Dysarthria management Flashcards
What is the primary goal of MSD treatment?
To minimise the effects of the dysarthria (and/or AOS) on the patient’s life and to accomplish that goal in the most efficient way possible
AKA improve speech and restore/maintain as close to pre-morbid levels as possible
Ways of achieving management goals (3)
- Restoring lost function (impairment based)
- Promoting use of residual functions (compensation)
- Reducing the need for lost function (adjustment: activities, environment, lifestyle)
Approaches to MSD management
- Medical intervention (pharmacological, surgical)
- Prosthetic management
- Behavioural management
- Speech-oriented approaches
- Communication-oriented approaches
- AAC
- Counselling and support
MSD treatment should commence early, WHY?
- Less compensatory strategies to undo
- Use it or lose it
- Building on pre-existing strengths
MSD treatment should be inter professional, WHO?
- Neurologists: primary person
- OT: mobility, feeding, home setups
- Support worker
- Physio
- AHA
Impairment-based MSD treatment should target underlying pathophysiology and level of breakdown, WHY?
- Compensation requires that speech production becomes conscious
- Motor reorganisation after injury requires use
- Principles of motor learning influence the structure of speech-oriented and communication-oriented treatment
Considering neuroplasticity in MSD treatment
- Neuroplasticity: if neural substrate is not biologically active it will degrade in function
- Training must be continuous of long periods of time to induce neural change
- Training must be sufficiently salient
- Changes in neural function are specific only to what is being trained
Steps in motor learning and adaptation
Cognitive stage: understanding nature of problem, knowing why it’s necessary to do certain things to achieve goal, learning procedures
Autonomous stage: transitioning from conscious to more automatic control through trial and error, feedback important
Automatic stage: skill can be performed quickly with little conscious effort, required EXTENDED PRACTICE
Motor learning principles
PREPRACTICE
- Activities prior to practice may influence motor learning
STRUCTURE OF PRACTICE
- Variability: phonetic contexts, parameters, tasks, conversational/functional context
- Target complexity: CV sequences, consonant clusters, phrases, speech
- Salience: core vocab, functional, motivating
- Specificity
- Schedule
- Amount
FEEDBACK CONDITIONS
- Type
- Frequency: not too frequent
- Timing: a few secs after
Prioritising speech subsystems
First Order: Respiration & Resonance Second Order: Phonation
Third Order: Articulation & Prosody
Recommends that we don’t treat articulation / prosody until the higher order systems have reached a criterion level.
Determining treatment goals based on dysarthria severity
Mild dysarthria
- Improve efficiency and naturalness while maintaining intelligibility
Moderate dysarthria
- Maximise speech intelligibility
Severe dysarthria
- Maximise speech comprehensibility
Common treatment approaches for dysarthria
- ‘Traditional dysarthria therapy
- Sub-system approach
- Oromotor exercises/strength training
- Intelligibility/speech strategies
- Rate control/pacing therapy
- PROMPT
- AAC/compensatory treatments
- Psychosocial interventions
Global approaches: LSVT, speechATAX
Caution of all approaches except this ^^
Dysarthria should be treated holistically, considering all aspects of ICF
Dysarthria treatment strategies/techniques - Body structure and function
- Behavioural
- Speaker-oriented, impairment-based
- Sub-system treatment
- Caution regarding promoter/strength training - Prosthetic
- Instrumental (biofeedback)
Sub-system treatment for dysarthria
- Physiological approach to target therapy at specific impairments
- Consider relative contribution of each sub-system in decreasing intelligibility
- Treat sub-system contributing most
- Range of behavioural/prosthetic/instrumental techniques
- Biofeedback can augment impairment-based therapy
Sub-system treatment: respiratory-phonatory impairment
Respiratory support
- Postural adjustment
- Breathing against resistance
- Abdom/diaphragmatic breathing
- Sustained phonation
- Biofeedback from sound level meter, etc
Respiratory-phonatory coordination
- Rehearsing speech breathing pattern (quick inspiration, slow controlled exp.
- Optimal breath groups
- Respiratory flexibility training (vary inhalation based on length/volume of utt
Phonatory function
