MSD Rx

Question 1

What is apraxia?

Answer 1

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

Question 2

Characteristics of apraxia

Answer 2

• 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

Question 3

Which cerebral hemisphere is usually affected in clients with apraxia?

Answer 3

left

Question 4

Most common rx foci for AoS clients

Answer 4

articulation and rate

Question 5

4 types of approaches for AoS

Answer 5

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

Question 6

What is integral stimulation

Answer 6

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

Question 7

Examples of articulatory kinematic approaches

Answer 7

Eight step Continuum, Sound Production Treatment hierarchy, PROMPT

Question 8

Sound Production Treatment process

Answer 8

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)

Question 9

Example of rate/rhythm approach for AoS

Answer 9

External pacing devices, singing, melodic intonation therapy

Question 10

A type of intersystemic facilitation for Aos?

Answer 10

Gesture Facilitation Hierarchy (Raymer and Thompson, 1991)

Question 11

Short term Goal for AoS

Answer 11

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.

Question 12

Session Goal for AoS

Answer 12

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.

Question 13

What kind of dysarthria is associated with Parkinsons?

Answer 13

hypokinetic

Question 14

3 goals for dysarthria Rx

Answer 14

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

Question 15

Intelligibility

Answer 15

Degree to which the acoustic signal can be understood

Question 16

Comprehensibility

Answer 16

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

Question 17

example of restore function goal target

Answer 17

lip seal exercises

Question 18

example of compensation goal target

Answer 18

slower speech rate

Question 19

example of adjustment goal target

Answer 19

change role at work to minimise need to speak

Question 20

example of dysarthria goal

Answer 20

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

Question 21

5 broad approaches to MSDs

Answer 21

medical, prosthetic, behavioural, AAC and counselling/support

Question 22

rx for hypoadduction in dysarthria

Answer 22

effortful closure

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

Question 23

rx for increasing loudness

Answer 23

LSVT or amplification if not suitable

Question 24

resonatory impairment rx

Answer 24

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

Question 25

When do you start working on naturalness of speech?

Answer 25

when intelligibility >90%

Question 26

Flaccid Dysarthria Rx

Answer 26

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

Question 27

Spastic Dysarthria Rx:

Answer 27

increase relaxation and prevent hyper adduction - RVT and relaxation - reduced rate - breath group tasks, anti-spasticity meds

Question 28

Ataxic Dysarthria Rx:

Answer 28

improving or compensating for issues with motor control and coordination - rate and prosody rx - respiratory control rx

Question 29

Hypokinetic Dysarthria Rx

Answer 29

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

Question 30

LSVT focuses on which subsystems?

Answer 30

respiratory and phonatory

Question 31

Hyperkinetic Dysarthria rx

Answer 31

primarily surgical and pharmacologic, not behavioural alone - botox - nerve resection, thyroplasty, DBS - reduced rate

Question 32

UMN dysarthria Rx

Answer 32

rate, prosody and articulation rx

Question 33

Communication-oriented rx: speaker strategies:

Answer 33

- 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

Question 34

Communication-oriented rx: listener strategies

Answer 34

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

Question 35

Communication-oriented rx: interaction strategies

Answer 35

- 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

Question 36

Impact of dysarthria on BS and F

Answer 36

impaired muscle tone and incoordination of musculature

Question 37

Impact of dysarthria on Activity

Answer 37

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

Question 38

Impact of dysarthria on Participation

Answer 38

reduced comm skills impact identity, relationships, education, employment

Question 39

Outcome measures for dysarthria

Answer 39

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

Question 40

5 stages of functional limitation

Answer 40

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

Question 41

considerations for commencing rx in MSDs and why

Answer 41

- 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

Question 42

``` 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 ```

Answer 42

``` - deep breath before speech Think Loud - breath group phrasing - focusing on keeping it loud right to the end - sovtes for strain ```

Question 43

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

Answer 43

= apraxia | Sound production treatment