MSD Rx Flashcards
What is apraxia?
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
Characteristics of apraxia
- 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
Which cerebral hemisphere is usually affected in clients with apraxia?
left
Most common rx foci for AoS clients
articulation and rate
4 types of approaches for AoS
articulatory-kinematic, rate/rhythm, intersystemic facilitation and AAC
What is integral stimulation
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
Examples of articulatory kinematic approaches
Eight step Continuum, Sound Production Treatment hierarchy, PROMPT
Sound Production Treatment process
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)
Example of rate/rhythm approach for AoS
External pacing devices, singing, melodic intonation therapy
A type of intersystemic facilitation for Aos?
Gesture Facilitation Hierarchy (Raymer and Thompson, 1991)
Short term Goal for AoS
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.
Session Goal for AoS
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.
What kind of dysarthria is associated with Parkinsons?
hypokinetic
3 goals for dysarthria Rx
Restore lost function
Compensate by promoting residual function
Adjust by decreasing need for lost function
Intelligibility
Degree to which the acoustic signal can be understood
Comprehensibility
the degree to which a listener can understand based on acoustic signal plus other linguistic and non speech cues
example of restore function goal target
lip seal exercises
example of compensation goal target
slower speech rate
example of adjustment goal target
change role at work to minimise need to speak
example of dysarthria goal
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
5 broad approaches to MSDs
medical, prosthetic, behavioural, AAC and counselling/support
rx for hypoadduction in dysarthria
effortful closure
if paralysis surgery to alter structure of VF (laryngoplasty, injection to increase bulk, reinnervation)
rx for increasing loudness
LSVT or amplification if not suitable
resonatory impairment rx
surgery, prosthetic palatal lift, LSVT, biofeedback (e.g. mirror) resistance training e.g. CPAP
When do you start working on naturalness of speech?
when intelligibility >90%
Flaccid Dysarthria Rx
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
Spastic Dysarthria Rx:
increase relaxation and prevent hyper adduction
- RVT and relaxation
- reduced rate
- breath group tasks, anti-spasticity meds
Ataxic Dysarthria Rx:
improving or compensating for issues with motor control and coordination
- rate and prosody rx
- respiratory control rx
Hypokinetic Dysarthria Rx
- behavioural: rate control, breath group tasks, LSVT, SOVTes
- prosthetic: pacing board, amplifier
- Surgery: DBS and laryngoplasty for medialisation of VF
- pharmacological meds for PD
LSVT focuses on which subsystems?
respiratory and phonatory
Hyperkinetic Dysarthria rx
primarily surgical and pharmacologic, not behavioural alone
- botox
- nerve resection, thyroplasty, DBS
- reduced rate
UMN dysarthria Rx
rate, prosody and articulation rx
Communication-oriented rx: speaker strategies:
- 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
Communication-oriented rx: listener strategies
- maintain eye contact
- listen attentively and work at comprehension
- manage enviro factors (e.g. background noise)
- maximise hearing and visual acuity
Communication-oriented rx: interaction strategies
- 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
Impact of dysarthria on BS and F
impaired muscle tone and incoordination of musculature
Impact of dysarthria on Activity
e.g. reduced intelligibility, loudness, comm ability,
Impact of dysarthria on Participation
reduced comm skills impact identity, relationships, education, employment
Outcome measures for dysarthria
frenchay intelligibility subtest,
communicative effectiveness survey,
dysarthria impact profile (psychosocial impact)
AIDS - assessment of intelligibility in dysarthria
objective data,
functional change
5 stages of functional limitation
- no detectable disorder
- obvious speech disorder with intelligible speech
- reduction in intelligibility
- natural speech supplemented by AAC
- No useful speech
considerations for commencing rx in MSDs and why
- 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
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
- deep breath before speech Think Loud - breath group phrasing - focusing on keeping it loud right to the end - sovtes for strain
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
= apraxia
Sound production treatment
