national-clinical-guidelines-for-stroke-fourth-edition

Evidence to recommendations
There is only one trial on this topic which included a small planned subgroup of 66
people with dysarthria (Bowen et al 2012a). There was no significant difference between
speech and language therapy treatment and attention control for people with dysarthria
in the first few months of stroke, but a nested, qualitative study found that early, regular
and frequent contact (from a therapist or a visitor) was positively rated by patients and
carers (Young et al 2012).
6.20.2.1 Recommendations
6.20.2.2 Sources
A Any patient whose speech is unclear or unintelligible following stroke so that
communication is limited or unreliable should be assessed by a speech and language
therapist to determine the nature and cause of the speech impairment and
communication restriction.
B Any person who has dysarthria following stroke which is sufficiently severe to limit
communication should:
● be taught techniques to improve the clarity of their speech
● be assessed for compensatory alternative and augmentative communication
techniques (eg letter board, communication aids) if speech remains
unintelligible.
C The communication partners (eg carers, staff) of a person with severe dysarthria
following stroke should be taught how to assist the person in their communication.
A Consensus
B King and Gallegos-Santillan 1999; Mackenzie and Lowit 2007; Palmer and Enderby
2007
C King and Gallegos-Santillan 1999
6.20.3 Apraxia of speech
A few patients have specific and relatively isolated impairment of the ability to plan and
execute the multiple skilled oral motor tasks that underlie successful talking; this is
apraxia of speech. It is usually associated with left hemisphere damage, and hence
requires careful separation from aphasia as well as from dysarthria. Studies are often
small, no trials were identified in a Cochrane review (West et al 2005) or in subsequent
searches for this guideline, and therefore the evidence of treatment effects is limited.
Interventions such as syllable level therapy and metrical pacing have been studied and the
use of computers to increase intensity of practice has been suggested.
6.20.3.1 Recommendations
6 Recovery phase from impairments and limited activities: rehabilitation
A Any stroke patient who has marked difficulty articulating words should be formally
assessed for apraxia of speech and treated to maximise articulation of targeted words
and rate of speech to improve intelligibility.
© Royal College of Physicians 2012 99