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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
What are 3 strategies for treating Spastic Dysarthria?
Antispasticity medications Relaxation exercises Management of pseudobulbar effect
26
What are 2 strategies for treating Ataxic Dysarthria?
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
What are 2 strategies for treating Hypokinetic Dysarthria?
Surgical Interventions – Pallidotomy, Thalamotomy, DBS Pharmacologic Treatments Behavioral Management – Rate control, postural management Lee Silverman Voice Treatment (LSVT)
28
What is LSVT? | 1+5
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
What are 3 strategies for treating Hyperkinetic Dysarthria?
Surgical (Pallidotomy, thalamotomy, DBS) Pharmacologic – Botox (spasmotic dysphonia) Behavioral – Usefulness is unclear
30
What is a strategy for treating UUMN Dysarthria?
Behavioral – Emphasize rate, prosody, articulation
31
What are | Communication Oriented Treatments?
Speaker Strategies Listener Strategies Interaction Strategies
32
What are Speaker Strategies for MSD? | 7
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
What are Listener Strategies for MSD? | 4
Maintain eye contact Attentive and active listening Modify physical environment Hearing and visual acuity
34
What are Interaction Strategies for MSD? | 6
Schedule important interactions Identify conducive speaking environments Eye contact (listener/speaker) Identify breakdowns; provide feedback Repair breakdowns Identify what works best
35
What are 4 Speech Supplementation for MSDs?
Alphabet supplementation Semantic or topic supplementation Gestures Syntactic supplementation
36
New speech treatment based on the principles of ______ and ______.
Neuroplasticity Motor learning
37
Intensive treatment program focuses on clear speech as a means of improving speech ______ in nonprogressive dysarthria.
Intelligibility
38
What is a Prepractice Phase? | 6
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
What is an Intensive Practice Phase? | 3
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
What is the primary goal for Apraxia of Speech?
Maximize effectiveness, efficiency and naturalness of communication
41
What is the treatment focus for Apraxia of Speech? | 2
Reestablish plans/programs Improve ability to select and activate plans/programs
42
What are 2 interventions for Apraxia of Speech?
Medical interventions Prosthetic interventions
43
Is early management important for Apraxia of Speech?
Yes
44
Should we take baseline data and consider stimulus order for Apraxia of Speech?
Yes
45
What are the principles of motor learning for Apraxia of Speech? (6)
Drill Self-learning and instruction Feedback Specificity of learning Consistent and variable practice Speed-accuracy tradeoff
46
What are 7 Approaches for treating Apraxia of Speech?
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
How should we choose targets when treating Apraxia of Speech at Level I? Level II? Level III?
Level I – General aspect of communication targeted Level II – Considerations for Individual targets Level III – Packaging the target
48
How can Imitation be used when treating Apraxia of Speech? | 4
Early stage tx Emphasizes volitional responses to clearly established targets Provides programming map Simplifies drill
49
What is an Intersystemic approach for treating treating Apraxia of Speech? (6)
Non-speech activity to facilitate speech Magnet effect Hand or finger tapping Foot tapping Head movements Pacing board
50
What is an Intrasystemic approach for treating treating Apraxia of Speech? (4)
Emphasize automatic or higher level of control More volitional or conscious Counting, singing, social phrases Phonetic placement
51
What is the Eight Step Continuum approach for treating Apraxia of Speech?
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. 6. Written stimuli, with delayed production after removal of the written stimuli. 7. The therapist elicits a response by asking a question. 8. Role playing is used to elicit responses.
52
What does Sound Production Treatment/Minimal Contrast Treatment rely on? (5)
Repetition Integral stimulation Modeling Phonetic placement cues Feedback
53
What does Sound Production Treatment/Minimal Contrast Treatment emphasize?
Minimal contrasts
54
What are the steps to Sound Production Treatment/Minimal Contrast Treatment? (6)
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
What is PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets)? (3)
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
What is Melodic Intonation Therapy (MIT)? | 4
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
What treatment approaches can be used for a Severely Apraxic patient? (5)
Automatic speech tasks Carrier phrases Singing Artificial larynx Pairing of gesture w/sound or word
58
What is Multiple Input Phoneme Therapy? | 3+2
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
What are 4 Additional Techniques for treating Apraxia of Speech?
Volitional sound, syllable, words Key word technique Multiple input phoneme (MIPT) Voluntary controls of involuntary utterances (VCIU)
60
Why was Script Training developed? | 4
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
What is the Goal of Script Training?
Production of islands of fluent speech in individuals without automatic speech
62
Has Script Training been successful and functional for clients with AOS? (2)
Yes Clients reported increased confidence, speaking ease, and speech naturalness.
63
Did scripts in Script Training become errorless?
No, but clients retained their scripts and reported using them frequently

ECU Motor Speech Disorders (16 decks)

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