Dysarthria Exercises for Adult Speech Therapy

In this post, you’ll find dysarthria exercises, strategies, and treatment ideas for your adult speech therapy patients.

As always, we include functional materials and step-by-step instructions for you to use during treatment. Bookmark this post to open during treatment or copy and print the resources.

For pre-made handouts and materials, visit our shop!

Popular Articles

• Goal Bank for Adult Speech Therapy
• Voice Therapy Exercises
• Apraxia Worksheets for Adults
• The Complete Guide to Adult Speech Therapy Assessments

1) Dysarthria Treatment Tips

• When treating dysarthria, focus on the underlying impairment.
  
  
• Ask yourself these questions:
  
  
  • What signs and symptoms am I seeing in my patient?
  • Would speech therapy improve their ability to communicate more effectively, efficiently, or naturally?
  • What subsystem(s) can treatment focus on to help them communicate best?
  • Should I refer out to ENT or a voice specialist?
    
    
• Encourage daily homework and encourage caregivers to follow through with listener strategies, including reminding the patient to use their strategies.
  
  
• Above all, remember that the ultimate goal of dysarthria therapy is to improve the patient’s quality of life—which you can only identify by listening to their wants and needs. Let that guide your decision-making!

2) Dysarthria Exercises: Articulation

Treat articulation by using a hierarchy of speech sounds (see examples below). Practice the sound groups that your patient is having difficulty with.

During articulation treatment, provide:

1. Articulatory placement cues
2. Biofeedback (a mirror, etc.)
3. Modeling
4. Encouragement! (“great effort”, “almost there”, “excellent work”)

For more articulation exercises and materials, visit our shop.

Hierarchy of Speech Sounds

1) Sounds in Isolation

2) Syllables

• Puh
• Paw
• Pee
• Poo
• Buh
• Bee
• Boo
• Bow
• Muh
• Me
• Mow
• My

3) Words

• Page
• Peace
• Peer
• Puck
• Peek
• Bake
• Beak
• Bed
• Bash
• Beef
• Meat
• Maze
• Move
• More
• Met

4) Longer words

• Parking
• Painful
• Polite
• Peaceful
• Package
• Birthday
• Bottle
• Baggage
• Breathy
• Boyish
• Marvel
• Master
• Molar
• Minimal
• Multitude

5) Minimal pairs

• Ten/Hen
• Name/Lame
• Lane/Lake
• Cut/Cup
• Knit/Sit
• Pass/Pad
• Zen/Pen
• Gain/Game
• Bank/Sank
• Set/Get

6) Phrases

• I say ____
• ____ is the word
• The word is ____
• Two bananas
• Credit Card
• Rest Area
• Good Luck
• Local bank
• The end
• Left turn only
• How are you?

Aphasia Readers offers free PDF practice phrases, organized by theme (holidays, pets, etc.)

7) Sentences

• Good to see you!
• I hope to arrive early.
• Take one pill with water.
• The best bookseller for board books is in Boston.
• Pass the pepper to my plate.
• Must we move to Montana on Monday?

8) Conversations

• What is your favorite season and why?
• What would you do if you inherited a million dollars?
• What are your favorite sporting events and why?
• What would you do if you were 25 again?
• Coffee or tea? Why?

Fun Bonus! Tongue Twisters

• Peter Piper picked a peck of pickled peppers
• She sells seashells by the seashore
• Which wristwatches are Swiss wristwatches?
• Seventy-seven benevolent elephants
• Betty bought some butter, but the butter was bitter, so Betty bought some better butter to make the bitter butter better
• How much wood would a woodchuck chuck if a woodchuck could chuck wood?
• Many an anemone sees an enemy anemone
• A skunk sat on a stump and thunk the stump stunk, but the stump thunk the skunk stunk

Non-Speech Oral Motor Exercises

Non-speech oral motor exercises are widely used by speech-language pathology professionals to improve articulation. Examples include lip and tongue strengthening and range of motion exercises.

There’s currently not enough evidence to either support or refute whether non-speech oral motor exercises improve articulation (Lass & Pannbacker, 2008; Mackenzie et al, 2014; McCauley et al, 2009).

ASHA’s Practice Portal does recommend using a shaping technique (phonetic derivation) as a treatment option. For example, shaping blowing into /u/.

While this technique uses non-speech elements to improve articulation, its goal is to produce specific target sounds. This is different from oral motor exercises, which aim to strengthen weak muscles and/or improve muscle coordination.

If you believe that your patients would benefit from non-speech oral motor exercise, we recommend reading the literature and making your own evidence-based decision.

3) Dysarthria Exercises: Intelligibility

Intelligibility Tips

Signal The Start
Let your listener know when you’re about to start talking. You can lift your hand, make eye contact, write it down, etc.

Name the Topic
Say 2-3 words to set your topic

Keep it Simple
Use easier words and sentence structures

Use Gestures
Point, use hand gestures, shrug, shake your head, use facial expressions, etc. to help make your point

Signal the End
Avoid interruptions by holding up one finger. Signal when you’re finished by holding out your palm to the listener

Use a Pen and Paper or Alphabet Board
Write the first letter of the word you’re trying to say on a pad of paper/whiteboard or use an alphabet board.

Clear Speech Strategies

Teach your patients the following clear speech strategies. Practice these strategies by reading increasingly longer tasks out loud. See the hierarchy of reading tasks below for word lists.

TALK BIG
Over-articulate

TALK LOUD
Increase your volume

TALK SHORT
Take breaths more often; insert pauses every few words

For more intelligibility exercises and materials, visit our shop.

Hierarchy of Reading Tasks

1) Phrases

Click for a list of phrases.

2) Sentences

Click for a list of sentences.

3) Paragraphs

JaToya took her dogs out for a walk. Their normal route was blocked by construction, but the new route she chose was beautiful. They walked over two miles.

Washington State is known for being a rainy place. This is not unfounded, as some of its cities have over 140 rainy days per year. Washington rain, however, is usually a light drizzle. When measuring total inches of rain per year, Washington is only the 29th rainiest state. The frequency of rainy days in the western part of the state makes it a green, vibrant place most of the year. Locals know to invest in good waterproof jackets.

Osaka, pronounced “OH-saw-ka,” is the second-largest city in Japan. It is also one of the largest cities in the world, with a population of over 20 million people. Osaka is considered Japan’s economic center. It is home to electronics giants Panasonic, Sharp, and Sanyo. Osaka is also one of the most expensive cities in the world to live in—more expensive even than New York City or Los Angeles.

4) Page-Level Reading

To keep treatment functional and patient-centered, it’s best to use books, magazines, or other materials that your patient is already reading.

For free classic books in the public domain, check out Project Gutenberg.

Pride and Prejudice by Jane Austen

It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife.

However little known the feelings or views of such a man may be on his first entering a neighbourhood, this truth is so well fixed in the minds of the surrounding families, that he is considered as the rightful property of some one or other of their daughters.

“My dear Mr. Bennet,” said his lady to him one day, “have you heard that Netherfield Park is let at last?”

Mr. Bennet replied that he had not.

“But it is,” returned she; “for Mrs. Long has just been here, and she told me all about it.”

Mr. Bennet made no answer.

“Do not you want to know who has taken it?” cried his wife impatiently.

“You want to tell me, and I have no objection to hearing it.”

This was invitation enough.

“Why, my dear, you must know, Mrs. Long says that Netherfield is taken by a young man of large fortune from the north of England; that he came down on Monday in a chaise and four to see the place, and was so much delighted with it that he agreed with Mr. Morris immediately; that he is to take possession before Michaelmas, and some of his servants are to be in the house by the end of next week.”

“What is his name?”

“Bingley.”

“Is he married or single?”

“Oh! single, my dear, to be sure! A single man of large fortune; four or five thousand a year. What a fine thing for our girls!”

“How so? how can it affect them?”

“My dear Mr. Bennet,” replied his wife, “how can you be so tiresome! You must know that I am thinking of his marrying one of them.”

“Is that his design in settling here?”

“Design! nonsense, how can you talk so! But it is very likely that he may fall in love with one of them, and therefore you must visit him as soon as he comes.”

“I see no occasion for that. You and the girls may go, or you may send them by themselves, which perhaps will be still better, for as you are as handsome as any of them, Mr. Bingley might like you the best of the party.”

“My dear, you flatter me. I certainly have had my share of beauty, but I do not pretend to be anything extraordinary now. When a woman has five grown-up daughters, she ought to give over thinking of her own beauty.”

“In such cases, a woman has not often much beauty to think of.”

“But, my dear, you must indeed go and see Mr. Bingley when he comes into the neighbourhood.”

“It is more than I engage for, I assure you.”

“But consider your daughters. Only think what an establishment it would be for one of them. Sir William and Lady Lucas are determined to go, merely on that account, for in general, you know, they visit no newcomers. Indeed you must go, for it will be impossible for us to visit him, if you do not.”

“You are over scrupulous, surely. I dare say Mr. Bingley will be very glad to see you; and I will send a few lines by you to assure him of my hearty consent to his marrying whichever he chooses of the girls; though I must throw in a good word for my little Lizzy.”

“I desire you will do no such thing. Lizzy is not a bit better than the others; and I am sure she is not half so handsome as Jane, nor half so good-humoured as Lydia. But you are always giving her the preference.”

“They have none of them much to recommend them,” replied he; “they are all silly and ignorant like other girls; but Lizzy has something more of quickness than her sisters.”

4) Dysarthria Exercises: Phonation

Signs and symptoms of impaired phonation:

1. Decreased ability to phonate
2. Abnormal pitch and pitch breaks
3. Excessive loudness
4. Abnormal vocal quality
5. Speaking only in short phrases

Breath Control Exercises

These exercises are for patients who can’t phonate at all. They aim to build their ability to phonate so that they can move on to the more advanced exercises described below.

* These are NOT for patients who can’t phonate due to vocal cord paralysis. For those with vocal fold weakness or paralysis, make sure that the patient sees an ENT or voice specialist prior to speech therapy.

PATIENT INSTRUCTIONS

1. Breath in slowly for 3 seconds
   
   
2. Hold your breath for 3 seconds
   
   
3. Release the air slowly for 3 seconds
   
   
4. Continue breathing in this controlled manner
   
   
5. Now, when you exhale, hold out these sounds for as long as you can:
   
   
   • hhh
   • sss
   • thhh
   • fff
   • shhh
     
     
6. Now, add vowels to the end of the sounds and hold them out for as long as you can:
   
   
   • hhha, hhhoe, hhhi, hhhow, whho
   • sssah, ssso, ssseee, sssow, sssue
   • thhhaw, thhho, thhhee, thhhow, thhhew
   • fffa, fffoe, fffeee, fffow, fffoo
   • shhha, shhhow, shhhe, shhhaow, shhhoe

Effort Closure Techniques: Hypoadduction

Use effort closure techniques with patients with hypoadduction of the vocal folds. These techniques aim to increase the force of vocal fold adduction.

• Clasp hands together then squeeze the palms together as hard as possible
• If seated on a chair, pull upward or push downward with both hands
• Interlace hands and pull outward

Hyperadduction Exercises

Patients with hyperadduction of the vocal folds may present with abnormal vocal quality and too much loudness. Treat by practicing light articulatory contacts and easy phonation.

Light Sounds

Ha
How
Hoe
He
Hi
Who
Hey
Hall
Hose
Hot
Hole
Hear
Hug
Ham

LSVT LOUD®, SPEAK OUT!®, and Pitch Limiting Voice Treatment

LSVT LOUD is a treatment program that focuses on high phonatory effort to think loud and speak loud in order to increase vocal intensity.

SPEAK OUT! emphasizes that patients speak with intent to increase vocal intensity, clarity, and thinking processes.

Pitch Limiting Voice Treatment (PLVT) emphasizes speaking loud and low to increase vocal intensity without excessive pitch or hypertension of laryngeal muscles. The University that developed PLVT sells an app meant to enhance the treatment.

For summaries of these treatment programs, see LSVT LOUD® vs SPEAK OUT!® vs PLVT.

For more phonation exercises and materials, visit our shop.

5) Dysarthria Exercises: Respiration

Expiratory Muscle Strength Training (EMST) & Inspiratory Muscle Strength Training (IMST)

EMST and IMST are recommended for patients with significant weakness who have speech that is incomprehensible because they run out of breath.

EMST and IMST training typically involve specially designed one-way valves that only open and allow airflow when a certain threshold of effort is reached.

Examples are the EMST 150™, which is pictured above, and the POWERbreathe® Medic.

Postural Adjustments

Encourage your patient to sit upright to improve breath support for speech.

Position yourself, materials, communication partners, etc. to encourage an upright posture.

Diaphragmatic Breathing

Patient Instructions:

1. Put one hand on your stomach and your other hand on your chest. Feel your stomach rise and fall with each breath. Continue for one minute.
   
   
   • When you breathe in: Your stomach pushes out. The hand on your chest should remain still.
   • When you breathe out: Tighten your stomach muscles and feel them pull in. The hand on your chest should remain still.
     
     
2. Breathe in, feeling your stomach push out. As you breathe out, say the following sounds and words, remaining aware of your stomach slowly pulling in.
   
   
   • Start with simple sounds like “sss” and “shh”
   • Gradually work up to vowel sounds like “ahh” and “ooh”
   • Work up to single words like “hello” and your first name
   • Gradually work up towards longer words, phrases, and sentences

Breath Control Exercises

Click for step-by-step treatment patient instructions.

Building Up Breath Control

Print out reading material then add slash marks between words to denote a new breath group. Where you put the slash marks will depend on each patient’s skill level.

Patient Instructions:

Use your breath support strategies (from the above exercises) while saying the following. You may take breaths as needed.

1. Who, what, where, when why, how
   
   
2. Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday
   
   
3. One, two, three, four, five, six, seven, eight, nine, ten
   
   
4. Mercury, Venus, Earth, Mars, Jupiter, Saturn, Uranus, Neptune
   
   
5. January, February, March, April, May, June, July, August, September, October, November, December
   
   
6. She had three soft feathers

For more respiration exercises and materials, visit our shop.

6) Dysarthria Exercises: Prosody

The goal of treating prosody is to help your patients’ speech sound more natural and understandable to others.

Sentence Stress

Patient Instructions:

To improve your prosody, emphasize the bold word in each sentence. Emphasize the word by speaking it louder and with a higher pitch than the other words.

Exaggerate as much as you can! Try using a sing-song voice, like a school teacher.

How are YOU?
How ARE you?
HOW are you?

Where IS she?
Where is SHE?
WHERE is she?

I don’t KNOW
I don’t know
I DON’T know

What a FUNNY story!
WHAT a funny story!
What a funny STORY!

WHAT a lovely day.
What a LOVELY day.
What a lovely DAY.

For more sentences, check out the Motor Speech Pack on our shop.

Heteronyms

Patient Instructions:

Improve your prosody by emphasizing the hold heteronym in each sentence. Emphasize by increasing the loudness and pitch of your voice. Exaggerate as much as possible!

The subject was pretty boring.
Please don’t subject me to math.

Let’s resume the interview.
I need to submit my resume for the job.

Please relay my message to your boss.
The project was a relay race of tasks.

She can be such a rebel when she’s angry.
She will rebel when she hears the bad news.

7) Communication Partner Tips for Dysarthria

Dysarthria Listener Tips

Teach your patients’ communication partners the following listener tips.

Communication Partner Instructions:

Use these tips if you have a hard time understanding what a loved one is saying.

1. Give your full attention
   • Listen and watch the entire time the person is speaking
     
     
2. Confirm the topic
   • Check that you and the speaker are both on the same topic
   • “Are we still talking about…?”
     
     
3. Use keywords
   • Refer back to words the speaker said to try to create a full narrative
   • “You said ‘dinner’. Were you talking about dinner with your family next week?”
     
     
4. Encourage writing, drawing, or gesturing
   
   
5. Repeat each word
   • If the speaker is especially hard to understand, repeat each word they say. Confirm that each word is correct before moving on to the next word
     
     
6. Set ground rules
   • To avoid frustration, have a set number of times the speaker tries to say something before they take a break or use AAC

Alphabet Board

Ways to Use an Alphabet Board

• The patient points to the first letter of the word and says the word
• The patient spells out the entire words
• The patient spells out the code for a message on a code board

Tips for Listeners

• Make sure that the alphabet board is always within the patient’s reach
• Give the patient plenty of time to select each letter
• Confirm each letter the patient chooses by saying it aloud
• Only guess a word when you’re 90% sure you know what the word is

For AAC boards and materials, check out our shop.

8) Compensatory Strategies for Dysarthria

Clear Speech Strategies

Click for step-by-step patient instructions.

Personal Amplifier

Personal amplifiers increase the loudness of a patient’s voice in a noisy setting, such as at a restaurant or in a store. It helps others understand them better while also helping patients avoid yelling and feeling fatigued by speaking.

Personal amplifiers are available for sale at major retailers, including Amazon.com.

Communication Board

See the Alphabet Board section above.

9) Environmental Modifications for Dysarthria

Make environment modifications that will help your patient be more easily understood when communicating.

• Choose a quiet setting. Turn off the TV, fans, shut the window, etc.
  
  
• Choose an area with good lighting
  
  
• Avoid visual distractions
  
  
• Make sure that the speaker and communication partner are face-to-face and close enough
  
  
• Have a communication board or a notepad and pencil handy
  
  
• Use videoconferencing (FaceTime, Zoom, etc.) instead of phone calls
  
  
• Use the Telecommunications Relay Service where a specially trained communication assistant mediates phone calls for patients (the ADA requires telephone companies to provide the service for free)

10) Resonance Treatment for Dysarthria

Patients with velopharyngeal incompetence may benefit from surgery or a prosthesis to improve hypernasal resonance.

Speak with their PCP to recommend a prosthodontist, dentist, plastic surgeon, etc. referral, as appropriate.

References

• Lass, N.J. & Pannbacker, M. (2008). The application of evidence-based practice to non speech oral motor treatment. Language, Speech, and Hearing Services in Schools, 39, 408-421.
• Levitt, JS. & Walker-Batson, D. (2018). The Effects of The “Speak with Intent” Instruction for Individuals with Parkinson’s disease. Journal of Communications Disorders and Assistive Technology, 1, 1-15.
• Mackenzie, C., Muir, M., Allen, C., & Jensen, A. (2014). Non-speech pro-motor exercises in post-stroke dysarthria intervention: a randomized feasibility trial. International Journal of Language & Communication Disorders, 49(5), 602-617.
• McCauley, R.J., Strand, E., Lof, G.L., Schooling, T. & Frymark, T. (2009). Evidence-Based Systematic Review: Effects of Nonspeech Oral Motor Exercises on Speech. American Journal of Speech-Language Pathology, 18, 343-360.
• Clinical Review Dysarthria, Hypokinetic by Cinahl Information Systems
• Communication and Dysarthria by the American Stroke Association
• Dysarthria in Adults by ASHA
• The Adult Speech Therapy Workbook by Chung Hwa Brewer

More Dysarthria Resources

Visit our shop for pre-made dysarthria treatment activities, handouts, wordlist, and much more!