Impact of Post-Stroke Dysarthria on Social

Impact of Post-Stroke Dysarthria on Social Participation and
Quality of Life
Alison Tobison, OTS and Dorothy Farrar Edwards, Ph.D.
OCCUPATIONAL THERAPY PROGRAM, DEPARTMENT OF KINESIOLOGY, UNIVERSITY OF WISCONSIN-MADISON
Introduction
Results
Conclusions
• 795,000 people experience stroke each
individuals with mild
stroke are being discharged home without rehabilitation despite having
stroke-related deficits. 2
• Dysarthria, which affects 36-57% of individuals following stroke3, is an oral
motor problem that affects a person’s ability to produce speech.
• There is limited research available exploring the effect of dysarthria on
social participation and health-related quality of life (HRQoL)
• Individuals with post-stroke dysarthria take fewer and shorter times
speaking in conversations 4 and describe problems with social participation
including role loss, loss of self-identity, and emotional disturbances that
are unique from the other physical impairments following stroke .5
Persistent and Resolved dysarthria differed from Normal groups on
age, race, stroke severity, levels of disability and physical dysfunction
6 months post-stroke.
• 31.1% of participants reported persistent dysarthria 6 months poststroke and 61.2% of participants experienced some dysarthria poststroke.
• Higher levels of disability and physical dysfunction may be linked to
more severe strokes in the Persistent and Resolved groups and may be
linked to upper motor neuron involvement that may affect both oral
motor and gross motor function.
• The hypothesis was supported. Those with persistent dysarthria
reported significantly lower HRQoL and social participation at 6
months than those with no or resolved dysarthria.
• Findings quantitatively support previous qualitative description of the
effects of dysarthria on social participation and HRQoL.4,5
• These findings further illustrate reduced life satisfaction for
participants with persistent dysarthria compared to those without,
which has not been reported in current literature.
year,1 and
Age at Admission**
Years of Education
NIHSS stroke severity**
Sexa
Male
Female
Race*,a
Caucasian
African-American
FIM +FAM**
FIM motor subscale**
Purpose
To quantitatively assess the effect of post-stroke dysarthria on social
participation and HRQoL
Hypothesis
Persistent dysarthria at 6 months post-stroke will have a negative effect on
social participation and HRQoL as compared to dysarthria that has resolved
prior to 6 month assessment or did not develop.
Participants
• Sequential admissions of individuals who experienced stroke recruited
through a university based neurology stroke service.6
• Individuals with no significant functional impairment prior to stroke and no
presence of aphasia after stroke.
• 183 individuals met inclusion criteria.
5.7 (4.5)
36 (50.7%)
35 (49.3%)
29 (52.7%)
26 (47.3%)
25 (43.9%)
32 (56.1%)
49 (69.0%)
22 (31.0%)
202.1 (10.77)
88.0 (5.69)
30 (54.5%)
25 (45.5%)
196.1(20.91)
84.9 (13.27)
22 (38.6%)
35 (61.4%)
181.24 (34.49)
78.79 (18.55)
F (DF)
11.9 (2, 179)
M (SD)
49.6 (6.2)
47.0 (9.3)
42.3 (10.0)
4.8 (4.1)
183 (100%)
90 (49.2%)
93 (50.8%)
183 (100%)
101 (55.2%)
82 (44.8%)
174 (95.1%)
182 (99.5%)
Post Hoc
Normal
Resolved
speech
dysarthria
NS
p < .05
22.4 (3.0)
21.2 (4.4)
18.5 (5.3)
p < .05
NS
p < .05
p < .05
8.3 (2, 179)
27.2 (3.7)
25.8 (5.1)
23.8 (5.4)
NS
p < .05
Implications for Practice
• Individuals with mild to moderate stroke who do not receive rehab
after discharge from the hospital may have deficits, including
dysarthria, that affect functioning.
• Motor speech impairments affect domains addressed by occupational
therapy including social participation, occupational performance, and
HRQoL.
• Individuals with persistent dysarthria may benefit from OT focusing on
strengthening of the tongue and lips as well as strategies to encourage
social participation.
13.6 (2, 180)
p < .05
19.6 (2, 179)
2
SF-12 Social Participationa,*
Normal speech
Resolved dysarthria
Dysarthria
Measures
87.3 (15.4)
82.4 (24.2)
63.6 (26.2)
Mean Rank (MDN)
NS
p < .05
Acknowledgments
p < .05
7.8
76.7 (0)
86.5 (.5)
100.7 (1)
NS
p < .05
Thank you to those who were supportive throughout this
project:
NS
*p < .05
** p  .001
a Mann-Whitney U pairwise comparisons
Dysarthria group reports significantly higher percentages of healthrelated problems than Resolved and Normal groups on many factors
impacting HRQoL.
Normal Speech
70
Resolved Dysarthria
Persistent Dysarthria
• To my mentors who provided their expertise: Dorothy Edwards, Ph.D.
and Martha McCurdy, Ph.D.
• To my classmates on our research team: Katie Ziehr, Nick Hendrickson
and Jerel McKay
• To my friends and family, especially Tom Nygaard
• The project was supported by the James S. McDonnell Foundation,
9832CRHQUA11, PI: C.M Baum PhD
60
50
Percent
• Demographic and NIHSS data were collected at hospital admission.
• Outcome measures were collected by self-report via telephone interview 6
months post-stroke.
6.4 (3.7)
RNL total**
Normal speech
Resolved dysarthria
Persistent dysarthria
RNL physical**
Normal speech
Resolved dysarthria
Persistent dysarthria
RNL social**
Normal speech
Resolved dysarthria
Persistent dysarthria
ACS Activities Retained**
Normal speech
Resolved dysarthria
Dysarthria
• Secondary data analysis of prospectively collected data from Washington
University.6
Procedures
2.7 (3.0)
Total
(N = 183)
62.9 (14.8)
12.1 (3.4)
Primary Hypothesis: Persistent dysarthria differed from Resolved
and Normal groups on life satisfaction , occupational performance,
and social participation measures.
Design
National Institute of Health Stroke Scale (NIHSS): assesses stroke severity
Stroke-Adapted Sickness Impact Profile (SA-SIP30): assesses HRQoL
Reintegration to Normal Living Index (RNL): assesses life satisfaction
Activity Card Sort (ACS): assesses occupational performance via %
activities retained
• Combined Functional Independence Measure and Functional Assessment
Measure (FIM+FAM): assesses level of disability
• Short Form – 12 (SF-12): individual items to assess social participation,
depression, and role loss.
Resolved dysarthria Persistent dysarthria
(N = 55)
(N = 57)
62.5 (13.6)
57.4 (14.4)
12.3 (3.2)
11.7 (3.3)
* significant for p  .05
** significant for p  .001
a Chi Square test
Methods
•
•
•
•
Normal speech
(N = 71)
67.4 (14.6)
12.3 (3.7)
40
a
30
20
10
References
1.
a
a
a
a
a
a
a
a
a
a a
a
a a
a
a
2.
3.
0
Analysis
• Groups: Normal speech, resolved dysarthria, and persistent dysarthria
based on NIHSS dysarthria at admission. Self-reported SA-SIP30
communication items at 6 months post-stroke.
• ANOVA with Dunnet’s C post hoc analysis for pairwise comparisons.
4.
5.
SA-SIP30 Categories
a = significant pairwise comparison with persistent dysarthria group (p  .05)
6.
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Dickson, S., Barbour, R. S., Brady, M., Clark, A. M., & Paton, G. (2008). Patients’ experiences of disruptions
associated with post-stroke dysarthria. International Journal of Language & Communication Disorders / Royal
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