Dysarthria

Question 1

3 General Goals for Ix

Answer 1

1. Restoring lost function
2. Compensation: Promoting the use of residual function
3. Adjustment: Reducing the need for lost function

Question 2

Main overarching goal of Ix

Answer 2

To maximize the effectiveness, efficiency, or naturalness of communication (Duffy, 2013)

Question 3

Two main approaches to Ix

Answer 3

Speaker-oriented approaches (Direct Ix)

Communication-orientated approaches (Enviro modification. Comm partner training)

Question 4

Goal of Respiration Ix

Answer 4

Consistent air pressure to allow non-fatiguing production of speech
(Yorkston et al, 2010)

Question 5

Respiration

Answer 5

• Manometer/water blowing: nonspeech task to ↑ subglottal air pressure/ respiratory support
• Abdominal trusses (corsets)
Enhance posture, support weak abdominal muscles, ↑ respiratory support and airflow
• Gradually ↑ breath group length (the, the cat etc). Initiate speech at appropriate point in speech breathing cycle

Question 6

Approaches for improving phonation

Answer 6

• Voice amplifier: Outcome reduced activity limitation.
• Effort closure techniques: grunting & controlled coughing, pushing, lifting etc
• LSVT: a voice-strengthening program (PD)

Question 7

Why do Resonance Ix?

Answer 7

Velopharyngeal inadequacy = air wastage though excess. nasal airflow.
- Added demands on respiratory and laryngeal functions.
- Can reduce loudness
↓ distinctiveness of consonants

Question 8

Types of Resonance Ix

Answer 8

• Palatal Lift (flaccid dysarthria)
• Modifying the pattern of speaking; increased effort, reduced rate, over articulate influences velopharyngeal function
• Biofeedback; eg mirror, during efforts to decrease hypernasality/nasal airflow during speech

Question 9

Articulation Ix

Answer 9

• Bite block held bw teeth. Inhibits jaw opening (for jaw opening dystonia patients)
• Strengthening, Stretching, relaxation
• Traditional Approaches: integral stimulation (watch and listen imitation tasks); phonetic placement technique (instruction and feedback – hands on)
• Over-articulation – (emphasize phonetic placement ↑ precision)
• Minimal contrast production: helpful in achieving control over consonants
• Intelligibility drills: words, phrases, sentences are read and attempts to repair content misunderstood.

Question 10

Prosody Ix

Answer 10

• Contrastive stress tasks: (Eg “John loves Mary?” (question), “John loves Mary” (surprised)
• Referential tasks: patient reads randomized phrases / sentences containing prespecified stress targets unknown to listener, may help promote discovery learning of ways to signal stress, can evaluate the effectiveness of actively taught stress strategies.

Question 11

Rate Ix

Answer 11

Rate may be the most powerful behaviourally modifiable variable for improving intelligibility (Duffy, 2013)

(Reduction) Facilitates articulatory precision & intelligibility. Allows ↑ time for a full range of movement, sequencing and coordinating articulators, improved linguistic phrasing, allows listener more time to process
- Hand tapping -Alphabet supplementation - Pacing boards

Question 12

Considering generalisation

Answer 12

• How functional / intrusive into their everyday life

* Generally progress from highly structured tasks to more naturalistic tasks

Question 13

Which Ix is appropriate for all dysarthria types:

Answer 13

Biofeedback, intelligibility drills, rate modification, first letter on alphabet board, contrastive/ referential stress tasks

Question 14

Ix for Flaccid Dysarthria

Answer 14

Rx goal: ↑ strength or compensate for weakness. Dependant on subsystem impacted (CN).
• Strengthening, deep inhalation, VF medialisation, palatal lift

Question 15

Spastic Dysarthria Ix

Answer 15

Rigidity / Hyperadduction problematic. Dependent on subsystem impacted (not respiration)
- Relaxation. Reduce hyperadduction,

Question 16

Ataxic Dysarthria Ix

Answer 16

Ataxic Dysarthria: Poor coordination of movement.

- Respiratory control, Rate, Prosody to improve intelligibility.

Question 17

Hypokinetic Dysarthria

Answer 17

(PD) Reduced ability to initiate & sustain movement through faulty feedback systems. Tremor, slowed movements. Treatment resembles Flaccid Dysarthria
• LSVT focuses on voice to modify laryngeal pathophysiology through exercise to increase loudness.
• Rate control - pacing board (if appropriate). Amplifier.

Question 18

Hyperkinetic Dysarthria

Answer 18

Difficulty suppressing unwanted movements. Rigid movements / sustained postures.
• primarily surgical and pharmacologic interventions. Also… bite block
• Behaviour treatment alone not recomm.

Question 19

Unilateral Upper Motor Neuron Dysarthria

Answer 19

Unilateral weakness of movements.
Damage typically affects tongue and lower face muscles
• Behavioural approaches usually focus on rate, prosody, and articulation

Question 20

Mixed Dysarthria Ix

Answer 20

Rapidly progressing (MND). Spastic and flaccid presentation. Impacts all components of speech, may require use of AAC devices. Very debilitating
- generally managed behaviourally with appropriate treatments for any of the present component types

Question 21

Comprehensibility vs Intelligibility

Answer 21

Comprehensibility: listeners’ perception of the ease or difficulty with which they can make out a speaker’s meaning / message
Intelligibility: extent to which listeners can correctly identify the words they hear

Question 22

Speaker Strategies

Answer 22

Set the context and identify the topic. Signal shift in topic (increase predictability)

Question 23

Listener Strategies

Answer 23

Maintain eye contact. Comprehensibility improves with visual-auditory information.

Question 24

Interaction Strategies

Answer 24

Schedule important interactions. Consider fatigue / stress and the impact on intelligibility.

Question 25

Factors Influencing Treatment Decisions

Answer 25

1. The individual’s communication needs (the person may not perceive a problem with their communication, it is not restricting them in any way),
2. Motivation – is a prerequisite for maximising adherence to recommended practice. The clinician must explain what therapy might accomplish.
3. Medical Prognosis – there may be medical treatment for the causal factors.
4. Associated Problems - The presence of other deficits or conditions may take priority in rehabilitation efforts.
5. The presence of an impairment does not indicate treatment is required - the nature and degree of impairment must be considered – ongoing intervention is not recommended if MSD not associated with activity limitations / participation restrictions (Duffy, 2013).

Question 26

ICF:

Impairment, activity, participation

Answer 26

I - impaired muscle tone. Incoordination of musculature.
A - Reduced intelligibility
P - Social participation, employment restricted.

Question 27

Neurodegenerative disease - Is treatment appropriate?

Answer 27

The goal of treatment is to maximize communication at each stage of the disease, not to reverse decline (Duffy, 2013). This may include strategies to conserve energy and minimize fatigue.