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ECU Motor Speech Disorders > 10 - Principles of MSD Management > Flashcards

10 - Principles of MSD Management Flashcards

1
Q

Is there one single method affective for treating all people with MSDs?

A

No

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2
Q

When treating MSDs, should we focus on speech or communication?

A

Speech

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3
Q

What is the ultimate goal when treating MSDs?

A

The ability to transmit thoughts and feelings

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4
Q

What does a focus on communication broaden?

2

A

Goals of management

Effectiveness of how a treatment is judged

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5
Q

What 3 things should management goals for MSD focus on?

A

Effectiveness

Efficiency

Naturalness

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6
Q

What does “effectiveness” mean in regard to MSD?

A

Intelligibility

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7
Q

What does “efficiency” mean in regard to MSD?

2

A

Optimal rate

Effort

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8
Q

What does “naturalness” mean in regard to MSD?

A

That the speech disorder does not call attention to itself

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9
Q

What are the 4 directions of treatment for MSD?

A

Restore lost function

Compensate

Adjust

Prevent

[RCAP]

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10
Q

How do we restore lost function in patients with MSD?

3

A

Spontaneous recovery (e.g., UUMN dysarthria)

Surgery (e.g., VF paralysis)

Speech pathology intervention/motor learning

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11
Q

How do we help patients with MSD to compensate?

4

A

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)

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12
Q

How do we help patients with MSD to adjust?

4

A

Reorganize work place

Modify social activities

Only to the extent necessary

Temporary vs permanent

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13
Q

What maladaptive behaviors can we help patients with MSD to prevent ?

(5)

A

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

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14
Q

How does the cause of a patient’s MSD influence whether a patient is a candidate for treatment?

A

Etiology

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15
Q

How does the course of a patient’s MSD influence whether a patient is a candidate for treatment?

(4)

A

Improving

Chronic and stable

Exacerbating-remitting

Progressive

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16
Q

How does the the MSD patient’s cognition influence whether a patient is a candidate for treatment?

(3)

A

Patient’s cognitive status

Patient’s insight

Patient’s motivation

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17
Q

What are the 5 treatment considerations for patients with MSDs?

A

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?

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18
Q

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)

A

Acute non-progressive

Chronic non-progressive

Degenerative

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19
Q

What Environment Settings should we consider when treating patients with MSDs?

(2)

A

Noisy, poor lighting

New setting vs familiar ones

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20
Q

What should we consider about Communication Partners when treating patients with MSDs?

A

Traits of communication partners (sensitivity)

21
Q

How does patient “Motivation” influence whether a patient is a candidate for treatment?

(3)

A

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)

22
Q

When might we refer a patient with MSD?

A

Depression

Cognitive impairments

Medical issues

Pressing personal concerns

23
Q

What associated deficits may be seen in patients with MSDs?

A

Motor; patient priority

Aphasia; other cognitive issues

(improving the “speech” of a severely demented individual not appropriate)

24
Q

What should be the focus of treatment of those with MSDs?

A

Greatest functional benefit

Greatest physiologic ‘upstream’ benefit

25
Q

How should we determine Duration when treating those with MSDs?

(3+4)

A

Make a plan: what and how long

Counsel patient (repeatedly)

Factors

  • Eitiology
  • Predicted course
  • Severity
  • Specific goals of management
26
Q

What are 3 types of management for patients with MSDs?

A

Medical

Prosthetic

Behavioral

27
Q

What is Medical management of MSDs?

2

A

Pharmacologic (e.g., dopamine for PD, BoTox for spasmodic dysphonia, etc.)

Surgical (e.g., neurosurgery, pharyngeal flap)

28
Q

What is Prosthetic management of MSDs?

6

A

Palatal lift

Voice amplifier

Pacing board

Delayed auditory feedback
Vocal intensity monitor

Picture, letter, word board

Pointers, etc.

29
Q

What are Behavioral goals of MSDs?

4

A

Restore (physiology)

Compensate

Adjust +

Prevent

30
Q

What are 3 types Behavioral management of MSDs?

A

Speech-oriented

Communication oriented

Counseling and support

31
Q

What is Speech-Oriented behavioral management of MSDs?

A

Work on increasing physiologic support for speech and

compensation

32
Q

What is Communication Oriented behavioral management of MSDs?

(5)

A

Modify listeners

Noise

Speaker-listener distance

Eye contact

Strategies for repairing breakdowns (repeating, rephrasing, spelling, writing)

33
Q

What are the 11 principles of Behavioral management of MSDs?

A

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

34
Q

What are the 16

principles of motor learning?

A

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!

35
Q

What should long term goals of MSDs reflect best thinking on?

A

Function

36
Q

Why should LT goals of MSDs reflect function?

3

A

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

37
Q

What is the point of short term goals?

A

To achieve long term goals

38
Q

What should short term goals be based on?

A

Perceptual parameters

39
Q

What are Treatment Objectives?

A

The smaller, measurable steps to achieve the short term goals

40
Q

What are Treatment Objectives based on?

A

The level of impairment

41
Q

How must Treatment Objectives be selected based on?

2

A

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

42
Q

Why do Oral Motor Therapy?

1+7

A

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
43
Q

What are the 4 assumptions about Oral Motor Therapy?

A

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.

44
Q

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)

A

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

45
Q

What is the argument against the assumption of Articulator Strength?

(a.k.a., Oral motor exercises strengthen the articulators)

A

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.

46
Q

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)

A

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.

47
Q

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)

A

Evidence indicates that non-speech behaviors are NOT a precursor to later speech learning, so they are not a “foundation” for speech

48
Q

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.

A

Alone

ECU Motor Speech Disorders (16 decks)

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