Management of Velopharyngeal Impairment in Adults With Dysarthria: A Systematic Review.

Purpose: Velopharyngeal impairment (VPI) is a common manifestation of dysarthria, yet there is uncertainty regarding the evidence for treatment options. The aim of this systematic review was to identify and evaluate published intervention studies of VPI and to update the original Practice Guidelines for VPI, as part of the Dysarthria Writing Group of the Evidence-Based Clinical Research Committee of the Academy of Neurologic Communication Disorders and Sciences.

Method: Four electronic databases were searched for articles published through September 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Multiple indices of methodological quality and risk of bias were used to evaluate studies.

Results: The search yielded 1,347 articles, of which 31 met inclusion criteria and were reviewed by two blinded co-investigators and a third consensus reviewer. Therapeutic approaches centered on prosthetic treatment (n = 13), prosthetic treatment combined with another form of therapy (n = 7), and behavioral exercise (n = 7), with four additional studies reporting unconventional approaches (e.g., use of medication). No single treatment approach garnered strong evidence. However, converging moderate evidence suggests positive treatment outcomes for prosthetic approaches for moderate-severe speakers with flaccid/spastic dysarthria and behavioral treatment approaches for speakers spanning a range of nonprogressive dysarthrias.

Conclusions: There is a critical need for well-controlled treatment studies of VPI that incorporate comprehensive and systematic description of baseline speech function, treatment protocols, and operationally defined outcome measures, particularly related to social validity and participation goals. Suggestions for how clinicians can apply extant research findings to practice are provided.

Supplemental material: https://doi.org/10.23641/asha.27655566.