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ECU Motor Speech Disorders > 11 - Dysarthria & Apraxia Management > Flashcards

11 - Dysarthria & Apraxia Management Flashcards

1
Q

What 5 techniques can be used to help an MSD patient improve Respiratory Support?

A

Maximum Vowel Prolongation

Optimal Breath Group

Controlled Exhalation Tasks

Expiratory muscle conditioning

Postural Adjustments

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2
Q

How can Prosthetic Assistance be used to help an MSD patient improve Respiratory Support?

(2)

A

Abdomoninal trussing (binders or corsets) – This can enhance posture, improve respirator support, improve respiratory support and air flow

Expiratory board or paddle – Lean on flat board or surface for support

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3
Q

How can Behavioral Compensation be used to help an MSD patient improve Respiratory Support?

A

Inhalation/exhalation practice

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4
Q

How can Instrumental Feedback be used to help an MSD patient improve Respiratory Support?

A

Visual biofeedback

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5
Q

How can Medical Treatments be used to help an MSD patient improve Phonation?

(8)

A

Medialization laryngoplasty

Lateralization laryngoplasty

Arytenoid adduction surgery

Recurrent laryngeal nerve resection

Injections

Teflon injection

Botox injection

Collagen injection

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6
Q

How can Prosthetic Management be used to help an MSD patient improve Phonation?

(2)

A

Amplification systems

Vocal intensity controller

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7
Q

How can Behavioral Management be used to help an MSD patient improve Phonation?

(2)

A

Effortful closure techniques – unilat or bilat VF weakness

Head turn techniques (postural)

Digital manipulation

LSVT

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8
Q

How can Surgical Management be used to help an MSD patient improve Resonance?

A

Pharyngeal flap

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9
Q

How can Prosthetic Management be used to help an MSD patient improve Resonance?

A

Obdurator

Palatal Lift

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10
Q

Can Behavioral Management be used to help an MSD patient improve Resonance?

A

Mixed opinions regarding efficacy

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11
Q

What are 4 general approaches for Behavioral Management to help an MSD patient improve Resonance?

A

Modifying the pattern of speaking

Resistance tx during speech

Feedback

Non-speech techniques for VP closure

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12
Q

How can Surgical Management be used to help an MSD patient improve Articulation?

(2)

A

Neural anastomosis (reconnection) – Typically CN 7

Botox

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13
Q

What symptoms of Dysarthria can Botox be used to treat?

5

A

Hemifacial spasms

Spasmotic torticollis

Oral mandibular dystonia

Lingual protrusion dystonia

Jaw tremor

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14
Q

Can Pharmacologic Management be used to help an MSD patient improve Articulation?

A

Yes

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15
Q

How can Prosthetic Management be used to help an MSD patient improve Articulation?

A

Bite block

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16
Q

How can Behavioral Management be used to help an MSD patient improve Articulation?

A

Strength training – Highly controversial

Relaxation – Improve muscle tone when spastic or rigid

Stretching – Evidence neither positive nor negative

Biofeedback – Reduction of hemifacial spasms

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17
Q

What are 6 traditional approaches for Behavioral Management for MSD?

A

Integral stimulation

Phonetic placement

Phonetic derivation

Exaggeration of consonants

Minimal contrasts

Intelligibility drills

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18
Q

What is the single most powerful single, behaviorally modifiable variable for improving intelligibility?

A

Rate

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19
Q

Rate modification most often means rate _______.

A

Reduction

Facilitate articulation precision and intelligibility

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20
Q

How can Prosthetic Management be used to help an MSD patient improve Rate?

(3)

A

DAF

Pacing boards

Alphabet boards

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21
Q

How can Non-Prosthetic Management be used to help an MSD patient improve Rate?

A

Hand/finger tapping

Visual feedback

Rhythmic cueing

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22
Q

What is the goal of improving prosody?

A

Maximize the naturalness of prosodic patterns

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23
Q

What are 4 strategies to improve Prosody and Naturalness?

A

Work at level of breath group

Contrastive stress tasks

Referential tasks

Work across breath groups

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24
Q

What are 6 strategies for treating Flaccid Dysarthria?

A

Respiratory support exercises

Surgical management or injections for ADDuctor VF
weakness

Effortful closure exercises for VF weakness

Amplifiers for reduced loudness

VP prosthesis

Anastomosis surgery for facial weakness

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25
Q

What are 3 strategies for treating Spastic Dysarthria?

A

Antispasticity medications

Relaxation exercises

Management of pseudobulbar effect

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26
Q

What are 2 strategies for treating Ataxic Dysarthria?

A

Pharmacologic treatments have been generally unsuccessful

Behavioral treatments emphasize improvement or compensation for decreased motor control and coordination

(Focus= modifying rate and prosody to improve intelligibility)

27
Q

What are 2 strategies for treating Hypokinetic Dysarthria?

A

Surgical Interventions – Pallidotomy, Thalamotomy, DBS

Pharmacologic Treatments

Behavioral Management – Rate control, postural management

Lee Silverman Voice Treatment (LSVT)

28
Q

What is LSVT?

1+5

A

Loud effortful phonatory tasks are aimed to improve…

  • Respiratory drive
  • Vocal fold adduction
  • Laryngeal muscle activity and synergy
  • Laryngeal and surpralaryngeal articulatory movements
  • Vocal tract configurations
29
Q

What are 3 strategies for treating Hyperkinetic Dysarthria?

A

Surgical (Pallidotomy, thalamotomy, DBS)

Pharmacologic – Botox (spasmotic dysphonia)

Behavioral – Usefulness is unclear

30
Q

What is a strategy for treating UUMN Dysarthria?

A

Behavioral – Emphasize rate, prosody, articulation

31
Q

What are

Communication Oriented Treatments?

A

Speaker Strategies

Listener Strategies

Interaction Strategies

32
Q

What are Speaker Strategies for MSD?

7

A

Prepare listeners w/alerting signals (Verbal or non-verbal)

Convey how communication should occur (AAC; convey rules to novel listeners)

Set the context and identify the topic

Modify sentence content, structure, length

Gestures

Modify listener comprehension

Alphabet boards

33
Q

What are Listener Strategies for MSD?

4

A

Maintain eye contact

Attentive and active listening

Modify physical environment

Hearing and visual acuity

34
Q

What are Interaction Strategies for MSD?

6

A

Schedule important interactions

Identify conducive speaking environments

Eye contact (listener/speaker)

Identify breakdowns; provide feedback

Repair breakdowns

Identify what works best

35
Q

What are 4 Speech Supplementation for MSDs?

A

Alphabet supplementation

Semantic or topic supplementation

Gestures

Syntactic supplementation

36
Q

New speech treatment based on the principles of ______ and ______.

A

Neuroplasticity

Motor learning

37
Q

Intensive treatment program focuses on clear speech as a means of improving speech ______ in nonprogressive dysarthria.

A

Intelligibility

38
Q

What is a Prepractice Phase?

6

A

Prepractice prepares the participants for more intensive practice sessions by ensuring that they have an adequate understanding of the task to be completed.

Provides an opportunity to shape the participants’ speech production attempts and elicit a small number of correct responses prior to practice.

1-hr prepractice sessions aimed to establish the participants’ understanding of the concept of clear speech and instate clear speech production.

Participants watched videos of healthy adults reading aloud a standard passage using both their normal speech and clear speech.

Participants required to identify which of the speech samples was clearest and then discuss the changes made by the speaker (e.g., exaggerated articulation) that may have contributed to the observed improvements in speech clarity.

Participants then read aloud the same standard passage while imitating the clear speech they had observed in the videos.

39
Q

What is an Intensive Practice Phase?

3

A

This phase followed the initial prepractice phase and consisted of 1-hr therapy sessions, four times a week, for a 1-month period (16 sessions in total).

The treatment schedule was consistent with the LSVT LOUD program (schedule, intensity, and homework)

Each treatment session in the intensive practice phase included a brief prepractice component and the intensive practice component.

40
Q

What is the primary goal for Apraxia of Speech?

A

Maximize effectiveness, efficiency and naturalness of communication

41
Q

What is the treatment focus for Apraxia of Speech?

2

A

Reestablish plans/programs

Improve ability to select and activate plans/programs

42
Q

What are 2 interventions for Apraxia of Speech?

A

Medical interventions

Prosthetic interventions

43
Q

Is early management important for Apraxia of Speech?

A

Yes

44
Q

Should we take baseline data and consider stimulus order for Apraxia of Speech?

A

Yes

45
Q

What are the principles of motor learning for Apraxia of Speech?

(6)

A

Drill

Self-learning and instruction

Feedback

Specificity of learning

Consistent and variable practice

Speed-accuracy tradeoff

46
Q

What are 7 Approaches for treating Apraxia of Speech?

A

Approaches

Imitation

Intrasystemic vs Intersystemic

Eight Step continuum

Sound Production Treatment

Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT)

Melodic Intonation Therapy (MIT)

Biofeedback

47
Q

How should we choose targets when treating Apraxia of Speech at Level I?

Level II?

Level III?

A

Level I – General aspect of communication targeted

Level II – Considerations for Individual targets

Level III – Packaging the target

48
Q

How can Imitation be used when treating Apraxia of Speech?

4

A

Early stage tx

Emphasizes volitional responses to clearly established targets

Provides programming map

Simplifies drill

49
Q

What is an Intersystemic approach for treating treating Apraxia of Speech?

(6)

A

Non-speech activity to
facilitate speech

Magnet effect

Hand or finger tapping

Foot tapping

Head movements

Pacing board

50
Q

What is an Intrasystemic approach for treating treating Apraxia of Speech?

(4)

A

Emphasize automatic or higher level of control

More volitional or conscious

Counting, singing, social phrases

Phonetic placement

51
Q

What is the Eight Step Continuum approach for treating Apraxia of Speech?

A
  1. Integral stimulation-the therapist asks the patient to look and listen AND imitate. (watch me and do the same).
  2. Same as 1 except the patient is asked to delay the response; then the therapists
    silently mimes the response while the patient is producing the target stimulus.
  3. Integral stimulation followed by imitation WITHOUT cues-miming or otherwise.
  4. Integral stimulation with several successive productions without simultaneous cues or intervening stimuli

• 5. Printed stimuli are presented by the therapist without auditory or visual cues followed by patients production while looking at the written stimuli.

  1. Written stimuli, with delayed production after removal of the written stimuli.
  2. The therapist elicits a response by asking a question.
  3. Role playing is used to elicit responses.
52
Q

What does Sound Production Treatment/Minimal Contrast Treatment rely on?

(5)

A

Repetition

Integral stimulation

Modeling

Phonetic placement cues

Feedback

53
Q

What does Sound Production Treatment/Minimal Contrast Treatment emphasize?

A

Minimal contrasts

54
Q

What are the steps to Sound Production Treatment/Minimal Contrast Treatment?

(6)

A

1 – Produce a target word or phrase in minimal pair context following
verbal model

2 – Repeat step 1 w/written cue

3 – Produce target word only w/integral stimulation

4 – Produce the target word only with placement cues and modeling
from the clinician

5 – Produce the target sound in isolation with a model from the clinician

6 – Next item

55
Q

What is PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets)?

(3)

A

Uses tactile cues to facilitate speech

Clinician serves as an “external programmer”

Highly structured finger placements on the patient’s face and neck are used to signal articulator placement

56
Q

What is Melodic Intonation Therapy (MIT)?

4

A

Reliance on singing

Utterances are based on melody, rhythm, patterns of stress

Does not target sound accuracy explicitly

Repetition is the core feature of MIT; fades during tx progression

57
Q

What treatment approaches can be used for a Severely Apraxic patient?

(5)

A

Automatic speech tasks

Carrier phrases

Singing

Artificial larynx

Pairing of gesture w/sound or word

58
Q

What is Multiple Input Phoneme Therapy?

3+2

A

Similar to VCIU (VCIU=visual-verbal); MIPT=auditory-verbal)

Clinician is controller vs facilitator

2 Levels

1. Decreasing the volitional intent of speech (Select the appropriate word for developing the stimulus response set + identify target sounds for phoneme generalization)
 2. Developing the SRS and eliciting the target utterance
59
Q

What are 4 Additional Techniques for treating Apraxia of Speech?

A

Volitional sound, syllable, words

Key word technique

Multiple input phoneme (MIPT)

Voluntary controls of involuntary utterances (VCIU)

60
Q

Why was Script Training developed?

4

A

To promote verbal communication on client-selected topics

Initially used to improve expressive language in aphasia

Scripts are practice at phrase and/or sentence level to facilitate automatic output

Repeated practice of phrases and sentences can lead to automatic and effortless speech productions

61
Q

What is the Goal of Script Training?

A

Production of islands of fluent speech in individuals without automatic speech

62
Q

Has Script Training been successful and functional for clients with AOS?

(2)

A

Yes

Clients reported increased confidence, speaking ease, and speech naturalness.

63
Q

Did scripts in Script Training become errorless?

A

No, but clients retained their scripts and reported using them frequently

ECU Motor Speech Disorders (16 decks)

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