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Motor speech Final Exam > Managing the dysarthrias > Flashcards

Managing the dysarthrias Flashcards

1
Q

Even individuals with _______ ____ ______ may have adequate respiratory support for speech.

A

significant respiratory problems

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2
Q

What generally promotes efficient use of the airstream?

A

Improving phonation, resonation and arituclation

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3
Q

According to Duffy, the clinician does not need to work on respiration if what?

A

If there is adequate loudness and capacity for flexible breath patterning (for phrasing) in speech.

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4
Q

What does the clinician need to work on if there is adequate loudness and capacity for flexible breath patterning (for phrasing) in speech?

A

Nothing.

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5
Q

How can the clinician know if respiratory support for speech is ok?

A

If the patient can maintain a stream of bubbles for 5 seconds in a glass of water with the straw at a depth of 5 cm.

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6
Q

What happens if the patient cannot maintain a stream of bubbles for 5 seconds in a glass of water with the straw at a depth of 5 cm?

A

Does not have adequate respiratory support for speech.. Clinician needs to work with patient on non-speech respiratory exercises, such as practice blowing a stream of bubbles. The idea is to be able to produce consistent subglottal air pressure sufficient for speech.

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7
Q

What is the purpose of blowing a stream of bubble in a glass of water?

A

Respiratory exercise to be able to produce consistent subglottal air pressure sufficient for speech.

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8
Q

Describe other respiratory exercises.

A
  • SeeScape
  • 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.
  • practice pushing, pulling or bearing down during speech and non-speech tasks helps to increase respiratory drive for speech.
  • postural adjustments may need to be made to maximize respiratory support. may just need to encourage patient to sit upright.
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9
Q

What is part of practicing maximum vowel prolongation with the clinician?

A

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.

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10
Q

Practice ______, ____ or _____ down during speech and non-speech tasks helps to increase respiratory drive for speech.

A

pulling
pushing
bearing

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11
Q

What does practicing pushing, pulling, and bearing down during speech and non-speech tasks help do?

A

Increase respiratory drive for speech.

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12
Q

What may need to be done to maximize respiratory support?

A

Postural adjustments

May need to be made to maximize respiratory support.

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13
Q

What can be used as prosthetic assistance for respiration?

A
  • abdominal binders and corsets
  • expiratory board/paddle
  • may push in on abdomen with hands in exhalation
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14
Q

______ ____ and _____ can help posture and weak abdominal muscles.

A

abdominal binders

corsets

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15
Q

What can abdominal binders and corsets help with?

A

posture and weak abdominal muscles

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16
Q

Abdominal binders and corsets should not be used with what patients?

A

ALS patients who have trouble with inspiration

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17
Q

Why does client need medical approval for binding?

A

It can sometimes restrict breathing and lead to pneumonia.

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18
Q

How is the expiratory board/paddle used?

A

Mounted on a wheelchair and put in position to lean into, may help to force air out in exhalation.

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19
Q

List Behavioral compensation for respiration

A
  • Practice inhaling more deeply
  • Practice exhaling 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 - - patients may only be producing one word per breath when they have sufficient support for more words per breath.
  • Use biofeedback machines with visual feedback
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20
Q

List medical treatment that can improve phonation:

A
  • Laryngeal surgery
  • Fat, collagen and teflon injections
  • toxin injection
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21
Q

When are implants used for vocal folds?

A

When vocal fold is paralyzed, implants pushes the fold medially so vocal fold approximation can occur. The implants can be removed.

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22
Q

_______ ______ surgery may aid in respositioning the paralyzed vocal fold by moving the arytenoids cartilage.

A

Arytenoid adduction

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23
Q

How may the arytenoid adduction surgery aid vocal folds?

A

In repositioning the paralyzed vocal fold by moving the arytenoids cartilage.

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24
Q

What is recurrent nerve resection?

A

Used for spasmodic dysphonia and prevents hyperadduction and laryngeal spasms in adductor SD.

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25
Q

How do injection of substances into the paralyzed vocal fold aids the vocal fold?

A

In vocal fold approximation

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26
Q

What substances can be injected into a paralyzed vocal fold to aid in vocal fold approximation?

A

Fat
collagen
teflon

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27
Q

When should the substances be injected into a paralyzed vocal fold.

A

At least one year after onset

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28
Q

Why should the substances be injected into a paralyzed vocal fold at least one year after onset?

A

Because some substances (especially Teflon) cannot be removed once applied.

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29
Q

What substance should be injected if you only want temporary vocal fold changes?

A

Fat from the person’s body, but it may be reabsorbed.

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30
Q

How long does botox last?

A

3-4 months

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31
Q

What are some side effects that can occur with injecting botox to vocal fold?

A
  • breathiness

- mild dysphagia

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32
Q

________ injections into the thyroarytenoid muscle for adductor spasmodic dysphonia.

A

Botox

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33
Q

What does botox do?

A

It blocks the release of ACH in some of the thyroarytenoid muscle fibers. The folds aren’t completely paralyzed so can approximate but with less hypperadduction than without the botox.

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34
Q

What are types of prosthetic management for phonation?

A
  • Vocal intensity controller

- amplification system

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35
Q

What is a vocal intensity controller?

A

Gives feedback about too much or little loudness with visual feedback (VU meter).

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36
Q

Name Behavioral management treatment for phonation:

A
  • effort closure strategies

- LSVT for Parkinson’s patients

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37
Q

Name effort closure strategies:

A
  • push/pull lift techniques

- coughing in controlled manner

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38
Q

What can help maxamimze vocal fold adduction and may help strengthen folds?

A

Effort closure strategies

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39
Q

What is a surgical management treatment for resonance?

A

Pharyngeal flap

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40
Q

Name treatment for resonance:

A
  • Surgical management: pharyngeal flap
  • Injection of some substance into posterior pharyngeal wall to improve VP closure.
  • Prosthetic management:
  • ————-palatal lift prosthesis: need dental support
  • ————-wearing a nose clip sometimes help improve resonance
  • Behavioral management:
  • ———slowing rate and over articulating may help hypernasality
  • ———-Visual feedback using mirror, see scape
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41
Q

What is the wording used to consult a physician about an injection?

A

Would this patient be a candidate for Teflon injection?

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42
Q

What are two prosthetic treatments for resonance?

A

-Palatal lift - need dental support

Wearing a nose clip sometimes help improve resonance

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43
Q

What are two behavioral management treatments for resonance?

A
  • Slowing rate and over articulating may help hypernasality

- Visual feedback using mirror, see scape

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44
Q

What is a prosthetic management treatment for articulation?

A

a bite block

45
Q

What is a bite block?

A

A bite block is a prosthetic management treatment for articulation that is sometimes used to help jaw control.
It stabilizes the jaw. Is most helpful in keeping jaw from opening.

46
Q

What is the bite block made of?

A

putty or similar material

47
Q

List behavioral management treatment for articulation:

A
  • strength training
  • Stretching
  • exaggerating consonants
  • compensatory strategies
48
Q

Behavioral management: Describe strength training for articulation.

A

Oral motor exercises- push tongue against tongue blade, etc
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.

49
Q

How effective is strength training?

A

The effectiveness of strength training to improve articulation is controversial. Not much research to support it.

50
Q

When is strength training used for articulation treatment?

A

When there is a weakness.

51
Q

Strength training is contraindicating with what disorders?

A

Myasthenia gravvis

ALS

52
Q

Why is strength training not necessary for many patients?

A

-The tongue and lips use only 10% to 30% of their maximum force in speech and the jaw just 2%.

53
Q

What does stretching technique to treat articulation involve?

A
  • should be steady, continuous, prolonged

- Involves slow movement of articulators beyond their typical ROM—-this may help to increase ROM.

54
Q

How does exaggerating consonants help articulation?

A

Helps improve imprecision

55
Q

List traditional articulation approaches:

A
  • phonetic placement
  • integral stimulation
  • phonetic derivation
  • minimal pairs
  • intelligibility drills
56
Q

What is phonetic placement treatment?

A

Articulation treatment that involves physical, verbal, and visual cues.

57
Q

What is integral stimulation?

A

Treatment for articulation—-watches and listen tasks.

58
Q

What is phonetic derivation?

A

Articulation treatment that involves non-speech gestures to establish targets - blowing to indicate /u/

59
Q

What are minimal pairs?

A

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

60
Q

_____ _______ help patient understand contrasts between phonemes.

A

Minimal pairs

61
Q

_______ ______ watches and listen tasks. Will be discussed further in apraxia treatment section.

A

Integral stimulation

62
Q

_____ _____ use nonspeech gestures to establish targets-blowing to indicate /u/.

A

Phonetic derivation

63
Q

_____ can be the most important behavioral change to improve intelligibility.

A

Rate

64
Q

What can be the most important behavioral change to improve intelligibility?

A

rate

65
Q

What are types of prosthetic management treatments to improve rate of speech?

A
  • Direct auditory feedback
  • Pacing board
  • Letter/alphabet board
66
Q

What does direct auditory feedback do?

A

slows rate

67
Q

What does a pacing board do?

A

slows rate

68
Q

What does a letter/alphabet board do?

A

slows rate

69
Q

List non-prosthetic rate management treatments for rate:

A
  • Hand/finger tapping in time to syllable production
  • Visual feedback from oscilloscope to pace rate
  • Rhythmic cueing
70
Q

What should you note when implementing the hand/finger tapping in time to syllable production with a patient with Parkinson’s?

A

Note that they may accelerate their hand tapping along with speech.

71
Q

What should you note when implementing the hand/finger tapping in time to syllable production with a patient with ataxic dysarthria?

A

May have irregular hand tapping.

72
Q

What do you do in visual feedback from oscilloscope to pace rate?

A

Tell patient to speak at a rate that would fill the screen-slows rate.

73
Q

What does rhythmic cueing involve to help rate?

A

Clinician points to word in rhythmic fashion.

74
Q

What are treatments for prosody and naturalness?

A
  • Chunking utterances into natural syntactic units
  • contrastive stress drills
  • LSVT
75
Q

How does chunking utterances into natural syntactic units help improve prosody and naturalness?

A

Patient may take breaths at odd points and need to be taught to do so at natural paces.

76
Q

How does contrastive stress drills help prosody and naturalness?

A

helps reduce monotone

77
Q

How does LSVT help prosody and naturalness?

A

Highs and lows work on pitch changing

78
Q

Flaccid dysarthria is due to _______ so work on ______ _____ unless LMN innervation is completely lacking.

A

weakness

increasing strength

79
Q

Increasing strength would not be an appropriate goal with what kind of diseases?

A

Progressive diseases, like ALS

80
Q

What type of goals would a clinician work on with a patient with a progressive disease, such as ALS.

A

Trying to maintain function, not increase function.

81
Q

If patient with flaccid dysarthria is having respiratory weakness what do you work on?

A

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

82
Q

For a patient with flaccid dysarthria with an adductor vocal fold weakness, look at ________, ______ or ________ ________ treatment.

A

surgical
injection
effortful closure

83
Q

What treatments would be implemented with a patient who has flaccid dysarthria and has resonance problems?

A
  • palatal lift or pharyngeal flap surgery
  • nares occlusion
  • VP strengthening exercises
84
Q

How is myasthenia gravis treated?

A

Patients are usually managed with meds but counseling them about limiting the length of time they speak can be done.

85
Q

Don/t do _____, _____ and ____ _______ techniques with people who are diagnosed with spastic dysarthria because hyperadduction is already a problem

A

pulling
pushing
effortfull closure

86
Q

Why should a clinician not work on pulling, pushing, and effortful closure techniques with a client with spastic dysarthria?

A

Hyperadduction is already a problem.

87
Q

What can help patients with spastic dysarthria if pseudobulbar affect is a problem?

A

Meds may help (Ellaville)

Behavior modification techniques may also help, but they have to be specific to the patient.

88
Q

______ exercises may help patients with spastic dysarthria.

A

Relaxation

89
Q

Which treatments are not needed with patients diagnosed with ataxic dysarthria?

A

Strength exercises
surgical
prosthetic treatment

90
Q

What should the clinician focus on with a patient with ataxic dysarthria?

A

Behavioral management- centering on improving in-coordination and intelligibility through modifying rate and prosody.

91
Q

What has research shown about emphasizing rate, loudness, or pitch control in ataxic speakers?

A

It has aided intelligibility in ataxic speakers

92
Q

List treatments for patients with hypokinetic dysarthria:

A
  • LSVT
  • surgical treatment
  • pharmacologic treatment
  • behavioral management
93
Q

Describe LSVT treatment:

A

Intensive period of treatment - 4 times a week for one month. Focus is on respiratory and phonatory effort.

94
Q

What is deep brain stimulation?

A

A treatment for hypokinetic dysarthria. It places electrodes into the brain which are activated at varying levels of intensity.

95
Q

What surgical treatment is done for patients with hypokinetic dysarthria?

A

Pallidotomy, thalamotomy

96
Q

What happens in a pallidotomy or thalamotomy?

A

Lesions are placed in globus pallidus or thalamus to reduce severe tremors.

97
Q

Surgical treatments for hypokinetic dysarthria aren’t done to _______ ____ and sometimes can ____ _____, but it is also possible for some ______ _______.

A

improve speech
worsen speech
speech improvement

98
Q

What are some pharmalogical treatment for hypokinetic dysarthria?

A
  • L dopa

- Sonemet

99
Q

What is the effect of pharmacologic treatment on patient’s with hypokinetic dysarthria?

A

It may improve speech but not always and varies across patients.

100
Q

What behavioral management treatment should be implemented with a patient with hypokinetic dysarthria?

A

Work on rate control and overarticulation

101
Q

What treatment is implemented with patients diagnosed with hyperkinetic dysarthria?

A

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

102
Q

Why are medical or prosthetic treatments not needed with patients diagnosed with UUMN?

A

Due to the mild and transient nature of UUMN.

103
Q

What will clinician work on with a patient diagnosed with UUMN?

A

May work on specific articulation problems or on tongue strengthening.

104
Q

How does a clinican approach a patient with mixed dysarthria?

A

Use treatments appropriate for the individual dysarthrias.

105
Q

List strategies for the speaker:

A
  • prepare listener
  • tell listener how communication will happen
  • identify topic
  • increasing redundancy may help some
  • Others may need to simplify content and length-making simple predictable sentences.
  • use gestures
  • monitor listener comprehension
  • use alphabet board
106
Q

List strategies for the listener:

A
  • keep eye contact - gives you information from face, etc.
  • work at comprehending
  • modify environment - reduce noise, improve lighting
107
Q

List interaction strategies:

A
  • Don’t communicate important things when fatigue or stress is a factor. Wait for a different time.
  • Select conducive speaking environment
  • maintain eye contact between speaker and listener
  • identify breakdown and establish means of feedback (shadowing- the listener repeats each word of speaker.)
  • repair breakdowns - rephrase, use synonyms, spell problem words, identify salient words
108
Q

How can clinician repair breakdowns?

A
  • rephrase
  • use synonyms
  • spell problem words
  • identify salient words

Motor speech Final Exam (6 decks)

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