clinical linguistics & phonetics, 2000, vol. 14, no.

1, 1± 11

Review article

Murdoch, B. E. (ed.), 1998, Dysarthria:

A Physiological Approach to Assessment and
Treatment (Cheltenham: Stanley Thornes,
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Ltd ). [Pp. 431 +xii.] ISBN 0-7487-3311-6

G A RY W E I S M E R
University of Wisconsin-Madison, Madison, WI, USA

Motor speech disorders, as a discipline, were systematized by the publication in

1969 of two papers by clinical scientists at the Mayo Clinic. Darley, Aronson and
Brown ( 1969a, b ) reported on a large-scale study in which perceptual data, generated
For personal use only.

by the authors while listening to utterances of persons with a variety of neurological

diseases, were argued to re¯ ect the speci® c attributes of individual diseases. The
basic data and perspectives of this study and several others were later organized
into textbook form, the result being Motor Speech Disorders ( Darley, Aronson and
Brown, 1975 ), a book with an attitude. The attitude was this: the perception of
speech produced by persons with neurological disease has a localizing value ( Darley
et al. 1975 ), in the sense that speci® c perceptions are linked to speci® c lesion
locations; in this view the linkage makes sense because the speech production
symptoms seen in neurological disease can be conceptualized as the classic (unique)
limb-based symptoms of the di€ erent diseases, ® ltered through the speech mechanism
(see review in Weismer 1997a, pp. 191± 197 ).
That a textbook has an attitude should hardly be taken as pejorative. In fact it
is an admirable quality, especially if the attitude is driven by an integrated perspective
(such as the one outlined above) that instructs and points in the direction of needed
research. The Darley et al. ( 1975 ) text certainly instructed, primarily by informing
clinicians and scientists of the main perceptual, observational dimensions of the
disease. Even if you did not buy into the alleged link between the perceptual symptoms
and lesion location (disease entity), the descriptive framework presented by Darley
and co-workers provided a much-needed structure for clinical and scienti® c discussion
of motor speech disorders. The heuristic value of the work was also obvious. The
famous clusters of deviant speech dimensions were not only thought to distinguish

Address correspondence to: Gary Weismer, Ph.D., Department of Communicative Disorders

& Waisman Center, Goodnight Hall, 1975 Willow Drive, University of Wisconsin-Madison,
Madison, WI 53706, USA. e-mail: weismer@waisman.wisc.edu
Clinical L inguistics & Phonetics
ISSN 0269-920 6 print/ISSN 1464-507 6 online Ñ 2000 Taylor & Francis Ltd
http://www.tandf.co.uk /journals/tf /02699206.html
 2 G. Weismer

the dysarthrias from each other, but also served as hypotheses concerning the physio-
logical de® cits underlying the perceptual phenomena. Here was a textbook, then,
that challenged speech scientists to plan their research programmes in such a way as
to bridge the gap between theory and clinical practice: discovery of the physiological
bases of the disease-speci® c perceptual clusters would lead to therapeutic strategies
aimed at the root of the problem, residing in speech physiology. As the physiology
was improved or `cured’ by appropriate remediation strategies, the perceptual symp-
toms would take care of themselves. As a text, then, Motor Speech Disorders did a
lot of good things, which probably explains its status over many years as the gold
standard of theoretical and clinical information about dysarthria.
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The physiological hypotheses that were obvious, if not explicitly stated, in Motor
Speech Disorders spawned a great deal of interest in the physiology of dysarthria.
Since the late 1970s there have been 75± 100 published research papers reporting on
some aspect of speech physiology in dysarthric individuals. These studies have
employed a variety of technologies, using electromyographi c ( EMG ), kinetic (force),
kinematic, and aerodynamic measures, but many if not most seemed to be inspired
by the challenge raised by the Mayo perspective, that of locating the speech physio-
logical correlates of dysarthria-speci® c perceptual symptoms.
This brings us to the subject of this review: Murdoch ( 1998; hereafter D:APA).
This text is written by a group of ® ve scientists working at the University of
Queensland, Australia, all of whom are participating in a productive research
For personal use only.

programme dealing with the physiological basis of motor speech disorders. Here
there is a similarity to the Mayo text, wherein a group of cooperating scientists pool
their accumulated knowledge and present it as a `state of the art’. Indeed, Murdoch
states the purpose of the text clearly, in the preface:
The stimulus for the present book was the editor’s perception that no other
publication to date had adequately synthesized the literature in this area in a form
that could readily be used by speech/language pathologists, medical practitioners
and other relevant health professionals in their clinical settings. ( p. xi)

The preface also makes clear that, like Darley et al.’ s Motor Speech Disorders, this
text has an attitude. In the case of D:APA, however, the attitude is one of downplay-
ing the importance of the perceptual (and acoustic) approach, and claiming priority
for the physiological level of analysis in dysarthria. Once again, from the preface:
the central message of the text emphasizes the potential value of the physiological
approach in the management of dysarthria. ( p. xi )

and later, in Chapter 2, entitled `Perceptual analysis of dysarthric speech’ , the

following statements are made to support the primacy of physiological analyses:
As yet, the results from detailed perceptual assessments have failed to de® ne
accurately the relative contribution of individual functional components of the
speech mechanism to the perceived disturbances in a sample of dysarthric speech
... The importance of relating disordered perceptual speech symptoms to the
possible underlying physiological disturbance will be emphasized ( p. 36 )

Note the apparent resonance of this last statement with the implied physiological
hypotheses of the Mayo perceptual classi® cation system. The resonance is not real,
however, because D:APA holds perceptual analysis in a kind of clinical contempt,
pointing to its failures in revealing the underlying physiology of dysarthria. Throughout
this text the message is pounded home that speech physiological measures and the
 Review article 3

information derived from them are of primary importance, and that measures at other
levels simply cannot do the job. Let us examine this logic in a little more detail, by
considering the implicit, interrelated assumptions driving D:APA.

Assumption 1: The primacy of the physiological approach is self-evident

The physiology is `closest’ to the neurogenic disease, the fewest transforms removed
from the biological basis of the disturbance, so logic dictates that one can learn the
most about the disorder by collecting information here, rather than at levels more
removed from the origin of the disorder (e.g. acoustic and perceptual ). On closer
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inspection, however, this form of reasoning can be shown to be especially vulnerable

to the in® nite regress problem: how close can one get to the actual origin of the
problem ( Weismer and Liss 1992 )? The measures proposed in D:APA, many of
which involve movement, force, and aerodynamic transduction, are more removed
from the root of the problem than, say, standard EMG measures, which are more
removed than single-motor unit behaviours, which are more removed than neuro-
chemical behaviours, and so forth. So, the self-evident nature of the primacy of
physiological analysis in motor speech disorders is not straightforward, and must
depend on empirical criteria, as must all levels of analysis. Some comments on the
evidence available to support a preference for speech physiology measures, as
compared to perceptual measures, are o€ ered below, but we can ask whether the
preference is self-evident to other authorities in motor speech disorders. Here is a
For personal use only.

passage from J. Du€ y’ s ( 1995 ) update of Darley et al. ( 1975 ), in which Du€ y is
considering the infrequent usage of instruments in the motor speech disorders clinic:
Another possible explanation [for the infrequent usage of instrumentation] is that
the clinical value of instrumental analysis has not been established. Gerratt and
others concluded, `clinicians’ reluctance to use instrumentation may result from a
lack of knowledge and a lack of evidence to support the contribution of instru-
mentation in dysarthria management.’. . . The current uncertainty regarding reliabil-
ity, validity, and clinical applicability of acoustic and physiologic methods to
clinical di€ erential diagnosis and management justi® es a peripheral role for instru-
mental analysis in the clinical examination and diagnosis of motor speech disorders
at this time. In fact, perceptually based clinical assessment will always be the
mainstay of clinical diagnosis. ( pp. 92± 93 )
Thus the physiological approach is not necessarily the `right’ one, and Du€ y’ s
remarks point to the need for empirical validation of the utility of any level of
analysis (see below, Assumption 3 ).

Assumption 2: Subsystems analysis is a requirement of proper diagnosis,

and can only be done using the physiological approach
This is the centrepiece assumption of D:APA, and its in¯ uence is found in almost
every chapter of the text. Somewhat surprisingly, though, the main case for sub-
systems analysis is made in Chapter 2 (`Perceptual Analysis of Dysarthric Speech’ ).
Here the Mayo-style, perceptual analysis of dysarthric speech is put on trial and
found guilty because of its alleged inability to shed light on subsystems dysfunction
of the speech mechanism.
What exactly do the authors mean when they use the term `subsystem’? The
inspiration for this idea comes from a paper by Netsell and Daniel ( 1979; see p. 41
of D:APA) in which a `point-place’ model of speech production was proposed; the
 4 G. Weismer

authors cite additional, subsequent publications by Netsell and his group in which
the physiological model is advanced (see D:APA, p. 50, section 2.4 ). In this model,
evaluation of certain critical locations throughout the speech mechanism (such as
the velopharyngea l port, the lips, the larynx) was thought to provide the highest
yield in terms of knowledge about the relationship between physiological de® cit and
loss of speech intelligibility. This is fairly consistent with the use of the `subsystems’
idea in D:APA, which advocates breaking the speech mechanism into its component
parts and obtaining separate indices of their dysfunction, independent of de® cits in
other parts. Here is that philosophy in the authors’ own words:
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The physiological approach is based on the premise that the problem in dysarthria
is one of motor control, secondary to a nervous system lesion or lesions. Thus the
assessment of the individual motor speech subsystems (respiratory, laryngeal, velo-
pharyngeal, and articulatory) is crucial in de® ning the underlying motor speech
pathophysiology that is the basis of the perceived speech deviations. (D:APA, p. 50 )

Aside from the tautological nature of the ® rst part of this statement (what else
would dysarthria be but a motor control problem?), one might ask why a conception
of a motor control problem requires an investigation of the individual system
subcomponents. Do contemporary motor control theorists view the performance of
complex systems, such as the speech mechanism, as a linear sum of independently
evaluated parts? Leading theorists in general motor control (e.g. Kugler and Turvey
For personal use only.

1987, Willingham 1998 ), as well as speech motor control (see reviews in Liberman
1998 and LoÈfqvist 1997 ) have for many years viewed motor control systems as goal-
oriented ; that is, as specialized for particular tasks. In this view `parts’ of the
mechanism are not controlled independently of each other, but rather are controlled
cooperatively in the service of the goal-to-be-achieved . This is why many contempor-
ary speech-production theorists have concerned themselves with interactions between
di€ erent speech mechanism structures, and the relations between those interactions
and the vocal tract acoustic output. The goal of speech production, in this view, is
the acoustic signal (see, for example, Perkell 1996 ), which is dependent on the
shaping of the vocal tract as produced by the cooperating activity of all structures
capable of producing the shape changes.
The subsystems analysis idea probably makes more sense at the respiratory and
laryngeal levels of the speech mechanism than it does at the articulatory level
(although even at these levels the idea of independent analyses is questionable, but
we will not pursue these concerns here). Murdoch and his colleagues have published
a number of papers on the control characteristics of independent articulatory struc-
tures (such as the lips, the jaw, the tongue), using measures such as ® ne (submaximal )
or maximum force control in non-speech tasks. These studies are complemented by
the pioneering studies of non-speech, orofacial control performed by Barlow and
his colleagues (e.g. Barlow and Abbs 1984, 1986, Barlow and Burton 1990 ) and the
continuing e€ orts along these lines from the University of Iowa (see review in Robin,
Solomon, Moon and Folkins 1997 ). One might pose the question: `If the primacy
of physiological analyses is self-evident and subsystems analysis is the correct imple-
mentation thereof, shouldn’t this be evident in the relevant literature? Shouldn’t
there be clear evidence of systematic relationships between subsystems impairments,
as measured in one of the ways suggested in D:APA (and found in the literature
referred to above), and measures of speech intelligibility and/or perceived severity?
 Review article 5

Weismer ( 1997b ), in reviewing the approximatel y 35 relevant studies1 that have been
done since the 1960s, showed that the evidence in support of the subsystems approach
was not only unconvincing, but in many cases negative. For example, there are
several studies in which correlations between an orofacial, non-speech measure and
a measure of speech intelligibility (or speech severity) were absent (e.g. Thompson,
Murdoch and Stokes 1995, LaPointe and Wertz 1974 ) or low, but statistically
signi® cant (e.g. Solomon et al. 1995 ). The promises of the physiological approach
would seem to require the physiology measures to perform better than this
in predicting an important speech variable. More importantly, there are studies
(e.g. Schliesser 1982, Langmore and Lehman 1994 ) in which non-speech measures
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sampled from an isolated articulatory structure (such as the lips) did not predict the
behaviour of that structure during speech-production tasks. Contemporary motor
control theorists would not be surprised at this ® nding: motor control styles are
often said to be task-speci® c, requiring performance of the task of interest to
understand the nature of motor control for that task. Holding a submaximal force
with the tongue, or even producing sinusoidal ¯ uctuations of the forces exerted by
the tongue, is as di€ erent from the use of the tongue during speech production as
is transporting a coin across the ® ngers of a single hand from performing an intricate
piano arpeggio with the same hand. It should be pointed out here that Murdoch
and his associates are not alone in espousing the idea of component analysis of the
speech mechanism in the absence of speech. Robin et al. ( 1997 ) argue that such
For personal use only.

analyses must be done to separate out the motor component of speech from the
linguistic component, as if the speech mechanism can be partitioned not only
anatomically for diagnosis ( i.e. lips, tongue, jaw, and so forth) but also functionally
( the motor component alone, `pulled apart’ from the linguistic component).
It is interesting that D:APA takes its inspiration from Netsell’s work, because
his writings do not seem to welcome the idea of non-speech evaluation of the speech
mechanism to learn something about the speech production/intelligibility de® cit
in dysarthria. In a 1984 paper meant to summarize his physiological approach,
Netsell says:
There is the possible illusion that, because physiological studies are `closer to’ the
underlying physiological problem, they are our best chance to understand what
has gone wrong with the nervous system. In my opinion, physiological studies in
isolation ( that is, without concomitant measures of the perceptual or acoustic
correlates) are uninterpretable. In short, the physiology data must be `tied’ to their
acoustic± perceptual consequences. ( p. 281)

The lip, tongue and jaw force measures described in D:APA, plus the non-speech
respiratory measures, cannot be tied diagnostically to any acoustic/perceptual con-
sequences, because they are not collected during speech production. As reviewed
above, the studies in which both kinds of measure are collected have not produced
the kinds of results expected from a self-evident relationship.
Netsell ( 1984 ), in presenting a broad-stroke view of the physiological approach,
argues that it can be brought into the instrumentation-poo r clinical arena (recall the
quote from Du€ y, above) because

1
The discussion that follows is a paraphrase of material from Weismer ( 1997b). A summary
and bibliography of the studies referred to here are available from the author on request. A
videotape is available from the National Center on Neurogenic Communication Disorders,
University of Arizona, Tucson, AZ, USA.
 6 G. Weismer

Fortunately, the physiological orientation does not require actual physiological

recording but rather an attitude; a set of ideas that allows physiological inter-
pretations and inferences to be made from controlled, systematic behavioral
observations. ( p. 281)

In section 2.4 of Chapter 2 of D:APA, after Netsell’s work is identi® ed as the main
inspiration for the view presented in the text, the quote from Netsell is closely
paraphrased:
The results of detailed physiological investigations of the motor speech production
processes, while desirable, are not crucial in the physiological approach. What is
required is an attitude or set of beliefs by the clinician that allows physiological
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interpretations and inferences to be made from detailed, controlled, systematic

behavioural and perceptual observations. ( p. 50 )

If this statement was included to describe Netsell’s thoughts, then its inclusion here
is quite understandable. But it occurs in a chapter in which a strong argument is
presented for the weakness of perceptual judgements of dysarthric speech, and it
occurs in a text that claims to present examples showing the superiority of physio-
logical measures over perceptual measures (see below). Netsell clearly does not view
physiological measures as superior; my reading of D:APA (other than this paraphrase
of Netsell ) is that it does.
For personal use only.

Assumption 3: It is easy to show the ability of physiological data to go

past the information provided by perceptual analyses
One of three questions Netsell ( 1984 ) suggests should be asked of authorities who
make claims about problem-solving strategies in understanding speech disorders is:
`What di€ erence does it make?’ How does D:APA address the question of : What
di€ erence do physiological measures make in the understanding, diagnosis, and
treatment of motor speech disorders? I have already commented on how D:APA
addresses this question on theoretical or logical grounds (e.g. the physiology is closer
to the origin of the problem, dysarthria is a motor control problem and therefore
must be evaluated by subsystems analysis), but what is the empirical support for
the claim that physiological measures do make a di€ erence? We have already pro-
vided Du€ y’ s ( 1995 ) opinion on this matter (see above); In D:APA the evidence of
how physiological measures go past perceptual measures is o€ ered in the form of
juxtaposed perceptual and physiological pro® les of selected case studies (see pp. 197,
201, 231, 234, 261, 300, and 303). It is impossible to go through these pro® les item
by item to support my opinion that the case for the priority (or even necessity) of
physiological measures is not made, in any of the paired pro® les, so an example or
two will have to su ce. In case 1 of Chapter 6 (`Flaccid dysarthria’, p. 197), the
perceptual pro® le indicates `mildly reduced breath support for speech and mildly
audible inspiration’, whereas the physiological measures for respiratory function
reveal a reduced vital capacity and forced expiratory volume, a reduced rib cage
contribution to the exchange of lung volume ( presumably during a speech task),
and increase of paradoxical movements of the chest wall (where the rib cage and
abdomen are moving in opposite directions to each other, and hence contributing
in con¯ icting directions to the desired change in lung volume), a decreased number
of syllables per breath group, and a decreased speaking rate. The implications of
these ® ndings for management are as follows:
 Review article 7

Considering that the instrumental assessments identi® ed an incoordinated pattern

of chest wall movement during speech breathing, some time should be spent
establishing a more coordinated pattern of chest wall movements to help maximize
lung volume exchanges. In addition, the relatively low vital capacity, the reduced
lung volume excursions observed during speech breathing and the reduced number
of syllables produced per breath during reading indicate a need to target enhanced
respiratory support for speech and expiratory breath control. (D:APA, p. 198)
Do these instrumental observations go past the perceptual observations in a clear
way? First, vital capacity and forced expiratory volume, both non-speech measures
of maximum e€ ort, have never been shown to provide useful information for
understanding speech breathing. In addition to the comments made above concerning
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the dubious status of non-speech measures in understanding speech production

behaviour, maximum e€ ort tasks of any kind may not be predictive of the submaxi-
mal e€ ort expenditures typical of speech production ( Kent, Kent and Rosenbek
1987 ). Speech breathing, for example, commonly requires the use of only about
20± 30% of the vital capacity; why vital capacity measures should be useful in
understanding speech breathing problems (except in extreme cases of negligible vital
capacities, which do no require instruments for identi® cation) has never been
addressed satisfactorily in the literature. Second, reduced lung volume excursions
during speech production are presumably correlated with breath group durations
and therefore easily inferred from perceptual analyses, as are reduced number of
syllables per breath and speaking rate (why these latter two measures are listed as
For personal use only.

`physiological’ is not made clear). Third, the instrumental observations of reduced

rib cage contribution to lung volume exchange, as well as the paradoxical chest wall
movements, are used to motivate the management plan for `a more coordinated
pattern of chest wall movement’. I would agree that these observations would be
more di cult to obtain using perceptual measures (although paradoxing, especially
when the abdomen moves in the inspiratory direction during speech production, is
easy to diagnose from simple observation of the patient’s abdomen), but it is not
clear that the plan for more coordinated speech breathing could not have been
generated from a perceptual analysis.
I purposely selected the paired pro® le for respiratory function, because it is here
that the authors of D:APA might have made their best case for instrumental measures
going well past perceptual measures. As indicated in the preceding paragraph,
however, the case is made ( in my opinion) only weakly, at best. The paired pro® les
for articulatory function, on the other hand, do nothing to promote the desirability
of instrumental measures over and above a traditional intelligibility assessment,
which can be supplemented by some careful ( perceptual ) observations of the types
of articulatory problem making a signi® cant contribution to the intelligibility de® cit
( Kent, Weismer, Kent and Rosenbek 1989 ). The non-speech, instrumental demon-
stration of weakness and endurance problems in the lips and tongue are used to
motivate strengthening exercises, with the suggestion of computer-based, biofeed-
back therapy `to help maximize lip strength and bilabial closure during speech’
( p. 199). As reviewed above, though, there is little or no evidence that such non-
speech therapy activities have anything to do with speech production.

Some general comments

I have focused this review on the big picture presented in D:APA, and I am obviously
not sympathetic to the philosophical orientation of the text. I do not go so far as
 8 G. Weismer

Du€ y ( 1995 ), however, in expecting instrumental measures to have a limited future

as a primary tool in the motor speech disorders clinic, but in my opinion D:APA
does little to advance the cause. At a more logistical level there are certain aspects
of the text deserving of mention. D:APA has value by virtue of its huge, up-to-date
literature review. These reviews are scattered throughout the text, and I found myself
encountering a number of recent citations of work unknown to me. I believe that if
someone is looking for a single book source with the most current listings of the
research literature in motor speech disorders, D:APA would be the obvious choice
( this is not to take anything away from Du€ y’ s ( 1995 ) ® ne review of the available
literature at the time of publication of his text). I also very much like the design of
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the text, the wide margins allowing for extensive note-taking ; the margins of my
copy are ® lled. A third welcome component of this text is the ® nal chapter, dealing
with childhood motor speech disorders. Among the various general texts on motor
speech disorders, I believe this is the only one with extended material on pediatric
populations.
On the negative side of the logistics ledger, the text is initiated with a long,
ine€ ective chapter entitled `The neuroanatomical framework of dysarthria’.
Preparation of this kind of chapter in a text on motor speech disorders is often
tricky, because the success of the material depends so much on careful coordination
between selected anatomical images and organizational and expositional clarity. In
my opinion this chapter does not achieve this coordination. There are numerous
For personal use only.

mismatches between the text and the ® gures, and the organization of the material
is not obvious. Scientists and practitioners looking for a much more e€ ective pre-
sentation of the neuroanatomy relevant to motor speech disorders should consult
Chapter 2 in Du€ y ( 1995 ). Finally there is a lot of redundancy in D:APA. In
particular, most of the treatment suggestions in the individual chapters on di€ erent
types of dysarthria (Chapters 6± 11 ) are presented earlier and sometimes nearly
verbatim, in Chapter 5 (`Treatment of dysarthria’ ). The text probably would have
been better served by an organization in which the chapters on the individual
dysarthrias were followed, rather than preceded by, a chapter on treatment.
Each of the texts available on motor speech disorders has something unique to
o€ er, but if I was selecting a text to accompany a course in dysarthria, it would be
the one by Du€ y ( 1995 ). Other worthy texts include Yorkston, Beukelman and Bell
( 1988 ), which is somewhat dated but is of interest because it takes a di€ erent
perspective on the problem, and Love and Webb ( 1996 ), which is less detailed than
the others mentioned here but does a good job as a handbook. It is curious that
D:APA contains no citation to J. P. Dworkin’s ( 1991 ) text, Motor Speech Disorders:
A Treatment Guide. Dworkin’s philosophy of the primacy of physiological measures
in understanding and treating dysarthria is virtually indistinguishable from the ethos
of D:APA; the former text would have been a useful ally of the latter in making the
case for a physiological orientation to the dysarthrias.

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 Review article 9

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 10 B. Murdoch

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Dysarthric Speakers ( Boston, MA: College Hill Press).

A brief response

That Dr Weismer is critical of the overall philosophy of the text Dysarthria: A

Clin Linguist Phon Downloaded from informahealthcare.com by Central Michigan University on 12/11/14

Physiological Approach to Assessment and Treatment (D-APA) is not surprising,

given the strong bias towards acoustic methods of analysis espoused in his own
publications. However, I believe his review misrepresents the true message that I
and my colleagues are trying to convey to readers of D-APA by his overstating the
importance we place on physiological measures. Certainly the text promotes the use
of physiological measures in the assessment of dysarthria, pointing out their relative
advantage s and disadvantage s while at the same time indicating a number of limita-
tions of perceptual and acoustic methods. The central message that is continuously
conveyed throughout the various chapters, however, is that physiological measures
should be used in combination with the ® ndings of perceptual and acoustic analyses.
For example at the conclusion of Chapter 3, `Instrumental assessment of the speech
For personal use only.

mechanism’ , page 89, we state: `It is important, however, to keep in mind that,
although instrumentation has opened a whole new range of assessment techniques,
physiological data should be integrated with data from other appraisal procedures
( i.e. combined information from perceptual, physiological and acoustic information)
to ensure that an accurate diagnosis is made and that the subsequent remediation
techniques are appropriate. In particular the limitations of each of the instrumental
procedures need to be kept in mind when making clinical decisions based on their
® ndings.’ At no time do we suggest that physiological measures should be used in
isolation of other forms of assessment.
Although we do point out some of the reported limitations of perceptual forms
of assessment, we certainly do not hold perceptual analysis in a `kind of clinical
contempt’ as suggested by Dr Weismer ( I draw your readers attention to the fact
that these are his words, not ours). In all of the research in the area of dysarthria
published to date by the authors of D-APA, perceptual analysis has consistently
been used in combination with physiological forms of assessment. To this end we
agree with Netsell that physiological measures need to be interpreted in the context
of perceptual and acoustic ® ndings.
The authors of D-APA believe that one of the major strengths of the text is the
provision of separate chapters for discussion of each of the major assessment types,
i.e. perceptual, acoustic and physiological assessments. As a consequence, rather
than neglecting perceptual and acoustic measures as suggested by Dr Weismer,
D-APA provides a more comprehensive coverage of the pros and cons of the di€ erent
dysarthria assessments available to clinicians than any other single text published
to date. In addition, in discussing each of the di€ erent classi® cations of dysarthria,
detailed and comprehensive information is provided to the reader regarding not
only the ® ndings of physiological studies of that type of dysarthria but also those
® ndings based on perceptual and acoustic techniques. We contend that no other
text published to date provides the reader with the depth of information across