Intervention Flashcards
Purpose of intervention
Restore lost function. Develop speech that's intelligible, natural and effecient as possible. Compensate for lost function. Establish a means of communication. Facilitate adjustment to lost function. Maximise communication success. Reduce the impact of dysarthria.
For intervention what should the focus be?
Focus should be on communication not just speech.
What are the factors influencing intervention?
Cognitive Status-including patient awareness and insight
Psychological Status
Underlying medical condition, it’s complications, likely prognosis, speed of deterioration etc.
The patient needs and priorities
Important to also involve family.
Goal Setting
Clearly Defined
Agreed with patient
Short and Long term
Use ICF think about impairment, activity and participation- also consider personal and env. factors (influencing factors)
What is it important to do throughout intervention?
Monitor and evaluate :)
When to offer intervention.
If dysarthria is due to a sudden onset e.g. stroke, TBI- what is best?
It is best for direct treatment to commence if and when the patient is mentally stable and ready to engage.
The patient has to be in a stable condition :)
In intervention, what’s encouraged?
Individual practice of direct treatment.
What is the best timing for intervention in progressive conditions, and why?
Early intervention is the goal in progressive conditions. This is in order to:
- Increase awareness and monitoring of speech
- Promote purposeful activity
- Prevent maladaptive behaviour
In degenerative conditions, what can the individual decide?
If they want shorter but frequent input at repeated intervals OR Input in response to changes OR input to prepare for the likely changes
We have to respect if people don’t want intervention, but have a plan in place for future etc.
Types of intervention.
Patient
Treatment of impairment Compensatory Strategies Education and awareness training Introduction and practice of AAC Psychosocial support Individual or group based
Types of intervention.
Communication partner.
Education and advice about dysarthria and underlying neurological condition.
Increase awareness of their role in communication exchange.
Education and advice on how to support communication.
Psychological support.
Types of intervention.
Indirect
Environmental modifications e.g. reduce background noise, appropriate positioning, seating, lighting etc.
Education and awareness training for care staff and general public.
Name the different intervention methods.
Behavioural
Biofeedback/instrumental
Surgical and prosthetic
Pragmatic
Behavioural Intervention.
The behavioural approach to dysarthria involves teaching patients new skills, compensations or adjustments that us traditional stimulus presentation, patient response and subsequent response contingencies.
What are the advantages of behavioural intervention?
The ability to conduct these techniques in any situation.
Relatively little or no cost for equipment.
Give an example of a behavioural intervention.
LSVT - Lee Silverman Voice Treatment for PD and other neurological conditions. “speak loud”
instrumental approach involving…
biofeedback techniques.
What do biofeedback methods provide?
They provide an effective method of establishing motor control of sensory input at all levels of the speech production mechanism.
What does the biofeedback encourage?
It encourages patient self-monitoring.
but the therapist must ensure that over reliance doesn’t occur.
Give examples of biofeedback .
volume meter, vispitch and sound meter apps.
What is an alternative to traditional or biofeedback therapy techniques?
Surgical and prosthetic approach.
Define prosthetic treatment.
any method that alters the physical properties of the motor speech system.
Give examples of prosthetic treatment.
Amplification Devices.
Palatal lift- improves palatopharyngeal closure to improve resonance and articulation
Name examples of surgical procedure.
Botocx into thyroarytenoid muscle where hypo-adduction of vocal folds occurs.
Nasal obturator- reduces nasal escape of airflow-unlikely to find this socially acceptable though.
When should botox injections only be considered?
only considered if poor voicing is the main reason for communication breakdown.
Name some specific approaches.
AAC
Treatment techniques specifically designed to target neurologically impaired subsystems of speech.
Who would be best suited to use AAC?
People with progressive dysarthria, to overcome problems with intelligibility.
What does introduction of AAC depend on?
Patient Needs
Cognitive skills
Motor skills
Staging of neurological disorder.
What is the fourth approach?
The Pragmatic Approach
What is the pragmatic approach?
Helping the patient to maximise communication within situations and contexts of daily life.
What does the pragmatic approach require?
SLT to work closely with the patient and family.
Give examples of pragmatic treatment
Alter the communication environment in order to enhance communication. Modify utterance length Teach effective repair strategies Effective self-monitoring Improve topic orientation.
What are some environmental changes?
avoid dark, noisy places, reduce distance to compensate for volume deficits, use non-verbal and verbal cues.
