General principles of Managing MSDs Flashcards
Why is it better to focus on communication than just speech?
Other things can augment speech, such as gestures. Sometimes patients cannot regain 100% normal speech.
List management goals for MSDs:
- Restore lost function
- promote use of residual function
- reducing need for lost function
What does the management goal to restore lost function depend on to succeed?
Success depends on etiology and course of the disease, as well as the type and severity of the MSD.
People with _____ diseases will not be able to restore the lost function.
degenerative
What kind of patients can probably restore lost function?
People diagnosed with UUMN.
How does the clinician promote us of residual function?
Client learns to compensate by using prosthetic devices, pacing strategies, AAC, or modifying physical environment.
What does reducing need for lost function entail?
Must adjust to reality. If a person’s work depends on his speech, adjustments may need to be made.
List factors influencing management of MSDs:
- Medical dx and prognosis
- disability and societal limitation
- environment and communication disorder
- motivation and needs
- associated problems
- health care system
How does medical dx and prognosis influence management of MSDs?
Will it progress, get better?
How does disability and societal limitation influence management of MSDs?
Does it limit the person an dhow much. If it doesn’t limit them, is it really something to work on?
How does environment and communication disorders influence management of MSDs?
Are there supportive people in their environment to communicate with the person?
What can you try doing if the patient is not motivated?
Try counseling the person to see if that changes motivation.
How does the health care system influence management of MSDs?
is there money for treatment, if so how much?
What associated problems can influence management of MSDs?
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.
What component of speech should the clinician focus on first?
Should be the one from which the pt will receive the greatest functional benefit.
What is the rule of thumb for treatment duration?
Treat for as long as necessary to achieve goals but for as short a time as possible.
Patients with ______ disease who are functioning optimally may be discharged with prescheduled reassessment.
degenerative
What should the clinician do with patients who are diagnosed with a degenerative disease who are functioning optimally?
May be discharged with pre-scheduled reassessment.
What is the notion of plateau?
Making no more progress at that time.
Who would be an example of a patient who tends to plateau?
A stroke patient in chronic stage.
What happens when a patient hits plateau?
They may have adapted to the therapy regimen. So novel tasks requiring repeated practice should be considered for these patients.
Will a patient who has hit plateau stop making progress?
They may make progress later on.
L-Dopa is a type of pharmacological management that is used with what patients?
Parkinson’s disease
Deep brain stimulation is a surgical treatment that is used with what patients?
Parkinson’s disease
What is a pharyngeal flap?
A surgical treatment for VP function, it helps improve speech deficits.
____ ____ for VP closure is hard to get used to and need to be molded for individual patients - are often uncomfortable.
Palatal lift
Patients need to have their own teeth for the ____ ____.
Palatal lift
Palatal lift may be used with patients diagnosed with ____.
ALS
What prosthetic management technique can be used to slow rate of speech, especially for hypokinetic dysarthria?
- pacing board
- pointing to first letter of word
- direct auditory feedback
What is a voice amplifier used for?
to aid in reduced intensity.
The voice amplifier is useful with what types of patients?
Patients with ALS and Parkinsons’, because they are degenerative and won’t improve.
What are types of AAC intervention?
Light pointers
switches
How do clinicians maximize communication?
By whatever means that will produce the most rapid, effective, natural results.
What is the goal of speaker oriented approaches?
To improve the speaker
How can clinician reduce MSD impairment?
By increasing physiologic support - oral motor exercises to increase strength and ROM.
Name speaker oriented approaches:
- increase physiologic support - oral motor exercises to increase strength and ROM.
- use compensatory strategies such as slow rate and over articulation.
What do communication oriented approaches do?
structure the interaction to improve speaking strategies. Give patient hierarchy of strategies.
How does the clinician provide counseling and support?
Providing information on the disease and future course as well as types of intervention; assisting patient in learning to live with the disease.
What are the foundations for behavioral management?
- neuroplasticity
- motor activity itself help in this reorganization
- the nervous system is capable of some recovery
What is neuroplasticity?
The ability of the injured brain to reorganize itself to compensate for impaired abilities.
What does repeated motor performance affect?
cortical reorganization and improves performance
The nervous system is capable of ______ _______. There are _____ to what can be expected but we should not assume there can be no ______.
some recovery
limits
recovery
What does motor reorganization require after injury?
Use - you must use it to improve it.
For patients with non-progressive disorders, recovery requires lots of ______.
speaking
Speech must become _______ - patients must learn to _________ and _________ —–and must start early on.
conscious
self-monitor
self-criticize
What should be first consideration in MSDs?
increasing essential physiologic support
Improving speech requires ______.
speaking
Drill is essential—-What is more effective?
Short, frequent periods (minutes) are more effective than long periods (hours).
Both _____ and _______ are important in principles of motor learning for speech.
instruction
self-learning
______ is important especially in early stages, can be provides by SLP or others, _______ through instruments is helpful also.
Feedback
feedback
What does data show regarding feedback?
Frequent feedback may decrease performance and that less frequent feedback (after every 5 trials or so) is better for long-term effects.
_______ of training is important. Data shows that use of _____ ______ exercises may not assist in speech improvement. Speech tasks should be the focus
Specificity
oral motor
What does data show regarding oral motor exercises?
The use of oral motor exercises may not assist in speech improvement. Speech tasks should be the focus.
What are consistent practice examples?
-saying the same sound, word, etc for a number of times.
What are variable practice examples?
Focusing on slowing rate on a group of words then focusing on stress of those words.
There is a trade-off between _____ and _____. If you emphasize speed, it reduced accuracy and vice versa.
speed
accuracy
Initially emphasize _______ till the patient is ______, then work on increasing rate but keep an eye on accuracy.
accuracy
intelligible
When should strength training be considered?
Should only be used for those with weakness as the cause of speech problems and for whom there are no contraindications.
What kind of exercises should be avoided by patients with ALS and other degenerative diseases?
strength training
______ _____ help shape management goals.
Medical diagnosis
Ataxic dysarthria might suggest working on ______ first and not work on ______.
incoordination
strength
How does a clinician determine what to work on with a patient diagnosed with a MSD?
- Determine the component of the speech system that needs tx.
- Establish a hierarchy of which subsystems to treat first. Tx should begin with the source.
- Rule of thumb- begin working on the component that will have the most benefit on other components.
- Consider that what changes with minimal instruction and effort may be easiest to change habitually.
Management should start _____ most of the time, but must be out of _____ _______.
early
medical danger
What has research shown regarding patient in the chronic stage and treatment?
They can show improvement
Why is baseline needed?
To establish goals and measure change.
______ frequency is better. Typically ____ _____ in rehab settings.
Greater
twice daily
How should clinician organize session in terms of tasks?
Start with easy tasks, then harder ones & end with success
What performance level should client work at?
60-80%. When 90% accuracy is achieved, increase difficulty.
What should be considered to have an effective session?
Fatigue. Tx is best early in day if possible
What type of treatment is best in initial stages of tx?
Individual tx
Why is group treatment helpful?
With carry over and generalization
What should clinical decisions be based on?
Evidence based practice but with considerations for all the variables that involve individual patients.
What is the primary goal for tx of AOS?
To maximize the effectiveness, efficiency and naturalness of communication.
What does treatment of AOS focus on?
Restoring or compensating for impaired function and adjusting to the loss of normal speech.
What differentiates treatment for dysarthria vs treatment for apraxia?
Treatment of dysarthria focuses on improving the physiologic support for speech whereas for apraxia treatment it focuses on improving the programming of speech.
Apraxia treatment should allow time for learning to be _______. Don’t stop treatment as soon as _______ is seen.
solidify
improvement
What should be the goal for patients with progressive diseases with apraxia?
The goal should not be to work toward improvement but to maximize communication.
What targets for apraxia do SLP traditionally started with?
Targets that were stimulable, however, research has shown that working on more difficult targets may result in better generalization but will be harder to initially acquire.
