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SLP Rx > MSD Rx > Flashcards

MSD Rx Flashcards

1
Q

What is apraxia?

A

a neurologic speech disorder that involves impaired capacity to plan and program sensorimotor commands necessary for directling movements that result in phonetically and prosodically normal speech

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2
Q

Characteristics of apraxia

A
  • reduced overall speech rate
  • inconsistent errors
  • impaired prosody
  • greater difficulty with SMRs than AMRS
  • errors with increasing word length and complexity
  • groping movements
  • normal automatic speech
  • imitation difficulty
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3
Q

Which cerebral hemisphere is usually affected in clients with apraxia?

A

left

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4
Q

Most common rx foci for AoS clients

A

articulation and rate

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5
Q

4 types of approaches for AoS

A

articulatory-kinematic, rate/rhythm, intersystemic facilitation and AAC

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6
Q

What is integral stimulation

A

a method for practicing movement gestures for speech production that involve imitation and emphasises multiple sensory models - watch me, listen to me, say it with me

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7
Q

Examples of articulatory kinematic approaches

A

Eight step Continuum, Sound Production Treatment hierarchy, PROMPT

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8
Q

Sound Production Treatment process

A

request imitation and If error proceed down
- Modelling
- Modelling plus visual clue
- Integral stimulation (watch, listen say with me)
- modelling with silent juncture e.g. z…ip
- verbal instruction on articulatory placement
(Wambaugh 1998)

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9
Q

Example of rate/rhythm approach for AoS

A

External pacing devices, singing, melodic intonation therapy

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10
Q

A type of intersystemic facilitation for Aos?

A

Gesture Facilitation Hierarchy (Raymer and Thompson, 1991)

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11
Q

Short term Goal for AoS

A

X will demonstrate 50% accuracy of labio-dentals* at the sound/word onset level after four sessions of sound production treatment with the clinician in the clinic.

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12
Q

Session Goal for AoS

A

X will produce 10 single syllable words with bilabial onsets, with 3 sets of 5 productions of each word in time with a metronome, with 80% intelligibility as rated by May, independently, four times a day.

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13
Q

What kind of dysarthria is associated with Parkinsons?

A

hypokinetic

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14
Q

3 goals for dysarthria Rx

A

Restore lost function
Compensate by promoting residual function
Adjust by decreasing need for lost function

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15
Q

Intelligibility

A

Degree to which the acoustic signal can be understood

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16
Q

Comprehensibility

A

the degree to which a listener can understand based on acoustic signal plus other linguistic and non speech cues

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17
Q

example of restore function goal target

A

lip seal exercises

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18
Q

example of compensation goal target

A

slower speech rate

19
Q

example of adjustment goal target

A

change role at work to minimise need to speak

20
Q

example of dysarthria goal

A

X will rate himself above 3/5 when utilising his clear speech strategy of over-articulation when talking with his wife in a 5 minute conversation in the morning after an 8 week block of therapy

21
Q

5 broad approaches to MSDs

A

medical, prosthetic, behavioural, AAC and counselling/support

22
Q

rx for hypoadduction in dysarthria

A

effortful closure

if paralysis surgery to alter structure of VF (laryngoplasty, injection to increase bulk, reinnervation)

23
Q

rx for increasing loudness

A

LSVT or amplification if not suitable

24
Q

resonatory impairment rx

A 
surgery, 
prosthetic palatal lift, 
LSVT, 
biofeedback (e.g. mirror)
resistance training e.g. CPAP
25
Q

When do you start working on naturalness of speech?

A

when intelligibility >90%

26
Q

Flaccid Dysarthria Rx

A

aim to increase strength or compensate for weakness:

  • respiration -> increase breath group duration, posture, abdominal trussing
  • phonation -> increase VF adduction
  • resonance -> lift, VP exercises e.g. CPAP
  • Artic -> surgery for facial nerve paralysis, bite block
27
Q

Spastic Dysarthria Rx:

A

increase relaxation and prevent hyper adduction

  • RVT and relaxation
  • reduced rate
  • breath group tasks, anti-spasticity meds
28
Q

Ataxic Dysarthria Rx:

A

improving or compensating for issues with motor control and coordination

  • rate and prosody rx
  • respiratory control rx
29
Q

Hypokinetic Dysarthria Rx

A
  • behavioural: rate control, breath group tasks, LSVT, SOVTes
  • prosthetic: pacing board, amplifier
  • Surgery: DBS and laryngoplasty for medialisation of VF
  • pharmacological meds for PD
30
Q

LSVT focuses on which subsystems?

A

respiratory and phonatory

31
Q

Hyperkinetic Dysarthria rx

A

primarily surgical and pharmacologic, not behavioural alone

  • botox
  • nerve resection, thyroplasty, DBS
  • reduced rate
32
Q

UMN dysarthria Rx

A

rate, prosody and articulation rx

33
Q

Communication-oriented rx: speaker strategies:

A
  • get listener’s attention with verbal or nonverbal cues
  • convey how communication should take place e.g. asking for clarification
  • set the context and topic to increase predictability
  • modify sentence content, structure and length
  • use gestures
  • monitor listener comprehension
  • alphabet supplementation
34
Q

Communication-oriented rx: listener strategies

A
  • maintain eye contact
  • listen attentively and work at comprehension
  • manage enviro factors (e.g. background noise)
  • maximise hearing and visual acuity
35
Q

Communication-oriented rx: interaction strategies

A
  • schedule important interactions for best time of day
  • select conducive environment
  • identify breakdowns and establish feedback methods e.g. shadowing
  • repair breakdowns with pre-determined plan (e.g. use synonyms, rephrase)
  • establish what works best when
36
Q

Impact of dysarthria on BS and F

A

impaired muscle tone and incoordination of musculature

37
Q

Impact of dysarthria on Activity

A

e.g. reduced intelligibility, loudness, comm ability,

38
Q

Impact of dysarthria on Participation

A

reduced comm skills impact identity, relationships, education, employment

39
Q

Outcome measures for dysarthria

A

frenchay intelligibility subtest,
communicative effectiveness survey,
dysarthria impact profile (psychosocial impact)
AIDS - assessment of intelligibility in dysarthria
objective data,
functional change

40
Q

5 stages of functional limitation

A
  1. no detectable disorder
  2. obvious speech disorder with intelligible speech
  3. reduction in intelligibility
  4. natural speech supplemented by AAC
  5. No useful speech
41
Q

considerations for commencing rx in MSDs and why

A
  • is it impacting activity and participation? If not MSD rx is not recommended (Duffy 2020)
  • level of motivation, as it is important for adhering to practice
  • underlying cause and diagnosis, as this may indicate suitable rx approach
  • associated problems - other issue may complicate rx or be more important to prioritise
42
Q 
Rx for:
63yo female
MPT 15 secs
Reduced volume, particularly at end of sentences
Vocal strain at end f sentences
decreased speech clarity overall
flat prosody
A 
- deep breath before speech
Think Loud
- breath group phrasing
- focusing on keeping it loud right to the end
- sovtes for strain
43
Q

rx for 67 yo man post L stroke
receptive language intact, minimal verbal output
difficulty with OMA - laboured groping movements, watching cues carefully
mild asymmetry on lower right face
tongue strength good, but difficulty coordinating
cant cough on command, but spontaneous fine
SMRs significantly impaired
AMRs impaired but not as much

A

= apraxia

Sound production treatment

SLP Rx (6 decks)

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