Guide to Dysarthria Management: A Client-Clinician Approach (2000). By Monique S. Kaye. Thinking Publications, 424 Galloway St., Eau Claire, WI 54703. $42. Reviewed by Charles Ellis, Charlotte, NC.

Guide to Dysarthria Management: A Client-Clinician Approach is a comprehensive dysarthria management guide designed to address assessment, program planning, and intervention of individuals with dysarthria. This guide focuses on all aspects of dysarthria management and encourages client participation in planning, intervention, and monitoring their progress. Guide to Dysarthria Management includes goals for both the clinician and the client. This allows the client to take a more active role in the rehabilitation process. As noted in the overview, this guide allows the clinician to create an individualized intervention program by choosing appropriate materials from each section based upon client needs, goals, and interests. Therefore, the client should have a better feel for the generalization process to daily living situations.

Guide to Dysarthria Management: A Client-Clinician Approach provides the user with an overview of the dysarthria program including target population, rationale for change intervention focus, client empowerment, and goals. General guidelines for use are also included in this easy-to-use tool. Section 1, "Getting Started," is designed to assess the client's communicative strengths and weaknesses and their impact on the communication process. This section includes an assessment form that evaluates the following motor speech areas: oral motor function, laryngeal function, sequenced movements, speech production, connected speech: reading passage, and connected speech: structured conversation. In addition, an inventory of dysarthria is available to gain additional information into the client's perception of his communication ability and/or difficulties. This inventory allows the client to identify problem areas in everyday speaking situations. All portions of the assessment form are reproducible.

Section 2, "Education," is designed to provide client and/or family members information on dysarthria and the impact on the communication process. This section also includes reproducible handouts with emphasis on basic definition, cause and symptoms of dysarthria, and review of specific medical conditions that may cause dysarthria. These specific conditions include: amyotrophic lateral sclerosis, brain tumors, traumatic brain injury, cerebral palsy, Parkinson's disease, multiple sclerosis, Guillain-Barre syndrome, and Huntington's disease. Each handout provides the reader with contact information for national organizations and support groups for each condition. All handouts are easy to read, informative, and include a small section for the reader to write specific questions about each specific condition.

Section 3, "Therapeutic Exercises," provides the client with specific exercises to address the symptoms typical of dysarthria. Exercises focus upon the following seven components of speech production: oral motor, respiration, phonation, articulation, volume, rate of speech, and prosody. Subsection 1, oral motor, includes tasks to improve oral movements and resistance as well as strategies for stretching, and therapeutic techniques such as icing stimulation. Subsection 2, respiration, provides tasks to improve awareness of respiration, increasing breath support for phrases, sentences, and paragraphs. Subsection 3, phonation, includes the pushing approach, relaxation technique, and analysis of phonation. Subsection 4, articulation, provides over 80 pages of articulation exercises at the word, phrase, and sentence level. Subsection 5, volume, focuses on heightening awareness of current voice levels and increasing voice volume to be audible to others. Subsection 6, rate of speech, addresses current rate of speech and reviews a variety of techniques to normalize rate. These techniques include syllable-by-syllable method, chunking method, and use of pacing board and strip. The final subsection, prosody, provides tasks to improve stress, intonation, and rhythm. As in the prior two sections, reproducible handouts with a brief discussion of the purpose and goal of each exercise is included.

The fourth and final section, "Carryover Exercises," provides the client with tasks to practice use of learned strategies in real-world situations. Activities for individual and group treatment are included. These activities may also be attempted outside of the clinical setting. Specific activities are centered on communication in functional, community-based settings. The guide concludes with four appendices containing supplemental educational and clinical materials.

Guide to Dysarthria Management: A Client-Clinician Approach covers all aspects of dysarthria management. This resource should provide graduate students, speech-language pathology assistants, and experienced clinicians with a comprehensive program for dysarthria management. It will also enable the clients to take a proactive approach in their treatment. I strongly recommend this very economical and easy-to-use program.