CH17 Managing the Dysarthrias Flashcards
what are the subsystems for treatment?
respiration, phonation, resonance, articulation, rate, prosody and naturalness
when would you not need to work on respiration?
if there is adequate loudness and capacity for flexibile breath patterning (phrasing)
what task indicates good breath support?
maintain a stream of bubbles for 5 seconds, SEE Scape, need sufficient subglottal air pressure
what are some nonspeech respiratory exercises?
bubbles, vowel prolongation, tape recorder with a VU meter or Visipitch, pushing/ pulling/ or bearing down, postural adjustments, prosthetic assistance, behavioral compensations
list some prosthetic assistance for respiration
abdominal binders, corsets, expiratory board/paddle (wheelchairs)
why would you not use prosthetic assistance with ALS patients?
may restrict breathing and cause pneumonia
what are the behavioral compensations for respiration?
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
what can be done to improve phonation?
medical treatment (laryngeal surgery), fat/collagen/and Teflon injections, toxin injections, phonation prosthetic management, phonation behavioral management
what is included with laryngeal surgery?
implants, recurrent nerve resection, arytenoid adduction surgery
what is included in phonation prosthetic management?
amplification, vocal intensity controller (visual feedback)
what is included in phonation behavioral management?
LSVT, controlled coughing
what are some treatments for resonance?
surgery, prosthetic management, behavioral management, injection of some sort
what is a surgical management technique for resonance?
pharyngeal flap
what are some prosthesis for resonance treatment?
palatal lift prosthesis, nose clip
what are some behavioral management for resonance treatment?
slowing rate and over articulation to help hypernasality, SEE Scape
what are some treatment options for articulation?
bite block, strength training, stretching, traditional artic approach
why wouldn’t you use strength training with ALS and Myesthenia Gravis?
makes condition worse
how many oral motor exercises should be done a day?
5 sets of 10 reps, 3-5 times a day
what are some traditional artic approach
phonetic placement (visual, physical, verbal cues), integral stimulation (watches and listen task), phonetic derivation (blowing to indicate /I/), minimal pairs, intelligibility drills
what are some treatment options for rate?
DAF, pacing board, letter alphabet board, hand/finger tapping, visual feedback (oscilloscope), rhythmic cueing
what are some treatment options for prosody and naturalness
pt takes breaths at natural places, contrastive stress drills, LSVT
what are some treatments for flaccid dysarthria? (weakness)
- 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
what are some treatments for spastic dysarthria? (hyperadduction)
behavioral management, meds for pseudobulbar affect, relaxation exercises
what are some treatments for ataxic dysarthria? (lack of coordination)
behavioral management centering on improving incoordination and intelligibility by modifying rate and prosody
