The present study aims to explore the practices and attitudes of Lebanese SLTs who assess adults with non-progressive dysarthria and sites them in a broader context of professional guidelines. In Lebanon, speech and language therapy is considered a new field of specialty, with the first promotion of SLTs being graduated in 1999. Scarce information is available on the assessment practices of Lebanese SLTs, as well as Arab SLTs, in the different clinical areas including non-progressive dysarthria and their adherence to the ICF framework. Collecting information about Arab SLTs’ approaches to assessment and measurement of therapeutic outcomes is highly valuable to ensure that the appropriate tools are being used. Inadequately selected measures fail to accurately evaluate the baseline skills of the client and could not be able to deliver indications for intervention.
The study reported the responses of 50 Lebanese SLTs, nearly half of which reported providing private therapy services at the client’s home. In contrary to studies conducted abroad in the ROI and Australia, SLTs working with adults with non-progressive dysarthria reportedly delivered therapy services primarily at hospitals [16, 17]. It should be remarked that the Lebanese healthcare system is mostly a private sector, where speech and language therapy services are solely delivered in private hospitals or medical centers as well as private clinical settings and are completely funded by the clients and their families. This fact reflects the clients’ preferences for choosing home therapy services that require less waiting time before therapy initiation. Furthermore, SLTs represented variability in years of experience. The diversity in the workplaces and the years of clinical experience did not ascertain any differences in the assessment practices of respondents.
Fortunately, 100% of SLTs reported conducting a form of assessment with clients with non-progressive dysarthria. All SLTs indicated evaluating at least three speech subsystems including articulation, phonation, and respiration. Nevertheless, informal assessments were regularly used by a large proportion of SLTs (86%), while a few numbers of SLTs (14%) used formal assessments; such results correspond to the findings of previous studies [16, 17, 21]. However, this is the case of a distinct reason, where formal or published assessments for non-progressive dysarthria are not available yet in the Arab countries. Furthermore, the qualitative comments of Lebanese SLTs who use formal assessments, standardized in foreign countries, suggested that these measures are either implemented with their bilingual clients or utilized perceptually. This would run in a deviating pattern against the professional recommendations underlining the importance of conducting a detailed assessment without which a differential diagnosis could not be reached, and the therapeutic goals could not be evaluated for effectiveness [33].
Similar to previous studies’ findings [16, 17, 21], the oral motor examination (94%) was the most frequently used informal assessment tool in clients with non-progressive dysarthria, although limited evidence is present on the correspondence of oral motor functions to speech production [34,35,36,37]. However, the large proportion of SLTs embedding the oral motor examination within their assessment practices reflects the importance of this tool in evaluating the underlying conditions associated with the client’s initial medical etiology as well as with dysarthria. Although Lebanese SLTs agreed on the importance of assessing communication beyond the level of impairment, responses suggested that they utilize predominantly impairment-based assessments, which align with the findings of previous studies [16, 17, 21]. This may be partly related to the fact that research on the clinical presentation and evaluation of dysarthric symptoms is largely impairment-focused [4, 18]. On the other hand, dysarthria-specific impact and participation measures are present and published [38, 39], however, they are not translated and validated among the Arabic cultures.
Based on the SLTs’ responses, the application of instrumental assessments was markedly rare. Similarly, previous studies exploring the assessment practices of non-progressive dysarthria in the ROI, UK, and Australia demonstrated similar results [16, 17, 21], along with those observed in the assessment of progressive dysarthria [40]. A recent survey conducted in the UK on the use of technology in the assessment and treatment of motor speech disorders indicated that the majority of SLTs used loudness meters and voice recorders to analyze the voice and speech of their clients during the assessment process [41]. According to the qualitative comments of Lebanese SLTs, they stated that the availability of specialized instrumental tools in Lebanon would be of value, as limited access is reported. In addition, most of the SLTs (86%) agreed that they need more training in instrumental assessments. This indicates that the reasons behind the restricted implementation of instrumental assessments are mainly related to limited availability or access as well as constrained expertise.
Lebanese SLTs acknowledged important value for the assessment of functional communication beyond the clinical setting and investigating the underlying barriers. Recent studies have shed light on the psychosocial impact of dysarthria on the client’s life and participation in society [3, 4, 18], which seemed to raise SLTs’ awareness toward these issues and influenced their perspectives on related mental health problems. Generally, the assessment practices of Lebanese SLTs respected the ICF framework, as they tended to define the functional profiles of adults with non-progressive dysarthria. Lebanese SLTs reported the importance of evaluating the interaction between the motor speech condition and the environmental factors of the society in which individuals with non-progressive dysarthria live. However, SLTs relied mostly on informal assessments to evaluate the activity and participation domains of dysarthria, since comprehensive formal assessments targeting these areas are scarce in the Arab countries. These findings were found consistent with previous studies [16, 17, 21], where SLTs favored informal assessments despite the presence of several validated and standardized formal assessments.
Several barriers to effective assessment were documented by Lebanese SLTs. Some of which were consistent with the reported findings of previous studies including clinical comorbidities, professional limitations, and client’s compliance [16, 17, 21]. Additionally, a notable proportion of SLTs complained about financial problems. To elaborate more, 2 years ago, Lebanon has slid into an economic crisis characterized by a significant progressive decline of the Lebanese pound against the American dollar, leading to a dollar shortage in the country. The devaluation of the Lebanese currency severely constrained the purchasing capacity of Lebanese SLTs and limited the funding provided by the medical centers or workplaces. The captured qualitative comments suggested that several SLTs were not able to pay for formal assessments and instrumentations and reported using free assessment tools including free acoustic softwares or apps that are relatively accessible on smartphones or tablets. Also, the qualitative comments supported the fact that most of the SLTs could not afford international specialized trainings which are mostly offered in American dollars. Still, the most-reported barrier to effective assessment was the scarcity of Arabic standardized assessments available for non-progressive dysarthria. Only 4% of respondents reported that they were satisfied with the currently available assessment tools. Furthermore, test availability was reported as a key factor influencing assessment choice. Therefore, the development and validation of Arabic assessments for non-progressive dysarthria are highly recommended and valued as these measures can potentially depict the efficacy of the chosen treatment modalities, guide clinical practice, and thus improve clinical outcomes.
SLTs have the responsibility to maintain competency and up-to-date learning. Lebanese SLTs are facing daunting challenges to enhance professional practices during the current Lebanese crisis. This is related to their limited access to educational resources, e-learning modules, and specialized training programs due to financial concerns. The findings of this study disclose that the assessment practices of Lebanese SLTs working with adults with non-progressive dysarthria follow the international guidelines. Therefore, SLTs are recommended to develop interprofessional collaboration groups to share experiences and resources and thus improve therapeutic outcomes. Such collaborative practices will help in promoting SLTs’ skills and identify the present gaps in their area of practice.
It is important to mention the strengths and limitations of this study. To the best of our knowledge, this is the first study conducted in Lebanon and the Arab world to investigate the assessment practices of SLTs working with non-progressive dysarthria. Research on speech therapy-related topics are extremely limited in the Arab area, and thus, there is a paucity of information on the general practices of Arab SLTs. In sum, the present study can support the development of speech therapy services in Arab countries and hypothesize future research statements. The findings of the present study must be considered in light of several limitations. Firstly, in Lebanon, there is no national register for the profession, so, a response rate couldn’t be estimated; thus, the findings of this study could not be generalized to reflect the assessment practices of all Lebanese SLTs. Secondly, whilst the findings of this study shed light on important and novel findings, a larger sample size could have added more statistical power. When compared with other studies conducted previously in ROI, UK, and Australia [16, 17, 21], the sample size of this study is relatively similar, knowing that Lebanon is a very small country. Thirdly, the survey methodology is limited as it presented specific response options [40], which might not necessarily reflect SLTs’ true perspectives and clinical practices. Fourth, it is possible that SLTs may have been biased to respond to questions about their assessment practices in a way that reflects valued standards more than actual practices. Nonetheless, this manuscript will encourage further studies, of larger sample sizes, to be conducted in the Arab countries to ensure that Arab SLTs are practicing according to prevailing professional standards. On the other hand, the findings provided here support a need for the establishment and standardization of Arabic measures to quantitatively evaluate dysarthria.