Adult Speech Flashcards
Characteristics of dysarthria - how would you determine this?
- Characterised by “abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production” (Duffy, 2020, p. 3)
- Respiration
- Articulation
- Phonation
- Prosody
- Resonance
- Neurological in origin
How would you assess adult speech?
- Case history – onset of symptoms, medical/social history, self-perception
- Goal setting
- OMA
- Anatomical and physiological features – strength, range, speed, steadiness, tone and accuracy
- Perceptual
- Instrumental:
- Acoustic (Visual display of acoustic properties - frequency, intensity, temporal speech patterns
- Physiological (Muscle contractions, airflow, biomechanical aspects
- Visual imaging (fluoroscopy, nasendoscopy)
Non-speech tasks:
* OMA – speed, strength, range, accuracy and coordination
* Observe muscle tone at rest
* Ax of Alternating motion rates (AMR- pa pa pa) and Sequential motion rates (SMR- pa ta ka)
* also known as diadochokinetic rates (DDK)
* Respiration:
- Observe breathing pattern
- Note how many words output per breath
- Maximum phonation time (MPT) “ah” – as long as you can x3
* Phonation:
- Vocal quality
- MPT, perceptual judgement, acoustic analysis
- Ability to change loudness and pitch
* Prosody:
- Variation in pitch, loudness and duration to convey emotion, stress, emphasis and linguistic information
* Resonance:
- Sentences loaded with nasal phonemes
- Prolonged “eee” with nose pinched and not
- Mirror?
* Articulation:
- Single word production
- Sentence production
- Connected speech
What treatment options are there for dysarthria?
- Medical intervention
- Prosthetic device
- Behavioural
- AAC
- Counselling
How would you conduct treatment options with a client?
Multiple approaches can be used to achieve goal
* Management across these areas can be DIRECT or INDIRECT
- Medical intervention
- Prosthetic device
- Behavioural
- AAC
- Counselling
Respiration treatment
EMST
* Expiratory checking – take a deep breath and let out slowly during speech
* Optimal breath group – speaking at higher lung volumes
* LSVT – also works on respiratory support
* Postural adjustments
Phonation treatment
- Lee Silverman Voice Treatment (LSVT®; Ramig, Bonitati, Lemke, & Horii, 1994)—an intensive program that targets high phonatory effort to improve loudness and intelligibility
- Effort closure techniques to increase adductory forces of vocal folds (e.g., pulling upward on chair seat; squeezing palms of hands together)
- Improved timing of phonation (e.g., initiating phonation at beginning of expiration)
Prosody treament
* Breath support linked to verbal output
* Contrastive stress patterns
* Chunking utterances
* Pacing boards
Resonance treatment
* Modification of speech pattern
* Resistance training (CPAP)
* Biofeedback
Articulation treatments
Strength training (although limited evidence and not supported in progressive dysarthria)
* Biofeedback – sEMG, electropalatography, augmented feedback during speech tasks
* Traditional articulation therapy – discrimination, placement, production
* Clear speech strategies – e.g. overarticulate, slow down.
Other considerations to optimise communication
- ICF - participation and activities, envronment and personal factors
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Types of dysarthria
Group of neurologic speech disorders resulting from abnormalities in the strength, speed, range, steadiness, tone or accuracy of movement to control respiration, phonation, resonance and prosody.
* Flaccid
* Spastic
* Ataxic
* Hypokinetic
* Hyperkinetic
* Mixed
* Unilateral UMN
What is respiration?
Inspiration and expiration
What is articulation?
Being able to shape articulators (eg teeth, tongue, palate) to make correct sounds as needed for particular words
What is phonation?
Quality of vocal output – sound quality. Eg breathiness is a description of phonology (linked to our breath)
What is prosody?
Pacing of speech, the rhythm or pattern of speech. Where we put stress on different words or phrases.
What is resonance?
Related to nasality (hypernasality or hypo nasality)
What is Flaccid dysarthria?
Wasted and weak tongue, weak voice, nasal emission of air, dysphonia, poor or absent palatal elevation, absent gag reflex, poor articulation, poor or absent jaw jerk
What is Spastic dysarthria?
Non-wasted tongue, poor tongue movements, slurred, strained, slow speech and voice, por palatal elevation, brisk gag reflex, brisk jaw jerk, corneo-mandibulars, pout, palmomentals, emotional lability
What is Ataxic dysarthria?
Scanning speech, irregular articulation and poor voice volume, breathing control, variable vowel and consonant duration
What is Hypokinetic dysarthria?
Hypophonia, monopitch, slurring, festinant speech (increasing fast rate)
