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What are speech supplementation strategies?
Speech supplementation is a compensatory strategy often used in addition to natural speech (Roth, 2021). For many individuals with dysarthria, one of the primary goals of speech intervention is to increase speech intelligibility. Supplementation strategies can help increase intelligibility by providing listeners with additional context to support understanding. There are several types of supplementation strategies including: alphabet supplementation, semantic/topic supplementation, syntactic supplementation, and gestures (Roth, 2021). Alphabet supplmentation and topic supplementation are further described below.
Alphabet Supplementation
Alphabet Supplementation
In alphabet supplementation, the speaker indicates the first letter of each word they say using an alphabet board or another type of AAC display (Roth, 2021).
Topic Supplementation
Topic Supplementation
In topic supplementation, the speaker indicates the semantic context to the listener using a list of meaningful topics or photographs (Roth, 2021).
Who should I use speech supplementation with?
Speech supplementation can be adapted to fit a variety of skill levels and can be used with patients who present with any type of dysarthria. These strategies are most commonly used to increase intelligibility in patients with severe to profound dysarthria (Beukelman & Light, 2020). While topic supplementation can also be beneficial for patients with aphasia, alphabet supplementation is often difficult due to word-finding difficulties (Beukelman & Light, 2020).
Severity Levels of Dysarthria:
What goals does speech supplementation address?
Increases speech intelligibility
Reduces rate of speech
Decreases communication breakdowns
Data Collection
Clinicians can monitor speech intelligibility as well as the overall rate of speech
Guide to Intervention:
Supplementation strategies need to be explicitly taught; some clients may pick it up quickly while other may need more practice
Choose targets that are meaningful for each individual; include the names of people, places, and events that are relevant to their lives
Increase complexity as skills develop; ultimately the goal is for individuals learn to utilize the strategy in conversational interactions
Evidence-Based Practice
Beukelman & Yorkston (1977) evaluated the effects of alphabet supplementation on speech intelligibility in two severely dysarthric patients. They found that intelligibility increased from 33% to 66% at sentence-level when using this strategy.
Hanson et al. (2004) evaluated the use of alphabet supplementation in speakers with various types of dysarthria. Researchers found that intelligibility increased by 10% at word-level and 25.5% at sentence-level when using alphabet supplementation. When using topic supplementation, intelligibility increased by 28% at word-level and 10.7% at sentence-level.
Beukelman et al. (2002) reported intelligibility gains were larger for individuals with more severe cases of dysarthria.
References:
Beukelman, D. R., & Yorkston, K. (1977). A communication system for the severely dysarthric speaker with an intact language system. Journal of Speech and Hearing Disorders, 42(2), 265–270.
Beukelman, D. R., & Light, J. C. (2020). Augmentative & Alternative Communication: Supporting Children and adults with complex communication needs. Paul H. Brookes Publishing Co., Inc.
Beukelman, D. R., Fager, S., Ullman, C., Hanson, E., & Logemann, J. (2002). The impact of speech supplementation and clear speech on the intelligibility and speaking rate of people with traumatic brain injury. Journal of Medical Speech-Language Pathology, 10(4), 237-242.
E.K. Hanson, K.M. Yorkston, D.R. Beukelman (2004). Speech supplementation techniques for dysarthria: a systematic review
Jounral of Medical Speech-Language Pathology, 12 (2), pp. ix-xxix.
Roth, F. P., & Worthington, C. K. (2021). Treatment resource manual for speech-language pathology. Plural.
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