Dysarthria Assessment For Speech Therapy: 11 Simple Steps

Dysarthria is common in many neurological diseases, including Parkinson’s disease, stroke TBI, ALS, and multiple sclerosis.

In this post, you’ll learn how to assess dysarthria, including step-by-step guides and helpful links to dysarthria resources, like our Dysarthria Assessment PDF.

There’s a lot to cover, so let’s dive into the 11 steps!

How to Do A Dysarthria Assessment

Dysarthria is a motor speech disorder that can affect many aspects of speech production, including strength, speed, range of motion, and coordination.

To assess dysarthria, you’ll start with a case history and then evaluate cranial nerves, speech production, speech subsystems, and non-speech movements.

Follow the 11 steps below. Then keep scrolling for help with differential diagnosis and finding norms.

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• Dysarthria Exercises
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1. Oral Mechanism Examination

Observe strength, range of motion, speed, and symmetry of the following:

• Mandible (CN V): at rest, open (pressure), close (pressure), lateralization, protrusion, retraction
• Lips (CN VII): at rest, protrusion, retraction, repetitive protrude/retract, puff cheeks, strength, sensitivity (CN IX)
• Tongue (CN XII): at rest, protrusion (strength), stick up (strength), stick down (strength), lateralization (strength), retraction (CN V, XII), strength, lick teeth, lick lips
• Velum: at rest (CN IX), prolonged “ah” (CN X), repetitive “ah” (CN X)
• Reflexes (CN IX, X): gag, faucial arches

Read How To Do An Oral Motor Exam for more details.

2. Diadochokinetic Rate

• Prompt the patient to say the following sounds as quickly and clearly as they can for 15 seconds each. They will repeat each 3 times.
• “puh puh puh”
• “tuh tuh tuh”
• “kuh kuh kuh”
• “puh tuh kuh”

You can compare their DDK rate with norms.

3. S/Z Ratio

1. Have the patient say ‘sss’ for as long as they can, recording their time in seconds
2. Have them repeat this 3 times. Note their longest trial
3. Next, have the patient say ‘zzz’ for as long as they can, recording their time in seconds
4. Repeat this 3 times, noting their longest trial
5. Divide their longest /s/ trial over their longest /z/ trial for their s/z ratio
6. You can compare their s/z ratio with norms

_{Sample from The Adult Speech Therapy Evaluation Pack}

4. Maximum Phonation Time (MPT)

• Prompt the patient to say ‘ah’ for as long as they can. They should use their normal loudness. Record their time in seconds
• Have them repeat this 3 times. Their MPT is the longest of the 3 trials
• You can compare their MPT with norms

5. Additional Observations

Observe dentition, oral mucosa, raised eyebrows (CN VII), breath support, vocal quality, resonance, volitional cough, and volitional throat clearing.

6. Connected Speech and Reading Sample

• Ask open-ended questions or statements (i.e., Tell me about your favorite job, a place you have lived, etc.)
• Have the patient read the Rainbow Passage:

The Rainbow Passage:

When the sunlight strikes raindrops in the air, they act as a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond his reach, his friends say he is looking for the pot of gold at the end of the rainbow. Throughout the centuries people have explained the rainbow in various ways. Some have accepted it as a miracle without physical explanation. To the Hebrews it was a token that there would be no more universal floods. The Greeks used to imagine that it was a sign from the gods to foretell war or heavy rain. The Norsemen considered the rainbow as a bridge over which the gods passed from earth to their home in the sky. Others have tried to explain the phenomenon physically. Aristotle thought that the rainbow was caused by reflection of the sun’s rays by the rain. Since then physicists have found that it is not reflection, but refraction by the raindrops which causes the rainbows. Many complicated ideas about the rainbow have been formed. The difference in the rainbow depends considerably upon the size of the drops, and the width of the colored band increases as the size of the drops increases. The actual primary rainbow observed is said to be the effect of superimposition of a number of bows. If the red of the second bow falls upon the green of the first, the result is to give a bow with an abnormally wide yellow band, since red and green light when mixed form yellow. This is a very common type of bow, one showing mainly red and yellow, with little or no green or blue.

7. Repetition of Words

Have your patient repeat 10 or more words that are increasingly longer and more complex. For example:

• act, action, activity
• hip, hippo, hypocrite
• miss, missile, Mississippi

8. Repetition of Phrases

Have your patient repeat 5 or more phrases with increasing length and complexity. For example:

• I’m tired
• Let’s go together
• A quick brown fox jumped out
• The motorcycle drove down the windy road

9. Picture Naming

Present 10 pictures to the patient (using picture cards).  Ask, “What is this? Please repeat what you just said two more times.”  

Record latency time and naming accuracy. Phonetically transcribe responses, as needed.

10. Picture Description

Have your patient describe a picture.

Record responses and phonetically transcribe, if able.

11. Complete a Self-Report Questionnaire

Ask your patient to complete a self-report questionnaire to understand the beliefs and attitudes they have about their communication, voice, and/or speech.

For example, you can download the free Communicative Effectiveness Index.

Getting caregiver feedback can be especially helpful for some patients (notably those with Parkinson’s disease) who may be unaware of their communication issues.

Dysarthria Norms 

Informal speech therapy assessments are great because they provide quick and valuable objective data. But they don’t always come with norms for comparison.

We have you covered! Read Norms for Voice, Motor Speech, and Resonance.

Differential Diagnosis

Now that you’ve completed your dysarthria assessment, it’s time to ask yourself: Is it dysarthria, apraxia of speech, or aphasia?

Below is a quick guide. For a printable checklist, download the Differential Diagnosis Chart.

1. It May Be Dysarthria If:

• Articulators seem weak (slurred or mumbled speech, etc.)
• Respiration is abnormal (patient seems out of breath, only gets in a few words in per breath, etc.)
• Phonation is abnormal (voice sounds strangled, etc.)
• Resonance is abnormal (consistently hypernasal, etc.)

2. It May Be Apraxia If:

• Speech sounds are distorted
• Saying “puhpuhpuh” is inaccurate
• Saying “puhtuhkuh” is more challenging than “puhpuhpuh”
• There were more distortions the longer the word/utterance or the faster they spoke

3. It May Be Aphasia If:

• They seem to have a hard time understanding you
• They have difficulty reading
• They have difficulty writing

For more on the topic, read Aphasia vs Dysarthria vs Apraxia.

Recommended Dysarthria Assessments

Below is a list of informal and formal dysarthria assessments, plus other helpful resources.

Informal Assessments

• The Adult Speech Therapy Evaluation Pack
• Word Intelligibility Test. Scroll down to pages 11-12 and 18-19 for the lists
• Motor Speech Disorders Evaluation by ASHA
• ALS Communication Assessment
• Parkinson’s Disease Communication Assessment

Formal Assessments

• Assessment of Intelligibility in Dysarthric Speech
• Frenchay Dysarthria Assessment

Dysarthria Assessment PDF

For a print-and-go Motor Speech assessment template, visit our shop!

References

• Allison KM, Cordella C, Iuzzini-Seigel J, Green JR. Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review. J Speech Lang Hear Res. 2020 Sep 15;63(9):2952-2994. doi: 10.1044/2020_JSLHR-20-00061. Epub 2020 Aug 12.
• American Speech-Language-Hearing Association. (n.d.). Acquired Apraxia of Speech. (Practice Portal). Retrieved June, 23, 2022, from www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/
• American Speech-Language-Hearing Association. (n.d.). Dysarthria in adults [Practice portal]. Retried Feb 15, 2024. https://www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/
• Brewer, C.H. (2019). The Home Health SLP Handbook (M. Aparo, Ed.). Harmony Road Design, LLC.
• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Duffy, J. R. (2020). Motor speech disorders: Substrates, differential diagnosis, and management (4th ed.). Elsevier.
• Strand, E. A., Duffy, J. R., Clark, H. M., & Josephs, K. (2014). The Apraxia of Speech Rating Scale: a tool for diagnosis and description of apraxia of speech. Journal of communication disorders, 51, 43–50. https://doi.org/10.1016/j.jcomdis.2014.06.008