418 Caring to Corn rn un ica te

Respiratory support for speech in multiple sclerosis

KIM BRADLEY University College London, UK

ABSTRACT The dysarthria of multiple sclerosis (MS) is known to worsen as the disease progresses (Darley, Brown & Goldstein, 1972). Thus, as an MS sufferer’s activities of daily life and opportunities for activity are curtailed by increasing dis- ability, the capacity of their respiratory system is also diminished both by disease and lack of demand on the system (Olgiati, Hofstetter & Bailey, 1988). It may be that disuse creates a discrepancy between the functional ability that is neurologically auailable and that which is characteristically used. It is this functional overlay that may be the target of speech therapy (Farmakides & Boone, 1969). Five patients with MS and dysarthria affecting intelligibility were involved in a multiple baseline therapy study to establish the efficacy of respiratory exercises in improuing func- tional speech performance. Intervention effects were demonstrated by introducing the therapy to different patients at successive points in time. Speech therapy exer- cises targeted the respiratory system alone with no phonatory or articulatory com- ponents. Intelligibility was chosen as a global and objective repeat measure of functional speech performance and was established for each patient by use of the Yorkston-Beukelman Assessment of the Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981). Findings cautiously suggest that with certain patients respi- ratory exercises can improve speech performance as measured by intellligibility. Thus, a component of the dysarthria of MS may not be neuromotor dysfunction, but atrophy based on fatigue and disuse - and may be reversible. Conclusions on appropriate subject selection are made. The experience of the study with objective measures of intelligibility and the use of the multiple baseline across subject ex- perimental format are also presented. A wider distribution in intelligibility scores generated by multiple listeners than that reported by Yorkston and Beukelman (I 981) generated the necessity of a single listener for all tests. Wide variation in subjects’ baseline speech performance despite stringent controls on factors known to affect intelligibility demonstrates the futility of single ‘before and after’ treat- ment measures with MS sufferers. Also, the limitations of the research format, especially the long basline phase for later subjects, are discussed.