Management Flashcards
Overall goal of managing motor speech disorders is to…
Improve communication
3 overall things that management should focus on
Restoring, compensation, adjusting to MSDs
5 factors that the decision to treat and selection of management strategies are influenced by
- Medical diagnosis and prognosis
- Disability and societal limitations
- Environment in which communication will occur and the characteristics of the patient’s communication partners
- Patient’s motivation and needs for communication
- Presence and nature of additional problems that may affect communication (memory, learning impairments, oral sensory and motor deficits)
Treatment should be terminated when _____, _____, or _______
- Functional goals are met
- True plateauing occurs
- Patient decides they no longer want treatment
Management of MSDs can be _____, _____, or ______
Medical, prosthetic, or behavioral
Medical management of MSDs can include
Pharmacologic and surgical (some might be done to improve speech and others can be done to treat general effects of the causal conditions)
Prosthetic management includes
Mechanical and electronic devices (some improve speech or intelligibility whereas others augment or substitute verbal communication)
Behavioral management for motor speech disorders includes
- Speech oriented treatment (improve intelligibility, efficiency, or naturalness or spoken communication by reducing or compensating for underlying impairment)
- Communication oriented treatment . (Emphasize environmental modifications and strategies for interacting and repairing breakdowns in communication when they occur) (AAC)
General principles of management of MSDs (4 things)
- Recognizing the relevance of medical and speech diagnoses
- Advantages of starting management early on
- The need to acquire baseline data to set goals and measure change
- Value of increasing physiologic support early in treatment
Actual treatment of MSDs must recognize (5 things)
- Patient’s need to make speech a conscious act
- Importance of principles of motor learning in the conduction of treatment
- Importance of drills
- Value of instruction, self-learning and feedback
- Value of consistent and variable practice
Overall, treatment of flaccid dysarthrias should focus on…
Increase strength or compensate for weakness
Flaccid dysarthria treatment should focus on the ____, _____, ____, and _____ components of speech
respiratory, phonatory, resonatory, and articulatory
Respiratory goals for flaccid dysarthria
- Increase sub glottal air pressure on non speech tasks
- Increase maximum vowel duration
- Increase loudness
- Increase breath group duration and words per breath group
- Establish maximum breath groups for speech
Methods to increase physiologic support for speech breathing in flaccid dysarthria
- Pushing/pulling exercises to increase respiratory support and drive
- Postural adjustments
- Prosthetic aids
- Compensatory efforts- deep inhalation, controlled exhalation, inspiratory checking, increased force
Spastic dysarthria treatment techniques
- Relaxation exercises
- Stretching exercises of the articulators
- Reducing rate of speech movements
- Use of anti spasticity medications
Ataxic dysarthria treatment techniques
- Pharmacological treatments have been effective
- Behavioral treatment is the focus
- Improve or compensate for difficulties related to motor control and coordination
- Modifying rate and prosody to improve intelligibility and when possible, modifying such to improve naturalness (LSVT)
Treatment techniques for ataxic dysarthria
- Similar in nature to flaccid dysarthria
- Laryngeal surgical and neurosurgical interventions
- Deep brain stimulation- reduce activity in overactive brain structures through inhibition of neuronal firing or facilitation of inhibitory interneurons
- Pharmacological Treatments- Effects of parkinsonian medication can fluctuate as a function of the drug cycle
Behavioral management of hypo kinetic dysarthria should focus on (4 things )
Respiration, phonation, rate, and prosody
Popular behavioral treatment for hypo kinetic dysarthria
LSVT
Hyperkinetic dysarthria treatment is primarily
Surgical, pharmacologic (although research has indicated that behavioral treatments have benefited some patients)
Treatment for unilateral upper motor neuron dysarthria focuses on (3 things)
Rate, prosody, and articulation
Mixed dysarthria treatment…
may vary
Speaker oriented treatment for respiration
- Increasing respiratory support
- Prosthetic assistance
- Behavioral compensation and control
- Instrumental biofeedback
Speaker oriented treatment for phonation
- Laryngeal framework and related laryngeal surgeries (medialization, larygoplasty, resection of recurrent laryngeal nerve)
- Injectable substances for vocal fold paralysis (collagen, homologous collagen, autologous fat)
- Botulinum toxin injections (for spasticity)
- Pharmacological management
3 Prosthetic managements for phonation
Portable voice amplifier, artificial larynx, vocal intensity controller
Behavioral management techniques for phonation
- Effort closure
- Initiate phonation at the beginning of exhalation
- Turning the head left or right
- Lateral digital manipulation
- LSVT
Surgical management technique for resonance
Pharyngeal flap or sphincter pharyngoplasty surgery for velopharyngeal insufficiency
Behavioral management for resonance
- Modify pattern of speaking
- Resistance training during speech
- Feedback
- Nonspeech velopharyngeal movements
Surgical management for articulation
Neural anastomosis
Botox injection
Speaker oriented management for articulation can be
Surgical, pharmacological, prosthetic, behavioral
Behavioral techniques for articulation
- Strengthening
- Stretching
- Relaxation
- Instrumental biofeedback
Speaker oriented treatments for rate
- Rate modification
- Prosthetic management
- Nonprosthetic rate reduction strategies
What are some non prosthetic rate reduction strategies?
- Hand or finger tapping
- Rhythmic cueing
- Visual feedback
Speaker oriented treatments for prosody and naturalness
- breath group
- contrastive stress tasks
- referential tasks (finding stress words for emphasis during speech)
Strategies for communication oriented treatment
- Prepare listeners with alerting signals
- Convey how communication should occur
- See the context and identify the topic
- Modify sentence content, structure, and length
- Use of gestures
- Monitor listener comprehension
List some listener strategies
- Maintain eye contact
- Listen attentively and actively work at comprehension
- Modify the physical environment
- Maximize listener hearing and visual acuity
List some interaction strategies
- Schedule important interactions
- Select a conducive speaking and listening environment
- Maintain eye contact between listener and speaker
- Identify breakdowns and establish methods for feedback
- Repair breakdowns
- Establish what works best and when
Treatment of AOS may be precluded if….
There is cooccurring aphasia
There are no surgical or pharmacological interventions for….
AOS
_____, _____, ______ can be effective tools in treating AOS
Rate control devices, biofeedback, and AAC
Are prosthesis for modifying the vocal tract and the acoustic signal appropriate for AOS?
NO
Are communication oriented approaches appropriate for AOS?
YES
Speaker oriented approaches to AOS focus mainly on ______ and ________
articulation and prosody
__________ is an important component of speaker oriented treatment of apraxia of speech
systematic, intensive, and extensive drill
Indirect pharmacological treatment for AOS
- Antibiotics for infection, anticoagulants to prevent stroke, anticonvulsants to prevent seizures
Indirect surgical procedures to treat AOS
Pharyngeal flap, tumor resection
AOS patients tend to benefit from prostheses that….
Promote rate reduction or pacing of word production
_____ can be used to pace word production and promoter movements
metronome
List some prostheses used as part of AAC systems
- Pictures, letter and word boards, electronic and computerized devices,
- Degree of accompanying aphasia can place limits on the sophistication of messages
- ASL can improve communication
AOS is predominantly a disorder of _______ and _______
articulation and prosody
______ and _____ drill is important to treat AOS
Intensive and extensive
Self feedback is important in drill therapy for (disorder)
AOS
What is specificity of training for speech tasks in AOS
Taking the simple form of a syllable and progressing it into the form of a word, phrase, and sentence
What is specificity of training for non speech tasks in AOS
Use of vegetative or reflexive actions such as grunting, coughing, and laughing which may be shaped into volitional control as a precursor to voluntary or automatic speech production
What is consistent or blocked practice
Use of multiple trials of multiple repetitions of sounds ,words, phrases, nonsense syllables, or non speech oral motor movements in treatment
What is variable or random practice
Multiple sounds are targeted or the patient is required to program more elements into responses with syllable to syllable or response to response variability. Minimal or greater contrasts are targeted.
What is speed-accuracy trade off in AOS treatment?
Reduced rate is often emphasized early in treatment, giving way to attempts to increase speed as accuracy increases
Once accurate articulation has been achieved during treatment, increased rate should be pursued
Imitation in AOS treatment. What is it?
Require volitional responses to clearly established targets with parameters that can be carefully selected to ensure an appropriate level of challenge and success.
Advantages of imitation in AOS treatment
Simplifies drill, facilitates obtaining a maximum number of responses, reduced demand for cognitive and linguistic processing and bypasses some of the language deficits that affect comprehension and formulation when aphasia is also present
1 important thing in treating acquired psychogenic and related nonorganic speech disorders
Require that speech symptoms and explanation for their existence be explained to the patient.
In psychogenic speech disorders, ________ is crucial to management
Clinician’s attitude
Therapy for PNSDs involves
Efforts to reduce excessive musculoskeletal tension, may involve physical contact to decrease laryngeal tension, identify normal behaviors and gradually shape normal speech responses with continuous explanation and reinforcement for change
