Merck Manual

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Rehabilitation for Speech Disorders


Zacharia Isaac

, MD, Brigham and Women's Hospital

Reviewed/Revised Dec 2023

Rehabilitation Overview of Rehabilitation Rehabilitation services are needed by people who have lost the ability to function normally or have pain. Loss of function may be due to fracture, amputation, stroke or another neurologic disorder... read more services are needed by people who have lost the ability to speak normally, often because of an injury, a stroke, an infection, a tumor, surgery, or a progressive disorder.


The goal of rehabilitation is to establish the most effective means of communication. For people with mild impairment, a speech therapist uses an approach that emphasizes ideas and thoughts rather than words. Pointing to an object or picture, gesturing, nodding, and relying on facial expressions are often sufficient for basic communication. For people with more severe impairment, a stimulation approach (frequently repeating words to the person) and a programmed stimulation approach (speaking words and presenting objects that can be touched and seen) help people regain some ability to use language. People with aphasia may use a letter or picture board to communicate.

Caregivers of a person with aphasia need to be very patient and to understand the person's frustration. Caregivers must also realize that the person is not mentally impaired and should not be spoken to in baby language, which is insulting. Instead, caregivers should speak normally and, if necessary, use gestures or point to objects.


Rehabilitation goals depend on the cause of the dysarthria. If the cause is a stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more , a head injury Overview of Head Injuries Head injuries that involve the brain are particularly concerning. Common causes of head injuries include falls, motor vehicle crashes, assaults, and mishaps during sports and recreational activities... read more , or brain surgery, the goal is to restore and preserve speech. If dysarthria is mild, repetition of words or sentences may enable people to relearn to use facial muscles and the tongue for correct pronunciation. If dysarthria is severe, people may be taught to use a letter or picture board or an electronic communication device with a keyboard and message display (print or screen).

If dysarthria is caused by a progressive disorder of the nervous system, such as amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis (ALS) and Other Motor Neuron Diseases (MNDs) Motor neuron diseases are characterized by progressive deterioration of the nerve cells that initiate muscle movement. As a result, the muscles stimulated by these nerves deteriorate, become... read more (ALS or Lou Gehrig disease) or multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more , the goal of therapy is to maintain speech function for as long as possible. People are taught exercises that increase control of the mouth, tongue, and lips and are taught to speak more slowly and use shorter phrases. Poor control of breathing muscles may force people to take a breath in the middle of a sentence. Planning punctuation in a sentence can help. Doing breathing exercises can also help, sometimes by breathing through handheld assistive devices, which help dislodge mucus in the airways.

Verbal apraxia

A therapist may have people practice making sound patterns over and over or teach them to use the natural melody and rhythm of common phrases. Every phrase has its own melody and rhythm depending on the mood of the speaker. For example, "Good morning! How are you?" has a particular melody and rhythm when the speaker is feeling cheerful than it does when the speaker is feeling unsociable. The therapist encourages people with verbal apraxia to exaggerate the natural melody and rhythm of phrases. As people progress, the exaggeration of melody and rhythm is gradually toned down.

If apraxia is severe, people may be taught to use a letter or picture board or a electronic communication device with a keyboard and message display (print or screen).

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