understand language, find the right words when speaking, or use appropriate sentence structure.
How common is dysarthria?
The overall prevalence of dysarthria is not well understood. However, based on information presented by the American Speech-Language-Hearing Association (ASHA), here are some estimated figures for how often dysarthria occurs after common neurological disorders:
Stroke: An estimated 8% to 60% of individuals who have a stroke present with dysarthria.
Traumatic brain injury: About 10% to 65% of people who experience a traumatic injury to their brain will develop dysarthria.
Parkinson's disease: Between 70% to 100% of individuals with Parkinson’s disease will develop dysarthria.
Multiple sclerosis: An estimated 25% to 50% of people with multiple sclerosis develop dysarthria at some point during the disease.
Amyotrophic lateral sclerosis (ALS): Almost all people with ALS will develop dysarthria in the later stages of their diagnosis. It is estimated that roughly 30% of people show signs of dysarthria when ALS is first diagnosed.
What causes dysarthria?
Dysarthria is often caused by damage to the brain and, in particular, to specific areas of the brain that are important for the motor aspects of speech.
While dysarthria can occur at birth (referred to as congenital dysarthria), it is often a result of an illness or injury. Some common causes of dysarthria include:
Amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease)
In addition to brain damage, dysarthria can be caused by damage to the organs involved in speech production. For example, someone who’s received surgery to their head, tongue, or voice box may develop dysarthria, as well as someone who has experienced trauma to their face or mouth.
It’s important to note that dysarthria is not caused by issues that are more structural in nature, such as a cleft palate. While these issues may still lead to speech problems, they are classified as dysglossias. Dysarthria must involve damage to the brain or nerves.
What are common symptoms of dysarthria?
Dysarthria can affect your speech patterns in many different ways, depending on its cause. Some people with dysarthria may only experience minor speech problems that still allow them to maintain everyday conversations without trouble. Others have more severe symptoms that make it difficult for other people to understand them at all.
Typical signs and symptoms of dysarthria include:
Changes to the speed at which you talk; you may talk rapidly or very slowly
Speech that sounds slurred, mumbled, or choppy
Abnormal or varied rhythm in your speech
Difficulty controlling the volume of your voice
Difficulty controlling your facial muscles and moving your lips, jaw, and tongue
A nasally or hoarse voice quality
Trouble with chewing and swallowing
It’s important to know that dysarthria can affect more than just a person’s speech abilities. Because of limited movement of the facial muscles, a person may drool uncontrollably. It may also look like their face is drooping. In addition, dysarthria can affect an individual’s lungs, which causes their breathing to become irregular.
How is dysarthria diagnosed?
If you have trouble with speaking, you should see your doctor right away. Your doctor may conduct a physical exam and order tests to determine the underlying cause of your symptoms. These tests may include an MRI or CT scan of your neck and brain, an electromyography to test the function of your muscles and nerves, blood tests, and more.
In many cases, your doctor will refer you to a speech-language pathologist, also known as a speech therapist. Speech therapists are communication experts, and they are the most qualified professionals to evaluate, diagnose, and treat dysarthria.
A speech therapist can help determine whether you have dysarthria or another speech and language problem, along with the severity of your condition. They will evaluate how well you move the muscles in your face (your mouth, lips, and tongue) and how well you breathe. Your speech therapist will also listen to your speech patterns, including how well you say single words, say sentences, and speak in conversation. Finally, they will assess your vocal quality.
How is dysarthria treated?
There are a number of ways that dysarthria can be treated by your doctor. There are also specific steps that speech therapists take to help improve your communication abilities. Both your doctor and your speech therapist will develop an individualized treatment plan for you based on your diagnosis and symptoms.
Your medical treatment
As we’ve mentioned, dysarthria has a wide range of causes including stroke, head injury, brain tumor, a congenital disorder like cerebral palsy, or a degenerative disease like ALS or Parkinson’s disease. Your doctor’s treatment recommendations may depend on the cause of your dysarthria.
For example, if dysarthria is related to the side effects of a medication, they may suggest you change your regimen. If it’s caused by a brain tumor, they may recommend surgery. In many cases, your doctor may suggest that you seek professional help from a speech therapist to improve any speech and language problems associated with dysarthria.
Your speech therapy treatment
Your speech therapist will develop a personalized treatment plan designed to help you regain normal speech and meet your communication goals. Your speech therapist will help you:
Strengthen your speech muscles
Increase the movement of your lips and tongue
Clearly articulate your words for clearer speech
Adjust the rate and pace at which you talk
Increase your breathing support for louder speech
Practice communicating in real-life situations
Provide your family with strategies for easier communication
If you have severe dysarthria that significantly affects your ability to communicate, your speech therapist may recommend alternative communication methods. These can include using visual cues, writing, and gestures to get your message across, as well as a computer or electronic device. These tools are referred to as augmentative and alternative communication, or AAC.
How Expressable evaluates and treats dysarthria
Expressable matches individuals and families with a certified speech therapist trained to evaluate and treat speech and language disorders related to dysarthria. All therapy is delivered online via face-to-face video conferencing.
Based on the client’s age, communication difficulties, and speech and language goals, the speech therapist will develop a personalized treatment plan. Adult clients can choose to attend sessions by themselves but are also welcome to bring caregivers or family members to the sessions.
For toddlers, school-age children, and younger adults, Expressable speech therapists will use different strategies to interact with them through video chat capabilities and ensure parents and caregivers are actively involved:
Ages 0-3: Caregivers work directly with their child's speech therapist to learn cues and at-home strategies. This way they can confidently practice with their child outside the session and improve their child's communication. Learn more about the importance of parental involvement in children’s speech therapy here.
Ages 3-6: Caregivers attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.
Ages 7 and up: Most children attend video sessions independently, but caregivers are kept in the loop with updates and tips during each session.
Tips for coping and communicating with dysarthria
If you have dysarthria, there are simple techniques you can use every day to communicate more effectively. While your speech therapist will be able to provide more tailored recommendations, these tips are a good place to start.
Slow down: Try to relax, stay calm, and slow the rate at which you speak. This can help listeners better understand what you’re trying to say and give them more time to interpret what they’re hearing. Remember to pause and take a breath when you need to.
Make sure listeners understand: Pause once in awhile when speaking and have the listener confirm that they understand what you’re saying.
Keep it short: If speaking starts to feel exhausting, try to communicate your thoughts in as few words as possible. Fatigue can make your speech harder to understand.
Find other ways to communicate: If you’re unable to communicate your message, have a backup plan in place. For example, you may want to carry a notepad with you to write down your messages. You can also type them in a cell phone to present to your listener. Additionally, gesturing and pointing to objects of interest can go a long way in communicating your thoughts.
Talk face-to-face: While not always possible, it's helpful to speak with people in-person versus on the phone. Be sure to make eye contact. This allows the listener to see how your mouth and lips are moving, which may help them better understand what you’re trying to say.
Establish the topic: Getting the listener on the same page by quickly establishing the topic of conversation will help them better interpret your message. For example, if you’d like to discuss what meal you’ll be eating later, start by saying “dinner.” This helps to ground the discussion.
Avoid noisy environments: Before you speak, turn down your music or television, or find a better location with less background noise.
How to communicate with someone who has dysarthria
If you're a family member, friend, or caregiver to someone with dysarthria, here are some easy ways to help you better understand what your loved one is trying to say.
Speak up if you don't understand: Pretending you understand someone when you don’t isn’t doing anyone any favors. So speak up and ask them to kindly repeat themselves. If you’re still having trouble, ask them to write down their thoughts.
Let them finish: If the speaker is struggling to get out the right words, give them time to collect their thoughts and finish their sentence. You never want to rush or pressure them.
Repeat what you understood: If you can only interpret a portion of what someone is saying, repeat back the part you understood and ask for clarification. This will save the person energy by not repeating the whole sentence again.
Treat them the same: It’s important to continue to involve loved ones with dysarthria in your conversations and talk to them as you would anyone else. This will ensure they don’t feel isolated.
Ask simple questions: If you’re struggling to understand what someone is trying to say, ask simple “yes” and “no” questions. Or ask them to write their thoughts down. This will help the flow of conversation.