Behavioral management of respiratory/phonatory dysfunction from dysarthria: A systematic review of the evidence

This systematic review of the literature addresses behavioral techniques for the management of respiratory/phonatory dysfunction in dysarthria. It was carried as part of the development of practice guidelines for the Academy of Neurologic Communication Disorders and Sciences (ANCDS). A search of electronic databases (PsychINFO, MEDLINE, and CINAHL) and hand searches of relevant edited books yielded 35 intervention studies in the categories of biofeedback, device utilization, the Lee Silverman Voice Treatment (LSVT), and several miscellaneous studies. A review of this literature suggests that biofeedback can be effective in changing physiologic variables. However, the relationship between changes in specific physiologic variables and speech production or communicative participation has yet to be clearly established. Conclusions about the effectiveness of devices are limited by the small number of subjects studied; however, the devices may improve the speech loudness and, in most cases, intelligibility of individuals with hypokinetic dysarthria who have not experienced success with behavioral intervention alone. LSVT has been systematically studied in a relatively large number of individuals with idiopathic Parkinson disease. There is strong evidence to suggest immediate posttreatment improvement; there is some evidence of long-term maintenance of effect, but the data are complicated by the expected neurologic deterioration in this population and by the small number of studies that report long-term follow-up. Directions for future research are provided.