managing dysarthrias Flashcards
speaker-oriented treatment
medical, prosthetic, and behavioral tx directed at modifying respiration, phonation, resonance, artic, rate, prosody, and naturalness
Respiration - Increasing respiratory support tx
- Require 5cm water pressure for 5 sec
- Controlled exhalation
- Pushing, pulling, bearing down
- Inspiratory and Expiratory Muscle Strength Training
Respiration - prosthetic tx
- Abdominal trussing for posture and support
- Abdominal force for increased expiratory strength
respiration- behavioral tx
- Deep breath before speech
- Limit breaths per expiration: Establish optimal breath group and advance as tolerated
- Speech breathing treatment + Lee Silverman Voice Therapy (LSVT)
phonation- surgical tx
- 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
phonation- prosthetic tx
- SpeechVive for increasing loudness in individuals with Parkinson’s disease
- Ambulatory voice monitoring and feedback devices
- Portable voice amplifier
phonation- behavioral tx
For unilateral/bilateral VF paralysis: effort closure techniques, initiate phonation at the beginning of exhalation, turning head, lateral digital manipulation, LSVT
resonance - medical/surgical tx
injection pharyngoplasty
resonance- prosthetic tx
- palatal lift prosthesis
- nasal obturator
- one-way nasal speaking valve
resonance- behavioral tx
- Modifying the pattern of speaking
- resistance training (CPAP)
- feedback
- nonspeech velopharyngeal movement
artic- medical/surgical tx
- Neural anastomosis
- Botox injection
artic- prosthetic tx
bite block for jaw opening
artic-behavorial
- 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
rate
Possibly most effective treatment area at increasing intelligibility
rate- prosthetic tx
- Delayed auditory feedback, pacing board
- auditory and visual metronomes
- alphabet supplementation
rate- behavioral tx
- Slow speech rate, hand or finger tapping, rhythmic cueing, visual feedback, backdoor approaches
- SLP should also adopt approach to model
naturalness
reflects the overall adequacy of prosody
prosody- behavioral tx
- Breath group- prosodic pattern during a single exhalation
- Chunking utterances
Contrastive stress tasks
Referential tasks
Can convey stress by modifying pitch, loudness, or duration
flaccid- main issue
weakness
note: Exercises will not be successful if LMN innervation is completely lost
flaccid- respiratory weaknesss
- 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
flaccid- Adductor VF weakness/paralysis
- medialization thyroplasty, arytenoid adduction surgery, surgery to reinnervate a paralyzed vocal fold, or injectable substances to bulk up the vocal folds
flaccid- Velopharyngeal dysfunction
palatal lift prosthesis
flaccid- Lingual and labial weakness
bite block
flaccid- myasthenia gravis
behavioral speech treatment contraindicated
spastic tx
- Relaxation and stretching exercises?
- Behavioral treatment for pseudobulbar affect?
- Behavioral treatment for most affected speech characteristics
ataxic tx
- 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
hypokinetic- surgical tx
- VF paresis or bowing = medialization laryngoplasty or VF injections
- Neurosurgical: thalamotomy, pallidotomy, and deep brain stimulation
hypokinetic - pharmacologic tx
Dopamine agonist medications (e.g., Simenet)
hypokinetic - behavioral tx
- Rate control techniques (DAF, pacing boards), loudness (intensity monitors, amplification devices, improving posture, EMST)
- LSVT LOUD
LSVT LOUD characteristics
- Intensity (four times per week for 1 month)
- Requirement for energetic, high levels of physical effort to increase loudness and vocal fold adduction
- Exclusive focus on respiratory-phonatory effort (i.e., not resonance, articulation, rate or prosody)
- Focus on increasing sensory awareness of loudness and effort. Exercise includes vowel, word, phrase, sentence, and conversation production tasks.
hyperkinetic - Primarily surgical and pharmacologic tx
- Essential tremor, dystonia, dyskinesia, tics = deep brain stimulation
- Spasmodic dysphonia (SD) = Botox injection
hyperkinetic - behavioral prosthetic tx
- Jaw, tongue, or face dystonia =bite block, gum
- Adductor SD =increasing pitch, breathy vocal quality
- Adductor SD = hard glottal attacks, voicing voiceless consonants
UUMN - behavioral tx
- 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
mixed tx
- Treat individual dysarthrias
- note: Some treatments may be contraindicated by the presence of another dysarthria type
ALS tx
palatal lift prosthesis
PSP tx
LSVT
communication-oriented tx
- Speaker strategies
- Listener strategies
- Interaction strategies
speaker strategies
- 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
listener strategies
- maximize hearing and visual activity
- eye contact
- optimized physical environment
- improve listening skills: perceptual training and listener familiarization
interaction strategies
- schedule important interactions
- select conductive speaking and listening environment
- identify breakdowns sand est. methods of feedback
- repair breakdowns
- est. what works best and when
