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msd final - new content > managing dysarthrias > Flashcards

managing dysarthrias Flashcards

1
Q

speaker-oriented treatment

A

medical, prosthetic, and behavioral tx directed at modifying respiration, phonation, resonance, artic, rate, prosody, and naturalness

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2
Q

Respiration - Increasing respiratory support tx

A
  • Require 5cm water pressure for 5 sec
  • Controlled exhalation
  • Pushing, pulling, bearing down
  • Inspiratory and Expiratory Muscle Strength Training
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3
Q

Respiration - prosthetic tx

A
  • Abdominal trussing for posture and support
  • Abdominal force for increased expiratory strength
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4
Q

respiration- behavioral tx

A
  • Deep breath before speech
  • Limit breaths per expiration: Establish optimal breath group and advance as tolerated
  • Speech breathing treatment + Lee Silverman Voice Therapy (LSVT)
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5
Q

phonation- surgical tx

A
  • VF paralysis or bowing: Medialization (type I) thyroplasty, Arytenoid adduction surgery, Surgical anastomosis
  • Adductor spasmodic dysphonia: Recurrent laryngeal nerve resection, Botox injection, Laryngeal adductor denervation-reinnervation, Lateralization (type II) thyroplasty
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6
Q

phonation- prosthetic tx

A
  • SpeechVive for increasing loudness in individuals with Parkinson’s disease
  • Ambulatory voice monitoring and feedback devices
  • Portable voice amplifier
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7
Q

phonation- behavioral tx

A

For unilateral/bilateral VF paralysis: effort closure techniques, initiate phonation at the beginning of exhalation, turning head, lateral digital manipulation, LSVT

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8
Q

resonance - medical/surgical tx

A

injection pharyngoplasty

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9
Q

resonance- prosthetic tx

A
  • palatal lift prosthesis
  • nasal obturator
  • one-way nasal speaking valve
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10
Q

resonance- behavioral tx

A
  • Modifying the pattern of speaking
  • resistance training (CPAP)
  • feedback
  • nonspeech velopharyngeal movement
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11
Q

artic- medical/surgical tx

A
  • Neural anastomosis
  • Botox injection
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12
Q

artic- prosthetic tx

A

bite block for jaw opening

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13
Q

artic-behavorial

A
  • Strength training: Not generally advised or considered effective
  • Stretching: may have some effect on increasing ROM and decreasing the effects of spasticity on speech; Sustained maximum jaw opening; tongue protrusion, retraction, or lateralization; and lip retraction, pursing, and puffing
  • Relaxation: Not advised; focus on speech movements
  • Biofeedback: Limited research
  • Traditional articulation methods: Integral stimulation, phonetic placement, phonetic derivation; Minimal contrasts, clear speech, intelligibility drills
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14
Q

rate

A

Possibly most effective treatment area at increasing intelligibility

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15
Q

rate- prosthetic tx

A
  • Delayed auditory feedback, pacing board
  • auditory and visual metronomes
  • alphabet supplementation
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16
Q

rate- behavioral tx

A
  • Slow speech rate, hand or finger tapping, rhythmic cueing, visual feedback, backdoor approaches
  • SLP should also adopt approach to model
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17
Q

naturalness

A

reflects the overall adequacy of prosody

18
Q

prosody- behavioral tx

A
  • Breath group- prosodic pattern during a single exhalation
  • Chunking utterances
    Contrastive stress tasks
    Referential tasks
    Can convey stress by modifying pitch, loudness, or duration
19
Q

flaccid- main issue

A

weakness
note: Exercises will not be successful if LMN innervation is completely lost

20
Q

flaccid- respiratory weaknesss

A
  • need increase physiologic support for speech breathing
  • increase subglottal air pressure on nonspeech tasks, increase maximum vowel duration, increase loudness, increase breath group duration and words per breath group, and establish maximum breath groups for speech
21
Q

flaccid- Adductor VF weakness/paralysis

A
  • medialization thyroplasty, arytenoid adduction surgery, surgery to reinnervate a paralyzed vocal fold, or injectable substances to bulk up the vocal folds
22
Q

flaccid- Velopharyngeal dysfunction

A

palatal lift prosthesis

23
Q

flaccid- Lingual and labial weakness

A

bite block

24
Q

flaccid- myasthenia gravis

A

behavioral speech treatment contraindicated

25
Q

spastic tx

A
  • Relaxation and stretching exercises?
  • Behavioral treatment for pseudobulbar affect?
  • Behavioral treatment for most affected speech characteristics
26
Q

ataxic tx

A
  • focus on BEHAVIORAL tx
  • emphasis on improving or compensating for problems related to motor control and coordination
  • Modifying rate and prosody to improve intelligibility
  • Further modifying rate and prosody to improve naturalness
  • Techniques that emphasized rate, loudness, or pitch control
27
Q

hypokinetic- surgical tx

A
  • VF paresis or bowing = medialization laryngoplasty or VF injections
  • Neurosurgical: thalamotomy, pallidotomy, and deep brain stimulation
28
Q

hypokinetic - pharmacologic tx

A

Dopamine agonist medications (e.g., Simenet)

29
Q

hypokinetic - behavioral tx

A
  • Rate control techniques (DAF, pacing boards), loudness (intensity monitors, amplification devices, improving posture, EMST)
  • LSVT LOUD
30
Q

LSVT LOUD characteristics

A
  1. Intensity (four times per week for 1 month)
  2. Requirement for energetic, high levels of physical effort to increase loudness and vocal fold adduction
  3. Exclusive focus on respiratory-phonatory effort (i.e., not resonance, articulation, rate or prosody)
  4. Focus on increasing sensory awareness of loudness and effort. Exercise includes vowel, word, phrase, sentence, and conversation production tasks.
31
Q

hyperkinetic - Primarily surgical and pharmacologic tx

A
  • Essential tremor, dystonia, dyskinesia, tics = deep brain stimulation
  • Spasmodic dysphonia (SD) = Botox injection
32
Q

hyperkinetic - behavioral prosthetic tx

A
  • Jaw, tongue, or face dystonia =bite block, gum
  • Adductor SD =increasing pitch, breathy vocal quality
  • Adductor SD = hard glottal attacks, voicing voiceless consonants
33
Q

UUMN - behavioral tx

A
  • Focus on rate, prosody, and articulation
  • Compensation > restoration
  • Mirror for reduced saliva management
  • As dysarthria is usually mild, SLP focus shifts to co-occurring impairments
34
Q

mixed tx

A
  • Treat individual dysarthrias
  • note: Some treatments may be contraindicated by the presence of another dysarthria type
35
Q

ALS tx

A

palatal lift prosthesis

36
Q

PSP tx

A

LSVT

37
Q

communication-oriented tx

A
  1. Speaker strategies
  2. Listener strategies
  3. Interaction strategies
38
Q

speaker strategies

A
  • prep listeners with alerting signals
  • convey how communication should occure
  • set context/identify topic
  • modify sentence content, structure, length
  • gesturess
  • monitor listener comprehension
  • alphabet supplementation
39
Q

listener strategies

A
  • maximize hearing and visual activity
  • eye contact
  • optimized physical environment
  • improve listening skills: perceptual training and listener familiarization
40
Q

interaction strategies

A
  • schedule important interactions
  • select conductive speaking and listening environment
  • identify breakdowns sand est. methods of feedback
  • repair breakdowns
  • est. what works best and when

msd final - new content (5 decks)

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