Advancing understanding of post-stroke dysarthria in the UK and Arabic-speaking populations: Clinical practice, communication outcomes, and lived experiences

Abstract

Dysarthria, a motor speech disorder affecting the neuromuscular system underlying speech production, is a common sequela of stroke and has significant functional and psychosocial consequences. This PhD thesis aimed to advance understanding of post-stroke dysarthria in both UK English-speaking and general Arabic-speaking populations by examining clinical practice, communication outcomes, and the lived experiences of stroke survivors. The thesis comprises four interrelated studies: a systematic review and three empirical studies. The first study was a systematic review that identified 14 measurement instruments across 9 studies for the assessment of non-progressive dysarthria in Arabic-speaking contexts. These instruments were evaluated in terms of their availability, clinical utility, psychometric properties, and alignment with the ICF framework. Most were clinician-rated, focused on impairment, and based on norms derived from English-speaking populations. The second study explored assessment and treatment practices through surveying 55 SLTs working with Arabic-speaking stroke survivors. Building on the findings of the systematic review, the survey examined the extent to which the identified instruments are used in clinical practice. The survey indicated that, although the availability of some of these tools were reported, two-thirds of SLTs relied on informal assessments. Clinicians also highlighted the need for formal, culturally and linguistically appropriate tools. The third study was a quantitative investigation describing the baseline demographic and clinical profile of 169 stroke survivors with dysarthria in the UK, a well-established healthcare and research context. It also examined communication outcomes and the relationship between assessment domains and patient and clinician perspectives, demonstrating alignment across ICF domains and positive associations between clinician-rated and patient-reported outcomes. The fourth study explored the lived experiences of stroke survivors with dysarthria in the UK through qualitative semi-structured interviews with 27 participants. Findings indicate that communication is shaped by interacting factors, including speech difficulties, co-occurring impairments, and the cognitive and emotional demands of social interaction, with significant implications for self-image and participation. Collectively, these studies provide a comprehensive, multidimensional understanding of post-stroke dysarthria. They highlight the need for culturally and linguistically appropriate tools and a holistic understanding of stroke survivors with dysarthria, including co-occurring impairments. They further emphasise the importance of incorporating the patient perspective to support person-centred care within contemporary stroke pathways. The findings establish a clear agenda for future research, particularly to continue exploring the long-term impact of dysarthria, develop comprehensive frameworks for dysarthria management in Arabic-speaking contexts, and explore the lived experiences of Arabic-speaking stroke survivors with dysarthria.