INT J LANG COMMUN DISORD, FEBRUARY 2021,

VOL. 0, NO. 0, 1–9

Research Report
Dysarthria following acute ischemic stroke: Prospective evaluation of char-
acteristics, type and severity
Elien De Cock†‡ , Kristine Oostra‡ , Lisa Bliki§, Anne-Sophie Volkaerts§,
Dimitri Hemelsoet† , Veerle De Herdt† and Katja Batens†‡¶
†Stroke Unit, Department of Neurology, Ghent University Hospital, Ghent, Belgium
‡Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
§Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
¶Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
(Received October 2020; accepted January 2021)

Abstract
Background: Dysarthria is a common symptom following stroke and represents an important cause of functional
impairment in stroke patients. A better characterization of dysarthria could facilitate differential diagnosis and
optimize healthcare service distribution.
Aim: To determine the speech characteristics, dysarthria type and severity in the acute phase following ischemic
stroke in a comprehensive stroke centre.
Methods & Procedures: First-ever ischemic stroke patients consecutively admitted to the Stroke Unit of Ghent
University Hospital were included in this prospective clinical study between March 2018 and October 2019. All
participants admitted to the Stroke Unit were screened for dysarthria by a speech–language pathologist within 72
h after admission. When dysarthria was identified, speech characteristics were evaluated via auditory–perceptual
assessment and objective measurement of acoustic parameters. Dysarthria type was determined based on the
Mayo Classification System. Severity of impairment was scored at function and activity level using the Radboud
Dysarthria Assessment and the evaluation of speech intelligibility at sentence level using the Dutch Speech Intelli-
gibility Assessment. In addition, dysarthria recovery was separately evaluated in all participants using the National
Institutes of Health Stroke Scale (NIHSS) at hospital admission, day 3 ± 2 and day 7.
Outcomes & Results: A total of 67 out of 151 participants (44%; mean age = 69 years; SD = 13; 28 females)
were diagnosed with dysarthria in the acute phase following stroke. Standardized assessments were possible in
72% (48/67) of participants. Imprecise articulation of consonants, harsh voice quality and audible inspiration
were the most frequent observed speech characteristics. The acoustic parameters maximum phonation time and
maximum loudness deviated most from normative values. Unilateral upper motor neuron (UUMN) was the main
dysarthria type present in 52% (25/48) of participants. A total of 58% (28/48) and 71% (34/48) of participants
had no/minimal/mild difficulties at the functional and activity levels, respectively. Speech intelligibility was mildly
impaired (median = 91%; IQR = 73–97). According to the NIHSS, sub-item speech score at hospital admission,
46% (70/151) of participants had dysarthria, of which half recovered completely from their dysarthria within 1
week after stroke symptom onset.
Conclusions & Implications: UUMN was the dominant dysarthria type, and the majority of participants had a
mild dysarthria. Half the participants showed complete recovery within 1 week following symptom onset. The
observed speech characteristics mainly reflect impairments in the subsystem’s articulation, phonation and respi-
ration. Objective measurements of acoustic parameters corroborate these findings. Future research should focus
on longitudinal assessment to investigate recovery of symptoms and the long-term impact of dysarthria on social
participation.

Keywords: dysarthria, stroke, acute, type, severity, characteristics.

Address correspondence to: Veerle De Herdt and Katja Batens, Stroke Unit, Department of Neurology, Ghent University Hospital, Ghent,
Belgium; e-mails: veerle.deherdt@uzgent.be and Katja.Batens@uzgent.be

International Journal of Language & Communication Disorders

ISSN 1368-2822 print/ISSN 1460-6984 online © 2021 Royal College of Speech and Language Therapists
DOI: 10.1111/1460-6984.12607
2 Elien De Cock et al.

What this paper adds

What is already known on the subject
• There are few data concerning the presentation of dysarthria following acute ischemic stroke. Moreover,
previous research did not include objective measurements of speech characteristics and dysarthria severity.
There was a need to determine prospectively speech characteristics, dysarthria type and severity in a stroke
population using standardized assessments.

What this paper adds to existing knowledge

• The findings of this study show a high prevalence of dysarthria following acute ischemic stroke. This
study confirms previous findings that the speech of dysarthric patients following acute ischemic stroke was
mostly characterized by imprecise articulation of consonants, a harsh voice quality and audible inspiration.
The results of the objective measures confirm these findings. We added evidence that UUMN is the most
prevalent dysarthria type in a stroke population, and that the majority of participants had mild dysarthria.
A high rate of dysarthria recovery was seen in the first week following symptom onset.

What are the potential or actual clinical implications of this work?

• The findings of this study contribute to the limited research performed regarding post-stroke dysarthria.
The results can help optimize the distribution of healthcare resources. The majority of participants have a
mild dysarthria, making the identification of the specific needs of this group an important area of concern.
The evaluation of impaired speech subsystems and characteristics, especially supplemented with objective
measures of acoustic parameters, and the classification of the type and severity of dysarthria can be helpful
to monitor early progress in the acute phase post-stroke.

Introduction our knowledge, only one study reported dysarthria type

Dysarthria is a common symptom following stroke with
incidences ranging between 25% and 70% in the acute
phase, with 42% of patients showing persistent symp-
toms at 3 months post-stroke (Ali et al. 2015, De Cock
et al. 2020, Lubart et al. 2005). Moreover, dysarthria is
an important cause of functional impairment following
stroke and has a big impact on a person’s psychosocial
well-being (Brady et al. 2011, Dickson et al. 2008).
Surprisingly, little is known about the characteristics
of this communication disorder following stroke (Ali
et al. 2015, Canbaz et al. 2010, Chand-Mall and
Vanaja 2017, Mackenzie 2011, Urban et al. 2006).
Auditory–perceptual assessment of speech character-
istics is the gold standard in dysarthria assessment
and is typically used to describe abnormalities in the
subsystems phonation, resonance, respiration, prosody
and articulation (Spencer and Brown 2018). Articu-
latory inaccuracy, imprecise consonant articulation,
harsh, hoarse and breathy voice quality, monopitch and
loudness and speech pauses were the most common
features observed via auditory–perceptual assessments
following stroke (Chand-Mall and Vanaja 2017, Urban
et al. 2006). According to the Mayo Classification
System, the dysarthria types unilateral upper motor
neuron (UUMN), flaccid, spastic, ataxic, hypokinetic,
hyperkinetic and mixed can be distinguished based on
lesion location, aetiology and observed speech charac-
teristics (Darley et al 1968, Duffy and Kent 2001). To
following stroke, with half the participants classified
as UUMN dysarthria (Chand-Mall and Vanaja 2017).
By contrast, several studies have investigated dysarthria
severity in a stroke population. A retrospective analysis
of a large, pooled data set reported a mostly mild to
moderate dysarthria severity based on a neurological
screening test performed at acute stroke units (Ali et al.
2015). This is in line with two prospective studies,
rating dysarthria severity as mild to moderate in most
participants, with mildly impaired speech intelligibility
(Canbaz et al. 2010, Chand-Mall and Vanaja 2017).
To our knowledge, no objective measures of speech
characteristics and dysarthria severity were performed
in previous research.
The use of objective measures of acoustic parame-
ters in addition to perceptual assessments can help iden-
tify the presence and severity of impaired speech char-
acteristics by comparing outcomes to normative values,
which in turn can further help to distinguish dysarthria
type. In addition, objective measures of speech char-
acteristics and dysarthria severity allows for a more
precise, quantitative monitoring of dysarthria recovery
and/or treatment success. The need for reliable consen-
sus outcome measures at function, activity and partici-
pation level was also highlighted in the latest Cochrane
review concerning the effect of dysarthria therapy, as the
variability in measures between included trials limited
generalizability of results (Mitchell et al. 2017).
Characteristics of dysarthria post-stroke
Most studies evaluating post-stroke dysarthria were
performed before recent advancements in acute stroke
care such as the implementation of acute reperfusion
therapies. Ali and colleagues found a significant associ-
ation between intravenous thrombolysis and improved
recovery for dysarthria following acute stroke (Ali et al.
2015). Although not yet specifically investigated for
post-stroke dysarthria, intra-arterial thrombectomy was
associated with better early recovery in patients with
aphasia and motor deficits (Crijnen et al. 2016). Due
to the increased implementation of acute reperfusion
therapies, it might be possible that dysarthria presenta-
tion (prevalence, type and severity) has changed com-
pared with previous research performed in the pre-
thrombolysis and thrombectomy era.
The aim of this study was to prospectively evalu-
ate speech characteristics, type and severity of dysarthria
in consecutive patients with a first-ever acute ischemic
stroke in a comprehensive stroke centre. The specific
objectives of our study were (1) to evaluate speech char-
acteristics based on auditory–perceptual assessment and
objective measures of acoustic parameters; 2) to deter-
mine dysarthria type according to the Mayo Classifica-
tion system; and (3) to evaluate dysarthria severity at
function and activity levels using standardized assess-
ments and evaluation of early dysarthria recovery.
Methods
Participants
All consecutive patients admitted to the Stroke Unit
of Ghent University Hospital between March 2018
and October 2019 following a first-ever ischemic
stroke were prospectively screened for the presence of
dysarthria. Data collection was performed as part of an
overarching study evaluating the incidence of dyspha-
gia, dysarthria and aphasia following a first ischemic
stroke (De Cock et al. 2020). Inclusion criteria for this
study were (1) diagnosis of a first-ever ischemic stroke;
(2) minimum age of 18 years; (3) Dutch speaking; and
(4) admitted within 48 h after the onset of acute stroke
symptoms to the Stroke Unit of the Ghent University
Hospital. Exclusion criteria were (1) a history of other
diseases that influenced swallowing, speech and/or lan-
guage, such as dementia, Parkinson’s disease or oral car-
cinomas; and (2) the presence of a serious cognitive
impairment. More detailed information on data collec-
tion and study protocol is described by De Cock et al.
(2020).
Demographic information including age, sex, hand-
edness, ischemic stroke aetiology according to the
Study of Org 10172 in Acute Stroke (TOAST) clas-
sification, lesion location (magnetic resonance imag-
ing (MRI) and/or computed tomography (CT)) and
3
treatment with acute reperfusion therapy was docu-
mented. This prospective study was approved by the
medical Ethics Committee of Ghent University Hospi-
tal (EC/2018/0122) and written informed consent was
obtained from all participants, or from a first-degree
family member or legal representative when the partici-
pant was not able to consent.
Dysarthria screening
One of two trained speech–language pathologists
(SLPs) (E.D.C. or K.B.) screened all participants using
a bedside dysarthria screening performed within 3 days
following admission to the Stroke Unit to determine the
presence of dysarthria. Participants were asked to per-
form several non-speech oral motor exercises to eval-
uate morphology, strength, sensibility and function of
oral musculature. Subsequently, participants had to re-
peat words with increasing length and complexity, and
spontaneous speech was elicited via open-ended ques-
tions to comprehensively assess the speech subsystems
respiration, phonation, resonance, prosody and articu-
lation. When dysarthria was confirmed by the SLP, a
standardized assessment was performed. In addition, all
participants underwent a clinical neurological evalua-
tion upon hospital arrival by the attending neurologist
including the National Institutes of Health Stroke Scale
(NIHSS) assessment (National Institute of Neurolog-
ical Disorders and Stroke 2010). The NIHSS scale is
used by healthcare professionals to quantify the sever-
ity of neurological deficit following stroke with higher
scores representing more disability. The scale consists of
11 sub-items including, but not limited to, the evalua-
tion of speech (National Institute of Neurological Dis-
orders and Stroke 2010). Dysarthria recovery was evalu-
ated by using the NIHSS scale sub-item speech at hospi-
tal admission, day 3 ± 2 and day 7 ± 2 or earlier when
discharged before that time period. Speech was rated on
a three-point scale, ranging from no to severe dysarthria.
Dysarthria assessment
All participants with confirmed dysarthria following
SLP screening were extensively evaluated through stan-
dardized assessments which were audio recorded with
an over-ear headset with microphone. All assessments
were performed by one of the two SLPs (E.D.C., K.B.).
The Radboud Dysarthria Assessment (RDA) consists
of several speech tasks such as spontaneous speech,
reading of a standardized text, diadochokinesis, sliding
tones, shouting and maximal phonation time (MPT)
(Knuijt et al. 2017). Auditory–perceptual assessment
was performed for evaluation of the speech subsystems
and characteristics described by Darley et al. (1968).
Objective measurements of the acoustic parameters
4 Elien De Cock et al.
alternating and sequential motion rate (AMR and
SMR), minimum, maximum and range of pitch,
maximum loudness and MPT were analysed via the
computer software ‘Praat’ (Boersma & Weenink).
Dysarthria type was determined according to the Mayo
Classification System (Darley et al. 1968). Dysarthria
severity was assessed at function (assessment of speech)
and activity level (assessment of effective communica-
tion) via the six-point scale included in the RDA (0 =
no impairment, 5 = very severe impairment). Speech
intelligibility was quantified using the Dutch Sentence
Intelligibility Assessment (DSIA). For this assessment,
participants were asked to read aloud randomly com- Figure 1. Dysarthria type according to the Mayo Classification Sys-
puted sentences without meaning, after which audio tem (total n = 48).
recordings were transcribed by the SLP unaware of the
intended content of the sentences. The percentage of
correct understood words is then calculated. As some
participants could not perform this assessment, intelli-
gibility was perceptually rated in all participants on a
visual analogue scale based on the recording of sponta- 13, range = 42–97), 28 females (42%), median to-
neous speech (Martens et al. 2010). All audio recordings tal NIHSS score of 4 (2–14) at hospital admission).
were analysed by the same SLP (E.D.C.). Dysarthria Demographic and clinical information is reported in
type was independently evaluated by both SLPs (E.D.C. table 1. In 48/67 participants, standardized assessments
and K.B.) and any disagreement was resolved by con- could be performed. Audio recordings were not possible
sensus. in 19 participants due to severe aphasia and/or mutism
(n = 9), reduced alertness (n = 5), in-hospital medical
complications (n = 2), fast transfer to another hospital
Data analysis
(n = 1), severe verbal apraxia (n = 1) and one partici-
Descriptive analysis of demographic, clinical and speech pant refusing audio recordings. Dysarthric participants
variables was performed in SPSS version 26. Depend- without audio recordings were significantly older (p =
ing on normality, means with standard deviation (SD) 0.002) and had more severe strokes (p < 0.001). No
or medians with interquartile range (IQR) were re- other statistically significant differences in demographic
ported. Participants without audio recordings were not and clinical variables were found between dysarthric
included in the analyses of standardized assessments. participants with and without audio recordings.
Differences in clinical and demographic variables be-
tween participants with and without audio recordings
were performed with the Mann–Whitney U-test or in- Auditory–perceptual and objective analysis of speech
dependent t-test for continuous variables and with the characteristics
Fisher’s exact test for categorical variables with p < 0.05 The distribution of impaired speech subsystems and
being significant. Objective measurements of acoustic characteristics is reported in table 2. Harsh voice
parameters were compared with the normative values (phonation), imprecise articulation of consonants (ar-
for healthy Dutch-speaking persons to objectively iden- ticulation) and audible inspiration (respiration) were
tify the number (%) of people with an impairment per most commonly observed. The acoustic parameters
acoustic parameter (score below the cut-off ) (Knuijt maximum loudness and maximum phonation time
et al. 2017). (MPT) deviated most in participants compared with
The data that support the findings of this study are normative values. Alternating motion rate (AMR) was
available from the corresponding author upon reason- more often impaired than sequential motion rate
able request. (SMR), with AMR /pa/ being most affected (table 3).

Results
Dysarthria type
Participants
UUMN was the most prevalent dysarthria type, present
Dysarthria was present in 67 of 151 (44%) first-ever is- in more than half the participants (25/48; 52%). The
chemic stroke patients (mean age = 69 years (SD = distribution of dysarthria types is reported in figure 1.
Characteristics of dysarthria post-stroke 5
Table 1. Demographic variables dysarthric participants

Demographic variables Dysarthric participants (n = 67)

Age, mean (SD) 69 (13)

Female sex, n (%) 28 (42)
Right handedness, n (%) 64 (96)
Co-occurrent dysphagia, n (%) 32 (48)
Co-occurrent aphasia, n (%) 20 (30)
a
Total NIHSS score at hospital admission, median (IQR) 4 (2–14)
Acute reperfusion therapy, n (%) 36 (54)
Only thrombolysis 20 (30)
Only thrombectomy 8 (12)
Thrombolysis and thrombectomy 8 (12)
Stroke aetiology (TOAST), n (%)
Large artery atherosclerosis 8 (12)
Cardio-embolism 18 (27)
Small vessel occlusion 6 (9)
Other determined source 4 (6)
Undetermined source 31 (46)
Lesion location
b
Supratentorial, n (%) 54 (82)
Left hemispheric 27 (50)
Right hemispheric 21 (39)
Bilateral 6 (11)
Infratentorial, n (%) 7 (11)
Mixed, n (%) 5 (7)
Notes: a Total NIHSS score at hospital admission is missing in two patients.
b
Lesion location could not be determined in one patient.

having no/minimal/mild impairments at both function

(58%) and activity level (71%) (figure 3).
Median speech intelligibility perceptually rated on a
VAS scale (n = 48) was 87% (IQR = 70–96) and ob-
jectively measured with the DSIA (n = 39) 91% (IQR
= 73–97).

Figure 2. Dysarthria severity according to NIHSS sub-item speech
at three time points (total n = 70).
Dysarthria severity
According to the NIHSS scale, 47/70 (67%) of all
dysarthric participants were classified as having a mild
to moderate impairment of speech at hospital ad-
mission. Half the participants (35/70), regardless of
dysarthria severity at hospital admission, recovered
completely from their dysarthria within 1 week after
stroke symptom onset (figure 2). According to the RDA
(n = 48), the majority of participants were scored as
Discussion
Speech characteristics, type and severity of dysarthria
were prospectively evaluated in first-ever ischemic
stroke patients consecutively admitted to the Stroke
Unit of Ghent University Hospital.
Auditory–perceptual assessment of speech charac-
teristics in our study showed that the subsystems ar-
ticulation and phonation were affected in (almost) all
dysarthric participants, mainly characterized by impre-
cise articulation of consonants and a harsh voice qual-
ity. Audible inspiration was also frequently observed,
demonstrating impairments in respiration. The objec-
tive measures of speech characteristics in our study
demonstrated impairments in AMR diadochokinesis
(irregular and reduced number of repetitions) and a
reduced maximum loudness and MPT, quantifying
the perceptually observed impairments in articulation,
phonation and respiration. In addition, the commonly
observed characteristics imprecise articulation of conso-
nants, a harsh voice quality, reduced loudness and slow
AMRs are associated with UUMN dysarthria (Duffy
6 Elien De Cock et al.
Table 2. Auditory–perceptual assessment of speech characteristics

Subsystems N (%) Speech characteristics N (%)

Phonation 48 (100) Pitch level 8 (17)

Pitch breaks 1 (2)
Monopitch 13 (27)
Voice tremor 2 (4)
Mono-loudness 9 (19)
Excessive loudness variation 2 (4)
Loudness decay 2 (4)
Alternating loudness 1 (2)
Loudness level (overall) 5 (10)
Harsh voice 46 (96)
Hoarse (wet) voice 23 (48)
Continuous breathiness 17 (35)
Transient breathiness 8 (17)
Strained-strangled voice 25 (52)
Voice stoppages 5 (10)
Resonance 24 (50) Hypernasality 17 (35)
Hyponasality 4 (8)
Nasal emission 6 (13)
Respiration 38 (79) Forced inspiration/expiration 16 (33)
Audible inspiration 38 (79)
Grunt at end of expiration 2 (4)
Prosody 33 (69) Rate 19 (40)
Variable rate 7 (15)
Increase of rate in segments 2 (4)
Increase of rate overall 4 (8)
Short rushes of speech 4 (8)
Prolonged intervals 18 (38)
Inappropriate silences 7 (15)
Short phrases 18 (38)
Reduced stress 8 (17)
Excess and equal stress 4 (8)
Articulation 44 (92) Imprecise consonants 44 (92)
Prolonged vowels 11 (23)
Repeated phonemes 8 (17)
Irregular articulatory breakdowns 4 (8)
Distorted vowels 18 (38)

Table 3. Objective analysis of acoustic parameters

a b
Acoustic parameters Median (IQR) N (%) impaired

Pitch range (N semitones) 22 (17–26) 16 (31)

Maximum loudness (dB) 91 (84–93) 39 (87)
Diadochokinesis (syllables/s)
AMR /pa/ 5.4 (4.6–6.0) 26 (56.5)
/ta/ 5.4 (4.4–6.0) 19 (44.2)
/ka/ 5.0 (4.0–5.4) 19 (42.2)
SMR /pataka/ 5.6 (4.7–6.4) 15 (32.6)
MPT (s) 9 (3–13) 28 (64)
Notes: a Missing values: pitch range, one missing value; maximum loudness, three missing values; AMR/pa/2,/ta/5,/ka/, three missing values; and SMR/pataka/, two missing values.
b
Four missing values for MPT impairment.
dB, decibels; AMR, alternating motion rate; SMR, sequential motion rate; MPT, maximal phonation time.

2013), the most prevalent dysarthria type in our study.
As far as we know, only two previous studies have
described speech characteristics following auditory–
perceptual assessment in a stroke population. The
results of these studies corroborate with our findings,
with the subsystems phonation and articulation be-
ing most commonly affected (Chand-Mall and Vanaja
2017, Urban et al. 2006). The frequency of affected
speech subsystems and characteristics was considerably
lower in one of these studies (Chand-Mall and Vanaja
2017). A possible reason is that they included not only
acute but also chronic stroke patients, which could have
Characteristics of dysarthria post-stroke
Figure 3. Dysarthria severity on function and activity level (RDA) (total n = 48).
led to symptom resolution in some participants at the
time of assessment.
Dysarthria severity in our study was mostly mild
as perceptually rated by an experienced SLP at
function and activity level. Median speech intelligibil-
ity was mildly impaired (91%). These findings are in
line with previous studies; however, most studies a pri-
ori excluded patients with severe strokes, reduced alert-
ness or other confounding variables, possibly leading to
an underestimation of impairment (Canbaz et al. 2010,
Chand-Mall and Vanaja 2017, Mackenzie 2011, Urban
et al. 2006).
A large proportion of participants in our study re-
ceived a form of acute reperfusion therapy (36/67;
54%). However, due to the high variability in method-
ological designs between studies (e.g., stroke popula-
tion, assessment tools, time of evaluation post-stroke,
etc.), it is difficult to compare our findings concerning
the incidence and presentation of post-stroke dysarthria
with previous research (De Cock et al. 2020). However,
there does not appear to have been a change in observed
speech characteristics and severity of impairment com-
pared with Urban et al. (2006).
The findings of our study contribute to the limited
research performed regarding post-stroke dysarthria.
Improved knowledge of dysarthria presentation—
especially after the introduction of acute reperfu-
sion therapies—can have important clinical implica-
tions. The epidemiology and characterization of post-
7
stroke dysarthria can facilitate differential diagnosis
with apraxia of speech and aphasia, and help optimize
healthcare service distribution. The findings demon-
strate that the majority of participants had a mild
dysarthria, making this patient population a potentially
important group of healthcare service users, especially as
it is known that even mild impairments of speech can
affect a person’s social participation and quality of life
(Brady et al. 2011). In addition, our study demonstrates
that extensive evaluation and monitoring of speech is
feasible in a large proportion of patients in the early
acute phase post-stroke.
Our study had several strengths compared with pre-
vious research. We used objective measures of acous-
tic parameters in addition to auditory–perceptual as-
sessment of speech characteristics. Although perceptual
analysis of speech is the gold standard in dysarthria
assessment, the level of the rater’s experience with
dysarthria may affect the reliability of outcomes (Knuijt
et al. 2017). The added value of objective measures is
already well known in studies evaluating voice qual-
ity and, in addition to its easy and low-cost admin-
istration, mainly encompasses the reliable and quan-
tifiable monitoring of changes over time (Dejonckere
et al. 2001, Maryn et al. 2010). Dysarthria severity
was determined via standardized assessments at func-
tion and participation level and we quantified speech
intelligibility at sentence level in contrast to previous re-
search using non-standardized perceptual estimates only
8 Elien De Cock et al.
(Chand-Mall and Vanaja 2017, Spencer and Brown
2018, Urban et al. 2006). In addition, this is the first
study to investigate dysarthria type in a consecutive
group of solely acute ischemic stroke patients.
A major limitation is that we were not able to per-
form standardized assessments and audio recordings in
19/67 (28%) participants who were significantly older
and had more severe strokes compared with partici-
pants with audio recordings. This might have skewed
the results towards less severe dysarthrias. However, we
were able to determine dysarthria severity in all partic-
ipants via the NIHSS score sub-item speech, corrobo-
rating the finding that most participants have a mild
to moderate dysarthria following acute ischemic stroke,
independent of age and stroke severity at baseline. A
bias in the results for speech characteristics, dysarthria
type and speech intelligibility could however be possi-
ble. Another limitation of our study is that, although
dysarthria type was determined by two SLPs and dis-
crepancies were resolved by consensus, we did not re-
port on inter-rater agreement. Lastly, it must be noted
that the findings of our study concern a relatively ho-
mogeneous first acute ischemic stroke population, and
might therefore not be generalizable towards the general
stroke population.
Conclusions
This prospective study investigating a group of con-
secutive dysarthric participants following a first acute
ischemic stroke showed that UUMN dysarthria was
the most common dysarthria type. Dysarthria sever-
ity ranged from mild to severe, with the majority of
participants having mild dysarthria. Half the partici-
pants showed recovery of symptoms following the first
week of symptom onset. Speech was mostly character-
ized with imprecise articulation of consonants, a harsh
voice quality and audible inspiration, which was re-
flected in the objective acoustic measurements. Char-
acterization of post-stroke dysarthria is of clinical im-
portance as it can lead to better differential diagnosis,
healthcare service distribution and early monitoring of
progress. Longitudinal research including standardized
assessments by trained SLPs is necessary to determine
recovery patterns and the impact of dysarthria on social
participation in later stages following stroke.
Acknowledgements
We thank the members of the Stroke Team of Ghent University
hospital for facilitating this research project. Declaration of interest:
None of the authors have conflicts of interest to declare.
Funding
Elien De Cock is supported by a bursary from
the Ghent Institute of Neuroscience of Ghent Uni-
versity Hospital. This investigation was conducted
as part of a larger study (https://clinicaltrials.gov/
ct2/show/NCT03472625) (NCT03472625).
Data availability statement
The data that support the findings of this study are
available from the corresponding author upon reason-
able request.
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