Dysphagia, Dysarthria, Voice,

& Apraxia

POINTS OF INTEREST

· evidence for dysphagia & dysarthria therapies

· client factors & voice therapy outcomes

· treatments for apraxia

THE ISSUE Dysphagia, dysarthria, voice disorders, and apraxia are neurologically and/or physiologically-based conditions that are often encountered by speech language pathologists in acute care and rehabilitative medical settings. Often the disorders co-occur and assessment and intervention planning for one may be influenced by the presence of another.

THE REVIEWS Nine of the 65 reviews in the Catalogue addressed issues relating to dysphagia, dysarthria, voice disorders, and apraxia. Six of these reviews focused on individual intervention techniques that are commonly used in clinical practice, such as strength training in dysarthria and placement cueing in apraxia of speech. Two reviews provided information on the etiology of voice disorders. One review provided information specific to the assessment and treatment of velopharyngeal dysfunction.

WHAT THE REVIEWS CONCLUDE Dysarthria and Dysphagia: Many neuromuscular treatments for dysarthria and dysphagia (e.g., strength training, stretching, thermal tactile approaches, and electrical stimulation strategies) that are commonly used in clinical practice were shown to have only minimal evidentiary support.

Voice: Behavioural treatment of voice disorders, including those caused by vocal nodules, can be effective for children; however, factors such as family/teacher involvement and the amount of education about vocal hygiene affect the outcomes of behavioural interventions. Additionally, the appropriateness of materials and children’s motivation are mediating factors in voice treatment effectiveness. Specific voice therapy techniques such as the “yawn sigh” or “chewing” were not reviewed. One group of authors found insufficient evidence for determining the comparative benefits of behavioural versus surgical interventions for the treatment of vocal nodules. Client characteristics remain important in predicting the effectiveness of behavioural interventions following surgery.

Two reviews addressed the etiology of voice disorders. One described the structure and function of the paediatric larynx, as well as specific childhood voice disorders. The other review examined the limited research evidence on the relationship between personality and voice disorders. Personality traits thought to be associated with functional dysphonia, vocal nodules, and spasmodic dysphonia were described. Finally, an article reviewed evidence-based screening and assessment techniques for velopharyngeal dysfunction and provided scoring forms.

Apraxia: Treatments for apraxia of speech such as temporal (rate reduction), prosodic (stress and intonation), articulatory placement cueing, and biofeedback were often found to be effective in a treatment setting; however, most lacked evidence of generalization.