Managing the dysarthrias Flashcards
T or F. typically speech demands on respiration are not great. Even individuals with significant respiratory problems may have adequate respiratory support for speech.
True
T or F. improving phonation, resonation and articulation generally promotes efficient use of airstream
true
If there is adequate loudness and capacity for flexible breath patterning for phrasing in speech do you need to work on respiration?
No
T or F. If a ptnt can maintain a stream of bubbles 5 sec in a glass of water with the straw a depth of 5 cm, respiratory for speech is ok. If they cannot then you need to work on nonspeech respiratory exercises.
True
What are some nonspeech respiratory exercises?
blowing bubbles, seascape
what do you do when you practice maximum vowel prolongation?
with the clinician giving feedback as to duration and loudness. Use a tape recorder with a VU meter or visipitch. Work for 5 seconds of steady strong vowel prolongation and being able to produce several syllables on one exhalation.
what other things can help with respiration?
postural adjustments
pushing, pulling or bearing down during speech and nonspeech tasks helps increase resp. drive for speech
What are some prosthetic assistance for respiration?
- abdominal binders and corsets can help posture and weak abdominal muscles (don’t use with ALS ptnts)
- expiratory board/paddle-mounted on a wheelchair and put in position to lean into may help force air out in exhalation.
what are some behavioral compensation for respiration that can be done?
- practice inhaling more deeply
- practice inhaling more forcefully
- work on controlling breath-not letting all air out on one breath-learning to let air out slowly
- use shorter phrases per breath group
- correct maladaptive breath groups-ptnt may only be producing one word per breath when they have sufficient support for more words
- use biofeedback machines with visual feedback
what can u do medically to improve phonation?
-laryngeal surgery
-Arytenoid adduction surgery
fat collagen and Teflon injections
-toxin inection
What kind of surgeries can you do to help aid phonation (laryngeal surgery)?
laryngeal surgery( uses implants for paralyzed v.folds which pushes the fold medially so v.fold approximation can occur.)
- Arytenoid adduction surgery may aid in repositioning the paralyzed v.fold by moving the arytenoid cartilage
- recurrent nerve resection-used for spasmodic dysphonia and prevents hyperadduction and laryngeal spasms in adductor sd
What happens in fat, collegen and Teflon injections in the vocal fold?
injection of substances into paralyzed v. fold aids in v.folds approximation
don’t do it till at least one year after onset as some substances (espc. Teflon) cannot be removed once applied
-fat from a person’s body can be harvested and used but may be reabsorbed -this is ok if you want temporary v. fold change.
what do they do in toxin injections to aid in phonation?
botox injections into the thyroarytenoid muscle for adductor spasmodic
-botox blocks the release of ACH in some of the thyroarytenoid muscle fibers. The folds aren’t completely paralyzed so can approximate but with less hyperadduction than without the botox. (lasts 3-4 mos) some side effects can occur such as breathiness and mild dysphagia.
what is a vocal intensity controller?
it is a prosthetic management technique used to aid in phonation
it gives feedback amount about too much or too little loudness with visual feedback (VU meter)
what are some behavioral management strategies used to help aid in phonation?
effort closure strategies such as push/pull/lift techniques, coughing in controlled manner these maximize v. fold adduction
-LSVT for PD
what are some things you can do to help manage resonance problems in dysarthrias?
surgical management (pharyngeal flap)
- Injection of a substance (fat?) into posterior pharyngeal wall to improve VP closure
- Prosthetic management:
- -palatal lift prosthesis-need dental support
- –wearing nose clip
what are some behavior management techniques for resonance?
slowing rate and over articulating may help hypernasality visual feedback using mirror (see scape)
what are some prosthetic management techniques you can use for better articulation in people with dysarthria?
prosthetic management:
–bite block is sometimes used to help jaw control (it is made of putty or similar material and is held btwn teeth it stabilizes the jaw. Is most helpful in keeping jaw from opening.
what are some behavioral management techniques for articulation?
strength training-oral motor exercises
do not do for myasthenia gravis and ALS
- typically exercises are done in 5 sets of 10 reps 3-5 x’s per day ptnt must be motivated to do these on their own.
- -stretching
- traditional artic approach
what are some stretching techniques used for management of dysarthrias? (artic)
should be steady continuous and prolonged
involves slow movement of articulators beyond their typical ROM-this may help increase ROM
-
What are the traditional articulation approaches?
phonetic placement (visual, physical, verbal cues) integral stimulation--watches and listens tasks. phonetic derivation-use nonspeech gestures to establish targets (blowing to indicate /u/) minimal pairs (may/pay) intelligibility drills: the listener is naïve to the task and tells the speaker what was heard
what are some prosthetic management skills that can help people with dysarthria with their rate problems?
DAF
Pacing board-slows rate
letter/alphabet board
What are some nonprosthetic rate management techniques?
hand/finger tapping in time to syllable production
visual feedback from oscillopscope to pace rate (tell ptnt to speak at a rate that would fill the screen)
Rhythmic cueing-clinician points to word in a rhythmic fashion
What are some techniques for dysarthria that help with prosody and naturalness?
chunking utterances into natural syntactic units ptnt may take breaths at odd ptnts needs to be done in a natural place
contrastive stress drills
LSVT’s highs and lows to work on pitch changing.
