L6: Flaccid Dysarthria Treatment (Part B) Flashcards
strength exercise may have the following benefits in flaccid dysarthria
inc the force and stamina of remaining healthy muscle fibres
inc the recruitment of groups of motor units and muscle fibres
focus attention on a structure and enhance voluntary control of the structure
inc the effort level directed to a specific structure
in flaccid dys. instruments that provide visual feedback about a speech process often…
help to enhance practice and motor learning
there are often several different ways to accomplish the same perceptual goals ….. so
patients need to be encouraged to explore a variety of combos of articulatory patterns and placements
what are the 7 ways to enhance speech clarity in FD?
reduced speech rate
inc pause time
over articulation
inc force and intensity of speech
exaggerated prosodic patterns and stress
shorter more efficient messages
optimizing the enviro (noise, visibility, etc)
for FD there may be methods of providing physical support to…
weak or immobile structures
augmentative or alternative comm systems may need to be considered in…
severe or rapidly progressing patients
what 2 strength exercise/procedures can be used for palatopharyngeal weakness?
palatal closure against oral pressure (ex. 5cm H2O for 5 sec, focus attention/sensation on palate, tongue depressor)
mirror practice (tries to inc palatal elevation during phonation of ah)
what 4 instrumental (feedback) procedures can be used for palatopharyngeal weakness?
nasal air pressure
nasal accelerometer
nasometer
nasal endoscope
nasal air pressure can be measured via a _____ and can be used for ____
nasal bulb and pressure measurement device
work on reducing nasal pressure during various oral consonants
nasal accelerometer measures
amplitude of nasal tissue vibration
nasometer measures
nasalance (nasal intensity/nasal + oral intensity)
nasal endoscope is a
flexible fiber optic tube w a light source that is used for viewing the nasal cavity, palate, pharynx, larynx
what are compensation strategies for palatopharyngeal weakness?
more forceful articulation of oral consonants and louder speech (for loss of intraoral pressure)
exaggerated jaw movements (may reduce nasal airflow)
slower rate of speech (more time for palatal closure)
supine position (improve nasal resonace)
what are 3 prosthetic devices for palatopharyngeal weakness?
palatal lift
nasal obturator or nose clip
possible use of CPAP
what are 2 surgical procedures for palatopharyngeal weakness?
muscle augmentation
pharyngeal flap
what is the rationale behind strengthening procedures for laryngeal weakness?
inc adductory effort and incorporate more reflextive adduction seen during lifting into phonation
what are the 2 strengthening procedures for laryngeal weakness?
pushing procedures (ex. push up or down on arms of a chair)
hard glottal attack (hold breath briefly and begin phonation w grunt or foreceful onset)
what instrumental (feedback) procedure can be used for laryngeal weakness?
sound level meter or visipitch
provides visual feedback about speech intensity
what compensatory strategies can be used for laryngeal weakness?
unilateral = turn head away from side of weakness brings weaker fold into midline
lateral digitial manipulation (thyroid cart)
facing the listener/avoiding convos in noisy enviros
what 2 prosthetic devices can be used for laryngeal weakness?
voice amplifier (may become essential in bilateral weakness)
artificial larynx (in bilateral pts)
what 3 surgical procedures can be used for laryngeal weakness? (for unilateral)
injection augmentation (ex. collagen)
thyroplasty (small wedge placed bw thyroid cart and vocal fold)
newer innervation procedures
w/ respiratory weakness we need to confirm that…
laryngeal or palatal weakness isnt the source of the apparent resp symptoms
what 2 strengthening procedures can be used for resp weakness?
max depth of inhalations
max phonation time and max /s/ time
what 3 instrumental (feedback) procedures can be used for resp weakness?
oral air pressure
sound level meter or visipitch
expiratory muscle strength training (EMST) device
describe oral air pressure as an instrumental (feedback) procedures for resp weakness
non- speech = patient blows into oral tube and manometer (goal 5cm H2O 5 sec)
Speech = monitor air pressure during repeated bilabial syllables/words/phrases
describe sound level metetr/visipitch as an instrumental (feedback) procedures for resp weakness
step wise inc in intensity and duration of phonation
consistently higher intensity for words and phrases
describe expiratory muscle strength training (EMST) device as an instrumental (feedback) procedures for resp weakness
can set amount of resistance w a valve
promote strength in expiratory muscles w training program
what 4 compensation strategies can be used for resp weakness?
reduced number of syllables per breath
shorter more efficient utterances
environmental
postural adjustments that max resp function (upright better than supine for insp weakness, supine better than upright for exp weaknesss)
what 2 prosthetic devices can be used for resp weakness?
abdominal binder (corset) –> provides platform for exp and assists w elastic recoil of abdomen (needs good insp strength)
expiratory paddle –> for those in wheel chairs, paddle placed in front of abdomen, helps w exp during speech
what strength exercises can be used for oral articulation weakness?
oral movements against resistance of an object, an instrument or another oral structure (ex. w a tongue depressor)
focuses attention on specific structure and may inc effort level and strength of movements during speech
pair strength exercises w speech sound drills to enhance transfer
what 3 instrumental (feedback) procedures can be used for oral articulation weakness?
force transducers (visual targets and feedback)
electromyographic (EMG) feedback related to facial muscle activity in speech and non-speech tasks
mirror (to observe articulators)
what compensation strategies can be used for oral articulation weakness?
explore various alternate articulatory placements
lip protrusion compensated by laryngeal lowering
lingual-dental plosive for bilabials
variety of lingual postures/contacts to achieve similar perceptual results
what 2 prosthetic devices can be used for oral articulation weakness?
neck brace, cervical collar or jaw sling
rate reduction devices
what surgical procedures can be used for oral articulation weakness?
anastomosis of cranial nerves
