Understanding Dysarthria & Speech Intelligibility

I wanted to write a post on speech intelligibility specifically as it relates to dysarthria, which is one of the diagnoses I commonly work with in my practice following a stroke or brain injury. Dysarthria can be developmental or acquired and today we will focus on dysarthria that is acquired. As I have discovered throughout my career, many people are unfamiliar with the term “dysarthria.” Let’s review the basics of dysarthria and its core deficit, which is impaired speech intelligibility. 

What is dysarthria?

  • A speech disorder caused by problems with the muscles used for speech
  • Affects speech production only but may co-occur with other diagnoses such as aphasia or apraxia 
  • There are seven different types of dysarthria based on the part of the brain affected (for example- ataxic, hypokinetic, or flaccid dysarthria) 
  • Dysarthria is common after a stroke or brain injury (22-58% in acute stroke; 30-86% in acute or subacute TBI)
  • Dysarthria is also common in other neurological conditions such as Parkinson’s, ALS, & MS

What are the characteristics of dysarthria?

Difficulties in one or more of the speech subsystems: 

  • Respiration (Breathing)
  • Phonation (Voicing) 
  • Articulation (Pronunciation) 
  • Resonance (Nasality) 
  • Prosody (Stress/Intonation)

Someone with dysarthria might demonstrate: 

  • Rough, strained, or breathy voice
  • Pitch breaks
  • Imprecise speech sounds 
  • Hypernasal speech
  • Monotone speech
  • Too loud or too soft voice

What is intelligibility?

  • Intelligibility means how much of a person’s speech can be understood
  • Typically measured as a percentage (e.g., 50% intelligible)
  • Many real-life examples related to speech intelligibility exist outside of dysarthria- understanding every word my 1 year old daughter says but others have difficulty understanding her speech, trying to understand a professor’s speech whose first language is not English, or someone from Boston talking with someone from Atlanta in different dialects of English 

What are ways to improve speech intelligibility? 

Speaker:

  • Overarticulate
  • Divide syllables/ use a pacing board
  • Reduce distractions
  • Slow rate
  • Disclose your dysarthria
  • Name the topic 
  • Face the listener 
  • Prioritize rest breaks 

Listener: 

  • Ask for clarification or to repeat message 
  • Allow extra time
  • Give the speaker your undivided attention
  • Watch speaker as he/she talks 
  • Don’t pretend to understand!
  • Allow writing or gestures as needed

Sources: 

  1. American Speech-Language-Hearing Association. Dysarthria in adults [Practice portal]. https://www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/
  2. Dahl, Kimberly (2024). Dysarthria: Best Practices for Assessing Intelligibility [Continuing Education Course]. Speechpathology.com. https://www.speechpathology.com/slp-ceus/course/dysarthria-best-practices-for-assessing-10999

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Bethany Emanuel,

M.Ed., CCC-SLP

I’m an ASHA certified speech-language pathologist passionate about providing care that is client-centered and empowering clients to meet their goals. I have been an SLP for over 11 years and have worked in a variety of settings such as skilled nursing, private practice, and most recently at a nationally-ranked rehabilitation hospital. I obtained my bachelor’s and master’s degrees in speech pathology from the University of Georgia (Go Dawgs!). I see adolescents & adults with acquired brain injuries or diagnoses such as TBI/traumatic brain injury, concussion, stroke, or multiple sclerosis and also provide executive function coaching services to teens & adults with ADHD. My area of expertise is in cognitive communication disorders and I treat areas such as memory, attention, executive functioning, expressive and receptive language, swallowing, voice, and speech production.

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