Adult Acquired Conditions Flashcards
What is Parkinson’s Disease
PD is an age related degenerative condition caused by loss of nerve cells in the brain causing a dopamine reduction.
It is characterised by involuntary tremors, stiff/inflexible muscles, and slow movement
What is the role of SLT with Parkinson’s
Assessing communication and swallowing
Facilitating safe swallowing
Removing barriers to successful communication
Working in the MDT
How would a care plan for an individual with Parkinson’s look
Case history (?previous SLT input, severity of PD)
Initial Ax (speak to Pt and NOK/SO, gain understanding of baseline, what are Pts goals, assess swallow and comms, educate Pt RE swallow safety etc)
Therapeutic interventions based off initial Ax and Pts goals
Periodic reassessment
Onwards referral as required
How might you assess the speech and communication of someone with Parkinson’s
Informal Ax (what is Pts insight to their difficulties, speak to NOK/SO too if possible, how are their SLCN affecting their ADLs, what was their baseline, what are their goals, what communication environments do they particularly struggle in)
Formal Ax (maximum phonation time- pt say [a:] at a normal loudness and time for as long as possible and compare to norms, continuous articulation- [s]/[z] ratios, DDK rates- [p], [t], [k], Pt reading paragraph- to Ax breath support and voice quality,
How might you assess the swallow of someone with Parkinson’s
Informal Ax (has Pt/SO noticed any changes to their swallow, if so is it worse with certain foods/fluids/times of day, what environment do they eat in normally)
Formal Ax (oromotor Ax- Ax CN function, EAT 10- Ax qualitative impact of swallowing difficulties on the Pts QoL and ADLS, bedside Swallow Ax
What SLT interventions could support SLCN in someone with Parkinson’s
Singing/reading monologues to increase breath support
LSVT Loud (Lee Silverman Voice Training)
Voice excercises like SPEAK OUT program
Both help increase loudness, breath support and articulation
EMST
AAC
Memory strategies like chunking or association can support conversation
What SLT interventions could support swallowing in someone with Parkinson’s
EMST to strengthen muscles
Compensatory Strategies to increase swallow safety
Swallow coordination excercises
AND EATING!
What is a motor speech disorder
A motor speech disorder is characterised by difficulty moving the articulatory muscles needed for speech production due to weakness or reduced muscle coordination.
2 primary MSDs- Dysarthria and Apraxia
What is dysarthria
Dysarthria is when you have difficulty speaking because the articulatory muscles required for speech are weak. The term dysarthria refers to a group of speech disorders characterised by abnormal speed, strength, range, and accuracy of the movements required for phonation
Can be caused by conditions that affect the brain or nerves IE MS, cerebral palsy or Down’s syndrome
What are the 8 primary types of dysarthria
Flaccid
Ataxic
Spastic
Hypokinetic
Undetermined
Unilateral
Hyperkinetic
Mixed
(Fiona And Shrek Have Utterly Utterly Happy Marriage)
What are the 8 primary types of dysarthria and what features are associated with each type
Flaccid- breathiness, hypernasality, audible inspiration
Ataxic- distorted vowels, irregular articulatory breakdowns
Spastic- SLOW RATE OF SPEECH, strained/harsh voice quality
Hypokinetic- monopitch, monoloudness, palilalia (repetition of own speech)
Unilateral- reduced loudness, slow rate, imprecise articulation
Hyperkinetic- deterioration with increased rate, tremor, stoppages
Mixed- characteristics of 2 or more types
Undetermined- speech doesn’t fit into other categories
How does dysarthria differ from Aphasia or Apraxia of Speech
Characteristic AOS Dysarthria Aphasia
Muscle weakness No Yes No
Articulatory deficits Yes Yes No
Prosodic deficits Yes Yes No
Lang. processing deficits No No Yes
Consistent error patternsNo Yes No
Groping Yes No No
What are the primary indicators of dysarthric speech
1 UNCLEAR SPEECH
Difficulty moving articulatory (tongue, mouth, lips)
Slow/slurred speech
Difficulty controlling voice volume
Change in voice quality (IE becoming more nasal)
Hesitating a lot when speaking or using short sentences
How can the WHO ICF be used in assessing communication in adults
IMPAIRMENTS IN BODY STRUCTURE AND FUNCTION, including underlying strengths and weaknesses in speech production and verbal/nonverbal communication;
LIMITATIONS TO ACTIVITY AND PARTICIPATION, including functional status in communication, interpersonal interactions, self-care, and learning;
ENVIRONMENTAL AND PERSONAL FACTORS that serve as barriers to, or facilitators of, successful communication and life participation;
IMPACT OF IMPAIRMENT ON QoL and functional limitations relative to the individual’s premorbid social roles and abilities and the impact on their community.
What are the primary indicators of Apraxia of Speech (AoS)
Inconsistent speech errors
Difficulty imitating or saying sounds on your own
Groping with articulators
Slowed speech rate
Unaffected automatic speech IE “Hello! How are you”
No speech at all (severe cases)
Errors in tone, stress or rhythm
What is Apraxia of speech
Apraxia is an acquired motor speech disorder. It can be caused by any kind of brain damage (IE TBI, stroke). People with apraxia of speech do not have muscular weakness, but have impaired ability to produce words/sounds as a result of brain damage.
Sometimes people with AoS are unable to speak at all
How is Apraxia different to Dysarthria and how could you identify which is which
Apraxia is a motor speech disorder caused by damage to the brain, whereas dysarthria is a motor speech disorder caused by muscle weakness.
As apraxia is caused by brain damage, errors are often inconsistent, whereas dysarthria has more consistent error patterns, so if a Pt is repeating the same word/phrase with varying errors, this would indicate apraxia
Additionally, apraxia does not present with muscle weakness unless there is a co-occurring dysarthria
Outline an initial assessment for motor speech disorders
CASE HISTORY (medical hx, Pt + family informal Ax: person specific goals/needs, impact on QoL, barriers & facilitators to communication
NON SPEECH AX (CN Ax, check dentition, sustained vowel [a:] to check breath support), assess DDK to check articulator precision and coordination, observe posture and breath support)
SPEECH AX(standardised tests for dysarthria IE N-DAT, standardised tests for apraxia IE BDAE, informal Ax: observe phonation (what is voice quality like), articulation (stress-testing- 2-4 mins reading aloud to ax deterioration, or repetition of words/phrases to Ax error patterns, ax prosody and intelligibility through conversation
FURTHER AX as required to rule out other conditions (IE receptive/expressive language ax to rule out aphasia, or swallow ax, fluency ax etc as req)
DEVELOP PERSON CENTRED INTERVENTION PLAN INFORMED BY ICF AND PT GOALS
PERIODIC REASSESSMENT
What are the two styles of dysarthria intervention
Restorative (Impairment based interventions to restore the function of speech)
Compensatory (Function based interventions to support successful communication)
Examples of restorative dysarthria interventions
Postural Adjustment (to support respiration)
EMST (respiration and breath support)
LSVT/LSVT Loud (phonation support)
Speak out intervention (phonation support supporting intentional speech)
Exaggerated articulation (increase articulator precision AKA clear speech)
Pacing speech using hand tapping (decreases speech rate supports prosody)
Matching breath to natural speech pauses (supports prosody and breath support)
Examples of compensatory dysarthria interventions
Communication partner strategies (IE active listening, feedback)
Speaker strategies (conversationsational repair strategies IE gestures to support communication)
Modifying communication environment (reducing background noise, reducing distance between communication partners
AAC to facilitate meaningful communication
Examples of apraxia of speech interventions
Cued Speech- gestures near the mouth that cue a sound (can help in understanding the speech of others and in producing clear speech)
Melodic Intonation Therapy (singing/humming words/phrases that are hard to say. Helps with motor planning
Pacing speech-using hand tapping (decreases speech rate and supports intelligibility)
Verbal Motor Production Treatment (VMPT)- repeated practice of sounds/words/phrases to help in motor planning for speech
AAC- facilitates meaningful communication
Some people with AoS regain speech skill without SLT intervention (spontaneous recovery)
What is aphasia
Aphasia is an acquired, multimodal language disorder resulting from neurological damage such as stroke.
It can affect both written and spoken expressive and receptive language
What are the types of aphasia and what are the symptoms of each
Expressive/nonfluent/Brocas Aphasia: lesion in Broca’s area, anomia (word finding difficulties), a graphic (difficulty with written expression), only able to use single words or short phrases
Receptive/fluent/wernickes Aphasia: lesion in wernickes area, impaired spoken language comprehension, impaired written language comprehension, alexia (impaired reading comprehension)
Anomic Aphasia: mildest form of aphasia, characterised by anomia and semantic paraphasia (substituting words with similar words IE bird for chicken)
Global Aphasia: Most severe form of aphasia, characterised by written and spoken receptive and expressive language difficulties
Primary Progresssive Aphasia (PPA): this is a frontotemporal dementia, characterised by deterioration of written and spoken language abilities over time
