Evidence-based practice guidelines for dysarthria: Management of velopharyngeal function

The Academy of Neurologic Communication Disorders and Sciences (ANCDS) established a writing committee to develop evidence-based practice guidelines for speech-language pathologists who treat individuals with dysarthria. The current guidelines draw from both the research literature and expert opinion and address the issues of management of velopharyngeal impairment in dysarthria. A search of electronic databases (PsychINFO, MEDLINE, and CINAHL) and hand searches of relevant edited books yielded 33 intervention studies in the categories of prosthetics, surgery, and exercise. A summary of quality of evidence is provided along with a clinical decision-making flowchart for the management of velopharyngeal impairment in both degenerative and stable/recovering dysarthria. Palatal lift intervention was found to be effective in selected individuals with dysarthria. The best candidates have a flaccid soft palate, pharyngeal wall movement, good oral articulation and respiratory support, and a stable disease course. Recommendations for future research are provided.