Speech therapy for children with dysarthria

Last update: 9 Jun 2016

Speech therapy can improve the ability of children with cerebral palsy to communicate more clearly and interact with others
To be of benefit, regular therapy is essential and a substantial time commitment is needed
For some children with severe cerebral palsy and very limited speech, alternatives such as speech generating devices can supplement and even replace speech.

Who is it for?

Speech therapy may be suitable for adults as well as children with cerebral palsy who have the following characteristics:
Type of cerebral palsy : Bilateral cerebral palsy, Diplegia, Hemiplegia, Quadriplegia, Triplegia, Unilateral cerebral palsy

More information about cerebral palsy is contained in the What is CP? section.

Mobility : GMFCS I, GMFCS II, GMFCS III, GMFCS IV

Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

GMFCS Level I
Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

GMFCS Level II
Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

GMFCS Level III
Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

GMFCS Level IV
Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

GMFCS Level V
Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.

See full glossary

Arm ability : MACS I, MACS II, MACS III, MACS IV, MACS V

Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

MACS Level II
Handles most objects but with somewhat reduced quality and/or speed of achievement.

MACS Level III
Handles objects with difficulty; needs help to prepare and/or modify activities.

MACS Level IV
Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

See full glossary

Communication ability : CFCS I, CFCS II, CFCS III, CFCS IV

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

CFCS Level II
Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

CFCS Level III
Effective Sender and Receiver with familiar partners.

CFCS Level IV
Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

See full glossary

Movement disorder : Ataxia, Athetosis, Dystonia, Hypotonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : No intellectual disability, Mild intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

See full glossary

Cerebral Palsy Alliance offers a specialised service where our speech pathologists work with children and their families to determine whether speech therapy for dysarthria is a good choice.

Find a Cerebral Palsy Alliance service

Fees will apply for assessment and intervention with a speech pathologist and will depend on the provider and the number of sessions needed. Check with the provider whether fees will also apply for development of a home program, report writing or therapist travel.

Ask the speech pathologist if you are eligible for funding to assist with fees. People with a disability living in Australia may be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Therapy to treat dysarthria will involve the child attending two to three sessions each week with a speech pathologist – for at least six weeks. Parents are expected to attend the sessions so they can learn to carry out a daily home program between the sessions. The home program is essential for children to get the intensive levels of practice they need to improve their speech.

Because of the time involved, participating in dysarthria therapy requires a substantial commitment from families, for both the therapy sessions and the home program. Once therapy is completed, the child will need to continue with their home program on an ongoing basis to maintain their new speaking skills.

More about speech therapy for dysarthia

A common problem for children with cerebral palsy is having speech that is difficult to understand. This is called dysarthria. For children experiencing this communication challenge, a speech pathologist can provide intensive therapy to improve the clarity of their speech - helping them to be more easily understood by other people.

Dysarthria occurs when a child with cerebral palsy has difficulty coordinating the muscles they use for speaking and the coordination of their breathing as they talk. It is usually more common, and the person’s speech is more difficult to understand, when the child has severe cerebral palsy.

Children with cerebral palsy can be taught strategies that help improve their speech. Their therapy will focus on improving different components of their speech. The exercises they practice can help them:

  • Slow down their rate of speech
  • Pause to take a breath at appropriate times in a word or a sentence
  • Breathe deeply to increase the length of the speech they can produce using one breath
  • Produce clearer voice quality
  • Maintain even and appropriate vocal pitch
  • Produce accurate speech sounds

As a child’s speech becomes clearer, their intervention will gradually incorporate words and sentences that are longer and more difficult.

Choosing the right therapy

The child’s speech pathologist will also consider whether they would benefit from other communication supports, such as alternative and augmentative communication (AAC). For children who are not able to communicate effectively using speech alone, these can supplement and even replace speech.

Examples of alternative and augmentative communication methods include:

These options may be used as a short or long term strategy for a child’s communication, depending on how well they are able to communicate using speech. Alternative and augmentative communication may be the most helpful long term option for some children to enable them to participate in conversations at home, school and in other environments.

  • Dysarthria therapy is most suited for children aged three-years-old to 18-years-old with cerebral palsy who have moderate to severe dysarthria and are able to follow instructions. A speech pathologist can offer suggestions for other ways to improve the communication of children who are under three years of age
  • To help a child remain motivated with their practice, exciting and interesting activities and toys, including iPad applications, can be useful in speech therapy and home sessions.

Assessments

There are two types of assessment a child should undertake when having dysarthria therapy:

A thorough assessment by a speech pathologist is really important to identify the child’s specific communication difficulties. This will help set goals for therapy and ensure the exercises they select are suitable for the child’s ability level. The assessment will also determine how well the child can understand and follow instructions during their therapy. Assessments include:

  • Diagnostic Evaluation of Articulation and Phonology (DEAP) - measures and diagnoses a person’s speech errors and disorders
  • Goldman-Fristoe Test of Articulation – measures the accuracy of speech sounds

The purpose of using an outcome measure is to determine whether this intervention meets the individual’s needs and goals.

The speech pathologist, together with the child with cerebral palsy and their family, will decide on the most suitable measures to use. One outcome measure that is commonly used is:

  • Goal Attainment Scaling (GAS) – this measures the extent to which the child’s goals are achieved. This can also be used to measure change in a child’s ability to be understood in everyday environments.

Best available research evidence

We searched the medical and allied health literature looking for research published between 1995 and 2015 evaluating the outcomes when children and adolescents with cerebral palsy participated in speech therapy for their dysarthria.
The search was to find the best available research on whether speech therapy for dysarthria improves speech clarity and the ability to participate in everyday communication (this is known as functional communication).

The best available evidence was one systematic review of randomised controlled trials (RCTs)1. As this systematic review did not locate any RCTs to include, we then searched the literature for lower levels of evidence on this topic. This search revealed four small Level 4 studies2-5. They included 47 children with cerebral palsy aged five-years-old to 18-years-old. Collectively the studies were classified as low quality of evidence. This is because they were small, low level, and had some inconsistency in the type of therapy and outcome measures used.

Overall, it appears that intensive speech therapy for dysarthria may be effective for helping children with cerebral palsy to be better understood by others they communicate with. Children are more likely to maintain their skills if they continue to practice3, but younger children can maintain their skills up to 12 weeks after an intensive therapy block2. Families of children with dysarthria are encouraged to contact a speech pathologist to discuss creating an individualised speech therapy program.

Intensive dysarthria therapy appears to be effective for children with cerebral palsy

Each of the studies used intensive speech therapy, for instance, attending two to five sessions a week for five to six weeks. The studies concluded that these children’s speech was easier to understand after the therapy. For two of the studies2-3 children’s single words and sentences were more easily understood by people who were used to (familiar listeners) and people who were not used to (unfamiliar listeners) listening to children with dysarthria. A third study found improvements only for single words but not when the children were speaking in sentences4.

Changes in intelligibility may be sustained for six weeks and possibly up to 12 weeks

Three studies tested children six to seven weeks after their dysarthria therapy finished. One of these studies found that improvements in intelligibility were not retained after therapy4, however the other two larger studies found the improvement was sustained2-3. One of the studies assessed children 12 weeks after therapy and found that improvements in intelligibility remained3.

The effect of dysarthria therapy on functional communication is unknown

One study3 looked at whether children’s functional communication, or communication participation in everyday life increased. The results are inconclusive. Although their communication participation improved, the improvement was not correlated with increases in intelligibility and therefore may have been due to different factors in the children’s lives.

Date of literature searches: December 2015

  1. Pennington, L., Miller, N., & Robson, S. (2009). Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database of Systematic Reviews, (4).
  2. Pennington, L., Miller, N., Robson, S., & Steen, N. (2010). Intensive speech and language therapy for older children with cerebral palsy: a systems approach. Developmental Medicine & Child Neurology, 52(4), 337-344 338p. doi: 10.1111/j.1469-8749.2009.03366.x
  3. Pennington, L., Roelant, E., Thompson, V., Robson, S., Steen, N., & Miller, N. (2013). Intensive dysarthria therapy for younger children with cerebral palsy. Developmental Medicine & Child Neurology, 55(5), 464-471.
  4. Pennington, L., Smallman, C., & Farrier, F. (2006). Intensive dysarthria therapy for older children with cerebral palsy: findings from six cases. Child Language Teaching & Therapy, 22(3), 255-273 219p. See abstract
  5. Puyuelo, M., & Rondal, J. A. (2005). Speech rehabilitation in 10 Spanish-speaking children with severe cerebral palsy: A 4-year longitudinal study. Pediatric Rehabilitation, 8(2), 113-116. See abstract
Find out about CP Check-Up™

Cerebral Palsy Alliance offers a service called CP Check-Up™ which provides ongoing surveillance of the health and well-being of our clients aged 0-18 years.
The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.