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Cited by 111Voice and Speech DisordersDysphagia Assessment and ManagementNeurobiology of Language and Bilingualism

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Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury

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Mitchell, Claire, Bowen, Audrey, Tyson, Sarah, Butterfint, Zoe, Conroy, Paul·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002088.pub3PMC PMC6464736
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Abstract

BACKGROUND: Dysarthria is an acquired speech disorder following neurological injury that reduces intelligibility of speech due to weak, imprecise, slow and/or unco-ordinated muscle control. The impact of dysarthria goes beyond communication and affects psychosocial functioning. This is an update of a review previously published in 2005. The scope has been broadened to include additional interventions, and the title amended accordingly. OBJECTIVES: To assess the effects of interventions to improve dysarthric speech following stroke and other non-progressive adult-acquired brain injury such as trauma, infection, tumour and surgery. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (May 2016), CENTRAL (Cochrane Library 2016, Issue 4), MEDLINE, Embase, and CINAHL on 6 May 2016. We also searched Linguistics and Language Behavioral Abstracts (LLBA) (1976 to November 2016) and PsycINFO (1800 to September 2016). To identify further published, unpublished and ongoing trials, we searched major trials registers: WHO ICTRP, the ISRCTN registry, and ClinicalTrials.gov. We also handsearched the reference lists of relevant articles and contacted academic institutions and other researchers regarding other published, unpublished or ongoing trials. We did not impose any language restrictions. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) comparing dysarthria interventions with 1) no intervention, 2) another intervention for dysarthria (this intervention may differ in methodology, timing of delivery, duration, frequency or theory), or 3) an attention control. DATA COLLECTION AND ANALYSIS: Three review authors selected trials for inclusion, extracted data, and assessed risk of bias. We attempted to contact study authors for clarification and missing data as required. We calculated standardised mean difference (SMD) and 95% confidence interval (CI), using a random-effects model, and performed sensitivity analyses to assess the influence of methodological quality. We planned to conduct subgroup analyses for underlying clinical conditions. MAIN RESULTS: We included five small trials that randomised a total of 234 participants. Two studies were assessed as low risk of bias; none of the included studies were adequately powered. Two studies used an attention control and three studies compared to an alternative intervention, which in all cases was one intervention versus usual care intervention. The searches we carried out did not find any trials comparing an intervention with no intervention. The searches did not find any trials of an intervention that compared variations in timing, dose, or intensity of treatment using the same intervention. Four studies included only people with stroke; one included mostly people with stroke, but also those with brain injury. Three studies delivered interventions in the first few months after stroke; two recruited people with chronic dysarthria. Three studies evaluated behavioural interventions, one investigated acupuncture and another transcranial magnetic stimulation. One study included people with dysarthria within a broader trial of people with impaired communication.Our primary analysis of a persisting (three to nine months post-intervention) effect at the activity level of measurement found no evidence in favour of dysarthria intervention compared with any control (SMD 0.18, 95% CI -0.18 to 0.55; 3 trials, 116 participants, GRADE: low quality, I² = 0%). Findings from sensitivity analysis of studies at low risk of bias were similar, with a slightly wider confidence interval and low heterogeneity (SMD 0.21, 95% CI -0.30 to 0.73, I² = 32%; 2 trials, 92 participants, GRADE: low quality). Subgroup analysis results for stroke were similar to the primary analysis because few non-stroke participants had been recruited to trials (SMD 0.16, 95% CI -0.23 to 0.54, I² = 0%; 3 trials, 106 participants, GRADE: low quality).Similar results emerged from most of the secondary analyses. There was no evidence of a persisting effect at the impairment (SMD 0.07, 95% CI -0.91 to 1.06, I² = 70%; 2 trials, 56 participants, GRADE: very low quality) or participation level (SMD -0.11, 95% CI -0.56 to 0.33, I² = 0%; 2 trials, 79 participants, GRADE: low quality) but substantial heterogeneity on the former. Analyses of immediate post-intervention outcomes provided no evidence of any short-term benefit on activity (SMD 0.29, 95% CI -0.07 to 0.66, I² = 0%; 3 trials, 117 participants, GRADE: very low quality); or participation (SMD -0.24, 95% CI -0.94 to 0.45; 1 study, 32 participants) levels of measurement.There was a statistically significant effect favouring intervention at the immediate, impairment level of measurement (SMD 0.47, 95% CI 0.02 to 0.92, P = 0.04, I² = 0%; 4 trials, 99 participants, GRADE: very low quality) but only one of these four trials had a low risk of bias. AUTHORS' CONCLUSIONS: We found no definitive, adequately powered RCTs of interventions for people with

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Research works printed but not linked: 15

  1. Bowen, 2012, The ACTNoW study: a randomised controlled trials of speech and language therapy early after stroke, Neurorehabilitation and Neural Repair, 26, 680
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  3. Fukusako, 1989, Changes in the speech of spastic dysarthric patients after treatment based on perceptual analysis, Annual Bulletin of the Research Institute of Logopedics and Phoniatrics, 23, 119
  4. Main, 1998, The Use of Electropalatography in the Treatment of Acquired Dysarthria
  5. Qinglan, 2002, Treatment of pseudobulbar paralysis with acupuncture and sublingual blood-letting, International Journal of Clinical Acupuncture, 13, 251
  6. Togher, 2014, Training everyday communication partners is efficacious in improving the communication of people with severe TBI: findings from a single-blind multi-centre clinical trial, Brain Injury, 28, 723
  7. Varma, 2004, The effect of motor control on oro-facial dysfunctions in stroke patients under Indian conditions, Stroke, 35, e319
  8. Enderby, 1997, Therapy Outcome Measures: Speech-language pathology technical manual
  9. Higgins, 2011, Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updatedMarch 2011]
  10. Long, 2008, Development of a reliable self-report outcome measure for pragmatic trials of communication therapy following stroke: the Communication Outcome after Stroke (COAST) scale, Clinical Rehabilitation, 22, 1083, 10.1177/0269215508090091 · DOI
  11. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan) 2014
  12. Taylor-Goh, 2005, Royal College of Speech and Language Therapists Clinical Guidelines
  13. Yorkston, 1984, Assessment of intelligibility of dysarthric speech
  14. Sellars C Proceedings of the Consensus Conference on Stroke Treatment and Service Delivery Edinburgh, UK Royal College of Physicians of Edinburgh 2000
  15. Sellars, 2001, Determining the availability of good quality evidence for the effectiveness of speech and language therapy interventions for dysarthria post-stroke (Abstract), Cerebrovascular Diseases, 11, 43

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Metadata

Authors
Mitchell, C., Bowen, A., Tyson, S., Butterfint, Z., & Conroy, P.
Affiliations
  • Manchester Academic Health Science Centre (GB)
  • University of Manchester (GB)
  • University of East Anglia (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2017-01-25
Volume
2017
Issue
1
Pages
CD002088-CD002088
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002088.pub3
PMC
PMC6464736
OpenAlex
W2581309910
Cited by
111
References
69
Citations by year
2026: 5 · 2025: 7 · 2024: 10 · 2023: 21 · 2022: 16 · 2021: 23 · 2020: 10 · 2019: 8 · 2018: 8 · 2017: 3
FWCI
0.97
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Funders
National Institute for Health and Care Research (DRF-2014-07-043)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Voice and Speech Disorders
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
Keywords
dysarthria, stroke, speech therapy intervention, speech intelligibility, traumatic brain injury, intervention effectiveness, risk of bias, psychosocial functioning, communication disorders, speech motor control, usual care comparison
MeSH terms
Adult, Aged, Dysarthria, Humans, Language Therapy, Middle Aged, Speech Therapy, Randomized Controlled Trials as Topic, Brain Injury, Chronic, Stroke

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