Speech and language therapists' management practices, perceived effectiveness of current treatments and interest in neuromuscular electrical stimulation for acquired dysarthria rehabilitation: An international perspective.

BACKGROUND: Research is beginning to shed light on the practices employed by speech-language therapists (SLTs) for the management of acquired dysarthria. However, studies that explore SLTs' satisfaction with the effectiveness of current therapies and their interest in new treatment methods for this population have not been carried out. One potential new method is neuromuscular electrical stimulation (NMES): the pool of evidence for its use in rehabilitation is increasing, yet it has not been widely explored for use with dysarthria. AIM: To extend the understanding of acquired dysarthria management practices employed by SLTs across the globe and determine their satisfaction with current therapy options. To explore their interest in using NMES with this population. METHODS AND PROCEDURES: A cross-sectional international online survey was developed and disseminated to SLTs working with adults with acquired dysarthria through international professional associations. The survey collected information on demographic characteristics, dysarthria management practices, satisfaction with treatment effectiveness and interest in and knowledge of NMES. Survey responses were analysed using descriptive and inferential statistics, and quantitative content analysis. OUTCOMES AND RESULTS: A total of 211 SLTs (North America, 48.8%; Europe, 36%; Asia, 8.1%; Oceania, 5.7%; Africa, 0.9%; South America, 0.5%) completed the survey in full. Management practices varied considerably. There was a clear preference for informal assessments, mainly oral-motor examinations, focusing on body functions and structures. The majority of respondents rejected the use of non-speech oral motor exercises as a clinical or carryover exercise. Variable satisfaction with current speech subsystem treatments was noted; however, overall, there was a general dissatisfaction. Whilst a strong interest in the use of NMES for dysarthria was evidenced, it was noted that most SLTs lacked fundamental knowledge of NMES principles and application. CONCLUSION: SLTs' management practices and satisfaction with acquired dysarthria treatments differed substantially. Investigations of the potential use of NMES for dysarthria treatment are of interest. WHAT THIS PAPER ADDS: What is already known on the subject Recent country-specific surveys have explored speech-language therapists' (SLTs') assessment and intervention practices for acquired dysarthria. These studies indicate that although clinical management for this speech disorder mainly involves informal assessment tools and impairment-focused treatment, communication beyond the impairment, such as the activity and participation domains, is also frequently assessed and treated. What this paper adds to existing knowledge The majority of SLTs are dissatisfied with the overall benefits of current acquired dysarthria treatment. Phonatory, respiration and speech rate therapies are perceived to be more effective than prosody, articulation and resonance treatments. Despite a general lack of theoretical knowledge, most SLTs are interested in neuromuscular electrical stimulation treatment for acquired dysarthria. What are the potential or actual clinical implications of this work? New, evidence-based treatments are needed for SLTs to be confident in the effectiveness of their acquired dysarthria treatment.

Mapping the development process of transcutaneous neuromuscular electrical stimulation devices for neurorehabilitation, the associated barriers and facilitators, and its applicability to acquired dysarthria: a qualitative study of manufacturers' perspectives.

PURPOSE: The fragmented nature of the medical device market limits our understanding of how particular sub-markets navigate the device development process. Despite the widespread use of transcutaneous neuromuscular electrical stimulation (NMES), its use for acquired dysarthria treatment has not been sufficiently explored. This study aims to provide a preliminary understanding of the stages involved in the development of NMES devices designed for neurorehabilitation. It also aims to investigate manufacturers' perceptions concerning factors that facilitate or impede its development and determine its applicability for acquired dysarthria. MATERIALS AND METHODS: In-depth semi-structured online interviews were conducted with eight NMES device manufacturers located across Europe, North America and Oceania. The interviews were video-recorded, automatically transcribed, manually reviewed, and analysed using a qualitative content analysis. RESULTS: NMES device development for neurorehabilitation involves six complex phases with sequential and overlapping activities. Some emerging concepts were comparable to established medical device models, while others were specific to NMES. Its adaptability to different neurological disorders, the positive academia-industry collaborations, the industry's growth prospects and the promising global efforts for standardised regulations are all key facilitators for its development. However, financial, political, regulatory, and natural constraints emerged as barriers. Indications and challenges for the applicability of NMES for acquired dysarthria treatment were also discussed. CONCLUSION: The findings provide a foundation for further investigations on the NMES market sub-sector, particularly in the context of neurorehabilitation. The study also provides insights into the potential adoption of NMES for acquired dysarthria, which can serve as a reference for future research.

The mapped neuromuscular electrical stimulation (NMES) development phases and processes can serve as a framework for new device development initiativesOpportunities for NMES development included its adaptability to neurological disorders, its growth prospects, academia-industry relationships and regulatory standardisation initiativesFinancial, political, regulatory, and natural barriers were barriers for concern.From an anatomical and practical standpoint, it seems feasible to use NMES to treat several features of acquired dysarthria, however, clinicians' limited education on the use of electrical stimulation for neurorehabilitation may pose several constraints.

Non-invasive brain stimulation for treating neurogenic dysarthria: A systematic review.

BACKGROUND: Although non-invasive central and peripheral stimulations are accruing support as promising treatments in different neurological conditions, their effects on dysarthria have not been systematically investigated. OBJECTIVE: The purpose of this review was to examine the evidence base of non-invasive stimulation for treating dysarthria, identify which stimulation parameters have the most potential for treatment and determine safety risks. METHODS: A systematic review with meta-analysis, when possible, involving publications indexed in MEDLINE, PsychINFO, EMBASE CINHAL the Linguistics and Language Behavioral Abstracts, Web of Science, Cochrane Register of Control Trials and 2 trial registries was completed. Articles were searched in December 2018 and updated in June 2021 using keywords related to brain and electrical stimulation, dysarthria and research design. We included trials with randomised, cross-over or quasi-experimental designs; involving a control group; and investigating treatment of neurogenic dysarthria with non-invasive stimulation. Methodological quality was determined with the Cochrane's Risk of Bias-2 tool. RESULTS: In total, 6186 studies were identified; 10 studies (6 randomised controlled trials and 4 cross-over studies) fulfilled the inclusion criteria. All 10 trials (268 adults with Parkinson's disease, stroke and neurodegenerative cerebellar ataxia) focused on brain stimulation (6 repetitive transcranial magnetic stimulation; 3 transcranial direct current stimulation; and 1 repetitive transorbital alternating current stimulation). Adjunct speech-language therapy was delivered in 2 trials. Most trials reported one or more positive effects of stimulation on dysarthria-related features; however, given the overall high risk of bias and heterogeneity in participant, trial and outcome measurement characteristics, no conclusions can be drawn. Post-treatment size effects for 2 stroke trials demonstrated no statistically significant differences between active and sham stimulation across 3 dysarthria outcomes. CONCLUSIONS: Evidence for use of non-invasive brain stimulation in treating dysarthria remains inconclusive. Research trials that provide reliable and replicable findings are required.

Assessment of intelligibility in dysarthria: development of a Maltese word and phrase list.

This paper describes the development of the Maltese Intelligibility Lists (MIL) for the assessment of word and phrase intelligibility in dysarthria. Two main tools were employed: the Frenchay Dysarthria Assessment-2 (FDA), and the Maltese Language Resource Server (MLRS). Three main criteria served as the basis for the construction of the word and phrase lists: frequency of occurrence of Maltese phonemes, word frequency and an analysis of syllable types and structures. The most common 500 words in the MLRS corpus (Korpus Malti v. 3) were broadly transcribed and an analysis of different types of syllables and their frequency of occurrence was carried out. Based on this analysis, the relevant proportion of different syllable types required for the word and phrase lists for Maltese was calculated in line with the number of items present in the FDA-2. With regards to phoneme frequency, the words chosen demonstrate a similar short-vowel and consonant distribution as reported in a previous large-scale study. The MIL consists of 116 words and 50 phrases which are representative of Standard Maltese and can be used in the clinic to assess speech intelligibility in Maltese individuals with dysarthria.

Serial order in word form retrieval: New insights from the auditory picture-word interference task.

One important theoretical question about word production concerns whether the phonemes of a word are retrieved in parallel or in sequential order. To address this question, Meyer and Schriefers (Journal of Experimental Psychology: Learning, Memory, and Cognition 17:1146-1160, 1991) used an auditory picture-word interference task and manipulated the position of the phonemes shared between a distractor word and a target picture. They found that begin-related distractors (e.g., boat-bone) facilitated naming times when they were presented within 150 ms before or after the picture, whereas end-related distractors (e.g., cone-bone) were effective only if presented within 150 ms after the picture. This suggested that the word's end phonemes were activated later than the beginning ones. However, it remained unclear whether these effects genuinely reflected facilitation at the level of phonological retrieval. In this study, we examined later distractor presentation onsets, so that the distractors had little opportunity to influence earlier, lexical selection processes. At the latest onset tested, end-related-but not begin-related-distractors significantly facilitated naming. We concluded that late-presented distractors do indeed influence phonological encoding, and that their asymmetric effects support a sequential model of phoneme retrieval.