Application of the ICF in Reduced Speech Intelligibility in Dysarthria

ABSTRACT

Regardless of the underlying neuromotor impairment, an almost universal consequence of dysarthria is a reduction in speech intelligibility. The purpose of this article is to examine critically and to discuss issues related directly to speech intelligibility in speakers with dysarthria. Reduced speech intelligibility resulting from dysarthria is examined using the World Health Organization's International Classification of Functioning, Disability and Health (ICF) conceptual framework. We propose that the ICF conceptual framework facilitates an awareness of the multidimensional nature of disablement. Furthermore, the ICF facilitates a broad understanding of the complex nature of dysarthria, ranging from the neuroanatomical and physiological substrates contributing to reduced speech intelligibility, to the effects of this type of communication disorder on an individual's functioning in society and beyond. Finally, a case example is presented that describes how the ICF can be applied to an individual with dysarthria and reduced speech intelligibility.

KEYWORDS

Dysarthria - motor speech disorders - speech intelligibility - ICF

REFERENCES

• 1 Darley F L, Aronson A E, Brown J R. Clusters of deviant speech dimensions in the dysarthrias.  J Speech Hear Res. 1969;  12 462-496
• 2 Darley F L, Aronson A E, Brown J R. Differential diagnostic patterns of dysarthria.  J Speech Hear Res. 1969;  12 246-269
• 3 Darley F L, Aronson A E, Brown J R. Motor Speech Disorders. Philadelphia; Saunders 1975
• 4 Kent R D. Introduction. In: Kent RD Intelligibility in Speech Disorders Theory, Measurement and Management. Amsterdam, The Netherlands; John Benjamins 1992 110
• 5 Yorkston K M, Strand E A, Kennedy M RT. Comprehensibility of dysarthric speech: implications for assessment and treatment planning.  Am J Speech Lang Pathol. 1996;  5(1) 55-66
• 6 Yorkston K M, Dowden P, Beukelman D R. Intelligibility measurement as a tool in the clinical management of dysarthric speakers. In: Kent RD Intelligibility in Speech Disorders: Theory, Measurement and Management. Amsterdam, The Netherlands; John Benjamins 1992: 265-285
• 7 Yorkston K M, Beukelman D R, Bell K R. Clinical Management of Dysarthric Speakers. Austin, TX; Pro-Ed 1988
• 8 Duffy J R. Motor Speech Disorders. Toronto, Ontario, Canada; Mosby 1995
• 9 Netsell R. A Neurobiologic View of Speech Production and the Dysarthrias. San Diego, CA; College-Hill 1986
• 10 Barlow S M, Abbs J M. Fine force and position control of select orofacial structures in the upper motor neuron syndrome.  Exp Neurol. 1986;  94 699-713
• 11 Thompson E, Murdoch B E, Stokes P D. Lip function in subjects with upper motor neuron type dysarthria following cerebrovascular accidents.  Eur J Disord Commun. 1995b;  30 451-466
• 12 Dworkin J P, Aronson A E. Tongue strength and alternate motion rates in normal and dysarthric subjects.  J Commun Disord. 1986;  19(2) 115-132
• 13 Thompson E C, Murdoch B E, Stokes P D. Tongue function in subjects with upper motor neuron type dysarthria following cerebrovascular accident.  J Med Speech Lang Pathol. 1995;  3(1) 27-40
• 14 Caligiuri M P. The influence of speaking rate on articulatory hypokinesia in parkinsonian dysarthria.  Brain Lang. 1989;  36 493-502
• 15 World Health Organization .ICF: International Classification of Functioning, Disability and Health. Geneva, Switzerland; WHO 2001
• 16 Yorkston K M, Hammen V L, Beukelman D R, Traynor C D. The effect of rate control on the intelligibility and naturalness of dysarthric speech.  J Speech Hear Disord. 1990;  55 550-560
• 17 Crow E, Enderby P. The effects of an alphabet chart on the speaking rate and intelligibility of speakers with dysarthria. In: Yorkston KM, Beukelman DR Recent Advances in Clinical Dysarthria. Boston, MA; College Hill 1989: 99-108
• 18 Dagenais P A, Southwood M H, Lee T L. Rate reduction methods for improving speech intelligibility of dysarthric speakers with Parkinson's disease.  J Med Speech Lang Pathol. 1998;  6(3) 143-157
• 19 Hustad K C, Sussano S. Effects of rate reduction on severe spastic dysarthria in cerebral palsy.  J Med Speech Lang Pathol. 2002;  10 287-292
• 20 Yorkston K M, Beukelman D R, Tice R. Phoneme Intelligibility Test. Lincoln, NE; Institute for Rehabilitation Science and Engineering at Madonna Rehabilitation Hospital 1999
• 21 Yorkston K M, Beukelman D R. A comparison of techniques for measuring intelligibility of dysarthric speech.  J Commun Disord. 1978;  11 499-512
• 22 Yorkston K M, Beukelman D R, Tice R. Sentence Intelligibility Test. Lincoln, NE; Institute for Rehabilitation Science and Engineering at Madonna Rehabilitation Hospital 1997
• 23 Strand E A, Yorkston K M. Description and classification of individuals with dysarthria. In: Till JA, Yorkston KM, Beukelman DR Motor Speech Disorders: Advances in Assessment and Treatment. Baltimore; Brookes 1994: 37-54
• 24 Kent R D, Weismer G, Kent J, Rosenbek J. Toward explanatory intelligibility testing in dysarthria.  J Speech Hear Disord. 1989;  54 482-489
• 25 Enderby P M. Assessment and treatment of functional communication in dysarthria. In: Worrall LE, Frattali CM Neurogenic Communication Disorders: A Functional Approach. New York; Thieme 2000: 247-261
• 26 Hustad K C, Beukelman D R, Yorkston K M. Functional outcome assessment in dysarthria.  Semin Speech Lang. 1998;  19(3) 291-302
• 27 Yorkston K M, Klasner E R, Swanson K M. Communication in context: a qualitative study of the experiences of individuals with multiple sclerosis.  Am J Speech Lang Pathol. 2001;  10(2) 126-137
• 28 Hirsch F M, Holland A L. Beyond activity: measuring participation in society and quality of life. In: Worrall LE, Frattali CM Neurogenic Communication Disorders: A Functional Approach. New York; Thieme 2000: 35-54
• 29 Frattali C M, Thompson C K, Holland A L, Wohl C B, Ferketic M M. The American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS). Rockville, MD; ASHA 1995
• 30 Paul D R, Frattali C M, Holland A L, Thompson C K, Caperton C J, Slater S C. The American Speech-Language-Hearing Association Quality of Communication Life Scale (ASHA QCL). Rockville, MD; ASHA 2004
• 31 Yorkston K M, Beukelman D R, Strand E A, Bell K R. Management of Motor Speech Disorders in Children and Adults. 2nd ed. Austin, TX; Pro-Ed 1999
• 32 Eadie T L, Yorkston K M, Klasner E R et al.. Measuring communicative participation: a review of self-report instruments in speech-language pathology.  Am J Speech Lang Pathol. 2006;  15 307-320
• 33 Garcia L J, Laroche C, Barrette J. Work integration issues go beyond the nature of the communication disorder.  J Commun Disord. 2002;  35 187-211
• 34 Yorkston K M, Bombardier C, Hammen V. Dysarthria from the viewpoint of individuals with dysarthria. In: Till JA, Yorkston KM, Beukelman DR Motor Speech Disorders: Advances in Assessment and Treatment. Baltimore, MD; Brookes 1994: 19-35
• 35 Weiner W J, Lang A E. Movement Disorders: A Comprehensive Survey. Mount Kisko, NY; Futura 1989