Communication Supports for People with Motor Speech Disorders

Top Lang Disorders Vol. 37, No. 4, pp. 375–388 Copyright c 2017 Wolters Kluwer Health, Inc. All rights reserved. Communication Supports for People With Motor Speech Disorders Elizabeth K. Hanson and Susan K. Fager Communication supports for people with motor speech disorders can include strategies and tech- nologies to supplement natural speech efforts, resolve communication breakdowns, and replace natural speech when necessary to enhance participation in all communicative contexts. This article emphasizes communication supports that can enhance participation, as described in the World Health Organization’s International Classification of Functioning, Disability and Health. The article begins with a discussion of partner and patient-reported assessments to evaluate participation levels and barriers to participation. Then, it provides an overview of communication supports for speakers with motor speech disorders, organized by the status of the disorder as stable, improv- ing, or degenerative. The article includes nine case examples to illustrate principles and provide examples of how to address stable and changing needs. Key words: alphabet supplementation, augmentative and alternative communication, communication partner, digital images, dysarthria, motor speech, photographic supplementation, topic supplementation HIS ARTICLE describes the use of com- ciently and effectively. The focus is on the use T munication supports, also referred to as of supports and strategies to enhance spoken augmentative and alternative communication communication, and with it, participation and options, to assist adult speakers with motor independence in a variety of situations. speech disorders to communicate more effi- Individuals with a range of diagnoses and severity levels can have motor speech disorders. Some individuals have motor speech disorders as primary concerns; others have Author Affiliations: Communication Sciences and them concomitant with language or cognitive- Disorders, University of South Dakota, Vermillion communicative impairment. Individuals with (Dr Hanson); and Communication Center of motor speech disorders can be described as ei- Excellence, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospital, ther stable (chronic with no changes), recov- Lincoln, Nebraska (Dr Fager). ering, or degenerating in their motor speech This article was developed, in part, under a grant from abilities. These pervasive conditions have a the National Institute on Disability, Independent Liv- substantial impact on participation in home, ing, and Rehabilitation Research (NIDILRR grant # work, and community settings. The following 90RE5017-02-01). NIDILRR is a center within the Ad- ministration for Community Living (ACL), Department case example is a composite of cases facing of Health and Human Services (HHS). The contents of similar issues. It is used to illustrate the im- this article do not necessarily represent the policy of pact a motor speech disorder can have on a NIDILRR, ACL, and HHS, and you should not assume endorsement by the Federal Government. person’s participation and autonomy. Case example 1. A 28-year-old man with The authors have indicated that they have no financial and no nonfinancial relationships to disclose. spastic cerebral palsy had recently moved from his parents’ home to an assisted living Corresponding Author: Elizabeth K. Hanson, PhD, Communication Sciences and Disorders, University of facility as his next step toward achieving his South Dakota, 414 E Clark St, Vermillion, SD 57069 personal goal of increasing independence as ([email protected]). an adult. He had spastic dysarthria, with an DOI: 10.1097/TLD.0000000000000137 intelligibility level of only 40% at the sentence 375 Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 376 TOPICS IN LANGUAGE DISORDERS/OCTOBER–DECEMBER 2017 level, and spent the majority of his life com- tion Effectiveness Survey (Donovan, Velozo, municating with close friends and family us- & Rosenbek, 2007) or the Social Networks As- ing his natural speech, which was dysarthric sessment (Blackstone & Hunt Berg, 2012) de- but mostly intelligible to those who knew him scribed later. Application of communication well. However, when this young man made supports is driven by the participation level. his first unassisted visit to a bank to set up Participation refers to how well an individ- a bank account, he was extremely frustrated ual manages interactions in societal contexts. with the bank teller’s inability to understand The construct of participation takes two fac- him. As he became more frustrated, his spas- tors into account: performance of the indi- ticity increased, and his speech became less vidual with a motor speech disorder and the intelligible. The bank staff, alarmed by his in- response of their communication partner(s). creasing spasticity, contacted emergency per- Participation goals, along with consideration sonnel, as they thought he was having a health of the state of the speaker’s neurological con- crisis. The emergency medical technicians ar- dition (i.e., stable, recovering, or degenera- rived, determined where the man was resid- tive), drive clinical decision-making and inter- ing, and called the director of the assisted ventions related to communication supports living facility so that he could come to the for people with motor speech disorders. bank. The individual was embarrassed and an- Participation for persons with motor gry about the events that occurred. He real- speech disorders may be best assessed ized that he had no method or way to support through patient-reported outcome measures his communication attempts for use in such that document the individual’s perspective circumstances. He had always relied on his on his or her communication (Donovan natural speech because his environment typ- et al., 2007). For example, the Communica- ically contained individuals who knew him tion Effectiveness Survey, first introduced by well, and he had always been accompanied by Yorkston, Beukelman, Strand, and Bell (1999), a family member or friend. In order for him to revised by Ball, Beukelman, and Pattee (2004), participate in this new environment and meet and further revised and validated by Donovan his goals (increasing his independence), he et al. (2007), is an eight-item survey that doc- needed access to strategies to support accu- uments change in participation levels from rate communication with new and unfamiliar baseline to posttreatment for motor speech listeners. disorders. The survey uses a four-category response scale (from 1 = “not at all effective” PARTICIPATION AND RELATED to 4 = “very effective”) to gather input about ASSESSMENT TOOLS communication effectiveness in different contexts such as conversing with a family mem- Participation is a key component in the ber or friends at home, having a conversation World Health Organization’s International in a car, or with someone at a distance. In our Classification of Functioning, Disability and clinical practices, we have used the Communi- Health (World Health Organization, n.d.). This cation Effectiveness Survey with family mem- framework provides a model comprising im- bers of individuals with motor speech disor- pairment, activity, and participation. Motor ders, as well as the individuals themselves, speech disorders are assessed and diagnosed to compare perspectives. This can help indi- at the impairment level (e.g., decreased res- viduals understand the degree to which their piratory support, velopharyngeal incompe- communication effectiveness is impacted by tence, and imprecise articulation). Their im- their dysarthria, even with people who know pact on function is measured at the activity them well. level (e.g., objective speech intelligibility mea- Another tool that captures the participation sures). Participation may be assessed infor- aspect of communication disorders is the mally or with tools such as the Communica- Social Networks (Blackstone & Hunt Berg, Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Communication Supports for People With Motor Speech Disorders 377 2012) assessment protocol. It uses compre- information and case examples to illustrate hensive and systematic information gathering how to select among such supports and indi- and observation procedures to obtain infor- vidualize them to address participation needs mation about the individual’s communication of individuals whose motor speech disorder strengths, environments, communication status is stable, recovering, or degenerative. partners, and differences in the partners’ abil- ity and willingness to support the individual’s communication by learning new strategies. Supports when motor speech The protocol does not require training to impairment status is stable administer. The administrator gathers infor- Congenital neurologic conditions are often mation from multiple sources including inter- stable or chronic in their status. A report by views with the individual with the communi- the Centers for Disease Control and Preven- cation disorder (if possible), a family member, tion (2017) indicated that cerebral palsy is the and someone who is a paid communication most common motor disability in children, partner (such as a direct service professional, with worldwide prevalence reports that range personal care attendant, teacher, or speech- from 1.5 to more than 4 per 1,000 live births. language

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