Ataxic dysarthria: treatment sequences based on intelligibility and prosodic considerations.

Treatment programs of four improving ataxic dysarthric speakers are reviewed. Treatment sequences were based on two overall measures of speech performance-intelligibility and prosody. Increases in intelligibility were initially achieved by control of speaking rate. A hierarchy of rate control strategies, ranging from a rigid imposition of rate through thythmic cueing to self-monitored rate control is discussed. As speakers improved their monitoring skills, a compromise was made between intelligibility and rate. Normal prosodic patterns were not achieved by the ataxic speakers due to difficulty in precisely coordinating the subtle fundamental frequency, loudness and timing adjustments needed to signal stress. Three of the four subjects were taught to use only durational adjustments to signal stress. In this way, they were able to achieve stress on targeted words consistently and minimize bizarreness which resulted from sweeping changes in fundamental frequency and bursts of loudness. The need for further clinically oriented research is discussed.