Management of non-progressive dysarthria: practice patterns of speech and language therapists in the Republic of Ireland.

BACKGROUND

Dysarthria is a commonly acquired speech disorder. Rising numbers of people surviving stroke and traumatic brain injury (TBI) mean the numbers of people with non-progressive dysarthria are likely to increase, with increased challenges for speech and language therapists (SLTs), service providers and key stakeholders. The evidence base for assessment and intervention approaches with this population remains limited with clinical guidelines relying largely on clinical experience, expert opinion and limited research. Furthermore, there is currently little evidence on the practice behaviours of SLTs available.

AIMS

To investigate whether SLTs in the Republic of Ireland (ROI) vary in how they assess and manage adults with non-progressive dysarthria; to explore SLTs' use of the theoretical principles that influence therapeutic approaches; to identify challenges perceived by SLTs when working with adults with non-progressive dysarthria; and to determine SLTs' perceptions of further training needs.

METHODS & PROCEDURES: A 33-item survey questionnaire was devised and disseminated electronically via SurveyMonkey to SLTs working with non-progressive dysarthria in the ROI. SLTs were identified through e-mail lists for special-interest groups, SLT manager groups and general SLT mailing lists. A reminder e-mail was sent to all SLTs 3 weeks later following the initial e-mail containing the survey link. The survey remained open for 6 weeks. Questionnaire responses were analysed using descriptive statistics. Qualitative comments to open-ended questions were analysed through thematic analysis.

OUTCOMES & RESULTS: Eighty SLTs responded to the survey. Sixty-seven of these completed the survey in full. SLTs provided both quantitative and qualitative data regarding their assessment and management practices in this area. Practice varied depending on the context of the SLT service, experience of SLTs and the resources available to them. Not all SLTs used principles such as motor programming or neural plasticity to direct clinical work and some requested further direction in this area. SLTs perceived that the key challenges associated with working in this area were the compliance, insight and motivation of adults with dysarthria.

CONCLUSIONS & IMPLICATIONS: The use of specific treatment programmes varies amongst SLTs. A lack of resources is reported to restrict practice in both assessment and management. Ongoing research into the effectiveness of SLT interventions with adults with non-progressive dysarthria is required to guide clinical decision-making. SLTs identified further training needs which may provide direction for the development of professional training courses in the future.