L8: Treatment of Spastic Dysarthria Flashcards
what two things should be focused on for treatment of resp impairment in SD?
improving vital capacity and lung volumes during speech
improving abdominal contributions to speech breathing
murdoch et al - based on a speech study of 18 spastics recommends any therapy program for resp impairment that…
inc the depth of inspiration
inc the range and force of abdominal movements
what are 3 behavioural resp treatment methods for SD?
accent method
inspiratory checking
breathing-for-speech treatment program
what is accent method? what is the rationale?
a method of treatment for hyper functional voice
rationale = to normalize vocal fold vibratory patterns, inc the efficiency and flexibility of vocalization, reduce excessive muscular tension, and inc pulmonary output
what does the accent method involve?
extensive use of rhythmic vocal play, a variety of pitch and loudness patterns produced at diff rates and guided by external drum beats or rhythmic body movements
also focuses on the abdominal muscles - pts learn to monitor and enhance their activity during vocal exercises
shimizu et al found that the accent method post treatment…
inc phonation time, more consistent syllable durations and inc speech intelligibility
koschkee found that the accent method…
improvements in resp function, vocal shimmer, and pitch range
what is the rationale for inspiratory checking?
inc depth of inhalation, inc the length and control of exhalations
what are patients instructed to do during inspiratory checking?
instructed to take a deep breath and try to let the air out v slowly
requires insp muscle activity to check or slow the exhalation rate
try w speech and non speech tasks
netsell and hixon found that with inspiratory checking 3/6 SDs showed
improvements in speech breathing
what is the goal of breathing-for-speech program?
to achieve relaxed, coordinated breathing for nonspeech and speech activities
11 one hour sessions
what are patients instructed to do during breathing-for-speech treatment?
nonspeech slow/moderately paced abdominal and rib cage expansion during insp and relaxed exp w/o excessive tension
speech breathing tasks had same target to reduce overflow and tension during speech tasks
what are the results from breathing-for-speech treatment?
one case spastic TBI, lung volumes during speech, breath group length and syllables per breath near normal values post tx
what can be used instrumentally for resp impairments in SD?
Airflow transducer/respirometer to provide feedback about depth of inhalations
respitrace to provide feedback displays of ribcage and abdomen movements
what are 2 instrumental considerations for resp impairments in SD?
attempts to inc insp volume/abdominal effort may inc spasticity in the resp sys and in other systems
may need to assess and identify insp levels that are a prob and make sure the pt stays below these
what are 2 prosthetics that can be used for SD w resp impairments?
abdominal binding
abdominal paddle
weak recommendation tho!
what are the 3 behavioural treatment methods for laryngeal impairments in SD?
breathy phonation
self-monitoring
prosodic exercises
how does breathy phonation work for laryngeal impairments in SD?
breathy onsets and breathy sighs
yawning and chewing methods may inc spasticity due to excessive movements
raising the chin may facilitate breathiness
how does self-monitoring work for laryngeal impairments in SD?
teach pt to recognize diffs in the sounds of harshness and breathiness, strained and relaxed voice
how does prosodic exercises work for laryngeal impairments in SD?
to enhance pitch and loudness variation
what are the two prosodic exercises for laryngeal impairments in SD?
contrastive stress drills (ex. bob bit tod, who bit tod?, BOB bit tod)
pitch contour exercises (questions, exclamations, declaratives… variety of emotional states and levels of intensity)
what are the 3 instrumental techniques for laryngeal impairment in SD?
EMG Feedback
Intensity feedback
pitch (F0) feedback
voice quality feedback
how is EMG feedback for laryngeal impairment used for SD?
to reduce laryngeal muscle activity
surface EMG electrode records external laryngeal muscle activity from the sternohyoid muscle
feedback for pt on screen - pt tries to relax muscle to reduce EMG activity
how is intensity feedback for laryngeal impairment used for SD?
oscilloscope or visipitch to provide visual display of intensity
to facilitate gentle breathy vocal onsets
to enhance contrastive stress drills
how is pitch (F0) feedback for laryngeal impairment used for SD?
visipitch to provide visual display of pitch and enhance prosodic contour exercise or to practice expanding pitch range
how is voice quality feedback for laryngeal impairment used for SD?
the CSL version of visipitch provides real time feedback about jitter and shimmer
may be useful for feedback about vocal harshness
what are the 3 prosthetic/surgical/pharmaceuticals for laryngeal impairment in SD?
tranquilizers for spasticitu
anti-depressant
botulinum toxin injections
how do tranquilizers help with laryngeal impairment in SD?
reported to reduce limb spasticity but limitted data on speech
some reported reduced strain
one pt - improved intell
how do antidepressants help with laryngeal impairment in SD? (2 types)
elavil –> reported to dramatically reduce pseudobulbar laughing and crying
nuedexta –> MS/ALS pts = only about half as many laughing and crying episodes as those who took the placebo
how do botulinum toxin injections help with laryngeal impairment in SD?
used extensively w Spasmodic dysphonia
injected into thyroarytenoid muscle = causes partial paralysis for 3-6m
reduces tension and abnormal movements but also weakens the muscle
what evidence do they have for palatal lift in palatopharyngeal issues in SD?
9/10 SDs marked or moderate improvement in hypernasality
5/5 marked/moderate improvement at 1 yr post op
concern when patient has a very spastic or hyper reflexive palate
may need to examine effectiveness of gradual inc in lift length
Improved hypernasality in 84% of ALS patients
_____ more likely to have better outcome w palatal lifts than spastic Ds
flaccid Ds
what is the goal of behavioural interventions for oral articulation issues in SD?
to improve articulatory precision w/o inc tension/spasticity in oral articulators or other subsystems
what are the 3 proposed behavioural methods for oral articulation in SD?
rate reduction procedures
louder more forceful speech
intelligibility drills w familiar listener
how can rate reduction procedures be used for oral articulation issues in SD?
should be explored esp in mild or moderate slow pts but slowing an already slow pt may produce addition distortions
found 15% inc in intel in 9 SDs
how can louder more forceful speech be used for oral articulation issues in SD?
should be considered
LSVT LOUD w 5 spastic children - listeners preferred post tx speech, improved voice measures
but could lead to inc distortions
may need to explore in a v systematic way the effects of diff levels of force/rate on articulatory precision
what are the 2 instrumental approaches for oral artic issues in SD?
Spectrographic feedback
EMG feedback
how can spectrographic feedback be used w oral artic issues in SD?
look at formant trajectories and fricative/stop spectra during various tasks
how can EMG feedback be used w oral artic issues in SD?
EMG electrodes placed on the surface of the lip or jaw muscles may be used to provide the pt w info about muscle activity that can be used to facilitate muscle relaxation
nemec and cohen 1984 found that EMG feedback w one spastic D…
could reduce jaw spasticity
intel inc from 5% to 40% after 17 sessions
marchant et al 2008 used EMG feedback by..
used superior orbicularis oris and submental surface EMG to provide feedback and reduce muscle tension during rest and nonspeech lingual and labial movements in a 13 yr old w SD (and CP)
gradually reduced EMG levels
speech intel improved when EMG tx was combined w phonetic placements
what is the one prosthetic intervention for oral artic issues w SD?
bite block –> a small custom made piece of rubber-like material which is held bw the upper and lower teeth during speech
helps maintain a constant and possible more open jaw position
removes jaw contribution to lower lip and tongue movements
