L17: Treatment of severe (mixed) dysarthria: ALS Flashcards
what are the two main ways to treat ALS speech?
augmentative/alternative comm system (AAC)
Interaction strategies
AAC system is…
an integrated group of components, including the symbols, aids, strategies, and techniques used by individuals to enhance communication
although people with ALS and their family often request oral exercises to increase strength and mobility …
these are not recommended
for ALS pts: everyday speech is…
considered a sufficient level of activity and exercise
for ALS pts speech intervention should focus on learning…
to conserve energy, be more efficient and avoid fatigue
avoid adverse speaking/listening situations (i.e. noise, large interlocuter distances)
ALS pts may benefit from possible use of amplification in noise, and AAC systems should be…
explored early after diagnosis of ALS, particularly when speech has slowed and intelligibility starts to become inconsistent in adverse (i.e., noisy) listening conditions
appropriate timing of referral for AAC continues…
to be a most important issue in ALS
- it is recommended that individuals with ALS be referred for AAC assessment when speech rate slows to 125 words per minute on the SIT (normal =190 wpm) (Beukelman et al. 2011)
what are the 4 parts of ALS treatment to consider?
assess comm needs
assess specific capabilities
facilitator support
AAC facilities and equipment
what are the 5 things to consider when assessing comm needs for ALS pts
positioning and mobility needs (ex. sitting, standing/supine, wheelchair, walking or bed)
comm partners (familiar vs strangers, single vs multiple, partner’s hearing/visual acuity)
locations (one vs multiple, one room vs multiple, home vs public)
message needs (signal emergencies, make requests, carry on convos)
modality of comm
what different modalities of communication should be considered?
printed versus spoken messages
synthetic speech
use of the telephone
acceptance of low tech versus high tech aids
most ALS patients tend to develop their homes as their social centres and only leave the home for health related appointments
their homes must be customized to meet their physical and communication needs
about ____% of ALS patients are reported to experience cognitive impairment (mild to dementia), this may interfere with acceptance and training of AAC use
15-40
what 3 specific capabilities should be assessed for ALS pts for AAC?
cognitive/linguistic skills
sensory/perceptual skills (normal or minimally impaired in ALS)
motor skills (bulbar ALS vs spinal ALS)
for bulbar ALS pts in regard to ALS w AAC , we need to consider:
often can use their hands or fingers to manipulate AAC devices
handwriting, typing, pointing on alphabet boards, etc…
devices will usually need to be gradually modified over time (i.e., arm supports, larger key pads, scanning versus letter-by-letter, switches involving hand, finger, wrist, arm movements or muscle contractions, eye movement, etc.
for spinal ALS pts in regard to ALS w AAC , we need to consider:
usually need an augmented writing system first
may be able to use a speech recognition system at first (speech to text)
eventually will require a scanning system controlled by a switch
often the AAC system must…
evolve over time
finger typing - finger switch - head switch - facial switch - head pointer eyebrow switch - eye movements – eye blink
for AAC a facilitator must be …
identified to assist ALS patient with operation and maintenance of AAC device (95% of the time it is a family member)
need for AAC equipment is often…
urgent in ALS
patients should be referred to regional AAC centres very early in disease to avoid waiting lists and to develop plans for future
at the beginning of the AAC process…
patients are assessed and provided with temporary devices for evaluation
· the Assistive Devices Program provides funding for AAC systems that have been prescribed by AAC centres
· many computer-based systems cost as much as $20,000
· the ALS Society and support groups throughout the province have lending programs that include a number of used text-to-speech systems
letter by letter devices usually involve…
a computerized device with a printed or a synthetic speech output
what are the 3 direct selection devices?
Finger Touch selection: key boards, computer touch screen, etc…
Headlight pointer or eye pointing device
Voice recognition device
describe scanning devices
a computerized system that scans through a list of items until desired item is reached (many different scanning strategies)
patient indicates, usually with an electronic switch when the item has been reached
a wide range of switches have been designed for different parts of the body (eyebrow, head, forehead, oral air pressure, eye blinks, etc…)
what are the 3 main types of AAC devices?
direct selection devices
scanning devices
alphabet board supplemented speech
yorkston et al recommends that ____ should be the 1st AAC device to be introduced because rate of communication is often much more rapid than in letter-by-letter methods of communication
alphabet board supplemented speech
rate of speech w supplemented is around 18-28 WPM, where w letter by letter it is around 4-6 WPM
assessing what may reveal the effectiveness of the alphabet board?
assessing speech rate and intelligibility under different listening conditions
1- unaided
2- alphabet supplement
3- alphabet supplement w no visual cues (rate reduction effects)
what does a pt have to show in order to be a candidate for alphabet board supplemented speech?
must have consistent voluntary phonation and differentiate vowels
limb control that allows letter pointing or be able to use a head mounted pointing device
able to correctly indicate (spell) initial letters of words
ability to use a more telegraphic style of speech
ability to develop interaction skills for reducing and repairing communication breakdowns
use of standard phrases to control listener
provide listeners with listening instructions
ability to switch to letter-by-letter style to resolve breakdowns
what is the primary role of the SLP in ALS?
refer pt to AAC centre for assessment and system selection
teach patient use of alphabet board supplemented speech if appropriate
assist patient and facilitators with new device
assess and train interaction strategies in patient and family
monitor patient’s deterioration and need for AAC reassessments
