5 Dysarthria Treatments for TBI

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A traumatic brain injury (TBI) may cause dysarthria, a disorder where speech sounds slurred, mumbled, or muffled.

This article focuses on treatments that help these patients speak more intelligibly. You’ll learn:

  • What dysarthria in TBI looks like
  • 5 dysarthria treatments for TBI

Let’s get started!

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Table Of Contents
  1. What to Consider When Treating Dysarthria in TBI 
  2. What Does Dysarthria in TBI Look Like?
  3. Dysarthria Treatments for TBI
  4. 1. LSVT LOUD®
  5. 2. Clear Speech Strategies
  6. 3. Be Clear Dysarthria Treatment
  7. 4. Breath Support Exercises
  8. 5. Dysarthria Exercises
  9. More TBI Speech Therapy Activities 
  10. References

What to Consider When Treating Dysarthria in TBI 

dysarthria and cognition

Depending on the size, severity, and location of their brain injury, people with a TBI may have decreased awareness, attention, or memory.

This can make dysarthria treatment more challenging. You can add more support by:

  • Giving audio, visual, or tactile feedback to improve awareness
  • Teaching memory strategies such as writing, repetition, and spaced retrieval to improve recall of speech strategies
  • Increasing cues (written/environmental, verbal, and tactile cues) to improve carryover of speech intelligibility strategies

Be mindful of what areas of cognition are impacted when choosing dysarthria treatments for TBI. And for help with cognition assessment and treatment, visit our shop!

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What Does Dysarthria in TBI Look Like?

traumatic brain injury speech treatments\

Dysarthria in TBI often looks like deficits in speech pitch, rate, and stress. They may have aprosodia, which is monotone or monopitch speech, and a slower speech rate with imprecise articulation and reduced breath support (Wang, 2005; ASHA, n.d.)

Speech subsystems that can be affected by TBI include:

  • Respiration
  • Articulation
  • Resonance
  • Phonation
  • Prosody

When starting dysarthria treatment, focus on the speech subsystem that’s most affected. Pay attention to this during your motor-speech assessment.

For more on assessments, read your complete guide to adult speech therapy assessments.

Dysarthria Treatments for TBI

dysarthria treatments for tbi

Below are five dysarthria treatment options for patients with traumatic brain injuries.

1. LSVT LOUD®

The Lee Silverman Voice Treatment (LSVT LOUD) is an evidence-based voice treatment program for not only Parkinson’s disease but for those with other neurological conditions, including TBI.  

Learn more about the evidence supporting LSVT LOUD for patients with TBI on their website.

Read Is LSVT Loud Certification Worth It? for our full review.

2. Clear Speech Strategies

clear speech for tbi

Patients with dysarthria must often compensate for their speech deficits. Clear Speech Strategies are compensatory tactics that can improve speech intelligibility. 

The Clear Speech Strategies are simple! Encourage patients to: 

  • TALK BIG
  • TALK LOUD
  • TALK SHORT

Read 3 Clear Speech Strategies for more details plus a hierarchy of reading tasks to use with your patients.

3. Be Clear Dysarthria Treatment

For a more intensive take on clear speech, consider the ‘Be Clear’ dysarthria treatment program.

Be Clear was designed to improve speech intelligibility in adults with dysarthria caused by a traumatic brain injury or stroke. The protocol is based on clear speech and the principles of motor learning and neuroplasticity. 

Two small feasibility studies found that Be Clear had positive speech benefits, including decreased speech rate and improvements in some measures of intelligibility (Park, 2016; Whelan, 2022). 

How To Do ‘Be Clear‘

be clear for dysarthria

For the full protocol, read Be Clear: A New Intensive Speech Treatment for Adults with Nonprogressive Dysarthria and the Be Clear chapters in Clinical Cases in Dysarthria.

Here are some takeaways:

Intensive Schedule

The creators of Be Clear modeled their treatment schedule on LSVT LOUD:

  • 1 hour of Be Clear therapy per session
  • 4 sessions per week
  • For 4 weeks
  • Plus 15 minutes of homework every day

Do Pre-Practice

Take time to pre-practice before the upcoming treatment sessions to teach your patient how to use clear speech correctly. 

In the Be Clear protocol, patients watch a video of someone reading a passage using normal speech and then reading the same passage using clear speech.  

The patient then identifies which is easier to understand, and why.

Next, the patient practices reading that same passage using clear speech while the clinician gives feedback: “Use big speech movements,” “Slow down.”

Do Functional, Meaningful Treatment—Then Repeat It A Lot

After doing some pre-practice, you’ll start the intensive treatment sessions. 

Each 1-hour Be Clear treatment has 3 phases:

  1. Brief pre-practice of a couple of that session’s activities. (10 minutes)
    • Feedback: The clinician models and gives feedback about how to do clear speech: “Use big speech movements.” Or, “Slow down.”
  2. Structured speech drills. Before the first session, choose phrases with the patient that are functional and meaningful to them. (10 minutes each task)
    • 10 everyday, functional phrases (“Did you feed the cat yet?”) 5x
    • 10 service requests (“Where is the restroom?”) 5x
    • Intensity: Repeat the same functional phrases and service requests every session
    • Feedback: Throughout treatment, the clinician gives feedback about the results: “That was clear,” or “That was unclear.”
    • Modify: Adjust the repetitions as needed to ensure each patient has enough time to complete the next task
  3. 3 Functional speech tasks. Choose tasks that are functional and meaningful to each patient. (10 minutes each task)
    • Reading
    • Picture description
    • Conversation 
    • Feedback: Throughout treatment, the clinician gives feedback about the results: “That was clear,” or “That was unclear.”
    • Keep It Interesting: The Be Clear program changes up the stimuli every week

Do Homework

(15 minutes every day) The Be Clear program has patients practice the functional phrases, service requests, and functional speech tasks they did during the session.

Plus, patients do ‘transfer’ tasks, like making a phone call or ordering coffee, to help them generalize using clear speech outside of treatment.

(Park, 2016)

4. Breath Support Exercises

traumatic brain injuries breath support exercises

Patients with dysarthria caused by TBI often have difficulties with breath support and strength. Breath support exercises like respiratory muscle strength training or diaphragmatic breathing can help.

Read 3 Breathing Exercises for Speech for step-by-step treatment guides.

5. Dysarthria Exercises

tbi dysarthria exercises

These patients may also benefit from other dysarthria exercises.

Remember to focus on the speech subsystem that’s most affected or that you believe will have the greatest positive impact on their ability to communicate effectively and efficiently.

For step-by-step treatment guides, read 24 Dysarthria Exercises For Adult Speech Therapy.

More TBI Speech Therapy Activities 

For more therapy activities for your patients with TBI, visit our shop!

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New CF in the SNF setting. It helped me collect ideas for different patients in an EBP way. I was super overwhelmed and travelling between buildings, too burnt out to research on my free time. This saved me time and helped me feel at ease while transitioning to the job. The Motor Speech part has actually helped my client with apraxia and aphasia. I look forward to continuously using these. Thank you!

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Great for all SLP’s looking to get into adults.

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Morgan

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References

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