General Principles for Managing MSDs Flashcards
Is our knowledge of how to treat MSDs as good as our ability to describe and identify the MSDs?
No.
We can describe and identify MSDs much better than we can treat them.
Treatment for Communication versus speech?
– better to focus on communication than just speech.
- Other things can augment speech, i.e. gestures., etc.
- Sometimes patient cannot regain 100% normal speech
Management Goals (3):
o Restore lost function – success of this depends on etiology and course of the disease, as well as the type and severity of the MSD. People with degenerative diseases will not be able to restore the lost function. UUMN patients probably can.
o Promote use of residual function – learn to compensate by using prosthetic devices (e.g. for hyper-nasality = palatal lift {pushes up the soft palate}), pacing strategies (used with fluency and PD), AAC, or modifying physical environment.
o Reducing need for lost function – must adjust to reality. If a person’s work depends on his speech, adjustments may need to be made
Factors Influencing Management (6):
1 Medical dx and prognosis – will it progress, get better, etc.
2 Disability and societal limitation –does it limit the person and how much. If it doesn’t limit them, is it really something to work on?
3 Environment and communication disorders – are there supportive people in their environment to communicate with the person?
4 Motivation and needs – If a person is not motivated, don’t waste your time. You may try counseling the person to see if that changes motivation.
5 Associated problems – cognitive problems make it difficult to manage MSDs. If the person has cognitive deficits that make it difficult to maintain attention or to desire communication, don’t treat MSD directly.
6 Health care system – is there money for treatment, if so how much?
Approaches to Management (3):
1 Medical Intervention
2 Prosthetic management
3 Behavioral Management
Medical Intervention approach to management (2):
- Pharmacological management – as with using L-Dopa with Parkinson’s Dz.
- Surgical management – to improve speech deficits with such means as pharyngeal flap for VP function, or surgeries for the neurological condition itself, as in removal of tumor or blocked arteries
Prosthetic management approach to management (4):
1 Palatal lift for VP closure (good candidate = TBI patient with flaccid dysarthria [damage to CNX])– palatal lift is hard to get used to and needs to be molded for individual patients – are often uncomfortable. Sometimes used for ALS. Patients need to have their own teeth.
2 Pacing board, pointing to first letter of word or DAF – for slowing rate of speech, especially for hypokinetic dysarthria.
3 Voice amplifier – to aid in reduced intensity. Useful with Parkinson’s and ALS. They are degenerative and won’t improve.
4 Light pointers, switches – to point to letters or pictures
Behavioral Management approaches to management:
- Maximize communication by whatever means that will produce the most rapid, effective, natural results
Behavioral Management: Speaker oriented approaches to management:
– to improve the speaker is the goal. Reduce impairment by increasing physiologic support – Oral motor exercises to increase strength and ROM. Use compensatory strategies such as slow rate and over articulation
Behavioral Management: Communication oriented approaches –
- structure the interaction to improve speaking strategies.
- Give patient hierarchy of strategies. “If you’re not understood do …….,……. and …..”.
Examples of strategies:
- bring listener to a quiet corner
- turn off TV, etc. to reduce distracting noise
- give listener the topic of conversation
- if you breakdown – say one word at a time and point to first letter on letter board
Guidelines for Behavioral Management:
1 Management should start early most of the time – must wait for medical management to be underway or complete or till patient is out of medical danger and not in distress. But start as soon as is allowable.
2 Baseline data is needed to establish goals and measure change – for degenerative diseases, as abilities decrease, goals will have to be adjusted. For patients who are recovering, goals will need to be adjusted upward.
3 Initial treatment: Increasing physiological support of subsystems should be initial focus of treatment – this means improving function, such as stronger tongue, lips, better respiratory support, etc. It is usually best to start from the bottom up – respiratory first, phonatory next, then resonance and articulation.
4 Compensation requires that speech becomes conscious – when using compensatory strategies speech becomes more effortful – the patient has to think about speech. Sometimes patients consider it to be too much trouble to use compensatory methods.
5 Use principles of motor learning for treatment
What’s a good goal for degenerative diseases?
Help maintain function
Use principles of motor learning for treatment (7):
1 Practice is essential, therefore the person must speak.
2 Drill is necessary – it is often repetitive but it necessary. Brief periods of practice over time is usually better than longer periods occurring less often.
3 Patients need proper instruction, i.e. tell them what they need to do in their practice, such as over articulating, speaking slower, etc.
4 Patients need to discover what works best for them in terms of practice. Let them have ownership. Fade back clinician instruction as soon as possible.
5 Give appropriate feedback.
6 Practice tasks should be relevant to speech. Some data indicates that for dysarthric speakers nonspeech oral movement tasks may not be helpful.
7 Begin with most advanced skill that the patient has demonstrated in the assessment
