10 - Principles of MSD Management Flashcards
Is there one single method affective for treating all people with MSDs?
No
When treating MSDs, should we focus on speech or communication?
Speech
What is the ultimate goal when treating MSDs?
The ability to transmit thoughts and feelings
What does a focus on communication broaden?
2
Goals of management
Effectiveness of how a treatment is judged
What 3 things should management goals for MSD focus on?
Effectiveness
Efficiency
Naturalness
What does “effectiveness” mean in regard to MSD?
Intelligibility
What does “efficiency” mean in regard to MSD?
2
Optimal rate
Effort
What does “naturalness” mean in regard to MSD?
That the speech disorder does not call attention to itself
What are the 4 directions of treatment for MSD?
Restore lost function
Compensate
Adjust
Prevent
[RCAP]
How do we restore lost function in patients with MSD?
3
Spontaneous recovery (e.g., UUMN dysarthria)
Surgery (e.g., VF paralysis)
Speech pathology intervention/motor learning
How do we help patients with MSD to compensate?
4
Modify rate and prosody (e.g., pacing board)
Use prosthetic devices (voice amplifier, palate lift)
Modify environment
Use alternative communication (e.g., alphabet board, gestures)
How do we help patients with MSD to adjust?
4
Reorganize work place
Modify social activities
Only to the extent necessary
Temporary vs permanent
What maladaptive behaviors can we help patients with MSD to prevent ?
(5)
Speaking too fast
Becoming exhausted because of air wastage
Experiencing frustration due to communication failures
Overarticulating (e.g., overcompensating for tongue weakness with excessive jaw movement)
Speaking too loudly
How does the cause of a patient’s MSD influence whether a patient is a candidate for treatment?
Etiology
How does the course of a patient’s MSD influence whether a patient is a candidate for treatment?
(4)
Improving
Chronic and stable
Exacerbating-remitting
Progressive
How does the the MSD patient’s cognition influence whether a patient is a candidate for treatment?
(3)
Patient’s cognitive status
Patient’s insight
Patient’s motivation
What are the 5 treatment considerations for patients with MSDs?
What is the patient’s medical status?
Is the patient’s condition progressive or non- progressive?
If the disorder is non- progressive, is the dysarthria acute or chronic?
Does the patient have other diagnoses?
What about patients with mild dysarthria?
What types of MSDS might patients seen in acute care settings, sub-acute units, skilled nursing facilities, rehabilitation agencies, home health, and out-patient settings have?
(3)
Acute non-progressive
Chronic non-progressive
Degenerative
What Environment Settings should we consider when treating patients with MSDs?
(2)
Noisy, poor lighting
New setting vs familiar ones
What should we consider about Communication Partners when treating patients with MSDs?
Traits of communication partners (sensitivity)
How does patient “Motivation” influence whether a patient is a candidate for treatment?
(3)
Be alert to gap in perception of degree of disability and
handicap
“Unmotivated” (depression, cognitive impairments, or other personal concerns)
Respect patient’s choices
(Important factor for candidacy)
When might we refer a patient with MSD?
Depression
Cognitive impairments
Medical issues
Pressing personal concerns
What associated deficits may be seen in patients with MSDs?
Motor; patient priority
Aphasia; other cognitive issues
(improving the “speech” of a severely demented individual not appropriate)
What should be the focus of treatment of those with MSDs?
Greatest functional benefit
Greatest physiologic ‘upstream’ benefit
How should we determine Duration when treating those with MSDs?
(3+4)
Make a plan: what and how long
Counsel patient (repeatedly)
Factors
- Eitiology
- Predicted course
- Severity
- Specific goals of management
What are 3 types of management for patients with MSDs?
Medical
Prosthetic
Behavioral
What is Medical management of MSDs?
2
Pharmacologic (e.g., dopamine for PD, BoTox for spasmodic dysphonia, etc.)
Surgical (e.g., neurosurgery, pharyngeal flap)
What is Prosthetic management of MSDs?
6
Palatal lift
Voice amplifier
Pacing board
Delayed auditory feedback
Vocal intensity monitor
Picture, letter, word board
Pointers, etc.
What are Behavioral goals of MSDs?
4
Restore (physiology)
Compensate
Adjust +
Prevent
What are 3 types Behavioral management of MSDs?
Speech-oriented
Communication oriented
Counseling and support
What is Speech-Oriented behavioral management of MSDs?
Work on increasing physiologic support for speech and
compensation
What is Communication Oriented behavioral management of MSDs?
(5)
Modify listeners
Noise
Speaker-listener distance
Eye contact
Strategies for repairing breakdowns (repeating, rephrasing, spelling, writing)
What are the 11 principles of Behavioral management of MSDs?
Start early but not always
Understand medical diagnosis
Understand plasticity and motor reorganization
Establish speech diagnosis
Recognize underlying physiologic impairments
Recognize relative impairment of the speech systems
(hierarchies of symptoms)
Recognize interdependency of the speech subsystems
“Begin with the component whose improvement will have the most effect on other components”
Take baseline data (specific tasks)
Inventory communication needs, motivation, speaking
environments
Observe patient-partner communication
What are the 16
principles of motor learning?
Understand the problem, the goals
Work at a conscious level
Move gradually to automatic performance
Improving speech requires speaking
Drill is essential
Distributed practice
Clear, consistent instructions
Reinforce discovery learning
Criterion-based feedback
Instrumental feedback
Specificity of learning
Consistent practice (one goal; homogeneous stimulus sets)
Variable practice (one goal; heterogeneous stimulus sets)
Increasing strength
Speed-accuracy trade-off
Model the desired speech goal; auditory-visual cues help!
What should long term goals of MSDs reflect best thinking on?
Function
Why should LT goals of MSDs reflect function?
3
So patient will sound natural in all speaking situations
So patient will be able to communicate basic needs with speech and augmentative device
So patient’s speech will be understandable to family and friends
What is the point of short term goals?
To achieve long term goals
What should short term goals be based on?
Perceptual parameters
What are Treatment Objectives?
The smaller, measurable steps to achieve the short term goals
What are Treatment Objectives based on?
The level of impairment
How must Treatment Objectives be selected based on?
2
What physiology is causing the symptom (e.g. do you want to increase muscle tension or reduce muscle tension?)
Selected based on facilitation or compensation
Why do Oral Motor Therapy?
1+7
To facilitate or improve speech, by…
- Increasing the range, accuracy, power and rate of articulator movements,
- Enhancing voluntary control of oral movements,
- Heightening awareness of oral structures,
- Constructing motor programs underlying phonemic features,
- Tempting “reluctant” children to participate in therapy,
- Warming up the speech musculature,
- Disguising therapy as play and making fun of it
What are the 4 assumptions about Oral Motor Therapy?
Speech anatomy: The same structures used for speech perform the same way for non-speech gestures.
Articulator strength: Oral motor exercises strengthen the articulators.
Part to whole training: Non-speech activities are relevant to speech. You teach the necessary movements, and practice them, and then put them together for speech.
Muscle preparation: Warming up the speech musculature at the beginning of therapy will facilitate speech goals in a session, and lay the foundations for speech. With nonverbal children, they lay the foundation for learning to talk by getting the muscles used to the movements they must perform.
What is the argument against the assumption of Speech Anatomy? (2)
(a.k.a., The same structures used for speech perform the same way for non-speech gestures)
There are differences in nervous system organization for non-speech vs. speech movements
Therapy for the structures involved in swallowing will probably not effect a change in speech
What is the argument against the assumption of Articulator Strength?
(a.k.a., Oral motor exercises strengthen the articulators)
The level of exercise offered by OMT would not be sufficient to make a difference, because the number of repetitions is too low, the frequency of exercise sessions is too low, and the exercises themselves are not conducted against resistance.
What is the argument against the assumption of Part-to-Whole Training?
(a.k.a., Non-speech activities are relevant to speech. You teach the necessary movements, and practice them, and then put them together for speech)
OMT lack relevance to speaking because they are “disintegrated” from the goal of talking. The small “broken down” bits that oral motor exercises represent will not automatically integrate into speech behaviors.
What is the argument against the assumption of Muscle Preparation?
(a.k.a., Warming up the speech musculature at the beginning of therapy will facilitate speech goals in a session, and lay the foundations for speech. With nonverbal children, they lay the foundation for learning to talk by getting the muscles used to the movements they must perform)
Evidence indicates that non-speech behaviors are NOT a precursor to later speech learning, so they are not a “foundation” for speech
Responding to criticism, and despite evidence to the contrary, in recent times some of the oral motor therapy proponents now say that they have never claimed that oral motor therapy ______ improves speech output.
Alone
