Objective Assessment of Dysarthria (Even By Teletherapy!)

Have you run into issues assessing your patients with dysarthria while doing teletherapy? Me too! A lot of our typical objective measures are null-and-void when working through the computer. But what if I told you that you could complete a well-rounded motor speech assessment that provides objective data using the first paragraph of “The Rainbow Passage,” a recording device, and a timer? Sign me up! I’ve even compiled the materials, objective measures, and their norms into an easy-to-use handout that you can download for free at the end of this article. Now, let’s dive into what the experts are saying works for dysarthria face-to-face or by teleassessment!

Breath Pause Patterns

Analyzing the placement and amount of pauses during a passage reading can provide important information about breath support for speech. The first paragraph of “The Rainbow Passage” has been divided up into major (independent clause) and minor (dependent clause) boundaries to help with the calculation

How To Calculate Breath Pause Patterns:

1. Instruct the patient to read “The Rainbow Passage”

2. Mark each spot on the passage template where a pause or breath occurs

3. Pauses that occur on major or minor boundaries are syntactically appropriate, ones that occur mid-phrase or word are inappropriate

TIP: Watch for movement in the shoulder, chest, and abdomen (if camera angle allows) as some breaths may not be audible

Determine the percentage of pauses produced at:

• Major syntactic boundaries

• Minor syntactic boundaries

• Unrelated syntactic boundaries

FORMULA: number of pauses at (major/minor/unrelated) / total number pauses x 100

Why does this matter? Healthy adults demonstrate the most breath pauses at major syntactic boundaries and almost no pauses at unrelated boundaries while individuals with dysarthria show a more equivalent amount of pauses between major and minor boundaries and a higher percentage at unrelated syntactic boundaries as severity increases.

Utterance Length

Utterance length is a reliable indicator of respiratory support for speech as longer utterances correlate with greater respiratory support. The first paragraph of “The Rainbow Passage” is 127 syllables total and can be used to determine utterance length.

How To Calculate Average Utterance Length:

1. Instruct the patient to read “The Rainbow Passage”

2. Mark each spot on the passage template where a pause of breath occurs

3. Make note of any extra syllables added or omitted during the reading (use a recording device to ensure accuracy)

TIP: The total number of utterances spoken will always be one more than the total number of breath pauses

FORMULA: total number of utterances / total number of syllables produced

Speech Rate

Determining speech rate, whether fast or slow, can provide an indication of the overall naturalness of speech. Dysarthria is often associated with a slowed rate of speech, however, in some cases such as Parkinson’s, speech rate can become increased. Speech rate during a reading task can be completed using the first paragraph of “The Rainbow Passage” and a timer.

How To Calculate Average Rate of Speech:

1. Instruct the patient to read “The Rainbow Passage”

2. Time the patient as they read

3. Make note of any extra syllables added or omitted during the reading (use a recording device to ensure accuracy)

4. Stop the timer once the patient has completed the passage and write the amount of time taken to read the passage

TIP: For an accurate picture of speech rate, you can calculate speech rate of a spontaneous speech sample, too! This does require transcription of the sample and is a little extra work, but will illustrate how speech rate changes between conversation and reading tasks.

Diadochokinetic (DDK) Rates

Oh, our old & reliable friend, DDK. This objective measurement is likely ingrained in your brain since grad school, but I’ll talk about it anyway! DDK rates can help with rating severity and differential diagnosis of motor speech disorders. I like to use a free app called “DDK” to make recording DDK rates quick and easy. I recommend downloading it!

How To Calculate DDK:

1. Get your app (or stop watch with a ‘lap’ feature) ready

2. Instruct your patient to “Take a breath and repeat ‘puh puh puh puh puh’ for as long and steady as you can”

3. Press start when the patient begins and press ‘lap’ for each repetition

4. Rinse and repeat with “tuh,” “kuh,” and “puh tuh kuh”

BONUS: Patient-Reported Outcome Measure for Dysarthria

Sure, that hard data of DDK rates and breath pause patterns are great and can be used to measure progress over time, but let’s not forget about the whole person! I love using patient-reported outcome measures (PROMs) to get the client’s point of view on how their dysarthria impacts their identity, day-to-day life, and participation. Here are PROMs I use often in my practice.

Communicative Participation Item Bank (CPIB; Baylor et al. 2013)

• A short, 10-item, questionnaire for clients to self-report their communication skills and ability to participate. This can be used for disorders other than dysarthria as well as it is disorder generic. It was normed on individuals with Parkinson’s, MS, ALS, and head & neck cancer. A preliminary study conducted in 2017 suggested the CPIB may be valid for individuals with aphasia, though they recommend providing multimodal support and avoid using answers provided by a proxy/caregiver.

The Levels of Speech Usage categorical rating scale (Baylor et al., 2008)

• A simple rating scale completed by the client in order to determine the client’s typical speech demands and frequency of speech use. This rating scale can help create functional goals that target the types of speaking activities your clients participate in. It can be used for a variety of disorders including dysarthria, apraxia, dysphonia, and other voice disorders.

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ABOUT THE AUTHOR

Katie Brown, MA, CCC-SLP,CBIS

Katie is the owner and founder of Neuro Speech Solutions. She is passionate about providing person-centered treatment to her clients in order to meet their life participation goals. Katie is dedicated to helping other SLPs provide functional therapy through affordable materials and education courses.

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References:

Baylor, C., Oelke, M., Bamer, A., Hunsaker, E., Off, C., Wallace, S. E., Pennington, S., Kendall, D., & Yorkston, K. (2017). Validating the Communicative Participation Item Bank (CPIB) for use with people with aphasia: an analysis of Differential Item Function (DIF). Aphasiology, 31(8), 861–878.

Baylor, C., Yorkston, K., Eadie, T., Kim, J., Chung, H., & Amtmann, D. (2013). The Communicative Participation Item Bank (CPIB): item bank calibration and development of a disorder-generic short form. Journal of speech, language, and hearing research : JSLHR, 56(4), 1190–1208.

Baylor, C., Yorkston, K., Eadie, T., Miller, R., & Amtmann, D. (2008). Levels of Speech Usage: A Self-Report Scale for Describing How People Use Speech. Journal of medical speech-language pathology, 16(4), 191–198.

Sevitz, J.S, Kiefer, B.,R., Huber, J.E., & Troche, M.S. (2021). Obtaining objective clinical measures during telehealth evaluations of dysarthria, American Journal of Speech-Language Pathology, 30(2), 503-516.