Dysarthria, a difficulty with the physical production of speech, results largely from
impairment of voluntary movement.
Speech becomes slurred, dysrhythmic, variable in volume due to inconsistent breath support,
and increasingly difficult to understand.
TABLE 5: Coping Strategies for Communication|
- Allow the person enough time to answer questions.
- Offer cues and prompts to get the person started.
- Give choices. For example, rather than asking "what do you want for dinner?" ask "do you want hamburgers or meatloaf?"
- Break the task or instructions down into small steps.
- If the person is confused, speak more simply and use visual cues to demonstrate what you are saying.
- Ask the person to repeat phrases you did not understand, or spell the words.
- Alphabet boards, yes-no cards, or other communication devices may be helpful.
Furthermore, just as patients do not always appreciate the presence or degree of chorea, some patients do not seem to
be aware of distortions in their speech.
For others, articulation is a constant source of frustration. No medications are known to be helpful, and dysarthria
may be worsened by agents which suppress chorea.
However, several interventions may enhance communication in these patients. The listener
must do everything possible to promote successful communication, beginning with allowing enough time.
Many HD patients thought to be incapable of communication can be understood if the listener
is patient enough.
- Patients may need to be moved to a quieter, calmer environment, and urged to speak slowly.
- Patients can be asked to spell difficult to understand words.
- A communication board can also be useful in some cases.
A speech-language pathologist may be able to provide additional insights and management
Dysarthria may be compounded by cognitive problems found in HD, such as word-finding difficulty,
difficulty initiating speech, or difficulty completing a sentence.
Even those with severe cognitive impairments often respond to cues, such as asidng for
the size, shape or color of an object. Even severely impaired patients may be able to respond accurately to a series of yes
and no questions.
If unsuccessful attempts at communication become very frustrating, it may be better to
take a break. The desire for social inter-action generally remains, even in those with advanced HD, so strategies for communi-cation
should be a priority.