Chapter 17 Managing Dysarthrias

Question 1

Typically speech demands on respiration are:

Answer 1

not great, even individuals with significant respiratory problems may have adequate respiratory support for speech

Question 2

Improving phonation, resonation, and articulation generally promotes:

Answer 2

Efficient use of the airstream

Question 3

If the patient is able to maintian a stream of bubbles for 5 seconds in a glass of water at a depth of 5cm than

Answer 3

They have adequate respiratory support for speech and can produce consistent subglottal airpressure

Question 4

Pushing, pulling, or bearing down during speech and non speech tasks helps

Answer 4

Increase respiratory drive for speech

Question 5

Abdominal binders, expiratory board/paddle and pushing on the abdomen are all examples of

Answer 5

Prosthetic assistance for respiration

Question 6

Behavioral Compensation for Respiration

Answer 6

> Practice inhaling more deeply
Practice exhaling more forcefully
Controlled breathing letting air out slowly
Use shorter phrases per breath group
Use biofeedback machines with visual feedback
Correct maladaptive breathing

Question 7

Medical treatment for improving phonation

Answer 7

> Laryngeal surgery
Implants in paralyzed VF for medial approximation
Arytenoid adduction surgery (removing arytenoid cartilage)
Recurrent nerve resection prevents hyperadduction (SD and laryngeal spasms)
Fat, Collagen, Teflon, Botox injections (wait 1 full year to assess nerve regeneration)

Question 8

Vocal intensity controller and amplification systems are used as prosthetics for:

Answer 8

Phonation

Question 9

Behavoiral Management of Phonation

Answer 9

Effort closure strategies help strengthen vocal fold adduction:
>push/pull/lift techniques
>coughing in controlled manner
LSVT for Parkinson’s patients

Question 10

Surgical management for Resonance

Answer 10

> Pharyngeal flap
Injection into pharyngeal wall to improve VP closure
“would this pt be a candidate for Teflon injection?”

Question 11

Prosthetic management for Resonance

Answer 11

> Palatal lift prosthesis (need teeth)

>Wearing nose clip

Question 12

Behavioral management for Resonance

Answer 12

> Slowing rate and over articulate (hypernasality)

>Using a mirror for visual feedback

Question 13

Prosthetic management for Articulation

Answer 13

Bite block to help jaw control and keep jaw from opening

Question 14

Only use strength training to improve articulation if there is:

Answer 14

Weakness (do not use for ALS or MG)

Question 15

Recommend minimum sets, reps, and frequency of articulatory exercises:

Answer 15

5 sets of 10 reps 3-5 times a day

Question 16

Articulatory exercises

Answer 16

> Steady, continuous, prolonged stretches
Slow movement of articulators beyong normal ROM
Exaggerate consonants to improve imprecisions
Compensate with tongue blade instead of tip
Tradition artic approach, placement, minimal pairs, phonetic derivations
intelligibility drills

Question 17

Prosthetic management of Rate

Answer 17

> DAF
Pacing board
Letter alphabet board

Question 18

Non-prosthetic rate management

Answer 18

> Finger tapping each syllable (note: ataxic imprecise, Parkinson’s accelerate)
Visual feedback from oscilloscope
.Rhythmic cueing

Question 19

Chunking utterances into natural syntactic units, contrastive stress drills, and LSVT are all ways to improve:

Answer 19

Prosody and Naturalness

Question 20

Treatment for Flaccid dysarthria

Answer 20

> Work on increasing strenghth (unless there is no LMN innervation or if the patient has a progressive disease like ALS)
Push, pull (respiratory weakness)
Effortful closure tx or injections (VF weakness)
VP strengthening or prosthesis (resonance problems
For MG limit length of time for speaking

Question 21

Treatment for Spastic dysarthria

Answer 21

> Work on relaxation exercises (hyperadduction treatment)
Medications (Ellaville) for pseudobalbar affect
Modify behavior for individual behaviors that trigger pseudobalbar affect

Question 22

Treatment for Ataxic dysarthria

Answer 22

Focus on behavioral management to improve incoordination
>emphasizing rate
>loudness
>pitch control

Question 23

Treatment for Hypokinetic Dysarthria

Answer 23

> LSVT 4 times a week for one month focusing on respiratory and phonatory effort
Medications L-Dopa, Sinemet may improve speech
Work on rate and overarticulation
Surgery (Pallidotomy, thalalmotomy and Deep Brain Stimulation DBS)

Question 24

Treatment for Hyperkinetic dysarthria

Answer 24

> Mainly surgical and pharmacological tx to treat abnormal movements
SLPs can teach compensatory techniques such as holding a pipe in the mouth

Question 25

Treatment for UUMN

Answer 25

May work on specific articulation problems or on tongue strengthening

Question 26

Communication Oriented Treatment: Speaker strategies

Answer 26

>Prepare listener
>Tell listener how communication will happen
>Identify topic
>Increasing redundancy may help
>Simplify content
>Use gestures
>Monitor listener comprehension
>Use alphabet board

Question 27

Communication Oriented Strategies: Listener strategies

Answer 27

> Maintain eye contact
Work at comprehending
Modify environment

Question 28

Communication Oriented Strategies: Interaction strategies

Answer 28

> Don’t communicate important things when fatigued or stressed
Select conducive speaking environment
Maintain eye contact (everyone)
Identify breakdowns and establish means of feedback
Repair breakdowns by rephrasing, spelling, synonyms