Management Flashcards
When do you need to treat speech breathing?
If a patient has issues with decreased loudness, speech-breathing coordination, reduced naturalness of speech
RESPIRATION: Behavioural management
Increased inhalation (slow exhalation), optimal breath group, awareness of optimal breath group length, LSVT, postural changes
RESPIRATION: Postural considerations
Expiratory weaker than inspiratory (e.g., MS, TBI, SCI)
Supine
RESPIRATION: Postural considerations
inspiratory weaker than expiratory (e.g., ALS, lung disease)
Upright
RESPIRATION: Prosthetic
Abdominal trussing, pushing on abdomen (medical supervision)
PHONATION: Behavioural strategies
Effortful closure, phonation on exhalation, head turning, touch throat, breathy onset, LSVT
RESONANCE: Prosthetic
Palatal lift, nose clip, nasal obturator
RESONANCE: Behavioural
Speech hygiene, CPAP training, feedback
ARTICULATION: Prosthetic
Bite block (hypokinetic, hyperkinetic, spastic; never flaccid)
ARTICULATION: Behavioural
Strength/speed training (not for degenerative disease; only when weakness is impacting intelligibility; flaccid, UUMN, spastic, hypokinetic)
Biofeedback
Exaggerated articulation
Minimal contrasts (get good inventory, consider neighbourhood)
Intelligibility drills
RATE: Prosthetic
Delayed auditory feedback (hypokinetic)
Pacing devices (hypokinetic, spastic-ataxic)
Alphabet supplementation
RATE: Behavioural
Hand or finger tapping
Rhythmic cueing (point to words whole speaking in speech rhythm; Friedrich’s ataxia)
Visual feedback
‘Backdoor’ (increasing loudness, pitch variability, stress, phrasing)
PROSODY: Behavioural
Breath group (chunk utterances)
Contrastive stress
Referential tasks
Work across breath groups
Speaker Tx examples: Flaccid
Increasing respiratory support (MPT, subglottal air presure, posture, prosthetic, deep inhalation)
Surgery on VF
Palatal lift, surgery, CPAP
NSOMEs (non-degenerative only)
Myasthenia Gravis contraindications
Behavioural speech tx
Speaker Tx examples: Spastic
Medications, laryngeal botox
Relaxation, stretching
Spastic contraindications
Effortful closure techniques
Speaker Tx examples: Ataxic
Behavioural techniques (modifying rate or prosody)
Ataxic contraindications
Muscle strength training, surgery, prosthetics
Speaker Tx examples: Hypokinetic
Surgery, deep brain stimulation
Meds
Behavioural - rate control, increasing loudness, speech exercise, intensity
LSVT
Speaker Tx examples: Hyperkinetic
Behavioural - decreased rate, postural changes, increase pitch, breathy onset, glottal attack
Meds
DBS
Speaker Tx examples: UUMN
Treat areas of deficit
Speaker Tx examples: Mixed dysarthria
Usually behavioural Palatal lift (flaccid-spastic ALS)
Communication Tx Speaker strategies (7)
Prepare listeners Convey how communication should occur Set context and identify topic Modify sentence content, structure, length Gestures Monitor listener comprehension Alphabet supplementation
Communication Tx Listener strategies (4)
Maintain eye contact
Active listening
Modify environment
Maximize listener hearing and vision
Communication Tx Interaction strategies (6)
Schedule important interactions Select environment Eye contact Identify breakdowns and establish feedback Repair breakdowns Combine and modify strategies
Speech oriented approach
focus on restoring or modifying the patient’s speech
Communication oriented approach
focus on improving communication by modifying
communication interactions
Two main goals of speech oriented treatment
- Primary goal is on intelligibility/accuracy of speech
2. Secondary goal is on efficiency and naturalness
Efficiency & Naturalness?
Efficiency means increasing the rate of speech without
sacrificing intelligibility
Naturalness involves targeting prosody (rate, rhythm,
intonation and stress) as these give clues to meaning within an utterance
Speech Oriented tx methods (general)
Reducing impairment by increasing physiologic support
(behavioural)
Compensating for impairment and maximizing the use of
residual physiological support (behavioural, prosthetic,
medical)
the first step in your treatment / management
Understanding the WHY of the perceptual features
When to begin therapy - Trauma (CVA, TBI)
Client should be medically stable
Early intervention is best (usually within 1 – 4 weeks)
Chronic phase can still see improvements (esp functional)
When to begin therapy - Degenerative (i.e., PD, ALS, MS)
Early intervention is best – may help slow the deterioration of speech – may decrease the likelihood of maladaptive behaviours or strategies being learned
When to begin therapy - Pediatric
Early intervention is best (once identified as having a MSD)
Individual vs. group therapy
Individual therapy:
Good early on allows you to focus on specific aspects
Can obtain max number of responses
Alter therapy based on clients responses
Group:
Practice strategies in a more natural communication setting
Carry over of what is taught in individual therapy
Meet others, share experiences, get feedback from peers
Neurogenic stuttering: SLP Role
Behavioural: Improve self-monitoring Easy onset (yawn-sigh) Slowing rate of speech (pacing board, DAF*) Use of rhythm and singing Relaxation
Palilalia: SLP Role
If there is underlying Dysarthria, treat the Dysarthria
If palilalia is pervasive and disabling and client has intact
cognitive abilities…try to decrease the behaviours
Little is known about treatment… try:
Rate reduction
Increase awareness – self monitor
Practice speech in contexts not as impacted by palilalia
Foreign Accent Syndrome: SLP Role
Traditional treatments for AOS and aphasia can be used
Target vowels, prosody, syntax, word retrieval
Aprosodia: SLP Role
Increase awareness (if necessary)
Family education
Contrastive and/or lexical stress “drills”
May need to progress through a continuum of steps (i.e., model, unison, repeat…spontaneous)
Cognitive-linguistic approach:
Clients match emotion words with tone of voice or pictured facial expressions… producing words spontaneously with target emotion
Mixed dysarthria more or less common?
More common
Mixed Dysarthria causes
Combination of the same neurological event (e.g., multiple
strokes in different parts of the brain/brainstem)
Two or more neurological events (e.g., stroke and PD)
Very commonly due to degenerative disease (e.g., ALS)
Mixed dysarthria: ALS
Spastic + Flaccid
Mixed dysarthria: Friedrich’s ataxia
Ataxic – Spastic Dysarthria
Mixed dysarthria: Progressive Supranuclear Palsy (PSP)
Hypokinetic – Spastic – Ataxic Dysarthria
Mixed dysarthria: Multiple System Atrophy (MSA)
Any combination of Hypokinetic,
Hyperkinetic, Spastic, Ataxic
Mixed dysarthria:
Spastic – Ataxic Dysarthria
