Managing the dysarthrias Flashcards
Even individuals with _______ ____ ______ may have adequate respiratory support for speech.
significant respiratory problems
What generally promotes efficient use of the airstream?
Improving phonation, resonation and arituclation
According to Duffy, the clinician does not need to work on respiration if what?
If there is adequate loudness and capacity for flexible breath patterning (for phrasing) in speech.
What does the clinician need to work on if there is adequate loudness and capacity for flexible breath patterning (for phrasing) in speech?
Nothing.
How can the clinician know if respiratory support for speech is ok?
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.
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?
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.
What is the purpose of blowing a stream of bubble in a glass of water?
Respiratory exercise to be able to produce consistent subglottal air pressure sufficient for speech.
Describe other respiratory exercises.
- 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.
What is part of 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 ______, ____ or _____ down during speech and non-speech tasks helps to increase respiratory drive for speech.
pulling
pushing
bearing
What does practicing pushing, pulling, and bearing down during speech and non-speech tasks help do?
Increase respiratory drive for speech.
What may need to be done to maximize respiratory support?
Postural adjustments
May need to be made to maximize respiratory support.
What can be used as prosthetic assistance for respiration?
- abdominal binders and corsets
- expiratory board/paddle
- may push in on abdomen with hands in exhalation
______ ____ and _____ can help posture and weak abdominal muscles.
abdominal binders
corsets
What can abdominal binders and corsets help with?
posture and weak abdominal muscles
Abdominal binders and corsets should not be used with what patients?
ALS patients who have trouble with inspiration
Why does client need medical approval for binding?
It can sometimes restrict breathing and lead to pneumonia.
How is the expiratory board/paddle used?
Mounted on a wheelchair and put in position to lean into, may help to force air out in exhalation.
List Behavioral compensation for respiration
- 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
List medical treatment that can improve phonation:
- Laryngeal surgery
- Fat, collagen and teflon injections
- toxin injection
When are implants used for vocal folds?
When vocal fold is paralyzed, implants pushes the fold medially so vocal fold approximation can occur. The implants can be removed.
_______ ______ surgery may aid in respositioning the paralyzed vocal fold by moving the arytenoids cartilage.
Arytenoid adduction
How may the arytenoid adduction surgery aid vocal folds?
In repositioning the paralyzed vocal fold by moving the arytenoids cartilage.
What is recurrent nerve resection?
Used for spasmodic dysphonia and prevents hyperadduction and laryngeal spasms in adductor SD.
How do injection of substances into the paralyzed vocal fold aids the vocal fold?
In vocal fold approximation
What substances can be injected into a paralyzed vocal fold to aid in vocal fold approximation?
Fat
collagen
teflon
When should the substances be injected into a paralyzed vocal fold.
At least one year after onset
Why should the substances be injected into a paralyzed vocal fold at least one year after onset?
Because some substances (especially Teflon) cannot be removed once applied.
What substance should be injected if you only want temporary vocal fold changes?
Fat from the person’s body, but it may be reabsorbed.
How long does botox last?
3-4 months
What are some side effects that can occur with injecting botox to vocal fold?
- breathiness
- mild dysphagia
________ injections into the thyroarytenoid muscle for adductor spasmodic dysphonia.
Botox
What does botox do?
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.
What are types of prosthetic management for phonation?
- Vocal intensity controller
- amplification system
What is a vocal intensity controller?
Gives feedback about too much or little loudness with visual feedback (VU meter).
Name Behavioral management treatment for phonation:
- effort closure strategies
- LSVT for Parkinson’s patients
Name effort closure strategies:
- push/pull lift techniques
- coughing in controlled manner
What can help maxamimze vocal fold adduction and may help strengthen folds?
Effort closure strategies
What is a surgical management treatment for resonance?
Pharyngeal flap
Name treatment for resonance:
- 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
What is the wording used to consult a physician about an injection?
Would this patient be a candidate for Teflon injection?
What are two prosthetic treatments for resonance?
-Palatal lift - need dental support
Wearing a nose clip sometimes help improve resonance
What are two behavioral management treatments for resonance?
- Slowing rate and over articulating may help hypernasality
- Visual feedback using mirror, see scape
What is a prosthetic management treatment for articulation?
a bite block
What is a bite block?
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.
What is the bite block made of?
putty or similar material
List behavioral management treatment for articulation:
- strength training
- Stretching
- exaggerating consonants
- compensatory strategies
Behavioral management: Describe strength training for articulation.
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.
How effective is strength training?
The effectiveness of strength training to improve articulation is controversial. Not much research to support it.
When is strength training used for articulation treatment?
When there is a weakness.
Strength training is contraindicating with what disorders?
Myasthenia gravvis
ALS
Why is strength training 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%.
What does stretching technique to treat articulation involve?
- should be steady, continuous, prolonged
- Involves slow movement of articulators beyond their typical ROM—-this may help to increase ROM.
How does exaggerating consonants help articulation?
Helps improve imprecision
List traditional articulation approaches:
- phonetic placement
- integral stimulation
- phonetic derivation
- minimal pairs
- intelligibility drills
What is phonetic placement treatment?
Articulation treatment that involves physical, verbal, and visual cues.
What is integral stimulation?
Treatment for articulation—-watches and listen tasks.
What is phonetic derivation?
Articulation treatment that involves non-speech gestures to establish targets - blowing to indicate /u/
What are minimal pairs?
(may/pay, bye/pie) These help patient understand contrasts between phonemes.
_____ _______ help patient understand contrasts between phonemes.
Minimal pairs
_______ ______ watches and listen tasks. Will be discussed further in apraxia treatment section.
Integral stimulation
_____ _____ use nonspeech gestures to establish targets-blowing to indicate /u/.
Phonetic derivation
_____ can be the most important behavioral change to improve intelligibility.
Rate
What can be the most important behavioral change to improve intelligibility?
rate
What are types of prosthetic management treatments to improve rate of speech?
- Direct auditory feedback
- Pacing board
- Letter/alphabet board
What does direct auditory feedback do?
slows rate
What does a pacing board do?
slows rate
What does a letter/alphabet board do?
slows rate
List non-prosthetic rate management treatments for rate:
- Hand/finger tapping in time to syllable production
- Visual feedback from oscilloscope to pace rate
- Rhythmic cueing
What should you note when implementing the hand/finger tapping in time to syllable production with a patient with Parkinson’s?
Note that they may accelerate their hand tapping along with speech.
What should you note when implementing the hand/finger tapping in time to syllable production with a patient with ataxic dysarthria?
May have irregular hand tapping.
What do you do in visual feedback from oscilloscope to pace rate?
Tell patient to speak at a rate that would fill the screen-slows rate.
What does rhythmic cueing involve to help rate?
Clinician points to word in rhythmic fashion.
What are treatments for prosody and naturalness?
- Chunking utterances into natural syntactic units
- contrastive stress drills
- LSVT
How does chunking utterances into natural syntactic units help improve prosody and naturalness?
Patient may take breaths at odd points and need to be taught to do so at natural paces.
How does contrastive stress drills help prosody and naturalness?
helps reduce monotone
How does LSVT help prosody and naturalness?
Highs and lows work on pitch changing
Flaccid dysarthria is due to _______ so work on ______ _____ unless LMN innervation is completely lacking.
weakness
increasing strength
Increasing strength would not be an appropriate goal with what kind of diseases?
Progressive diseases, like ALS
What type of goals would a clinician work on with a patient with a progressive disease, such as ALS.
Trying to maintain function, not increase function.
If patient with flaccid dysarthria is having respiratory weakness what do you work on?
Practice pushing, pulling, or bearing down during speech and non-speech tasks helps to increase respiratory drive for speech.
For a patient with flaccid dysarthria with an adductor vocal fold weakness, look at ________, ______ or ________ ________ treatment.
surgical
injection
effortful closure
What treatments would be implemented with a patient who has flaccid dysarthria and has resonance problems?
- palatal lift or pharyngeal flap surgery
- nares occlusion
- VP strengthening exercises
How is myasthenia gravis treated?
Patients are usually managed with meds but counseling them about limiting the length of time they speak can be done.
Don/t do _____, _____ and ____ _______ techniques with people who are diagnosed with spastic dysarthria because hyperadduction is already a problem
pulling
pushing
effortfull closure
Why should a clinician not work on pulling, pushing, and effortful closure techniques with a client with spastic dysarthria?
Hyperadduction is already a problem.
What can help patients with spastic dysarthria if pseudobulbar affect is a problem?
Meds may help (Ellaville)
Behavior modification techniques may also help, but they have to be specific to the patient.
______ exercises may help patients with spastic dysarthria.
Relaxation
Which treatments are not needed with patients diagnosed with ataxic dysarthria?
Strength exercises
surgical
prosthetic treatment
What should the clinician focus on with a patient with ataxic dysarthria?
Behavioral management- centering on improving in-coordination and intelligibility through modifying rate and prosody.
What has research shown about emphasizing rate, loudness, or pitch control in ataxic speakers?
It has aided intelligibility in ataxic speakers
List treatments for patients with hypokinetic dysarthria:
- LSVT
- surgical treatment
- pharmacologic treatment
- behavioral management
Describe LSVT treatment:
Intensive period of treatment - 4 times a week for one month. Focus is on respiratory and phonatory effort.
What is deep brain stimulation?
A treatment for hypokinetic dysarthria. It places electrodes into the brain which are activated at varying levels of intensity.
What surgical treatment is done for patients with hypokinetic dysarthria?
Pallidotomy, thalamotomy
What happens in a pallidotomy or thalamotomy?
Lesions are placed in globus pallidus or thalamus to reduce severe tremors.
Surgical treatments for hypokinetic dysarthria aren’t done to _______ ____ and sometimes can ____ _____, but it is also possible for some ______ _______.
improve speech
worsen speech
speech improvement
What are some pharmalogical treatment for hypokinetic dysarthria?
- L dopa
- Sonemet
What is the effect of pharmacologic treatment on patient’s with hypokinetic dysarthria?
It may improve speech but not always and varies across patients.
What behavioral management treatment should be implemented with a patient with hypokinetic dysarthria?
Work on rate control and overarticulation
What treatment is implemented with patients diagnosed with hyperkinetic dysarthria?
Mainly surgical and pharmacologic to control abnormal movements. SLP can teach compensatory techniques, such as holding pipe in mouth.
Why are medical or prosthetic treatments not needed with patients diagnosed with UUMN?
Due to the mild and transient nature of UUMN.
What will clinician work on with a patient diagnosed with UUMN?
May work on specific articulation problems or on tongue strengthening.
How does a clinican approach a patient with mixed dysarthria?
Use treatments appropriate for the individual dysarthrias.
List strategies for the speaker:
- 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
List strategies for the listener:
- keep eye contact - gives you information from face, etc.
- work at comprehending
- modify environment - reduce noise, improve lighting
List interaction strategies:
- 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
How can clinician repair breakdowns?
- rephrase
- use synonyms
- spell problem words
- identify salient words
