Management

Question 1

Slowing speech rate

Answer 1

Alphabet boards, pacing boards.
Rationale: Modify rate leads to improved intelligibility.
Evidence: Improved intelligibility in severe dysarthria (Pilan et al 1988).

Question 2

Resonance

Answer 2

CPAP - Continuous positive airway pressure; provides resistance to velar movements during speech.
Palatal lift - dental retainer that helps push upward of the velum. Rationale - aid elevation of velum during speech. Duffy and Yorkston - palatal life is most succesful treatment for serious resonance problems in dysarthria. But tolerance, dentition, stable, prosthodontist.
NSOMES - little evidence - no likely

Question 3

Articulation

Answer 3

Modelling, repetition, and feedback.
Rationale - increase clients intelligibility.
Evidence - Roberston (2001) Intelligibility increased with increased practise.

Question 4

Prosody

Answer 4

LSVT - Increase vocal fold adduction and intensity of voice whilst decreasing monotone, increase loudness -‘think loud’. Use of motor learning principles. Evidence - Positive effects on speech (Story and Fox 07) but high intensity - high motivation.

Contrastive stress drills - alternatiting stress and intonation patterns. Development of stress as some patients with dysarthria has reduced stress. More effective in ataxic dysarthria associated with MS (Duffy).

Question 5

Respiration/Phonation

Answer 5

Biofeedback - improve respiratory control in some dysarthric speech. Visual feedback of chest movements during speech and non-speech, can lead to increased excursion and increased lung volume (Murdock et al 97).
Easy onset tasks - exhale and sigh, build towards easy phonation of CSP. - Darley (75) improved vocal quality.
Yawn sign - relax neck and reduce laryngeal tension.

Question 6

Compensatory Strategies

Answer 6

AAC
Listener/speaker strategies - repetition, face to face, decrease noise, eye contact (Berry and Sanow).
In severe - letter cueing is most helpful (Hunter et al 91).