L10: Ataxic Dysarthria Treatment Flashcards
what are the 3 ways we can stabilize the resp pattern when treating resp impairment in AD?
inc the size/volume of inhalations during speech
reducing abnormal resp patterns
establish more appropriate locus of breath groups
how can we inc the size/volume of inhalations during speech when treating resp impariment in AD?
work on improving lung volume range during speech
work on initiating speech breath groups at inspiratory volumes close to/or above 60% total lung volume
try to avoid going to excessively low lung volumes at the end of breath groups (end breath groups at 35% total lung volume)
how can a respitrace/transducer system be used when treating resp impariment in AD?
assess patient’s total lung volume range and determine 35-60% range for speech breathing
determine how effectively pt is using this range
provide visual feedback about lung volume targets during therapy
how can we reduce abnormal resp patterns when treating resp impairment in AD?
using feedback from the respitrace observe and train pts to avoid paradoxical resp patterns
may need to provide suggestions to stabilize or focus effort on abdominal muscles
slower speech and greater lung volumes may also reduce paradoxing
slower speech may also reduce the effects of paradoxing on intel
how can we establish more appropriate locus of breath groups when treating resp impariment in AD?
work on initiating breath groups at grammatically acceptable locations
part of this work would prob include extending the length of the breath groups
how can you treat laryngeal resp coordination w AD?
work on initiating phonation at the onset of the exhalation phase
via obs/feedback/oscilloscope/respirtace
how can you treat laryngeal on/off phonatory control w AD?
vowel repetitions at various states
determine limits of voice onset and offset control and see if it can be improved
try w repeated voiceless consonants
what are contrastive production/minimal contrast drills?
pt works on a single phonetic contrast (i.e. voiced/voiceless) in isolated syllables or monosyllabic words
task is to try to make the two sounds as diff as possible
naiive listner attempts to identify which sound was produced
a kind of compensation/exploration task w ongoing knowledge of results type feedback
During a contrastive stress drill a clinician may provide some suggestions for new parameters to explore such as…
For voiced/voiceless contrast
–>
longer vowel durations preceding voiced consonants
longer stop closure durations or pauses preceding voiceless
more asp noise in voicless
more intense stop bursts and fricatives for voiceless
prevoicing of voiced stop
for place contrasts –> suggestions about alternate tongue shapes or positions
slowing the rate (even tho they already have a slow rate) in AD may have what benefits?
time for more accurate articulatory positions and enhanced listener perception
more time for greater variations in the pitch and loudness contours may break up the excess and equal stress patterns
what could you use for rate control w AD?
pacing board
alphabet board
delayed aud feedback
waveform matching feedback procedures
how can rhythmic cueing and pacer software be used for AD?
clinician paces pt by pointing to printed material one word at a time
point for longer time to words that should be stressed and extended in duration
pt can lag behind clinician but should not get ahead
Yorkson et al 1988 had one women w Friedrich’s ataxia use a computerized rhythmic cueing to reduce rate and found that
speech rate dec (57 to 48 wpm)
intell inc (23 to 52%)
Yorkson et al 1990 w 4 ataxics using computerized rhythmic cueing found
20-30% inc in intell
requires many hours of training to establish desired rate
describe how fill the screen/waveform length matching (visual) feedback can be used in AD
intensity vs time displayed on a screen (like visipitch)
pt must stretch speech out to fill up the screen or to match a modelled utterance duration
berry and goshorn 1983 did a study on fill the screen/wavelength matching feedback on one AD and found that…
inc intell scores
dec rate of speech
some reduction effects at 2 weeks post
describe the diff bw rigid and less rigid rate control techniques
rigid = pacing board/metronome - involve some type of external pacing, impose a one-word-at-a-time style on the speaker
less rigid = ex. oscilloscope procedures or rhythmic cueing - more natural speech prosody
yorston et al suggests that less ridgid methods are better in AD bc … BUT… some less rigid methods require …
the rigid methods tend to exaggerate the excess and equal stress pattern
BUT some of the less‑rigid methods require more active learning and transfer of new motor skills than the rigid methods
Yorkston & Beukelman 1981 found that with 4 Ataxics ….
ataxics were most successful at improving prosody when they used extended durations to signal stressed words
use of pitch or loudness to signal stressed words did not improve prosody
Yorkston et al suggests that extending durations to signal stressed words has the following benefits
simplifies task to only one dimension
duration may be the easiest for ataxics to modify
exaggerated duration thought to be less bizarre than F0 or intensity
may be easier to overlay F0 and intensity once duration is established
Caligiuri and murry 1983 - w 2 ataxics looking at contrastive stress drills found…
visual feedback related to inc intensity and intraoral air pressure of stressed words
100% of listeners rated AD pts as sounding more normal after treatment
yorkston et al. suggest that monopatterned breat groups may lead to …. suggests that…
perception of monopitch and abnormal prosody
suggests that working on longer and more variable breath groups may improve perceived monotony of pitch
LSVT for AD found …
improved phonatory control and intel after LSVT
speech rate dec
did the slow rate make them more intel or the LSVT?
Riluzole 2010 did a medical intervention to open small-calcium activated potassium channels - which may…
they found…
reduce the hyper-excitability of deep cerebellar nuclei
ataxia found to be related to hyperexcitability of deep cerebellar nuclei
cerebello-spinal transcranial stimulation for 20 min temporarily…
improved speech
