Behavioral management of respiratory/phonatory dysfunction from dysarthria: A flowchart for guidance in clinical decision making

This work emerged from a larger effort by an Academy of Neurologic Communication Disorders and Sciences committee to establish Practice Guidelines for the management of speakers with dysarthria. A fundamental issue in dysarthria management is the availability of appropriate methods for assessing and treating speakers with compromised respiratory and phonatory subsystems. As such, a flowchart of behavioral management options for respiratory/phonatory dysfunction from dysarthria is provided. Three general areas of respiratory/phonatory dysfunction are identified to provide an organizing framework for a clinician's approach to respiratory/phonatory management. Those areas include (a) decreased respiratory support, (b) decreased respiratory/phonatory coordination and control, and (c) reduced phonatory function. Within each area, behavioral techniques are delineated in terms of the available support from the dysarthria literature. Support for a particular treatment may stem from evidence-based intervention research or expert opinion. Behavioral techniques lacking support also are highlighted, as are areas in particular need of treatment efficacy research.