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SPA 762 > Treatment/Management > Flashcards

Treatment/Management Flashcards

1
Q

What should MSD management focus on rather than speech?

A

Communication

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2
Q

Focus on…

A
  • Speech
  • Extralinguistic
  • Non-verbal cues
  • Writing
  • Gestures
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3
Q

What should long term goals focus on?

A

Maximize Effectiveness
Maximize efficiency
Maximize naturalness

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4
Q

What should short-term goals focus on?

A
  • Facilitation techniques
  • Restore lost function
  • Reduce impairment
  • Restore original function
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5
Q

What are compensatory techniques?

A
  • Use compensatory rather than restoration when full restoration will not occur in the short term
  • Compensate for the lost abilities
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6
Q

Is use of fascination and compensatory techniques appropriate?

A

Yes

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7
Q

What are SMART goals?

A

Specific
Measurable
Agreed upon
Realistic
Time based

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8
Q

What should you consider for management and decisions?

A

Medical diagnosis
Prognosis
Limitations
Environment and communication partners
Motivation and needs
Associated problems
Health care in general

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9
Q

5 approaches to management?

A

Medical intervention
Prosthetic management
Behavioral management
Alternative and augmentative communication
Counseling and support

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10
Q

Prosthetic intervention’s: Direct modification and alter rate?

A

Direction modification: palatal lift, nasopharyngeal obturator, and voice amplifier

Alter rate: pacing boards, metronomes, delayed auditory feedback and vocal intensity monitoring device

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11
Q

Prosthetic intervention to augment speech?

A
  • AAC
  • Picture, letter, word boards
  • Computerized devices and apps
  • Light pointers
  • Switches
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12
Q

What is behavioral management ?

A

compensatory speech production and consciousness

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13
Q

What concepts of motor learning should influence treatment? Improvement in speech requires.

A
  • Drill is essential
  • Instruction
  • Self learning
  • feedback
  • specificity of training
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14
Q

Principles of Neuroplasticity

A
  • Use it or lose it
  • Use it and improve it
  • Specifity
  • Repetition matters
  • Intensity matters
  • time matters
  • salience matters
  • age matters
  • transference
  • Interference
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15
Q

What is neurplasticity?

A

the mechanism by which the brain encodes experience and learns new behaviors
and also the mechanism by which the damaged brain relearns lost behavior in response to rehabilitation

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16
Q

Treatment: Specificity

A

Need to tap into the neural substrates for speech

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17
Q

Treatment: Repetition matters

A

LVST is a good model in voice.. they feel like they had a workout
Exact dosage hasn’t been determine yet, but if you look at exercise principles you will need higher reps

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18
Q

Treatment: Intensity matters

A

Dosage data for intensity is currently unknown, working longer doesn’t mean harder but it can be overused too

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19
Q

Treatment: Time matters

A
  • the time of intervention initiation post-injury often dictates the intensity of rehab
  • The earlier the better
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20
Q

Treatment: Salience matters

A
  • repetitive movements versus skilled movements
  • visual feedback may be important here, if you can make the connection for the patient visually they might work even harder
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21
Q

Treatment: Age matters

A
  • Generally younger brains are more responsive to neuroplasticity than older ones, however, it occurs across a lifetime
  • Important for setting treatment goals, are they reasonable but challenging enough?
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22
Q

Treatment matters: Interference

A
  • Does use of certain compensatory strategies impede rehab
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23
Q

What is important regarding referrals and. treatment?

A
  • Knowing our scope and when to refer a patient out
  • sometimes a referral can be for….. second option, to develop a team, outside of your experience/competence level
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24
Q

How do you refer a patient?

A
  • Discuss reasoning with patient and get agreement
  • Speak with referring physician
  • Contact the provider to whom you will refer
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25
Q

Who might we refer to?

A
  • Neurologist, OT, RT, ENT, GI, dentist, RD or another SLP
26
Q

Why do we use EBP?

A
  • You are required to evaluate the evidence available
  • Should be including this in your reports
  • Stay on top of new literature (conferences, blogs, subscriptions, emails, etc.)
27
Q

What are the types of treatment?

A
  • Medical
  • Surgical
  • Behavioral
  • Mixed
28
Q

Exercise principles

A
  • efforts that do not force the neuromuscular system behind the level of usual activity it will not elicit adaptations
  • adaptations occur to accommodate the increased demand
  • intensity
  • resistive loading
  • repetition
  • volume of practice
  • specificity
29
Q

Consistent Practice

A
  • Refers to repetitive practice on an unvarying task before moving to the next level
  • Blocked practice
30
Q

Variable practice

A
  • Same number of trials as blocked, but with randomization of tasks so the same task is not practiced on successive tasks
  • Random practice (harder tasks, better retention and generalization
31
Q

Speaker oriented treatment

A
  • respiration
  • phonation
  • resonance
  • articulation
  • rate
  • prosody and naturalness
32
Q

Speaker oriented treatment: Respiration

A
  • Increasing respiratory support
  • Prosthetic assistance
  • Compensatory strategies
  • Instrumental biofeedback
33
Q

Speaker oriented treatment: Phonation

A
  • Laryngeal framework
  • Related laryngeal surgeries
  • Injections
  • Pharmacological management
  • Prosthetic management
  • Behavioral management
34
Q

Speaker oriented treatment: Resonance

A
  • Surgical management
  • Prosthetic management
  • Behavioral management
35
Q

Speaker oriented treatment: Articulation

A
  • Surgical management
  • Pharmacological management
  • Prosthetic management
  • Behavioral management (strength training, stretching, instrumental feedback, traditional approaches)
36
Q

Speaker oriented treatment: Rate

A
  • Modification
  • Prosthetic management
  • Non prosthetic rate reduction strategies (hand and finger tapping, visual feedback, rhythmic cuing, backdoor approaches)
36
Q

Speaker oriented treatment: Rate

A
  • Modification
  • Prosthetic management
  • Non prosthetic rate reduction strategies (hand and finger tapping, visual feedback, rhythmic cuing, backdoor approaches)
37
Q

Speaker oriented treatment - Prosody and Naturalness

A
  • Breath group
  • Contrastive stress tasks
  • Referential tasks
  • Prosody
  • Intelligibility, comprehensibility, efficiency
38
Q

Treatment for Flaccid dysarthria

A
  • Physiological support
  • Increase strength
  • Compensate for weakness
  • Biofeedback
  • Prothetic palatal lift
39
Q

Treatment for Spastic dysarthria

A
  • DO NOT USE PUSHING, PULLING, EFFORT techniques because hyper adduction is a common issue
  • Surgery
  • Medications
  • Relaxation techniques
  • Stretching
40
Q

Treatment for Ataxic dysarthria

A
  • DO NOT WORK ON INCREASING MUSCLE STRENGTH OR REDUCING MUSCLE TONE
  • Surgical or prosthesis is NOT necessary to improve phonation or resonance
  • Pharmacology NOT effective
  • Center therapy around improving or compensating for motor control and coordination, modify rate and prosody, durational adjustment to signal stress
41
Q

Treatment for Hypokinetic dysarthria

A
  • Surgical intervention for severe: teflon injection
  • Thalamotomy
  • Pallidotomy
  • Deep brain stimulatiob
  • Pharmacology treatments
  • Behavioral treatments: LSVT, SPEAK OUT!
42
Q

Treatment for Hyperkinetic dysarthria

A
  • Surgical: pallidotomy, thalamotomy, DBS
  • Pharmacological: botox for SD
  • Behavioral: bite block, postural adjustments, low rate and pitch changes, breath onset, sEMG feedback
43
Q

Treatment for UUMN dysarthria

A
  • Generally do not need treatment
44
Q

Treatment for Mixed dysarthria

A
  • Prosthetic: palatal lift sometimes
  • Surgical
  • Pharmacological
  • Mostly target what is disordered
45
Q

Communication oriented treatment: Speaker strategies

A
  • prepare listeners….
  • how communication is supposed to occur
  • set the context
  • ID the topic
  • Modify sentence content, structure and length
  • Gestures
  • Monitor listener comprehension
  • Alphabet board supplementation
46
Q

Communication oriented treatment: Listener strategies

A
  • Attentive and active
  • Work at comprehension
  • Modify the physical environment
  • Maximize listener hearing and vision
47
Q

Communication oriented treatment interaction strategies

A
  • time important interactions
  • conductive speaking environment
  • maintain eye contact
  • ID breakdowns
  • Establish methods of feedback
  • Repair breakdowns
  • Establish what works best when
48
Q

Treatment of Apraxia maximizes?

A
  • Effectiveness
  • Efficiency
  • Naturalness

of communication

49
Q

What is the difference between apraxia and dysarthria treatment?

A
  • Nature of speaker oriented activities that attempt to restore function
  • Dysarthria treatment focuses on improving physiological support and support adequately planned and programmed speech
  • AOS treatment focuses on re-establishing plans and program, set parameters for speech movements in a given context and impressive the ability to select or active plans and program
50
Q

What influences decisions on AOS treatment?

A
  • Not all patients are candidates
  • Influence of aphasia
  • High proportion with SOS
51
Q

Who should you work on non-speech postures of movement sequences with?

A

Severe patients

52
Q

If you use oral-motor non speech practice you should..?

A

Only practice movement targets or patterns that closely approximate speech gestures
- lip rounding
- tongue evaluation to the alveolar ridge
- deep inhalation or prolonged exhalation

53
Q

Is motor learning highly relevant to AOS?

A

Yes

54
Q

For behavioral management approaches to be successful you must do what?

A
  • Careful stimulus selection
  • Orderly progression of treatment tasks
  • Intensive and systematic drills
55
Q

Behavioral management approach: Integral stimulation

A
  • Teaches words, phrases, or sentences-severe patients
56
Q

Behavioral Management approaches: Sound production treatment (SPT)

A
  • Focus on improving accuracy of spatial targeting and timing of articulation at the segmental and syllable level
57
Q

Behavioral management approaches: PROMPT

A
  • Use with adults and children
  • Use tactile cues to provide tongue pressure, kinesthetic, and proprioceptive cues
58
Q

Behavioral management approaches: Melodic intonation therapy (MIT)

A

Relies on singing and variants of intoned utterances based on melody, rhythm and patterns of stress

59
Q

Behavioral management approaches: Biofeedback

A
  • sEMG facilitate relaxation
60
Q

Behavioral management approaches for those who cannot speak

A
  • Automatic speech tasks
  • Singing
  • Push on abdomen
  • Artificial larynx
  • Pairing highly used symbolic gestures with associated sounds or words
61
Q

Behavioral management tasks (AOS)

A
  • working on volitional sounds, syllable or word level
  • isolated sound practice shaping
  • humming
  • chanting
  • rapid repetition of nonsense syllables

SPA 762 (5 decks)

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