Chapter 16 General Principles of Managing MSDs

Question 1

Communication vs. Speech

Answer 1

Focus on overall communication rather than just speech, i.e. gestures, AAC when patients cannot regain 100% of their normal speech

Question 2

Management Goals (3)

Answer 2

> Restore lost function
Promote use of residual function
Reduce need for lost function

Question 3

Management Goals: Restore lost function

Answer 3

Dependent on the type and severity of MSD

i.e. degenerative diseases will not be able to restore lost function whereas UUMN probably can

Question 4

Management Goals: Promote use of residual function

Answer 4

Learn to compensate by using:
>prosthetic devices
>pacing strategies
>AAC
>Modifying physical environment

Question 5

Management Goals: Reduce need for lost function

Answer 5

Must adjust to the reality of the lost function

>Change of occupation and other roles that depend on speech

Question 6

Factors influencing management (6)

Answer 6

>Medical Dx and prognosis
>Disability and societal limitations
>Environmental and communication disorders
>Motivation and needs
>Associated problems
>Health care system

Question 7

Factors influencing management: Medical Dx and prognosis

Answer 7

> Will the disease get worse?

>Can patient make progress?

Question 8

Factors influencing management: Disability and societal limitations

Answer 8

> Does the MSD limit the patient and how much?

>Is there benefit from working on it?

Question 9

Factors influencing management: Environmental and communication disorders

Answer 9

Are there supportive people in their environment to communicate with the patient

Question 10

Factors influencing management: Motivation and needs

Answer 10

If the person is not motivated don’t waste the time unless counseling can change patients motivation

Question 11

Factors influencing management: Associated problems

Answer 11

Other cognitive deficits may interfere with managing MSD

Question 12

Factors influencing management: Health care system

Answer 12

Is there funding for quality care?

Question 13

Approaches to Management (3)

Answer 13

> Medical intervention
Prosthetic management
Behavioral management

Question 14

Approaches to Management: Medical intervention

Answer 14

> Pharmacological management (L-Dopa for Parkinson’s)

>Surgeries (pharyngeal flap, remove tumors)

Question 15

Approaches to Management: Prosthetic management

Answer 15

> Palatal lift
Pacing board, DAF
Voice amplifier
Light pointers, switches

Question 16

Approaches to Management: Behavioral management

Answer 16

Speaker oriented approaches
>Oral motor exercises
>Slow rate and over articulate
Communication oriented approaches
>Give patient a hierarchy of strategies (if you’re not understand do _____ and ____)
>Change environment to reduce miscommunication and increase comprehension (turn of tv, move to quiet place)

Question 17

Guidelines for Behavioral Management

Answer 17

> Start as soon as allowable
Baseline data to establish goals and measure changes (even for degenerative dx)
Increase physiological support of subsystems and start from the bottom up (respiratory to articulatory)
Consideration of compensatory strategies: Compensation requires consciousness of speech and may make speech effortful
Practice is essential, Drill is necessary, Give proper instruction, Discover what works, Give appropriate feedback, Make it relevant to speech, and begin with the most advance skill