Innovations in Dysarthria Management

The topic of this issue is innovations in dysarthria management. No field can survive or thrive without an ongoing commitment to innovation. This is particularly true for the field of dysarthria and its treatment. This issue contains articles that either take us in new directions or fill critical gaps in our current clinical knowledge.

In the first articles, we are encouraged to consider the important role of speech-language pathologists (SLPs) in management of conditions not typically considered in our clinical practice. Britton, Hoit, and Benditt describe the dysarthria associated with spinal cord injury. They summarize how spinal cord injury and mechanical ventilation affects speech and suggest a role for SLPs as part of a multidisciplinary team. Page and Siegel offer a similar perspective with a description of speech associated with oromandibular dystonia. They offer insights from their patients about the psychosocial consequences of this condition and suggest the role of SLPs in caring for these patients.

Assessment is also an area where important innovations are apparent. Darling-White provides a rationale for the need to assess communicative participation in children with developmental speech disorders. Although her review suggests that no such measure is currently available, she offers a road map for future development of this important measurement tool. Fletcher and McAuliffe provide a novel perspective on treatment outcomes in dysarthria. They suggest that rather than categorizing patients solely on the basis of their underlying medical diagnosis, we might begin to use other salient speech and contextual factors for assessment and treatment planning. Studies of the physiology of speech production have a long history in the dysarthria literature. Huber and Darling-White add a missing piece to this literature by examining longitudinal changes in speakers with Parkinson's disease (PD) and compare these changes to those of speakers who are typically aging. The examination has important implications because it gives insight into the clinically important symptom of fatigue associated with PD and helps us to develop an evidence-based rationale for treatment approaches.

The next articles focus on speech treatment. Yorkston, Baylor, and Britton interviewed speakers with dysarthria associated with PD before and after treatment. The perspectives of these speakers help to develop better patient-centered interventions that might supplement traditional approaches with self-management techniques. Fager describes an innovative approach to speech treatment based on the use of speech recognition technology that may provide speakers with chronic dysarthria extended opportunity for the practice that is necessary for speech improvement.

The final articles take an innovative approach to service delivery in dysarthria because they do not focus on the speaker but rather on communicative partners and the environment. Burns, Baylor, and Yorkston describe the lessons they learned when delivering a program of training for medical and allied health students in how to communicate with patient with dysarthria or other communication problems. Finally, Beukelman and Nordness focus on patient-provider communication in various medical settings and the development of policies that ensure patients who are communication-vulnerable due to dysarthria are given appropriate access to health care.