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Motor Speech Disorders Final Exam > Managing the Dysarthrias > Flashcards

Managing the Dysarthrias Flashcards

1
Q

SPEAKER ORIENTED TREATMENT includes:

A 
1	Respiration
2      Improving phonation
3      Improving resonance
4      Articulation
5      Rate
6      Improving Prosody and Naturalness
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2
Q

Respiration (9):

A

1 Typically the speech demands on respiration are not great. Even individuals with significant respiratory problems may have adequate respiratory support for speech.

2 Improving phonation, resonation and articulation generally promotes efficient use of the airstream.

3 If there is adequate loudness and capacity for flexible breath patterning (for phrasing) in speech you do not need to work on respiration (According to Duffy).

4 If the patient can maintain a stream of bubbles 5 seconds in a glass of water with the straw at a depth of 5 cm, respiratory support for speech is OK. IF they cannot do this then you probably need to work on nonspeech respiratory exercises, such as practice blowing as described above. The idea is to be able to produce consistent subglottal air pressure sufficient for speech. You can also use the See Scape.

5 Other methods include practicing 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.

6 Practice pushing, pulling or bearing down during speech and nonspeech tasks helps to increase respiratory drive for speech.

7 Postural adjustments may need to be made to maximize respiratory support. May just need to encourage patient to sit upright.

8 Prosthetic assistance for respiration

9 Behavioral Compensation for Respiration

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3
Q

Prosthetic assistance for respiration:

A

1 Abdominal binders and corsets can help posture and weak abdominal muscles. Don’t use with ALS patient who have trouble with inspiration. Need to get medical approval for binding because it can sometimes restrict breathing and lead to pneumonia.

2 Expiratory board/paddle – mounted on a wheelchair and put in position to lean into, may help to force air out in exhalation.

3 May push in on abdomen with hands in exhalation.

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4
Q

Behavioral Compensation for Respiration:

A

1 Practice inhaling more deeply

2 Practice exhaling more forcefully

3 Work on controlling breath – not letting all air out on one breath – learning to let air out slowly.

4 Use shorter phrases per breath group

5 Correct maladaptive breath groups – patient may only be producing one word per breath when they have sufficient support for more words per breath.

6 Use biofeedback machines with visual feedback

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5
Q

Improving phonation:

A

1 Medical treatment
2 Phonation – Prosthetic management
3 Phonation – Behavioral management

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6
Q

Example of Medical treatment to improve phonation (3):

A

1 Laryngeal surgery
2 Fat, collagen and Teflon injections
3 Toxin injection

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7
Q

Fat, collagen and Teflon injections to improve phonation:

A
  • Injection of substances into the paralyzed vocal fold aids in vocal fold approximation
  • Don’t do it till at least one year after onset as some substances (especially Teflon) cannot be removed once applied
  • Fat from the person’s body can be harvested and used but may be reabsorbed – this is OK if you only want temporary vocal fold changes
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8
Q

Laryngeal surgery to improve phonation (3):

A

1 Using implants for paralyzed vocal fold which pushes the fold medially so vocal fold approximation can occur. The implants can be removed.

2 Arytenoid adduction surgery may aid in repositioning the paralyzed vocal fold by moving the arytenoids cartilage.

3 Recurrent nerve resection – used for spasmodic dysphonia and prevents hyperadduction and laryngeal spasms in adductor SD

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9
Q

Toxin injection to improve phonation:

A
  • Botox injections into the thyroarytenoid muscle for adductor spasmodic dysphonia
  • Botox blocks the release of ACH in some of the thyroartyenoid muscle fibers
  • The folds aren’t completely paralyzed so can approximate but with less hpperadduction than without the Botox
  • Botox lasts 3 to 4 months
  • Some side effects can occur such as breathiness and mild dysphagia
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10
Q

Phonation – Prosthetic management for improving phonation:

A

1 Vocal intensity controller – gives feedback about too much or little loudness with visual feedback (VU meter)

2 Amplification system

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11
Q

Phonation – Behavioral management for improving phonation:

A

1 Effort closure strategies such as push/pull/lift techniques, coughing in controlled manner. These maximize vocal fold adduction and may help strengthen folds.

2 LSVT for Parkinson’s patients

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12
Q

Improving Resonance (4):

A

1 Surgical management

2 Teflon injection

3 Prosthetic management

4 Behavioral management

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13
Q

Surgical management to improving resonance (1):

A

Pharyngeal flap

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14
Q

Teflon injection to improve resonance:

A

Injection of some substance (fat?) into posterior pharyngeal wall to improve VP closure.

Wording for a consult to physician “Would this patient be a candidate for Teflon injection?”.

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15
Q

Prosthetic management to improving resonance (2):

A

1 Palatal lift prosthesis – need dental support.

2 Wearing a nose clip sometimes help improve resonance

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16
Q

Behavioral management to improve resonance (2):

A

1 Slowing rate and over articulating may help hypernasality.

2 Visual feedback using mirror, See Scape.

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17
Q

Improving Articulation:

A

1 Prosthetic management

2 Behavioral management

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18
Q

Prosthetic management to improve articulation:

A
  • a bite block is sometimes used to help jaw control
  • It is made of putty or similar material and is help between teeth
  • It stabilizes jaw. Is most helpful in keeping jaw from opening
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19
Q

Behavioral management to improve articulation (5):

A

1 Strength training

2 Stretching

3 Exaggerating consonants may improve imprecision.

4 Use compensatory strategies (using tongue blade instead of tongue tip).

5 Traditional artic approach

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20
Q

Stretching to improve articulation (behavioral management):

A

1 Should be steady, continuous, prolonged

2 Involves slow movement of articulators beyond their typical ROM – this may help to increase ROM

21
Q

Traditional artic approach to improve articulation (behavioral management) (5):

A

1 Phonetic placement (visual, physical, verbal cues)

2 Integral stimulation – watches and listen tasks. Will be discussed further in apraxia treatment section.

3 Phonetic derivation - use nonspeech gestures to establish targets – blowing to indicate /u/.

4 Minimal pairs - (may/pay, bye/pie). These help patient understand contrasts between phonemes.

5 Intelligibility drills – the listener is naïve to the task and tells the speaker what was heard

22
Q

Strength training to improve articulation:

A
  • Oral motor exercises- push tongue against tongue blade, etc. The effectiveness of strength training to improve articulation is controversial. Not much research to support it. Use only when there is a weakness. Change: It is contraindicated with Myasthenia Gravis and ALS.
  • Strengthening is not necessary for many patients – the tongue and lips use only 10% to 30% of their maximum force in speech and the jaw just 2%.
  • Typically exercises are done in 5 sets of 10 reps, 3-5 times per day. Fewer don’t do much good. Patient must be motivated to do these on their own
23
Q

Rate – can be the most important behavioral change to improve intelligibility

A

1 Prosthetic management

2 Nonprosthetic rate management

24
Q

Prosthetic management for rate:

A

1 DAF – slows rate

2 Pacing board – slows rate - page 401 (old) 481 (new)

3 Letter/alphabet board – slows rate

25
Q

Nonprosthetic rate management:

A

1 Hand/finger tapping in time to syllable production – if Parkinson’s note that they may accelerate their hand tapping along with speech and ataxic patients may have irregular hand tapping also.

2 Visual feedback from oscilloscope to pace rate – tell patient to speak at a rate that would fill the screen – slows rate.

3 Rhythmic cueing – clinician points to word in rhythmic fashion

26
Q

Improving Prosody and Naturalness:

A

1 Chunking utterances into natural syntactic units – patient may take breaths at odd points and need to be taught to do so at natural places.

2 Contrastive stress drills

• LSVT highs and lows work on pitch changing

27
Q

Chunking utterances into natural syntactic units to improve prosody and naturalness:

A

– patient may take breaths at odd points and need to be taught to do so at natural places.

28
Q

Contrastive stress drills to improve prosody and naturalness:

A

– helps to reduce monotone

 John LOVES Mary
 JOHN loves Mary

29
Q

SPEAKER ORIENTED TREATMENT FOR SPECIFIC DYSARTHRIAS

Flaccid Dysarthria

A
  • Due to weakness so work on increasing strength unless LMN innervation is completely lacking – you would be wasting your time
  • New info: With progressive diseases like ALS, strength can not be increased so that would not be an appropriate goal. You would work on trying to maintain function, not increase function.
30
Q

T/F

You can use many of the same therapies for several dysarthrias but some techniques are more suited to specific types

A

True

31
Q

Treatment for Flaccid Dysarthria - IF patient has respiratory weakness

A

– work on pushing, pulling, etc.

32
Q

Treatment for Flaccid Dysarthria - for patients with adductor vocal fold weakness

A

– look at surgical, injection or effortful closure treatment.

33
Q

Treatment for Flaccid Dysarthria - for resonance problems

A

– consider palatal lift or pharyngeal flap surgery, nares occlusion or VP strengthening exercises.

34
Q

Treatment for Flaccid Dysarthria - Myasthenia gravis patients

A
  • usually managed with meds but counseling them about limiting the length of time they speak can be done
35
Q

SPEAKER ORIENTED TREATMENT FOR SPECIFIC DYSARTHRIAS

Spastic Dysarthria

A

1 Don’t do pulling, pushing and effortful closure techniques because hyperadduction is already a problem.

2 Relaxation exercises may help

3 If pseudobulbar affect is a problem – meds may help (Ellaville).

4 Behavior modification techniques may help pseudobulbar affect and are specific to the individual.

(Example – patient turned head each time before crying. The head turning was modified and that helped reduce crying.)

36
Q

SPEAKER ORIENTED TREATMENT FOR SPECIFIC DYSARTHRIAS

Ataxic Dysarthria

A

1 Strength exercises and surgical/prosthetic treatment not needed.

2 Focus of management is behavioral – centering on improving incoordination and intelligibility through modifying rate and prosody. Research has shown that emphasizing rate, loudness or pitch control has aided intelligibility in ataxic speakers

37
Q

SPEAKER ORIENTED TREATMENT FOR SPECIFIC DYSARTHRIAS

Hypokinetic Dysarthria (4)

A

1 LSVT

2 Surgical treatment

3 Pharmacologic treatment

4 Behavioral management – work on rate control & overarticulation

38
Q

LSVT for treatment of hypokinetic dysarthria:

A
  • intensive period of treatment – 4 times a week for one month. Focus is on respiratory and phonatory effort
39
Q

Surgical treatment of hypokinetic dysarthria:

A

– pallidotomy, thalamotomy,
– lesions are placed in globus pallidus or thalamus to reduce severe tremors. These treatments aren’t done to improve speech and sometimes can worsen speech, but it is also possible for some speech improvement. Also deep brain stimulation (DBS) places electrodes into the brain which are activated at varying levels of intensity

40
Q

Pharmacologic treatment for hypokineic dysarthria:

A

– L dopa, Sinemet, etc. These may improve speech but not always and varies across patients

41
Q

SPEAKER ORIENTED TREATMENT FOR SPECIFIC DYSARTHRIAS

Hyperkinetic Dysarthria

A
  • Mainly surgical and pharmacologic to control abnormal movements. SLP can teach compensatory techniques, such as holding pipe in mouth
42
Q

SPEAKER ORIENTED TREATMENT FOR SPECIFIC DYSARTHRIAS

UUMN

A

o Medical or prosthetic treatments not needed due to mild, transient nature.

o May work on specific articulation problems or on tongue strengthening

43
Q

SPEAKER ORIENTED TREATMENT FOR SPECIFIC DYSARTHRIAS

Mixed Dysarthrias

A

o Use treatments appropriate for the individual dysarthrias

44
Q

COMMUNICATION ORIENTED TREATMENT (3 types)

A

1 Speaker strategies

2 Listener strategies

3 Interaction strategies

45
Q

Speaker strategies to oriented treatment (8):

A

1 Prepare listener (gesture to let listener know you are about to talk)

2 Tell listener how communication will happen

3 Identify topic

4 Increasing redundancy may help some

5 Others may need to simplify content and length – making simple predictable sentences.

6 Use gestures

7 Monitor listener comprehension

8 Use alphabet board

46
Q

Listener strategies to oriented treatment (3):

A

1 Keep eye contact – gives you information from face, etc.

2 Work at comprehending

3 Modify environment – reduce noise, improve lighting, etc.

47
Q

Interaction strategies to oriented treatment (5):

A

1 Don’t communicate important things when fatigue or stress is a factor. Wait for a different time.

2 Select conducive speaking environment

3 Maintain eye contact between speaker and listener

4 Identify breakdown and establish means of feedback. (Shadowing – the listener repeats each word of speaker.)

5 Repair breakdowns – rephrase, use synonyms, spell problem words, identify salient words, etc.

48
Q

DBS (deep brain stimulation) side effects:

A

in some cases, can make tremors worse in some PD patients.

Motor Speech Disorders Final Exam (7 decks)

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