Dysarthria in Amyotrophic Lateral Sclerosis: A Systematic Review of Characteristics, Speech Treatment, and Augmentative and Alternative Communication Options

This evidence-based review addresses intervention and management of dysarthria related to amyotrophic lateral sclerosis (ALS; Lou Gehrig's disease) and is part of a series of evidence-based systematic reviews sponsored by the Academy of Neurologic Communication Disorders and Sciences. A search of electronic databases (PsychINFO, Medline, and CINAHL) and hand search of relevant edited books yielded 713 articles on the topics related to characteristics, intervention, and management of the dysarthrias associated with ALS. This review summarizes the characteristics of dysarthria in ALS and appraises and summarizes findings from studies investigating speech treatment and augmentative and alternative communication (AAC) interventions for people with ALS. Findings include (1) well-documented characteristics of the progressive, mixed spastic and flaccid dysarthria; (2) consensus of expert opinion indicating the benefits of communication strategies, including speech supplementation and partner training for mild to moderate dysarthria; (3) a lack of evidence supporting the use of strengthening exercises for improving speech; (4) usefulness of monitoring of rates of speech to predict intelligibility declines and thus inform the timing of AAC intervention; (5) emerging evidence of the long-term usefulness of AAC systems; and (6) the influence of other factors, such as cognitive decline, that may affect the success of various interventions.