Journal of Speech and Hearing Disorders, YOI1KSTON,BEUKELMAN,Volume 46, 398-404, November 1981

ATAXIC DYSARTHRIA: TREATMENT SEQUENCES BASED ON

INTELLIGIBILITY AND PROSODIC CONSIDERATIONS

ICa,TttRYN M. YORKSTON DAVID R. BEUKELMAN

Unicersity vf Washington1, Seattle

Treabnent programs of fimr improving ataxic dysarthric speakers are reviewed. Treatment sequences were based on two
overall measures of speech pertormance--intelligibility and prosody. Increases in intelligibility were initially achieved by
control of speaking rate. A hierarch~ of rate control strategies, ranging from a rigid imposition of rate through rhythmic cueing to
selfmunitored rate control is discussed. As speakers improved their monitoring skills, a compromise was made between intel-
ligibilit3, and rate. Normal prosodic patterns were not achieved by the ataxic speakers due to difficulty in precisely coordinating
the subtle flmdamental frequency, loudness and timing adjustments needed to signal stress. Three of the four subjects were
taught to use only durational adjustments to signal stress. In this way, they were able to achieve stress on targeted words
consistently and minimize bizarreness which resulted from sweeping changes in fllndameutal frequency and bursts of loudness.
The need tor further clinically oriented research is discussed.

Researchers have studied ataxic dysarthria from a vari-
ety of perspectives. Perceptual speech characteristics of
ataxic dysarthria include articulatory inaccuracy often
accompanied by irregular artieulatory breakdowns and
prosodic abnormalities such as slow rate, excess and
equal stress, monoloudness, monopiteh and prolonged
syllables (Brown, Darley, & Aronson, 1970). Physiologi-
cal characteristics of ataxie dysarthria include slow ar-
ticulatory movements, errors of direction and range of ar-
ticulatory movements, and reduced overall articulatory
mobility (Kent & Netsell, 1975). Acoustic characteristics
of ataxie dysarthria indicate timing control problems in
prolongation of segments and a tendency to equalize
segment durations (Kent, Netsell, & Abbs, 1979). Al-
though durational measures are usually outside normal
limits, formant frequencies for vowels in CVC syllables
are normal. Kent and his colleagues concluded "when
sufficient time was available, the ataxie speakers were
capable of reaching appropriate vowel targets," (p. 648).
Research has led to some understanding of the unique
constellation of perceptual, physiological, and acoustic
characteristics of ataxie dysarthria. However, this infor-
mation has not b e e n a p p l i e d to the selection and
s e q u e n c i n g of t r e a t m e n t tasks for ataxie speakers.
Rosenbek and LaPointe (1978) state that to their knowl-
edge no specific treatment programs exist for the dif-
ferent types of dysarthria. Bather, they suggest a "point-
place" approach that is based on the speech physiology
work of Netsell (1973). Using the point-place model, the
speaker is evaluated systematically b y determining
speech mechanism performance at points along the vocal
tract. Netsell and Daniel (1979) describe the treatment of
a flaccid dysarthric individual with whom the point-
place approach was used successfully. However, due to
the inability to coordinate and regulate the activities of
several speech components simultaneously, ataxic dysar-
thrie individuals are not easily treated using the point-
place approach alone. For example, it is difficult to at-
tribute the prosodic abnormalities of ataxic speakers to
specific points along the vocal tract. Also, treatment of
the complex, inconsistent and interrelating patterns of
artieulatory breakdown, laryngeal control, and respira-
tory support necessitates measurement of overall per-
formance in which coordination of all speech mechanism
components is involved. The purpose of this paper is to
review the treatment of four improving ataxic dysarthric
speakers. Attention is given to the use of overall meas-
ures of intelligibility and prosody as a means of making
decisions that guide treatment sequencing.
SUBJECTS
The four subjects described in this paper exhibited
sudden, adult-onset of ataxie dysarthria (see Table 1).
Subjects ranged in age from 23 to 55 years. Etiology in
two eases was anoxie eneephalopathy and in two eases
was closed head injury. Although these etiologies do not
rule out involvement of areas other than the cerebellum,
the predominant neurological symptoms including gait
disturbances and dysrhythmia were indicative of an
ataxic disorder. None of the subjects had degenerative
eerebellar disease. All experienced a period of coma
ranging from less than one week for Subject 1 to four
weeks for Subject 4. For all subjects, coma was followed
by a period of confusion, distractibility, and lack of atten-
tion lasting as long as six weeks. Speech treatment was
initiated from two to six weeks post onset and continued
until eight to ten months post onset. When speech treat-
ment was initiated, all subjects were wheelchair bound
because of severely ataxie gait patterns. At the time of
discharge from speeeh treatment, all were independent
ambulators except Subject i who continued to require
standby guarding for safety.
Initially, speech intelligibility scores of all subjects
were less than 30% and speaking rates were in excess of

© 1981, American Speech-Language-Hearing Association 398 0022-4685/81/4604-0398501.00/0

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TABLE 1. Subject characteristics.
Subject Age Etiology Coma
1 55 Anoxic
Encephalopathy
2° to Cardiac Arrest < 1 wk
2 39 Closed Head Injury
2° Motor Vehicle
Accident 1 wk
3 24 Anoxic
Encephalopathy
2° Drug Overdose 2 wk
4 23 Closed Head Injury
2° to Motor Vehicle
Accident 3-4 wk
100 wpm for oral reading tasks. Analysis of articulatory
performance revealed correct production of all sounds in
isolation, CV, or VC contexts. However, during oral read-
ing, articulatory targets were only occasionally approxi-
mated and speech was judged to be excessively hyper-
nasal. Therefore, speech intelligibility was severely
reduced and the initial phases of treatment were de-
signed to develop functionally intelligible speech. Pat-
terns of recovery and treatment strategies for all subjects
were so similar that the overall treatment approach will
be presented with occasional notes about individual dif-
ferences.
ACHIEVING INTELLIGIBLE
SPEECH
Rate Control
Control of speaking rate as a means of maximizing
speech intelligibility was an early goal for all subjeets. A
number of rate control techniques were ordered into a
hierarchy ranging from rigidly controlled tasks that lim-
ited speaking to essentially a "one-word-at-a-time" style
to techniques that required subjects to control their own
speaking rates voluntarily.
Rigid Imposition of Rate. As comas cleared, all four
subjects were unable to monitor the adequacy of their
speaking rate and thus compensate for their motor in-
coordination. Therefore, it was necessary to impose a
strict rate reduction program. For example, with Subject
4, a system similar to the one described by Beukelman
and Yorkston (1977) was used. This system requires
speakers to point to the first letter of each word on an
alphabet board as they speak that word. It not only slows
a speaker's rate, it also gives the communication partners
extra information in the form of the initial letter of each
word. Using the a l p h a b e t board, speakers r e s o l v e d
communication breakdowns by spelling out the entire
word.
Another technique for rigid imposition of rate control
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YORKSTON, BEUKELMAN: Ataxic Dysarthria 399
Pretreatment Post Treatment
Months
Intell. (%) Rate (wpm) InteU. (%) Rate (wpm) Post Onset
20 120 98 64 9
19 132 99 132 8
10 110 68 74 9
25 t15 98 60 10
was the pacing board described by Helm (1979). Helm
described the use of this system with a Parkinsonian pa-
tient who was thought to be demented, but actually was
severely palilalic. Verbal suggestions to reduce rate and
external rate control devices such as a m e t r o n o m e
proved ineffective for Helm's speaker. However, use of a
pacing board was thought to impose the necessary
"stop-go control" and to bring what had been automatic
motor acts under voluntary control. Although our sub-
jects were not palilalic, during the early stages of recov-
ery, they experienced confusion and reduced ability to
monitor their own rates voluntarily. Both the alphabet
board and the pacing board techniques may be effective
when other rate control strategies fail. However, such
techniques result in prosodic disruption. Often t h e s e
highly structured techniques appear to encourage the
relative lengthening of pause time rather than lengthen-
ing of all durational aspects of speech. As less rigid rate
control techniques became effective, they were incorpo-
rated into treatment,
Rhythmic Cueing. A technique used with all subjects
as a transition between the rigid control of rate'and the
self-monitoring of rate was called "rhythmic cueing."
Using this technique, the clinician paced the reading of
a passage by imposing on the speaker a slow rate with
appropriate pausing and phrasing. This technique results
in a more natural prosody than the "one-word-at-a-time"
quality of metronomic pacing or other types of pacing
that give equal time allotments to all syllables and rela-
tively large interword pause times. The clinician indi-
cated the pace with which words should be read by
pointing to them. Stressed syllables were cued slowly,
and u n s t r e s s e d syllables w e r e c u e d m o r e quickly.
Speakers were told to follow the rhythm and were per-
mitted to lag behind but not "get ahead" of the pacer. As
the speakers learned to control speaking rate success-
fully with obvious cueing, the cueing gestures were
faded by gradually diminishing and then eliminating
them.
Oscilloscopic Feedback. Another method of rate con-
trol that does not inherently disrupt prosody is oscillo-
 400 Journal of Speech and Hearing Disorders
scopic feedback of intensity by time tracings. Berry and
Goshorn (1979) described a technique in which their
speaker was asked to "fill up" the five-seeond window of
an oscilloscopic display or to match slow productions of
a target sentence. This technique is advantageous be-
cause speakers receive immediate feedback about the
success of their rate control attempts.
No specific instructions to control pause time or articu-
lation time were given to Berry and Goshorn's speaker.
However, d e p e n d i n g on the individual speaker, the
specific modification of either pause time or artieulatory
time may be taught via oscilloscopic feedback. This
point can be illustrated with Subject 3 who was taught to
lengthen pause time selectively. By increasing certain
pause times, the number of irregular articulatory break-
downs decreased markedly, and, as a consequence, intel-
ligibility was improved. For this subject, increasing the
inter-word pause time seemed to reduce the demands of
articulatory coordination of eomplex sequences of sylla-
bles. On the other hand, Subject 4, during the later
stages of treatment when intelligibility had improved,
was encouraged to reduce pause time and to increase ar-
ticulation time in an effort to normalize prosody. At this
point in his treatment program, long inter-word pauses
that tended to disrupt prosody could be reduced without
markedly affecting intelligibility.
Establishing Optimum Rate and Intelligibility Rela-
tionships. Perhaps the least rigidly imposed rate reduc-
tion technique used with our subjects was a process of
rate monitoring with feedback of intelligibility. Speakers
were recorded as they read passages of a known length
that were unfamiliar to the clinician. They were given
instructions to reduce speaking rate to the point at which
their speeeh was at least 95% intelligible to the clinician.
The clinician transeribed the recorded passage, deter-
mined the level of intelligibility, and computed speaking
rate. While maintaining intelligibility within the target
range, the subject was encouraged to maximize speaking
rate.
The following examples illustrate the use of this tech-
nique to estimate the optimum speaking rate. Figure 1
contains rate and intelligibility data obtained approxi-
mately one month post onset when Subject 1 was able to
maintain a slowed rate without rhythmic cueing. During
Condition A, the subject was instructed to speak at a
normal rate. At this rate (120 wpm), his intelligibility
score was 37%. During Condition B, he was asked to
achieve a rate at which the clinieian could understand at
least 90% of what was read. During this condition, he
slowed his rate to 90 wpm with an accompanying in-
crease in intelligibility to 82%. During Condition C,
Subject 1 was asked to slow his rate by an additional
25% as compared to Condition B. At this slowed rate, 61
wpm, his intelligibility score was within the target
range, 95%. Slowing the rate still further to 50 wpm
(Condition D) resulted in only a small increase in intel-
ligibility, to 98%. At 50 wpm, the subject appeared to
increase pause time rather than articulation time. At the
slowest of the four rates, prosody patterns were severely
disrupted. Therefore, 60-65 wpm was adopted, temporar-
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46 398-404 November 1981
I00-
D
90- ..........
80-
70-
60-
~- 50-
.-.."
40-
30-
20-
P0-
2's -/s ,do go
Rate (WPM)
FIGURE 1. Sentence intelligibility and speaking rates obtained
from Subject 1 as he read different passages. Instructions to
Subject 1 were as follows (A) "Speak at your normal rate," (B)
"Use a rate at which the clinician can understand 90% of the
passage," (C) "Slow the rate an additional 25% as compared to
Condition B," and (D) "Slow your rate as much as you can."
ily, as the patient's optimum rate. Treatment was focused
on achieving this rate on both reading and conversa-
tional tasks. Obviously, the optimum speaking rate for a
recovering dysarthric speaker changes over time. At each
point during the course of recovery, intelligibility can be
used to estimate the most efficient speaking rate.
Data obtained from Subject 2 also illustrates the com-
promise between intelligibility and rate. Over the course
of eight months, Subject 2 achieved the most normal
speaking rate of the four subjects. Figure 2 illustrates
rate and intelligibility data obtained at three points dur-
ing his improvement. During Session i, one month post
onset, Subject 2 read orally at a rate of 137 wpm. Al-
though this rate was somewhat reduced from a normal
oral reading rate of 160-170 wpm, it was too rapid to
permit intelligible speech. At this time his speech was
characterized by little articulatory movement. However,
an oceasional word could be recognized if a pause pre-
ceded it. Subject 2 seemed unable to modify his speak-
ing rate. Therefore, rhythmic cueing was employed to
control the rate. After four weeks of treatment, two
months post onset, Subject 2 was able to maintain a
slowed rate of 80 wpm when he read a passage. This
slowed rate enabled him to achieve articulatory targets
adequately. As Subject 2 continued to improve, the
speaking rate at which he was able to achieve target in-
telligibility increased. At eight months post onset, Ses-

I00- -150
90- -135
i sJSJ' Iq
80- -120
I
I
--, 70- -105
i !~, ~'isJs
I
~- 60-
50 ~ Session 2 75
4o- 60 .~
30- 45~
20- 30
I0 15
Months post onset
FIGURE 2. Intelligibility scores and speaking rates obtained as
Subject 2 read passages at one month post-onset (Session 1), two
and a half months post-onset (Session 2), and 8 months post-
onset (Session 3).
sion 3, speaking rate had increased to 134 wpm with an
intelligibility score of over 99%. Throughout the course
of treatment, a compromise was derived between intel-
ligibility scores within the target range and the most
rapid rate possible.
Developing Self-monitoring Skills. As improvement
progressed, an increasing ability to achieve articulatory
targets was noted in all subjects. Early in their recovery,
articulatory targets were almost never achieved in con-
nected speech. However, all subjects were able to
achieve articulatory targets in isolation and in some short
words. All appeared unable to monitor obvious failure to
reach articulatory postures in connected speech, and all
continued to speak at estimated premorbid rates. During
the course of treatment, ability to monitor rate improved
substantially. The monitoring process involved a series
of stages. Initially, there appeared to be little awareness
of the consequences of rates which were too rapid to
permit target intelligibility. During this time, rate con-
trol had to be imposed by the clinician. The next stage
appeared to be voluntary conscious control as subjects
began to recognize excessively rapid rates during treat-
ment related speaking activities. Finally, control of
speaking rate began to generalize to other speaking situ-
ations. By the time of discharge, the new, slowed rates
became so habitual that it was impossible for some of the
subjects to increase their rate beyond the point at which
they could maintain target intelligibility. For example,
Subject 1 was asked to re-record a series of passages at
rates similar to those produced earlier. At the time of
discharge eight months following the initial recordings,
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YORKSTON, BEUKELMAN:Ataxic Dgsarthria 401
Subject 1 was unable to achieve rates higher than 75-80
wpm even when asked to speak as rapidly as possible.
There appeared to be a new rate "ceiling" for this
speaker. The subject's rate was slow enough to allow for
achievement of the articulatory targets. The establish-
ment of this new rate may have been achieved through
careful treatment and continued drill to habituate this
new pattern. However, it is possible that as improve-
ment occurred, this speaker regained the ability to take
advantage of feedback, that was not available earlier.
Specific treatment strategies designed to improve
self-monitoring skills varied from subject to subject. Of-
ten, subjects were asked to predict, immediately follow-
ing a recorded trial, the percentage of their speech that
was understood by the clinician. These estimates were
compared to the clinician's transcription accuracy. Re-
cording tasks ranged in difficulty from single words, to
sentences, and, eventually, to paragraph material.
Because the subject's treatment was carried out on an
outpatient basis, a home practice program was devel-
oped for Subject 3. Sentence generation grids, similar to
the one shown in Table 2, were used to create practice
nonsense sentences. These grids contained the frame
sentences, for example, "The (adjective) (subject) are
(verbed) by the (agent)." As he practiced, Subject 3
created sentences by randomly selecting one of approx-
imately 50 words from each column. He then recorded
his verbal production for the sentence. On the following
day, he transcribed the tape, either by typing or verbal
dictation to a family member. The results of the tran-
scription were compared to a script which had been
created at the time of recording and intelligibility scores
were computed.
TABLE 2. Example of a sentence generation grid developed for
a home practice program.
Sentence Frame
(Adjective) (Subject) were (Verbed) by the (Agent)
some oranges thrown boys
those peas tossed men
few walnuts cooked neighbor
all tables sold clerks
free balls packed ladies
your cakes taken farmer
hidden telephones left family
etc. etc. etc. etc.
Specific Point-place Assessment and Treatment. Al-
though speech intelligibility, an overall indicator of
speech performance, was used to guide many treatment
decisions, the speech characteristics of these subjects
were also assessed using the point-place model (Rosen-
bek & LaPointe, 1978). As consistent specific deficits
were identified, treatment was undertaken to correct
 402 Journal of Speech and Hearing Disorders
those deficits. For example, Subject i distorted most
v o w e l p r o d u c t i o n s that i m m e d i a t e l y p r e c e d e d the
phoneme /1/. Contrast drills including the words hoe,
hill, heal, hell, who'll, Hal and hall, were developed and
e m p l o y e d in a t r a i n i n g p r o g r a m i n c l u d i n g words,
phrases, and sentences until the vowel production was
correct at least 95% of the time in sentence context.
Early in treatment, Subject 4 exhibited hypernasal
vowel quality and confusion of the nasality feature dur-
ing consonant production (/m/ for /b/ and /n/ for /d/).
Measures of volume velocity of nasal airflow and intra-
oral air pressure were completed (Netsell & Daniel,
1979). This evaluation demonstrated incomplete velo-
pharyngeal closure during production o f / p / a n d / b / d u r -
ing rapid speech. However, when rate was reduced and
Subject 4 was instructed to articulate carefully, adequate
velopharyngeal closure was achieved. It appeared that
inadequate velopharyngeal closure did not stem from
weakness or lack of ability to achieve closure, but rather
from problems in timing and overall coordination of the
speech mechanism. This problem was treated as an ar-
tieulatory problem, and no palatal lift was recommended.
Subsequent aerodynamic studies revealed only occa-
sional instances of velopharyngeal incompetency as this
subject's articulation became more preeise.
Early in treatment, Subject 3 consistently substituted
/p/ for /f/ in conversational speech. Since each of these
sounds could be correctly produced in isolation, a treat-
ment program was developed in which these sounds
were contrastedin words, phrases, sentences and finally
paragraphs. Eventually, Subject 3 eliminated this sub-
stitution error.
MAXIMIZING NORMAL PROSODY
Beeause of the elose relationship between intelligibil-
ity and the ability of a speaker to funetion in a com-
municative setting, intelligibility is undeniably of pri-
mary eoncern to the clinician treating the improving
ataxie dysarthric speaker. However, prosodic patterns
which are often markedly abnormal and eontribute to
bizarreness of dysarthric speakers, can not be ignored.
Beeause normal prosody requires precise eoordination of
all of the speech processes, ataxic dysarthrie speakers are
particularly susceptible to deficits in this area. These
a b n o r m a l i t i e s are well d o c u m e n t e d by Kent et al.,
(1979).
Although work on prosody typically comes late in
t r e a t m e n t programs, we concur with R o s e n b e k and
LaPointe (1978) who feel that early emphasis on appro-
priate stress patterns has a variety of beneficial effects.
Forcing marginally intelligible speakers into specific
stress patterns tend to increase intelligibility and reduce
bizarreness. Several techniques which attempt to pre-
serve and encourage appropriate prosody have b e e n
mentioned previously in the discussion of maximizing
intelligibility. For example, the time spent rigidly im-
posing rate control was minimized or eliminated al-
together when other rate control strategies beeame effec-
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46 398-404 November 1981
live. Rhythmic cueing for rate control was employed to
diminish excess and equal stressing and to encourage at
least primary stress patterns.
Normal stress patterns are thought to be achieved by a
combination of fundamental frequency shifts, loudness
variations, and durational adjustments. A normal speaker
may use any or all of these strategies, probably relying
most heavily on fundamental frequency adjustments
(Lehiste, 1970). A review of the characteristics of ataxie
dysarthrie speech reveals that many of these strategies
are not readily available to ataxie speakers because of the
precise coordination that is demanded. This point can be
illustrated with data o b t a i n e d from Subject 1. The
speaker was audio recorded while producing the target
sentence, "Show Sam some snow)' In response to the
examiner's questions, "To whom should I show the
snow?" The relative level of stress for each word was
rated according to a system developed by Chueng, Hol-
den and Minifie (1973). We rated the relative stress of
each word by placing marks on a five point continuous
scale from "most possible" to "least possible" stress.
From these judgments, the primarily stressed syllable in
the sentence was identified. Although Subject 1 did not
always achieve stress on the targeted word, in this in-
stance, he was judged to be achieving stress successfully
on the word, "Sam.'" Sentences with targeted stress on
the word "Sam" produced by Subject 1 and a normal
speaker were analyzed by computer using a fundamental
frequency and intensity extraction program (Yorkston,
Beukehnan & Minifie, 1979). Results of this analysis are
presented in Figure 3. Examination of the figure reveals
that the dysarthric sample was twice the duration of the
normal sample. Further the dysarthric sample tended to
contain larger fundamental frequency shifts than did the
normal sample. Finally, Subject 1 produced near-peak
intensities on all of the syllables, while the normal
speaker achieved peak intensity only on the primarily
stressed syllable. So, both in terms of loudness and fun-
damental frequency shifts, the prosodic patterns pro-
duced by this dysarthric speaker were abnormal. Dura-
tional data were extracted from these samples so that a
comparison of relative durational patterns for the normal
and dysarthric samples could be made. Figure 4 illus-
trates the duration (in reset.) for each word in each of the
samples. It is apparent that all of the dysarthric speaker's
words are longer than the normal speakers; but the rela-
tive patterns are similar.
Treatment, primarily designed to improve prosody,
was initiated after speech intelligibility had reached the
target level consistently. Clinical observations confirmed
what the acoustic data had suggested. Control of funda-
mental frequency shifts and loudness levels were dif-
ficult for Subject 1. When adjustments in fimdamental
frequency and intensity were used to signal stress, the
result was an increase in bizarreness with sweeping
changes in fundamental frequency and extreme bursts of
intensity. Durational adjustments seemed to be the only
stress strategy available to this ataxic speaker. Further,
his durational adjustments were essentially undirec-
tional. Subject 1 was t a u g h t to l e n g t h e n s y l l a b l e s
 YORKSTON, BEUKELMAN:Ataxic Dysarthria 403

NORMAL SPEAKER
300 I ~DYSARTHRIC

.... Fundamental frequency (Hz) ~NORMAL

- - Relative intensity
250 l

O m: ~ O A
3= ,¢ O Z o 20O
co t,D (D 09 o
AN 200
-•1oo E
t-
o~c- 17s ~8o O
O 150
C
60 ¢~
.E a
, ;
m.
e, 125 40 ~. £
Ig
G o 100
E
..~ 100 20 ¢
e,,

14.
75
300 600 50
Time (msec)

DYSARTHRIC SPEAKER
SHOW SAM SOME
A 200 -
~ 175 -
o I
'150
~ 125
E 100
"= 7S I I
1000
Time (msec)
FIGURE 3. Fundamental frequency, relative intensity, and dura-
tion for the sentence, "'Show Sam some snow" produced by a
normal and a dysarthric speaker in response to the question,
"'To whom should I show the snow?"
targeted for stress and to increase the length of pauses
prior to stressed words. He was unable to decrease the
duration of unstressed words without detrimental effects
on articulatory preeisions. Although these strategies for
achieving stress did not result in normal prosody, their
use allowed Subject 1 to achieve stress on targeted
words consistently and to reduce bizarreness caused by
bursts of loudness and sweeping changes in fundamental
frequency.
Three of our four subjects were trained to modify dura-
tion as a primary means of signalling stress. Subject 3,
the most severely involved speaker, was not taught to
make durational adjustments because they were so dif-
ficult for him. Rather, he was taught simply to decrease
the frequency of loudness bursts which contributed to
the bizarreness of his prosodic pattern. This training was
carried out with feedback from a VU meter. The "con-
trastive stress drill" similar to those described by Rosen-
bek and LaPointe (1978) was the primary technique for
SNOW SHOW SAM SOME SNOW
100
FIGURE 4. Duration (in msec.) of each word in the sentence
a
so "Show SAM some snow." produced by a dysarthric speaker
u)
(Subject 1) and a normal speaker.
C
60 •
._=
40 .-> encouraging more appropriate stress patterns for the
three subjects receiving specific stress training.
20 ¢ Obviously, it is not intended that durational adjust-
I ments be considered the primary strategy for training
stress in all ataxic dysarthric speakers. Rather, it is
2000 suggested that stress techniques need to be assessed sys-
tematically and a variety of issues need to be addressed.
For example, is the speaker achieving stress on words
that are targeted for primary stress? Are there different
levels of secondary stress or is one word primarily
stressed and all of the other words essentially equal? If
there is primary stressing, how is the speaker achieving
it? Are any of the stressing strategies used by a speaker
increasing the bizarreness of the prosody pattern? From
answers to questions such as these, programs designed
to improve prosody can be developed systematically.
DISCUSSION
The treatment programs for four reeovering ataxie
dysarthric speakers have been reviewed. The sequenc-
ing of treatment using two overall measures of speeeh
performance, intelligibility and prosody, have been illus-
trated. The treatment approach outlined here was neces-
sitated by the unique pattern of ataxic speakers whose
chief deficit appears to be coordination of speech proc-
ess components rather than deficits specific to certain
points along the vocal tract. This overall approach must,
of course, be s u p p l e m e n t e d by c o m p o n e n t consid-
erations when consistent, specific problem areas can be
identified. With dysarthrias other than the ataxic type,

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 404 Journal of Speech and Hearing Disorders
other d e c i s i o n - m a k i n g processes m a y g u i d e treatment.
F o r example, an a s s e s s m e n t of flaccid dysarthric speak-
ers f o c u s i n g on s p e e c h m e c h a n i s m c o m p o n e n t s m a y
h e l p to m a k e decisions about w h i c h c o m p o n e n t s should
be m a n a g e d p r o s t h e t i c a l l y and w h i c h s h o u l d be man-
a g e d through training. Progress in such t r e a t m e n t can b e
a s s e s s e d with m e a s u r e s of c h a n g e in specific compo-
n e n t s , p e r h a p s s u p p l e m e n t e d b y m e a s u r e m e n t s de-
s i g n e d to assess the i m p a c t of c o m p o n e n t changes on
overall s p e e c h performance.
Although m a n y p r i n c i p l e s w e have o u t l i n e d are d r a w n
from c l i n i c a l e x p e r i e n c e a n d have b e e n successful at
least to some extent for the subjects d e s c r i b e d , we be-
lieve r e s e a r c h is n e c e s s a r y to verify and refine clinical
practices. F o r example, rate control strategies have re-
c e i v e d little attention. Clinical j u d g e m e n t s , preferring
one rate control strategy over another, are m a d e w i t h o u t
a clear understanding of the consequences of these
strategies. As clinicians, it is important to a n s w e r such
q u e s t i o n s as: Are t h e r e s p e a k e r s w h o n e e d to a d j u s t
pause t i m e or articulation time s e l e c t i v e l y rather than
r e d u c e overall s p e a k i n g rate, and, w h a t are the conse-
q u e n c e s of l e n g t h e n i n g pause t i m e and/or articulation
time on i n t e l l i g i b i l i t y and p r o s o d y ? A n o t h e r area that
warrants attention is the a s s e s s m e n t of overall s p e e c h
performance. T e c h n i q u e s to m e a s u r e i n t e l l i g i b i l i t y are
r e c e i v i n g i n c r e a s i n g attention (Andrews, Platt & Young,
1977; B e u k e l m a n & Yorkston, 1980; Yorkston & Beu-
kelman, 1978, 1980). D e v e l o p m e n t a n d evaluation tech-
n i q u e s to m e a s u r e p r o s o d y are also necessary.
ACKNOWLEDGMENTS
The preparation of this article was supported in part by Insti-
tute of Handicapped Research Grant #16-P-56818-17. The au-
thors wish to express their thanks to Patricia Mitsuda for her
clinical assistance, to William Berry for personally discussing
certain aspects of this paper and to Dave Hooks for serving as
our normal speaker.
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Received April 16, 1980
Accepted October 23, 1980
Requests for reprints should be sent to Kathryn M. Yorkston,
Ph.D., Dept. of Rehabilitation Medicine, RJ-30, University of
Washington, Seattle, Washington 98195.