Updated: May 6
"My speech is slurred most of the time. "
"Sometimes it's easier to just give up."
"I sound like I'm drunk when I talk."
"I get tired of having to repeat myself."
These are some quotes from patients I've had in the past while discussing their difficulty with speaking clearly, what's known as dysarthria (dis-ARTH-ree-yuh). Dysarthria is a motor speech impairment that can be caused by neurological events such as stroke or brain injury, brain tumors, or diseases that cause weakness or paralysis of the face or tongue muscles. I've observed some individuals crack jokes at themselves as a way to cope, while others have allowed tears to slip down their cheeks because of the frustration that comes with not being understood.
When we're out in public, our body can assist with our communication. In fact, according to one famous (although old) study conducted by a professor of Psychology, body language can make up around 55% of the message we communicate (Mehrabian, 1967).
What does that mean when we're all social distancing, wearing masks, or quarantining?
There are video chat platforms, which is great! However, not everyone has access to internet or a computer. Not to mention internet speed and bandwidth, which can cause people to freeze or look choppy.
Then there's the trusted telephone. For most of us, we have access to a cell phone. When it comes to speaking on the phone, there are two critical components to a successful conversation: if you're using a cell phone, the first thing is having good cell phone reception! The second component? Having clear speech.
Basically, the message needs to be both sent and received well to be successful.
For many people who have dysarthria, speaking on the phone is challenging. Without the ability to see each other's facial expressions, lips, and body language, the message can become even more jumbled. This is also why we sometimes need to use a list of words to help illustrate which letters we're saying while spelling out our names over the phone (e.g. "F as in fox")
So what are some things that can be done to help improve speech intelligibility? First and foremost, there's speech therapy. For those who might be navigating a progressive degenerative disease that is impacting speech, sometimes implementing augmentative and alternative communication (AAC) devices, like a speech generating device or a letter board, might be appropriate. Speech therapists can offer treatment plans for either restoring speech or training compensatory strategies with the five speech subsystems: respiration, phonation, resonance, articulation, and prosody.
This is where one of my favorite acronyms for compensatory strategies come in. Let me introduce you to SLOP.
S. L. O. P.
L = Loud
For many people with dysarthria, speech can sound rushed or as if the sounds are "mushed together." Slowing down your rate of speech can help to separate the sounds into meaningful words. I always remind anyone to start by taking a deep breath (inhale through the nose, stretch your belly out) to help set their respiratory system up for greater success as they s l o w y o u r s p e e c h.
Sometimes an issue with our speech is poor breath support, which can result in our voices sounding hushed, quiet, or even strained/hoarse. Increasing your loudness when you speak not only helps to improve your volume, but occasionally speaking louder will also naturally cause you to slow down! This doesn't mean to yell or scream, however. There are safe ways to increase the loudness of your voice, which a speech therapist can help walk you through.
What do I mean by over-articulate? In its most rudimentary form, I mean "use your lips!" Really it's more than your lips- it's your lips, tongue, teeth, and soft palate! For simplicity, we'll focus on the lips: purse your lips together tightly for each /p/ sound, tuck your lips in for each /m/ production, and really round your lips for each "oh" and "oooo" sound you make.
Finally, pause. Take a second. Plan your next word and allow a second or two to finish your phrase.
There's a bonus result of slowing your rate and increasing your volume! One study found that individuals with dysarthria who practiced speaking slower-than-normal while increasing their volume also demonstrated more variation in the pitch of their voice (Tjaden & Wilding, 2011). This means that they had improved intonation patterns, or stress patterns in their speech.
I like SLOP because not only does it tap into some pretty important techniques for improved speech intelligibility, but it's a nice ironic reminder of how we can avoid feeling like we sound "sloppy" when we speak.
What are some tricks you find helpful for better speech intelligibility?
Mehrabian, A. (1972). Nonverbal Communication. New Brunswick: Aldine Transaction.
Tjaden, K. & WIlding, G. (2011). The impact of rate reduction and increased loudness on fundamental frequency characteristics in dysarthria. Folia Phoniatrica et Logopaedia. 63(4): 178–186.