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Non-speech oro-motor exercise use in acquired dysarthria management : regimes and rationales

Mackenzie, Catherine and Muir, Margaret and Allen, Carolyn (2011) Non-speech oro-motor exercise use in acquired dysarthria management : regimes and rationales. International Journal of Language and Communication Disorders, 45 (6). pp. 617-629. ISSN 1368-2822

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Abstract

Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy (SLT) manuals, and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. The investigation sought to collect development phase data, in accordance with the Medical Research Council evaluation of complex interventions. The aims were to establish the extent of NSOMExs use in acquired disorders, the exercise regimes in use for dysarthria, with which dysarthric populations, and the anticipated clinical outcomes. A further aim was to determine the influencing rationales where NSOMExs were or were not used in dysarthria intervention. SLTs throughout Scotland, Wales and Northern Ireland, working with adult acquired dysarthria, were identified by their service heads. They received postal questionnaires comprising 21 closed and two open questions, covering respondent biographics, use of NSOMExs, anticipated clinical outcomes, and practice influencing rationales. One hundred and ninety one (56% response) completed questionnaires were returned. Eighty-one per cent of respondents used NSOMExs in dysarthria. There was no association with years of SLT experience. Those who used and those who did not use NSOMExs provided similar influencing rationales, including evidence from their own practice, and Higher Education Institute (HEI) teaching. More experienced SLTs were more likely than those more recently qualified to be guided by results from their own practice. Input from the attended HEI was more influential for those less experienced than for those more experienced. Clinical outcome aims were not confined to speech, but included also improvements in movement, sensory awareness, appearance, emotional status, dysphagia and drooling. NSOMExs were used with many neurological disorders, especially stroke, all dysarthria classes, especially flaccid, and all severity levels. Tongue and lip exercises were more frequent than face, jaw and soft palate. The most common regimes were 4-6 repetitions of each exercise, during three practice periods daily, each of 6-10 minutes. Conclusions & Implications: NSOMExs are a frequent component of dysarthria management in the UK devolved government countries. This confirmation, along with the details of SLT practice, provides a foundation for clinical research which will compare outcomes for people with dysarthria, whose management includes and does not include NSOMExs. SLT practice may be guided by evidence that speech outcome is or is not affected by NSOMExs.