CH17 Managing the Dysarthrias

Question 1

what are the subsystems for treatment?

Answer 1

respiration, phonation, resonance, articulation, rate, prosody and naturalness

Question 2

when would you not need to work on respiration?

Answer 2

if there is adequate loudness and capacity for flexibile breath patterning (phrasing)

Question 3

what task indicates good breath support?

Answer 3

maintain a stream of bubbles for 5 seconds, SEE Scape, need sufficient subglottal air pressure

Question 4

what are some nonspeech respiratory exercises?

Answer 4

bubbles, vowel prolongation, tape recorder with a VU meter or Visipitch, pushing/ pulling/ or bearing down, postural adjustments, prosthetic assistance, behavioral compensations

Question 5

list some prosthetic assistance for respiration

Answer 5

abdominal binders, corsets, expiratory board/paddle (wheelchairs)

Question 6

why would you not use prosthetic assistance with ALS patients?

Answer 6

may restrict breathing and cause pneumonia

Question 7

what are the behavioral compensations for respiration?

Answer 7

practice inhaling deeply, exhaling more forcefully, learning to control breath, using shorter phrases per breath group, correcting maladaptive breath group, using biofeedback machines w/ visual feedback

Question 8

what can be done to improve phonation?

Answer 8

medical treatment (laryngeal surgery), fat/collagen/and Teflon injections, toxin injections, phonation prosthetic management, phonation behavioral management

Question 9

what is included with laryngeal surgery?

Answer 9

implants, recurrent nerve resection, arytenoid adduction surgery

Question 10

what is included in phonation prosthetic management?

Answer 10

amplification, vocal intensity controller (visual feedback)

Question 11

what is included in phonation behavioral management?

Answer 11

LSVT, controlled coughing

Question 12

what are some treatments for resonance?

Answer 12

surgery, prosthetic management, behavioral management, injection of some sort

Question 13

what is a surgical management technique for resonance?

Answer 13

pharyngeal flap

Question 14

what are some prosthesis for resonance treatment?

Answer 14

palatal lift prosthesis, nose clip

Question 15

what are some behavioral management for resonance treatment?

Answer 15

slowing rate and over articulation to help hypernasality, SEE Scape

Question 16

what are some treatment options for articulation?

Answer 16

bite block, strength training, stretching, traditional artic approach

Question 17

why wouldn’t you use strength training with ALS and Myesthenia Gravis?

Answer 17

makes condition worse

Question 18

how many oral motor exercises should be done a day?

Answer 18

5 sets of 10 reps, 3-5 times a day

Question 19

what are some traditional artic approach

Answer 19

phonetic placement (visual, physical, verbal cues), integral stimulation (watches and listen task), phonetic derivation (blowing to indicate /I/), minimal pairs, intelligibility drills

Question 20

what are some treatment options for rate?

Answer 20

DAF, pacing board, letter alphabet board, hand/finger tapping, visual feedback (oscilloscope), rhythmic cueing

Question 21

what are some treatment options for prosody and naturalness

Answer 21

pt takes breaths at natural places, contrastive stress drills, LSVT

Question 22

what are some treatments for flaccid dysarthria? (weakness)

Answer 22

• strength exercises for weakness unless progressive
• pushing, pulling for respiratory weakness
• surgery, injection, effortful closure for adductor VF weakness
• palatal lift, laryngeal flap surgery for resonance, nares occlusion, VP strengthening exercises
• counseling about length of time to speak for myasthenia gravis

Question 23

what are some treatments for spastic dysarthria? (hyperadduction)

Answer 23

behavioral management, meds for pseudobulbar affect, relaxation exercises

Question 24

what are some treatments for ataxic dysarthria? (lack of coordination)

Answer 24

behavioral management centering on improving incoordination and intelligibility by modifying rate and prosody

Question 25

what are some treatments for hypo?

Answer 25

LSVT, surgery, deep brain stimulation, meds, behavioral management for rate control and overarticulation

Question 26

what are some treatments for hyper?

Answer 26

surgery and meds for abnormal movement, compensatory strategies

Question 27

what are some treatments for UUMN?

Answer 27

articulation (primary), tongue strengthening

Question 28

what are some treatments for mixed?

Answer 28

use treatments appropriate for both dysarthrias involved

Question 29

what are the three communication oriented treatment strategies?

Answer 29

speaker, listener, interaction

Question 30

what is involved with speaker strategies?

Answer 30

prepare listener, tell listener how communication will happen, identify topic, repeat, simplify, use gestures, monitor listener comprehension, use alphabet board

Question 31

what is involved with listener strategies?

Answer 31

eye contact, work at comprehending, modify environment

Question 32

what is involved with interaction strategies?

Answer 32

don’t say important things when fatigued or stressed, select conducive speaking environment, eye contact, identify breakdowns and feedback (shadowing), rephrase, use synonyms, identify salient words