EBP Compendium: Summary of Clinical Practice Guideline

Academy of Neurologic Communication Disorders & Sciences
Evidence-Based Practice Guidelines for Dysarthria: Management of Velopharyngeal Function
Yorkston, K. M., Spencer, K., et al. (2001).
Journal of Medical Speech-Language Pathology, (9)4, 257–274.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the management of velopharyngeal dysfunction for individuals with dysarthria associated with traumatic brain injury, stroke, cerebral palsy, or amyotrophic lateral sclerosis. The target audience of this guideline is speech-language pathologists. 

Recommendations:

• Treatment
• Speech
• Oral Motor Treatment - "Exercise as a treatment for velopharyngeal impairment in dysarthria has been reported in a small number of cases, but evidence is so preliminary that recommendations for its use cannot be made at this time" (p. 271).
• Prosthetic Treatment - 
• While palatal lift interventions are only used with a small percentage of individuals with dysarthria, treatment is associated with improved speech function.
• Individuals with a “flaccid soft palate, pharyngeal wall movement, and good oral articulation and respiratory support” (p. 271) are the best candidates for palatal lift intervention.
• Contraindications to palatal lift intervention include lack of adequate dentition, hyperactive gag reflex, and reduced or changing cognitive status.
• A number of recommendations were made for future research which include further study comparing treatment techniques and better characterization of fitting protocols, fitting timing, speech function and outcome measures.

Keywords: Dysarthria

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Added to Compendium: November 2010