adult speech Flashcards
A disorder of motor execution
dysarthria
assessment steps for dysarthria
information gathering
cog-comm assessment/language
- orientation
- 1-2 step directions
- expressive language
-receptive language
oral peripheral exam
- muscle strength, ROM, speed, accuracy
auditory peripheral exam
diadochokinesis
connected speech sample
formal assessment for dysarthria
Frenchay Dysarthria Assessment (12+)
muscular weakness, hypotonia, stiffness/tightness
spastic dysarthria
etiologies for spastic dysarthria and SoL
CVA
als, ms
brainstem stroke
TBI
inflam disease
bilateral upper motor neurons
speech production errors - spastic dysarthria
resp - generally not an issue
artic - imprecise consonants
prosody - monopitch, monoloudness, reduced pitch
res - hypernasal
phonation - harsh vocal quality, strain-strangled
assessment for spastic
conversational speech
diadochokinesis
- AMR highlight slowed rate
vowel prolongation
Treatment for spastic
resonance - surgical flap, teflon injection, palatal lift
- velar strengthening - blowing and sucking, ^ loudness, slow rate, open mouth
artic - intell drills, phonetic placement, exaggerating, minimal contrast
prosody - pitch range, intonation profiles, contrastive stress
phonation - head and neck relax, easy onset, yawn- sigh
muscular weakness and hypotonia
flaccid dysarthria
etiologies for flaccid dysarthria
and sol
mysathenia gravis
polio
guillain-barre
tumors
brainstem stroke
sol - lower motor neurons in one or more cranial or spinal nerves
flaccid dysarthria speech production errors
respiration - shallow breathing, stridor
resonance - hypernasal
artic - imprecise consonants
prosody - reduced pitch and loudness
phonation - breathy
assessment for flaccid dysarthria
convo speech and reading
AMRs highlight slow rate
prolonged vowel for breathiness
speech stress in suspected myasthenia gravis
treatment for flaccid
respiration - correct posture, speak immediately on exhalation
resonance - increase loudness, reduce rate, open mouth
artic - intell drills, phonetic placement, exaggerating consonants
prosody - pitch range, intonation, contrastive stress, chunking utterance
phonation - pushing and pulling, holding breath, hard glottal attack
imprecise, jerky, poorly coordinated movements, inaccurate force, range, timing, direction
ataxic dysarthria
etiologies and site of lesion for ataxic
SoL- cerebellum
- degen diseases
- CVA
- toxic conditions
- TBI
- Tumor
speech production errors for ataxic
- respiration - slow and controlled, speak on exhale, stop phonation
- artic - traditional artic therapy
- prosody - rate control and stress/ intonation: contrastive stress drills, pitch range, intonation
hyperkinetic dysarthria sol and etiologies
Huntingtons TBI stroke infections
excessive and involuntary movements
hyperkinetic dysarthria
site of lesion and eitologies for hyperkinetic
basal ganglia
huntington’s
tbi
cva
infections
speech production errors for hyperkinetic
resp - unexpected inhalations or exhalations
reson - hypo or hypernasal
artic - imprecise consonants
prosody - prolonged intervals, pitch, monopitch
phonation - harsh, strain/strangled
assessment for hyperkinetic
vowel prolongation
AMRs- speech rate variations, breakdowns
convo speech
muscle rigidity, reduced ROM, slowed movement
hypokinetic dysarthria
SOL and etiologies for hypokinetic
basal ganglia
- TBI
- CVA
- tumors
- infections
- anoxia
speech production errors for hypokinetic
resp - reduced breath support impacts loudness and phonation
res- no
artic - imprecise consonants
prosody - monopitch, monoloudness, reduced stress, increased rate
phonation - breathy and soft
assessment for hypokinetic
convo speech - rate and prosody errors
AMRs - artic errors
vowel prolongation - vocal quality
treatment for hypo
compensatory
resp- speak immediately on exhalation, cues to increase inhalation, slow and controlled exhalation
prosody- rate control, intonation stress profiles, drills
phonation- voice amps
LEE SILVERMAN TREATMENT
main types of intervention dysarthria
compensatory techniques - slowing down, over artic, open wide
environmental - provide main topic before speaking, watch for turn-taking, ask yes/no
communication repair strategies - total rep, partial rep, spelling the first few letters, elaboration, simplifying message
a deficit in the ability to smoothly sequence the tongue lips, jaw; a disorder of motor planning
apraxia of speech
clinical characteristics of AOS
artic - subs and distortions
rate - slowed, lengthened segments, increased intersegment durations
prosody - equal stress, pitch and loudness errors
automatic speech less impacted
errors increase with word length
artic groping
assessment for AOS
AMR pa pa pa, ta ta ta, ka ka ka
SMR ptk
(SMR more effected)
muscle strength and ROM
Apraxia Battery for Adults
Behavioral checklists
Treatment for AOS
Hierarchy of difficulty
Modeling and repetition
various placement cues
minimal pairs
Rosenbek 8-step continuum
Sound production Treatment
Script Training
Metrical pacing
Hand tap
Rosenbek 8-step continuum
max to min cues
watch me listen to me then simultaneous production
end - role playing
sound production treatment hierarchy
target
minimal pair item
printed letter
integral stimulation
artic placement cues
disorders in oral domain
lip closure
tongue control during bolus hold
bolus preparation/mastification
bolus transport/ lingual motion
initiation of pharyngeal swallow
disorders in pharyngeal domain
soft palate elevation
laryngeal elevation
anterior hyoid movement - partial/ no movement affects larynx elevation, epiglottis inversion
epiglottis movement
laryngeal vestib control
pharyngeal stripping wave
pharyngeal contraction
cranial nerves involved in swallowing
5 trigeminal
7 facial
9 glossopharyngeal
10 vagus
11 spinal accessory
12 hypoglossal
signs and symptoms of dysphagia
drooling/increased secretions
weight loss
coughing/choking
difficulty chewing/ pocketing
swallow delay
changes in diet
food stuck
nasal regurgitation
assessment for dysphagia
Chart Review
Patient Interview and Observations
Bedside Eval
-oral mech
-respiratory check
-position patient
-ask to swallow before anything in the mouth
-ice chip spoon
-during trials, place hand under chin
-consistencies- ice chips, water/thin, nectar, pudding, solid
SAFE
MASA
MBS
FEES
allows you to see oral and pharyngeal phase
Modified Barium Swallow Study
passes transnasally to the pharynx can only see pharyngeal stage before and after swallow
FEES
Compensatory techniques for dysphagia
seating - up straight if able
chin down
head rotation to weak side - closes off weak
backward head tilt
sour bolus
food placement
external cheek pressure
labial support
chin support
labial and chin support
smaller bites, spoon only, multiple swallows
supraglottic swallow
effortful swallow
Mendelsohn
supraglottic swallow (5 steps)
Take a breath/hold it
take a bite of food/sip
swallow (hold breath)
cough on exhale
swallow again
diet changes
thin liquids, nectar/honey/pudding, mechanical soft
thin liquids best for
reduced pharyngeal wall contraction, reduced cricopharyn opening
nectar/honey/pudding best for
poor bolus control, delayed swallow trigger
