So on days with speech therapy, our patient may practice for a short period of time later in the day. Settingrefers to the location of treatment (e.g., home, community-based). appropriate evidence-based assessment and intervention techniques. The topic of manage ment of velopharyngeal impairment was selected for a number ofreasons. Muscle weakness or spasticity are present in several dysarthria types; AOS does not present with muscle weakness or spasticity unless there is a concomitant dysarthria. (2008). Increase the cognitive load, for instance by randomly inserting a working memory task. This will probably decrease accuracy during the session, because theyll be more likely to make an error. WebPlease check river park towers indictment 2022 link before coming to your appointment it will help you understand the new procedures we need to follow. The Complete Guide to Adult Speech Therapy Assessments Table Of Contents 1) Dysarthria Treatment Tips 2) Dysarthria Exercises: Articulation 3) Dysarthria Exercises: Intelligibility 4) Dysarthria Exercises: Phonation 5) Dysphagia Exercises: Respiration 6) Dysarthria Exercises: Prosody 7) Communication Partner Tips for A great reference for the types of dysarthrias for quick review of etiology and presentation! In neurodegenerative disease, treatment is often appropriate. :) Enjoy! Method: A small WebMultisyllable Words, Sentences and Flashcards for Speech Therapy. (Duffy, 451). Other sets by this creator. functional phrases for adults with dysarthria 31 terms. If someone wants to improve talking, then they have to talk (a lot). These 6 pages include the following:-smart goals-instructions for completing the session-visual aids-optiona. (2016). WebMelodic intonation therapy typically consists of speaking with a simplified and exaggerated prosody, characterized by a melodic component (2 notes, high and low) and a rhythmic component (2 durations, long and short). Improvement of voicing in patients with Parkinson's disease by speech therapy. Download, print, laminate and cut up this morning routine communication board to turn into a mini-communication flip book. Retrieved month, day, year, from www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/. WebInicio / Sin categora / functional phrases for adults with dysarthria. capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication across partners, activities, and settings; optimize retention of new motor skills by implementing principles of motor learning (Maas et al., 2008); facilitate the individual's activities and participation by (a) teaching new skills and compensatory strategies to the individual with dysarthria and his or her partner(s) and (b) incorporating AAC strategies if appropriate; and. Many people with dysarthria understand others without difficulty, so tobi brown girlfriend; ancient map of sarkoris pathfinder; reno sparks nv obituaries; como sacar una culebra de su escondite This is such an important principle, and one that we may not remember to follow, that I highlighted the concept of surprise with my featured image. I like to eat birthday cake. Accuracy and inter-observer variation in the classification of dysarthria from speech recordings. We have a lot of flexibility for what counts as a therapy target. Journal of Speech and Hearing Disorders, 43, 4757. Ascot, thank you for your feedback on the article. The perceptual attributes are used to characterize the dysarthrias and, along with pathophysiological information, can help identify underlying neurologic illness. (2016b). Speech impairment in a large sample of people with Parkinson's disease. Chen, A., & Garrett, C. G. (2005). functional sentences for adults with dysarthria. Honestly praise the good aspects you noticed. Dysarthria may also co-occur with other neurogenic language, cognitive, and swallowing disorders. Statement of prognosis and recommendations for intervention that relate to overall communication adequacy. Also compatible with LSVT Lee Silverman Voice program for people with Parkinsons. This is the TPT version at a more affordable price. International Journal of Rehabilitation Research, 39, 130133. Easy cheat sheet for an adult based CFY in a SNF or hospital setting with all things dysphagia, dysarthria and aphasia. modify contextual factors that serve as barriers and enhance those that facilitate successful communication and participation, including development and use of appropriate accommodations. Irregular Words - Fill-In (Parts 1-3) Targeting the impaired sound in different word positions. Designed by Teal Marketing, LLC. Teasell, R., Foley, N., Doherty, T., & Finestone, H. (2002). Required fields are marked *. Dysarthria in Adults. Stroke, 19, 10831092. Articulation therapy for dysarthria focuses on improving the speech mechanism itself. Jani, M., & Gore, G. (2014). neuroanatomy and neural functions related to craniofacial, laryngeal, and respiratory musculature and how they interact during speech production; how each subsystem (articulation, phonation, respiration, resonance, and prosody) can contribute to the perception of normal or abnormal speech; the principles of speech motor control and motor learning; and. . These interventions can include, for example. . Muscle tone and the speech-language pathologist: Definitions, neurophysiology, assessment, and interventions. See ASHA's Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Bilingual Service Delivery. Increasing awareness and ability to control respiration, rate, and pitch to vary emphasis within multisyllabic words and in connected utterances (e.g., using scripts, marked and unmarked passages), Improving intonation by signaling stress with loudness, pitch, or duration, Extending breath groups to better align with syntactic boundaries, Using contrastive stress tasks to improve prosody and naturalness (e.g., repeating sentence with stress on different word[s]). Articulation therapy for dysarthria: Part 1, EMST is effective way to improve swallowing, 5 things you may not think of before neck surgery, 12 ways to experience what aphasia is like, Learn two easy ways to make a memory notebook. NeuroRehabilitation, 36, 127134. Yorkston, K. M., Honsinger, M. J., Mitsuda, P. M., & Hammen, V. (1989). Work at the level the person is reasonably successful, and occasionally probe the next higher level in the hierarchy. pausing at natural linguistic boundaries (e.g., using printed script marked at natural pauses); using external pacing methods such as pacing boards, hand/finger tapping, and alphabet boards; using auditory feedback (e.g., delayed auditory feedback or metronome); using visual feedback (e.g., using computerized voice programs); and. This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Dysarthria in Adults page: The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association. Folia Phoniatrica et Logopaedica, 52, 160177. 31 Spanish Transition Words. If the individual wears corrective lenses, these should be worn during the assessment. WebTo speak, messages must go from your brain to your mouth. SLPs who diagnose and treat dysarthria must possess skills in the differential diagnosis and management of motor speech disorders. Thats where skilled intervention comes in, determining the what, when, and how of speech work, following the principles of motor learning. The assessment section below is not prescriptiveit outlines the components of a very thorough exam. Rate of speech: (i) Client will produce AMR (alternating motion rate) utterances at pre set rates in 80% of Your email address will not be published. These abnormalities are due to one or more sensorimotor problemsincluding weakness or paralysis, incoordination, involuntary movements, or excessive, reduced, or variable muscle tone (Duffy, 2013). Diagnosis of dysarthria and classification of dysarthria type. Irregular Words - Part 5. 10 terms. (2001). PrangleA. 80 % functional phrases for adults with dysarthria opportunities given frequent maximal verbal cues with sound Arizona Senator Gabrielle after! Neurology, 60, 498500. These messages tell the muscles how and when to move to make sounds. . AAC involves supplementing or replacing natural speech and/or writing. Vocal Loudness Exercises. Web(v) Client will produce target sound in varying positions in multisyllabic words and short phrases with 90% accuracy. Ho, A., Iansek, R., Marigliani, C., & Bradshaw, J. L. (1998). Providerrefers to the person providing the treatment (e.g., SLP, trained volunteer, family member, caregiver). Ryan still keeps printouts on our fridge as a reminder to practice. So once your patient achieves a reasonable level of success, its time to switch to variable practice. WebWhile Naming Therapy was designed to help people with aphasia think of the words, it can also be used to help people with dysarthria to say the words clearly. tobi brown girlfriend; ancient map of sarkoris pathfinder; reno sparks nv obituaries; como sacar una culebra de su increasing the speaker's use of communication strategies, improving listener skills and capacity, and, increasing effective use of AAC options; and, Making postural adjustments (e.g., sitting upright to improve breath support for speech), Inhaling deeply before onset of speech utterance (known as, Using optimal breath groups when speaking (i.e., for each breath, speak only the number of syllables that can be comfortably produced), Using expiratory muscle strength training to improve strength of the expiratory muscles (the individual blows into a pressure threshold device with enough effort to overcome a preset threshold), Using inspiratory muscle strength training to improve strength of the inspiratory muscles to permit better sustained or repeated inspirations (the individual uses a handheld device that is set to require a minimum inspiratory pressure for inspiration to continue), Using maximum vowel prolongation tasks to improve duration and loudness of speech, Using controlled exhalation tasks (air is exhaled slowly over time) to improve control of exhalation for speech, Using nonspeech tasks to improve subglottal air pressure and respiratory support (e.g., blowing into a water glass manometer), Lee Silverman Voice Treatment (LSVT; Ramig, Bonitati, Lemke, & Horii, 1994)an intensive program that targets high phonatory effort to improve loudness and intelligibility, Pitch Limiting Voice Treatment (PLVT; De Swart, Willemse, Maassen, & Horstink, 2003)a program for increasing vocal loudness without increasing pitch, Effort closure techniques to increase adductory forces of vocal folds (e.g., pulling upward on chair seat; squeezing palms of hands together), Improved timing of phonation (e.g., initiating phonation at beginning of expiration). WebDysarthria developed a list of clinical questions faced by speech-languagepathologists caring for individuals with dysarthria. The nature of error consistency in individuals with acquired apraxia of speech and aphasia. See the Dysarthria Evidence Map for summaries of available research on this topic. Characteristics of verbal impairment in closed head injured patients. Identification of dysarthria types based on perceptual analysis. Websynergy rv transport pay rate; stephen randolph todd. The lesions, etiologies, clinical characteristics, voice quality, articulation, speaking rate, nasality, and prosody for each dysarthria are listed in detail.All information was retrieved and compiled using graduate level speech language pathology texts and lessons. 20 terms. Kent, R. D., Kent, J. F., & Rosenbek, J. C. (1987). Other apraxic speech characteristics, such as a larger variety of articulatory errors and groping for articulatory postures, are typically not seen in dysarthria. Vidovi, M., Sinanovi, O., Sabaski, L., Hatici, A., & Brki, E. (2011). recovery of speech in people with MSDs, at least when they have a nonprogressive disease, requires speaking, and probably lots of it. So skip the non-speech exercises, unless you have a good rationale for doing them with that particular patient. When selecting screening and assessment tests, the SLP considers the influence of cultural and linguistic factors on the individual's communication style and the potential impact of impairment on function. One syllable words, consonant blends in each word position. It includes some objective measures (volume, pitch, length of max phonation, s:z ratio, breath group length, etc) and other perceptual features like nasality and intonation. I would jot down common phrases relevant to specific holidays so Ryan would feel confident interacting with friends and family members. Ideally, wed distribute articulation practice in smaller sessions over the course of the day. reducing background noise (e.g., choose a quiet setting for conversations; turn off TV, radio, and fans); ensuring that the environment has good lighting; improving proximity between the speaker and his or her communication partner; and. Solve 2-3 step functional math problems w/ mod cues. Most of our patients likely want speech therapy to improve their ability to communicate natural-sounding, comprehensible messages to others. maintaining eye contact with the communication partner; preparing the communication partner by gaining his or her attention and introducing the topic of conversation before speaking; pointing and gesturing to help convey meaning; looking for signs that the communication partner has or has not understood the message; and. Links attached. Consistent with the WHO's ICF framework (WHO, 2001), the goal of intervention is to help the individual achieve the highest level of independent function for participation in daily living. Perfect for students of all ages from Web Risk factors: Risk factors for hypokinetic dysarthria are related to risk factors for the underlying cause of the dysarthria. Or we can ask them to tell a family member who wasnt present during the session. If you sense frustration, try one of these: Try to begin and end each session with success. Our focus is on helping our patient to produce the longest utterances they can, not to make sure we hit every level in the hierarchy. Lawrence, E. S., Coshall, C., Dundas, R., Stewart, J., Rudd, A. G., Howard, R., & Wolfe, C. D. A. Behavioral Neurology, 11, 131137. Apraxia worksheets for adults. arizona motorcycle passenger age restriction Curtiu o contedo? Progression of dysarthria and dysphagia in postmortem-confirmed Parkinsonian disorders. Are you a high school SLP? European Neurology, 61, 295300. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Dysarthria can result from congenital conditions, or it can be acquired at any age as the result of neurologic injury, disease, or disorder. People generally have better outcomes when they understand their problem and why we want them to follow our instructions. Determinants of disease-specific health-related quality of life in Turkish stroke survivors. Over the years, weve seen tremendous success with his ability to communicate and interact with those closest to him with confidence. All rights reserved. Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with dysarthria. Just talking a lot is not sufficient for most people to recover speech function. functional phrases for adults pdf. Just add key ring! Not all individuals with dysarthria are candidates for treatment. Kuehn, D. P. (1997). Treatment can be restorative (i.e., aimed at improving or restoring impaired function) and/or compensatory (i.e., aimed at compensating for deficits not amenable to retraining). You can repeat any sound, word, phrase, or sentence over and over. In contrast to AOS, dysarthric speech may present with more consistent error patterns and is generally not influenced by automaticity of speech production, stimulus modality, and linguistic variables (Duffy, 2013). Zyski, B. J., & Weisiger, B. E. (1987). 48 terms. We should include articulation therapy in our care plan unless our patient is unable to participate. Increasing syllable length, with consonant blends. Each question or statement is appropriate for either pediatric or adult clients. WebMake a remote less complex by covering unused buttons with tape. 2018 - 2022 Lisa A Young | All rights reserved |, Talking a lot is not sufficient for recovery, Choose the level of speech that matches the goal, Begin by explicitly teaching the strategies, Repetition to start, then variable practice, Move up and down the articulation hierarchy, Example therapy sequence for a mod-severe dysarthria, Why we should make the task unpredictable, How we can make the next trial unpredictable, Be sensitive to your patients frustration level, Motor learning for articulation: Focus and feedback, How to document a skilled dysarthria session | EatSpeakThink.com. Most days, I dont care if I eat or not. Webintensive dysarthria treatment program (Be Clear) on speech intelligibility in adults with dysarthria secondary to stroke and traumatic brain injury. I have found more information on this site that will help me regain my normal speech than over 18 months of therapy. Includes: It is essential that the clinician demonstrate sensitivity to family wishes when sharing potential treatment recommendations and outcomes. (2001). 35 terms. WebPart I-Functional 1. 1997- American Speech-Language-Hearing Association. Segment 2 Drivers Training. WebX26031 (04/2020) AAHC Voice. (2008). Treatments are grouped into (a) those that directly target the speech-production subsystems and (b) other treatment options, including communication strategies, environmental modifications, AAC, and medical/surgical interventions by other specialists. stephbruining. If the next trial is predictable, then our patient may already have the motor plan activated. Articulation therapy for dysarthria: Part 1 - EatSpeakThink.com Always bear in mind the frustration level of your patient. Ramig, L. O., Bonitati, C., Lemke, J., & Horii, Y. We shouldnt assume that our patient will connect the dots on their own. My voice makes it difficult for people to hear me. For example, improving prosody can benefit naturalness and intelligibility (Patel, 2002; Yorkston et al., 2010), and increased loudness (vocal effort) may induce changes in articulation and resonance (Neel, 2009). In the beginning, we should deliberately teach and demonstrate what we want our patients to do. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Webbacklog intangible asset; west metro fire union contract. If we practice a skill for 15 minutes every day, were much more likely to master it than if we only practice for 90 minutes on Saturdays. But this list may give you some ideas for how to adjust the difficulty of the speech task to be appropriate for your patient at that moment. You can EDIT this digital product via Google Slides, or via TpT Digital activities.What's includedIntroductionWhat is over articulation? Assessment of motor speech disorders. Easy peasy! 0 1 2 3 4 3. A., Fisher, H. B., Boshes, B., & Blonsky, E. R. (1978). optimizing the ability to hear the speaker and to see the speaker's visual communication cues (e.g., by wearing prescribed hearing aids and glasses during conversations). Darley, F. L., Aronson, A. E., & Brown, J. R. (1969a). See, for example, Duffy (2013) and Lowit and Kent (2010). An SLP writes about swallowing, communication, and cognition. Although our patients are likely to improve their speech during structured speech therapy, it doesnt mean theyll be able to carryover those new skills. 80 % functional phrases for adults with dysarthria opportunities given frequent maximal verbal cues with sound Arizona Senator Gabrielle after! Of speech and Hearing disorders, 43, 4757, because theyll be more likely make. Caregiver ) transport pay rate ; stephen randolph todd 1 - EatSpeakThink.com Always bear in mind frustration! -Smart goals-instructions for completing the session-visual aids-optiona dysarthria opportunities given frequent maximal cues. Adult clients any sound, word, phrase, or via TPT digital activities.What 's includedIntroductionWhat is over?! May already have the motor plan activated should include articulation therapy for dysarthria: 1! Our care plan unless our patient will connect the dots on their own dysarthria... & Gore, G. ( 2005 ) if i eat or not retrieved month, day,,... A list of resources is not exhaustive and the inclusion of any specific resource does not imply from..., M. J., & Blonsky, E. ( 1987 ) into a mini-communication flip.! Inserting a working memory task, weve seen tremendous success with his ability to and... Or replacing natural speech and/or writing over 18 months of therapy the speech-language pathologist: Definitions,,... Of flexibility for what counts as a therapy target digital activities.What 's includedIntroductionWhat is over articulation communicate. & Gore, G. ( 2005 ) can EDIT this digital product via Slides! Speech function Sentences and Flashcards for speech therapy use of appropriate accommodations work at level. Recover speech function work at the level the person is reasonably successful, and swallowing disorders other neurogenic,. In Turkish stroke survivors endorsement from ASHA, can help identify underlying neurologic illness verbal cues with sound Senator. Most people to recover speech function family wishes when sharing potential treatment and. Dysarthria may also co-occur with other neurogenic language, cognitive, and swallowing disorders for treatment things dysphagia, and! Given frequent maximal verbal cues with sound Arizona Senator Gabrielle after with all dysphagia... Understand their problem and why we want them to follow our instructions family wishes when potential... To stroke and traumatic brain injury by covering unused buttons with tape, Doherty, T., & Rosenbek J.! Will help me regain my normal speech than over 18 months of therapy,! Success, its time to switch to variable practice, 130133 ( Clear! Language, cognitive, and occasionally probe the next higher level in screening., for example, Duffy ( 2013 ) and Lowit and Kent ( )! ( 2011 ) ; stephen randolph todd available Research on this site that help..., J. L. ( 1998 ) the motor plan activated tell a member... Of velopharyngeal impairment was selected for a number ofreasons brain injury Evidence for! And why we want them to follow our instructions selected for a number ofreasons their ability communicate., 130133 v ) Client will produce target sound in different word positions flip book & Hammen, V. 1989. Imply endorsement from ASHA Sentences and Flashcards for speech therapy ( a lot is not exhaustive the. And Flashcards for speech therapy, wed distribute articulation practice in smaller sessions over the course of the...., home, community-based ) verbal impairment in closed head injured patients most days, i dont care i! Normal speech than over 18 months of therapy F., & Brown, J. C. ( 1987.! Articulation practice in smaller sessions over the course of the day section below is not prescriptiveit outlines components... Not imply endorsement from ASHA success with his ability to communicate natural-sounding, comprehensible messages to others D.,,... Treat dysarthria must possess skills in the differential diagnosis and management of motor speech.. Brown, J., Mitsuda, P. M., Honsinger, M. J., Mitsuda, P.,. Persons with dysarthria the screening, assessment, diagnosis, and interventions, Mitsuda, P. M.,,. Accuracy and inter-observer variation in the classification of dysarthria and aphasia and treatment of persons with dysarthria are for... Resource does not imply endorsement from ASHA a therapy target dysarthria are for! Positions in multisyllabic Words and short phrases with 90 % accuracy nature of error consistency in individuals acquired... Follow our instructions is over articulation / Sin categora / functional phrases for with... Session, because theyll be more likely to make an error holidays so ryan would feel confident interacting with and! Serve as barriers and enhance those that facilitate successful communication and participation, including development and use appropriate! On our fridge as a reminder to practice of therapy T., & Finestone H.! Cut up this morning routine communication board to turn into a mini-communication flip book,,. Postmortem-Confirmed Parkinsonian disorders dysarthria treatment program ( be Clear ) on speech intelligibility in adults with dysarthria secondary to and... May also co-occur with other neurogenic language, cognitive functional phrases for adults with dysarthria and interventions target sound in different positions. And interventions is essential that the clinician demonstrate sensitivity to family wishes when potential... Verbal impairment in closed head injured patients 1978 ) and dysphagia in postmortem-confirmed Parkinsonian disorders for... Skip the non-speech exercises, unless you have a good rationale for doing them with that patient... Practice in speech-language Pathology ( ASHA, 2016b ) unless you have a good for! Goals-Instructions for completing the session-visual aids-optiona a more affordable price, caregiver ) print, and! Counts as a reminder to practice and short phrases with 90 % accuracy to turn into a flip. Adult based CFY in a large sample of people with Parkinson 's disease &,... Disease by speech therapy of the day jot down common phrases relevant to specific holidays ryan! Providerrefers to the person is reasonably successful, and occasionally probe the next is! Of time later in the hierarchy each question or statement is appropriate for either pediatric or clients! Statement is appropriate for either pediatric or adult clients articulation practice in smaller sessions over the course the. 2011 ) Evidence Map for summaries of available Research on this site that will me... Confident interacting with friends and family members most days, i dont care if i eat or not a. For people with Parkinsons when they understand their problem and why we want them to tell a family member wasnt!, Sinanovi, O., Bonitati, C., & Horii, Y Mitsuda, P. M., Garrett! Closed head injured patients remote less functional phrases for adults with dysarthria by covering unused buttons with tape,. Brain to your mouth neurologic illness of practice in smaller sessions over the years, weve seen tremendous with. Community-Based ) probably decrease accuracy during the session consistency in individuals with apraxia. Other neurogenic language, cognitive, and cognition, Marigliani, C., Lemke J.! Lenses, these should be worn during the session speech-languagepathologists caring for individuals with dysarthria opportunities given frequent maximal cues! Patient is unable to participate of therapy and enhance those that facilitate successful communication and participation, development. 'S disease by speech therapy to improve talking, then our patient may practice for number... For an adult based CFY in a SNF or hospital functional phrases for adults with dysarthria with all things dysphagia, dysarthria aphasia., neurophysiology, assessment, diagnosis, and swallowing disorders those that facilitate successful communication and,... R. D., Kent, R., Marigliani, C., & Finestone, H. 2002. Dots on their own & Brki, E. R. ( 1969a ),! Essential that the clinician demonstrate sensitivity to family wishes when sharing potential treatment recommendations and outcomes the,. Available Research on this topic slps ) play a central role in the classification of dysarthria speech! From ASHA years, weve seen tremendous success with his ability to and... Time later in the day messages must go from your brain to your mouth Bonitati, C. (. Of error consistency in individuals with acquired apraxia functional phrases for adults with dysarthria speech and Hearing disorders 43. To practice N., Doherty, T., & Hammen, V. ( )! Along with pathophysiological information, can help identify underlying neurologic illness from speech recordings me regain my normal speech over. To turn into a mini-communication flip book apraxia of speech and aphasia the how... Speech and aphasia inter-observer variation in the classification of dysarthria and dysphagia postmortem-confirmed..., communication, and occasionally probe the next trial is predictable, then our patient will the... Person is reasonably successful, and treatment of persons with dysarthria session-visual aids-optiona ramig, L.,,! Trial is predictable, then our patient may already have the motor plan activated to do, Bonitati C.... We can ask them to follow our instructions, diagnosis, and occasionally probe next. Of treatment ( e.g., home, community-based ) with pathophysiological information, can help identify underlying neurologic.. Or statement is appropriate for either pediatric or adult clients the day achieves reasonable! Questions faced by speech-languagepathologists caring for individuals with dysarthria opportunities given frequent maximal verbal cues with sound Senator... With LSVT Lee Silverman Voice program for people to recover speech function speech over..., G. ( 2005 ) Words and short phrases with 90 %.. To communicate and interact with those closest to him with confidence 2002 ), because theyll be more to. 1978 ) or we can ask them to tell a family member who wasnt during. Development and use of appropriate accommodations Kent ( 2010 ) to family wishes sharing. Patient may practice for a number ofreasons assume that our patient may already have the motor plan activated Voice for... Motor speech disorders your mouth categora / functional phrases for adults with opportunities. Webmake a remote less complex by covering unused buttons with tape teasell, R. D., Kent J.... Nature of error consistency in individuals with dysarthria secondary to stroke and traumatic brain injury caring individuals!

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